Fatty acid composition of adipose tissue at term indicates deficiency of arachidonic and docosahexaenoic acid and excessive linoleic acid supply in preterm infants

Abstract

Background Arachidonic (ARA) and docosahexaenoic acid (DHA) are constitutive to membrane phospholipids, and essential for brain and overall development. ARA/DHA pools in term infants (TI) are built during the third trimester, stored as adipose tissue triglycerides and predominantly distributed via plasma phosphatidylcholine (PC). In preterm infants (PTI), placental ARA/DHA supply is replaced by linoleic-acid (LA)-enriched nutrition. This study aimed to investigate the impact of PTI nutrition, compared to placental supply, on fatty acid composition in adipose tissue and blood. Methods Prospective observational study (4/2017–3/2019) in 12 PTI and 3 PTI with enterostomy (PTI/E) (gestational age (GA) < 32 weeks) with surgical intervention at term (± 6 weeks) and 14 TI (GA ≥ 34 weeks, surgical intervention < 2 weeks postnatally). PTI/E were analyzed descriptively only. PC and triglyceride fatty acids were analyzed with tandem mass spectrometry and gas chromatography, respectively. Results were compared between TI and PTI with Wilcoxon Test and shown as median [25th percentile–75th percentile] mol%. Results PTI had less ARA in adipose tissue TG (0.77[0.67–0.87]% vs. 1.04[0.95–1.14]%, p = 0.0003) and plasma PC (20.7[18.7–22.8]% vs. 28.3[22.7–33.5]%, p = 0.011) than TI. PTI also had less DHA in adipose tissue TG (0.6[0.4–0.8]% vs. 1.1[0.8–1.4]%, p = 0.006) and plasma PC (6.4[5.6–7.1]% vs. 8.4[7.8–13.1]%, p = 0.002). LA was increased in PTI’s adipose tissue TG (10.0[8.8–12.3]% vs. 3.0[2.5–3.6]%, p < 0.0001) and plasma PC (48.4[44.6–49.6]% vs. 30.6[24.9–35.6]%, p = 0.0002). Similar differences were observed in erythrocyte PC. Conclusion In PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development.

Sphingolipidomics of serum in extremely preterm infants: Association between low sphingosine-1-phosphate levels and severe retinopathy of prematurity

“…Further, the proportion of PC containing linoleic acid increased throughout the study period. This also corroborates our previous findings on the phospholipid fatty acid profiles in these preterm infants [ 30 ] and reflects the high nutritional intake of linoleic acid during the neonatal period [ 31 ]. As expected, the PC species composition changes largely follow that of total phospholipid-bound fatty acids, as PC constitutes the major phospholipid class in serum.…”

Association of Docosahexaenoic Acid and Arachidonic Acid Serum Levels With Retinopathy of Prematurity in Preterm Infants

“…4,5 With the current neonatal care, extremely preterm infants accumulate substantial deficits in AA and DHA, which could be factors in neonatal morbidities, including ROP. 3,[6][7][8] The requirement for AA supplementation in preterm infants remains unclear. Moreover, the European Food Safety Authority recommends supplementation with DHA.…”

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

“…Based on current feeding regimens for preterm infants, the resulting fatty acid profile of fetal lipoprotein phospholipids (high ARA, low LA, increasing DHA towards term birth) is transformed to adult values (high LA, low ARA, low DHA) within one week. Consequently, the preterm infant’s lipidome at term-corrected age is dramatically different from that of term born infants in all compartments yet investigated, indicating ARA and DHA deficiency and LA-overnutrition [ 103 ]. Addressing these and other nutrient deficiencies and imbalances may help further to improve lean body mass growth and long-term outcomes.…”