Effect of Early Enteral Feeding on Apolipoprotein AI Levels and High-Density Lipoprotein Heterogeneity in Preterm Infants

Abstract

Background/Aim: We have previously shown that infants receiving total parenteral nutrition have low apolipoprotein AI levels which are associated with high-density lipoprotein (HDL) class distributions as in lecithin:cholesterol acyltransferase deficiency. This study investigates the influence of early enteral feedings on apolipoprotein AI and HDL subclasses. Methods: Apolipoprotein AI and HDL distributions were determined in 15 total parenterally fed preterm infants (TPN group) receiving early feedings, in 28 enterally fed preterm infants (ENT group), and in 26 term infants at birth and on day 5. The HDL subclasses were determined by gradient gel electrophoresis. Results: In the TPN group, the apolipoprotein AI levels increased significantly postnatally (from 73 ± 16 to 104 ± 23 mg/dl) to levels found in the term and ENT groups on day 5 (88 ± 16 and 96 ± 19 mg/dl). The HDL subclass distributions at birth and on day 5 were similar in both TPN and ENT groups with more large HDL_2b and less small HDL_3cthan in term infants. Whereas the HDL subclass distribution of term infants remained unchanged, in TPN and ENT infants, a shift from HDL_2b to HDL_3c was observed, with no difference between term and preterm infants on day 5. Conclusion: In contrast to exclusively parenterally fed infants, infants receiving early enteral feedings exhibited a significant rise of apolipoprotein AI and HDL subclass distributions as fully enterally fed preterm infants.

Effect of Preterm Birth on Postnatal Apolipoprotein and Adipocytokine Profiles

“…As these apolipoproteins were low in infants born <29 gestational weeks we can speculate that low apolipoprotein levels at birth might reflect a more immature gut, even though gene expression was not investigated in this study. Positive effects on the HDL pattern after early enteral nutrition have previously been shown, and early enteral feeding facilitated postnatal rise in A-1, probably reflecting positive effects on gut maturation [20]. …”

Plasma Lipoprotein Particle Subclasses in Preterm Infants

“…Increased apoprotein A1 and HDL concentrations have been demonstrated in enterally fed preterm infants and preterm infants on TPN with early enteral feedings versus infants receiving TPN alone. 53 In a separate cohort, although breastfed preterm infants received twice as much fat intake as those receiving TPN, their plasma triglyceride concentration was lower. 54 In term breastfed and formula-fed infants from 37 to 41 weeks GA, plasma total cholesterol and LDL were inversely proportional to GA and were higher in those infants exclusively breastfed at 1 month of age.…”

HDL Function across the Lifespan: From Childhood, to Pregnancy, to Old Age

“…Elevated small dense LDL particles have been linked to the development of CVD in children [28] and adults [29]. Dietary intervention in preterm infants (≤32 weeks gestational age) can ameliorate lipoprotein profiles, with early total parenteral nutrition from birth to 5 days of age increasing both plasma ApoA1 concentration and shifting HDL subclasses, as measured by gradient gel electrophoresis, from large HDL 2b towards smaller and more dense HDL 3c particles of similar value comparable to healthy term infants [30]. At 1 month of age, late-preterm infants (n = 25, 34-37 weeks gestational age) compared to term infants (n = 56) displayed lower cholesterol concentration within several HDL subclasses, including very large, large, medium, and very small HDL [31], which suggests a reduction in HDL maturation.…”