早产儿营养来源中的脂肪酸及其对血浆脂肪酸谱的影响。

IF 2.4 Q1 PEDIATRICS Molecular and cellular pediatrics Pub Date : 2024-10-12 DOI:10.1186/s40348-024-00183-9
Gerhard Fusch, Naomi H Fink, Niels Rochow, Christoph Fusch
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引用次数: 0

摘要

背景:在早产儿中,静脉注射脂肪的耐受性不如通过肠道途径摄入,往往会导致高甘油三酯血症。因此,建议肠外脂肪摄入量不应超过每公斤 3.5 至 4.0 克/天,而母乳可提供高达每公斤 8 克/天的脂肪。目前还不清楚这种高甘油三酯血症是由所有脂肪酸的均匀增加引起的,还是与摄入不均衡导致的不同脂肪酸的增加有关。显然,这两种情况都有可能影响早产儿新型脂质解决方案的配制。这项探索性研究的目的是比较 a)不同营养来源和相应血浆样本之间的脂肪酸谱;b)喂养母乳和接受脂质乳剂的婴儿血浆之间的脂肪酸谱;c)甘油三酯水平正常和升高的婴儿血浆之间的脂肪酸谱:结果:与母乳水平相比,血浆中的 C8:0、C10:0、C12:0、C14:0、C19:1n9 和 C18:3n3 含量明显降低(p 结论:我们的研究揭示了早产儿血浆中的脂质水平:我们的研究表明,血浆中的脂质水平显示出不同脂肪酸的消耗和富集,这似乎与膳食摄入量没有密切关系。就像了解氨基酸代谢一样,我们需要更详细地了解脂肪酸的通量,而高甘油三酯血症可能是一种选择性脂肪酸蓄积状态的发现也支持了这一点。这将有助于为重症监护开发更均衡的饮食,并有可能改善临床结果。
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Fatty acids from nutrition sources for preterm infants and their effect on plasma fatty acid profiles.

Background: In preterm infants, IV administration of fat is less well tolerated compared to intake via the enteral route, often resulting in hypertriglyceridemia. It is therefore recommended that parenteral fat intake should not exceed 3.5 to 4.0 g/kg/d whereas human milk can provide up to 8 g/kg/d. It is unknown whether such hypertriglyceridemic conditions are caused by a uniform increase of all fatty acids or it is linked to an elevation of distinct fatty acids due to an unbalanced intake. Obviously, both scenarios could potentially influence the formulation of novel lipid solutions for preterm infants. Objective of this exploratory study was to compare fatty acid profiles between a) different nutritional sources and corresponding plasma samples, b) plasma of infants fed breast milk versus those receiving lipid emulsion, and c) plasma of infants with normal versus elevated triglyceride levels.

Methods: Forty-seven preterm infants < 36 weeks of gestation were included; fatty acid profiles were measured in serum samples and corresponding nutritional sources (breast milk and lipid emulsion) using gas chromatography/mass spectrometry.

Results: Compared to breast milk levels, plasma contained significantly lower C8:0, C10:0, C12:0, C14:0, C19:1n9, C18:3n3 (p < 0.0001). In contrast, relative abundance of C16:0, C18:0 and C20:4n6 was higher in plasma than in corresponding breast milk samples (p < 0.001) and lipid emulsion (p < 0.01). Compared to the corresponding lipid emulsion, the abundance of C18:2n6 and C18:3n3 was significantly lower in plasma (p < 0.001). Fatty acid profiles in plasma of infants fed breast milk compared to lipid emulsion were not markedly different. Hypertriglyceridemic samples showed elevated levels for C18:1n9 and C16:0 when compared with normotriglyceridemic samples.

Conclusions: Our study reveals that lipid levels in plasma show both depletion and enrichment of distinct fatty acids which do not seem to be closely related to dietary intake. A more detailed understanding of fatty acid flux rates is needed, like the understanding of amino acid metabolism and is supported by the finding that hypertriglyceridemia might be a state of selective fatty acid accumulation. This would allow to develop more balanced diets for intensive care and potentially improve clinical outcomes.

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