Serum choline in extremely preterm infants declines with increasing parenteral nutrition

Abstract

Purpose Choline is an essential nutrient for fetal and infant growth and development. Parenteral nutrition used in neonatal care lack free choline but contain small amounts of lipid-bound choline in the form of phosphatidylcholine (PC). Here, we examined the longitudinal development of serum free choline and metabolically related compounds betaine and methionine in extremely preterm infants and how the concentrations were affected by the proportion of parenteral fluids the infants received during the first 28 postnatal days (PNDs). Methods This prospective study included 87 infants born at gestational age (GA) < 28 weeks. Infant serum samples were collected PND 1, 7, 14, and 28, and at postmenstrual age (PMA) 32, 36, and 40 weeks. The serum concentrations of free choline, betaine, and methionine were determined by 1H NMR spectroscopy. Results The median (25th–75th percentile) serum concentrations of free choline, betaine, and methionine were 33.7 (26.2–41.2), 71.2 (53.2–100.8), and 25.6 (16.4–35.3) µM, respectively, at PND 1. The choline concentration decreased rapidly between PND one and PND seven [18.4 (14.1–26.4) µM], and then increased over the next 90 days, though never reaching PND one levels. There was a negative correlation between a high intake of parenteral fluids and serum-free choline. Conclusion Circulating free choline in extremely preterm infants is negatively affected by the proportion of parenteral fluids administered. Trial registration ClinicalTrials.gov Identifier NCT02760472, April 29, 2016, retrospectively registered.

Association of serum choline levels and all-cause mortality risk in adults with hypertension: a nested case–control study

“…However, it seems that the serum choline concentrations in our study are higher than those reported in previous studies [ 32 , 33 ]. We explored four possibilities that may affect serum choline concentrations: laboratory measurement, study population of hypertension, the crosstalk of choline and folic acid., and sample storage length.…”

Longitudinal Serum Metabolomics in Extremely Premature Infants: Relationships With Gestational Age, Nutrition, and Morbidities

“…Choline, a compound involved in one-carbon metabolism and phospholipid synthesis, correlated positively with enteral nutrition. Choline is not present in PN solutions, and we previously reported that high parenteral intake is associated with lower infant serum choline ( Nilsson et al, 2020 ). Somewhat surprisingly, the mean intake (ml/kg) of human donor and mother’s own milk, respectively, were grouped into two separate clusters.…”

“…Serum samples (50 μl) were prepared and then analyzed on an Oxford 800 MHz magnet equipped with an Avance III HD console and 3 mm TCI cryoprobe (Bruker BioSpin). Details of sample processing and the 1 H NMR analysis have been published ( Nilsson et al, 2020 ). Tentative annotations of peaks were made using ChenomX 8.3 (ChenomX Inc.) and the spectral data in the Human Metabolome Data Bank ( Wishart et al, 2018 ).…”

Impact of Parenteral Lipid Emulsion Components on Cholestatic Liver Disease in Neonates

“…These concentrations fall below the amount necessary to reach enteral RDAs. Due to this, low serum choline concentrations have been observed in both adults [143][144][145] and children [146][147][148][149] receiving long-term parenteral nutrition. In adults receiving PN that have developed PNALD, adding supplemental choline over 24 weeks can reduce markers of hepatic injury including ALT, AST, and ALP [144].…”