Early Enteral Fat Supplementation Improves Protein Absorption in Premature Infants with an Enterostomy

Abstract

Background: Early enteral fat supplementation and fish oil (FO) stimulates post-resection intestinal adaptation in rats and increases fat absorption in premature infants with bowel resection and an enterostomy. Objective: To test the hypothesis that early fat supplement and FO increases post-resection protein absorption, intestinal RNA, protein without decreasing intestinal arachidonic acid (AA) in premature infants with an enterostomy. Methods: 36 premature infants (<2 months old) with an enterostomy after surgical treatment for necrotizing enterocolitis or spontaneous intestinal perforation who tolerated enteral feeding at 20 ml/kg/day were randomized to usual care (control, n = 18) or early supplementing enteral Microlipid (ML) and FO (treatment, n = 18). Intralipid was decreased as the dose of enteral fat was increased. Daily weight, ostomy output and nutritional intake were recorded. Weekly 24-hour ostomy effluent was collected to measure fecal protein. Protein absorption was calculated by subtracting fecal protein from dietary protein. Tissue samples from the functional stoma and the nonfunctional distal diverted end were collected during bowel reanastomosis to measure RNA, protein, and fatty acid (FA) profile. Results: Compared to controls, the treatment group had higher protein absorption (g/kg/day) and intestinal RNA and protein (μg/mg tissue) proximal to the ostomy. The two groups had similar FA profiles except that the treatment group had higher n-3 eicosapentaenoic acid (EPA, μg/mg tissue) proximal to the ostomy. Conclusion: Early supplementation of enteral ML and FO to premature infants with an enterostomy increased dietary protein absorption, intestinal RNA, protein and n-3 EPA content without altering other FA content.

Nutritional strategies to enhance adaptation in intestinal failure

“…In line with these experimental findings a highfat diet, including fish oil stimulated protein and fat absorption as well as intestinal RNA and protein content in preterm neonates with an enterostomy [50][51][52]. Between the treatment and the control group there was no difference in weight gain, ostomy output, and duration of parenteral nutrition but the treatment group had lower bilirubin, fewer sepsis evaluations, less exposure to antibiotics, and had greater weight and length gain after reanastomosis [50].…”

Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant

“…Clinical nutrition intervention was widely used to compensate for preterm infants, especially babies with very low birth weight [7,8], such as breast milk forti er, high energy total nutrition formula. Although some of the low-quality evidence available have shown that speci c nutrients in uence the physical growth and mental development of premature infants, the results are contradictory due to study of object and design.…”