Evaluation of a Long-Chain Polyunsaturated Fatty Acid Supplemented Formula on Growth, Tolerance, and Plasma Lipids in Preterm Infants up to 48 Weeks Postconceptional Age

Vanderhoof, Jon A.; Gross, Steven J.; Hegyi, Thomas; Clandinin, Tom; Porcelli, Peter J.; DeCristofaro, Joseph D.; Rhodes, Torunn T.; Tsang, Reginald C.; Shattuck, Karen E.; Cowett, Richard M.; Adamkin, David H.; McCarton, C; Heird, William C.; Hook-Morris, Brenda; Pereira, Gilberto R.; Chan, Gary M.; Aerde, John Van; Boyle, Frances; Pramuk, Kathryn; Euler, Arthur R.; Lien, Eric L.

doi:10.1097/00005176-199909000-00015

Cited by 72 publications

(46 citation statements)

References 34 publications

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“…Eighteen of these studies were RCTs. [11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Among nonrandomized studies, 4 were interventional studies with a control group [30][31][32][33] and the remaining 2 studies 8,34 did not test an intervention because they examined the association of BPD with LCPUFA concentrations in blood or in tracheal aspirates. Fifteen RCTs presented dichotomous outcomes.…”

Section: Overview Of Included Studiesmentioning

confidence: 99%

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants.METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at ,29 weeks' gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS:Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82-1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at #32 weeks' gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74-1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23-1.10, 5 studies, n = 900 infants) was observed with LCPUFA.CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period. Dr Marc conceptualized and designed the protocol, screened the titles and abstracts, and retrieved articles for inclusion and quality, performed the analyses, drafted the initial manuscript, and approved the final manuscript as submitted; Ms Zhang critically reviewed the protocol, screened the titles and abstracts and retrieved articles for inclusion and quality, drafted the tables and figures, and reviewed the final manuscript as submitted; Dr Lavoie screened the articles for quality, revised the manuscript, participated in the redaction of the final manuscript, and reviewed the final manuscript as submitted; Dr Rhainds designed and conducted the systematic database search, reviewed the manuscript, and approved the final manuscript as submitted; and Dr Lacaze-Masmonteil reviewed the manuscript and approved the final manuscript as submitted.www.pediatrics.org/cgi

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Section: Overview Of Included Studiesmentioning

confidence: 99%

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

et al. 2014

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“…In modern times, this ensured supply of DHA during neurodevelopment has been abrogated by formula-feeding and by a very low maternal intake of n-3 fats in many modern women. Given the present state of knowledge from human and animal studies of changes in neural function associated with a low DHA status, coupled with biochemical and nutritional studies indicating the loss of DHA in both peripheral tissues and the nervous system when preformed DHA is not fed and the safety of ingredients (70,77) used to supply DHA, it is clear that a prudent course of action would be to supply sources of preformed DHA in the infant diet.…”

Section: Human Studiesmentioning

confidence: 99%

Mechanisms of action of docosahexaenoic acid in the nervous system

Salem

Litman

Kim

et al. 2001

Lipids

819

508

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This review describes (from both the animal and human literature) the biological consequences of losses in nervous system docosahexaenoate (DHA). It then concentrates on biological mechanisms that may serve to explain changes in brain and retinal function. Brief consideration is given to actions of DHA as a nonesterified fatty acid and as a docosanoid or other bioactive molecule. The role of DHA-phospholipids in regulating G-protein signaling is presented in the context of studies with rhodopsin. It is clear that the visual pigment responds to the degree of unsaturation of the membrane lipids. At the cell biological level, DHA is shown to have a protective role in a cell culture model of apoptosis in relation to its effects in increasing cellular phosphatidylserine (PS); also, the loss of DHA leads to a loss in PS. Thus, through its effects on PS, DHA may play an important role in the regulation of cell signaling and in cell proliferation. Finally, progress has been made recently in nuclear magnetic resonance studies to delineate differences in molecular structure and order in biomembranes due to subtle changes in the degree of phospholipid unsaturation.Paper no. L8776 in Lipids 36, 945-959 (September 2001)

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“…It would be useful to know how the LCPUFA status relates to the outcomes of adiponectin and lipid levels in serum. In addition, the AA and DHA content of the LCPUFA-formula were close to the lowest levels of supplementation of other experimental formulas (24,36). It has been reported that a higher content of AA and DHA supplementation (equal or higher than 0.49% AA and 0.35% DHA) is needed to provide sufficient levels of these fatty acids to achieve a fatty acid status in the plasma and erythrocyte membranes similar to that of infants fed breast milk typical of mothers in Western countries (36,37).…”

Section: Discussionmentioning

confidence: 60%

“…In infants, the relation between dietary LCPUFA and lipid profile has been rarely studied. In preterm infants fed a formula supplemented with 0.5% AA and 0.35% DHA, serum total C concentrations were found to be higher, and triglyceride levels lower, than in infants fed an unsupplemented formula (24). In addition, a previous randomized trial in full term infants has shown evidence of an acute plasma triglyceride-lowering effect of fish oil, known to be rich in n-3 LCPUFA, primarily eicosapentanoic acid (EPA) and DHA (25).…”

Section: Discussionmentioning

confidence: 97%

Circulating Adiponectin in Preterm Infants Fed Long-Chain Polyunsaturated Fatty Acids (LCPUFA)-Supplemented Formula—A Randomized Controlled Study

et al. 2008

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Adiponectin has potent insulin-sensitizing effects, improves lipid metabolism, and potentially protects against the development of metabolic syndrome. Thus, increasing adiponectin levels in preterm infants at risk for developing metabolic syndrome may be of special interest. The aim of this study was to examine the effects of dietary long-chain polyunsaturated fatty acids (LCPUFA) on serum adiponectin and lipid concentrations in preterm infants. Adiponectin and lipid levels of 60 healthy preterm infants [gestational age 32.7 (1.9) wk] randomly assigned to be fed either 1) a formula containing LCPUFA [arachidonic and docosahexanoic] (ϩLCPUFA group) or 2) the same formula without LCPUFA (ϪLCPUFA/control group), were determined at mean (SD) 33.8 (11.7) d. Adiponectin and HDL-C concentrations were significantly higher in the ϩLCPUFA group than in controls (p ϭ 0.002 and p ϭ 0.01, respectively); whereas, triglyceride levels were lower (p ϭ 0.06). Adiponectin correlated positively with HDL-C levels and negatively with triglyceride levels in the ϩLCPUFA group but not in the controls. In conclusion, circulating adiponectin concentrations were higher in preterm infants fed a formula containing LCPUFA than infants fed an LCPUFA-free formula and they correlated with lipidemic profile. L ow birth weight due to poor fetal growth has been identified as a factor contributing to the development of metabolic syndrome (insulin resistance, dislipidemia, hypertension) (1,2). Moreover, preterm infants are also at risk for insulin resistance, and possibly for other components of metabolic syndrome, irrespective of whether they were born appropriate or small for gestational age (3,4). Although the underlying mechanism(s) connecting preterm birth and the development of metabolic syndrome risk are not known, circulating concentrations of adiponectin have been shown to be lower in preterm than in full term infants (5). Adiponectin is an adipocyte-derived protein, which has potent insulinsensitizing effects, improves lipid metabolism, and potentially protects against the development of insulin resistance and metabolic syndrome (6). High plasma levels of adiponectin are associated with lower incidence of type-2 diabetes and coronary heart disease (7,8). Therefore, a means of increasing circulating concentrations of adiponectin in preterm infants may be of special interest.N-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA), mainly docosahexanoic (DHA) and arachidonic (AA) acid, have been added in some, but not all, commercially available infant formulas, in an attempt to mimic the composition of human milk. In animals and human adults, diets enriched with n-3 LCPUFA have been linked to beneficial effects against insulin resistance (9) and to a favorable impact on lipidemic profile (10,11). The influence of dietary n-3 LCPUFA on circulating concentrations of adiponectin has been studied in animals (12-15), in obese adults, and in patients, who have suffered a myocardial infarction (16 -18). Dietary n-3 LCPUFA appear to hav...

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Evaluation of a Long-Chain Polyunsaturated Fatty Acid Supplemented Formula on Growth, Tolerance, and Plasma Lipids in Preterm Infants up to 48 Weeks Postconceptional Age

Abstract: The results of this study demonstrate the safety and efficacy of a preterm formula supplemented with long-chain polyunsaturated fatty acids from single-cell oils.

Cited by 72 publications

References 34 publications

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

Mechanisms of action of docosahexaenoic acid in the nervous system

Circulating Adiponectin in Preterm Infants Fed Long-Chain Polyunsaturated Fatty Acids (LCPUFA)-Supplemented Formula—A Randomized Controlled Study

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