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Long-chain PUFA supplementation improves PUFA profile in infants with cholestasis
Piotr Socha1, Berthold Koletzko, Irena Jankowska
1Department of Gastroenterology, Hepatology and Nutrition, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-736 Warszawa, Poland, sochap@czd.waw.pl
Insights
Long-chain polyunsaturated fatty acid (LCP) supplementation improved LCP status in infants with severe cholestasis. However, this intervention may also increase lipid peroxidation, indicating a potential risk alongside the benefits.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Biochemistry
Background:
- Infants with cholestasis frequently develop long-chain polyunsaturated fatty acid (LCP) deficiency.
- Cholestatic infants often present with malnutrition and essential fatty acid (EFA) deficiency, characterized by elevated Mead acid and palmitoleic acid levels.
Purpose of the Study:
- To investigate the impact of LCP-supplemented infant formula on EFA status in infants diagnosed with cholestasis.
- To assess changes in lipid peroxidation markers following LCP supplementation.
Main Methods:
- A randomized controlled trial involving 23 infants with cholestasis, aged 1.9 to 4.9 months.
- Infants received either standard formula or formula supplemented with LCP from egg phospholipids for one month.
- Evaluated liver function tests, nutrient intake, and plasma phospholipid fatty acid composition at baseline and post-intervention.
Main Results:
- LCP-supplemented formula significantly increased plasma levels of arachidonic acid and docosahexaenoic acid (DHA) in cholestatic infants.
- Infants receiving LCP-supplemented formula showed a significant increase in thiobarbituric acid reactive substances (TBARS) concentration, a marker of lipid peroxidation.
- No significant differences in liver function or baseline EFA status were observed between the LCP-supplemented and non-supplemented groups.
Conclusions:
- LCP-supplemented formulas effectively improve LCP status in infants suffering from severe cholestasis.
- The enhanced LCP status in cholestatic infants receiving supplemented formula may be associated with increased lipid peroxidation, warranting further investigation.
Abstract:
Long-chain PUFA (LCP) deficiency is a frequent complication in cholestatic infants. We investigated the effects of LCP-supplemented formula on EFA status in infants with cholestasis. Twenty-three infants with cholestasis (biliary atresia after surgery, 8; intrahepatic cholestasis, 15) aged 1.9 to 4.9 mon (median 3.1 mon) were randomized to receive commercial infant formulas either without LCP or with LCP from egg phospholipids for 1 mon. Liver tests, nutrient intakes, and plasma phospholipid FA (%w/w) were determined at baseline and after intervention. At baseline, patients had high serum direct bilirubin levels (5.9 +/- 3.0 mg/dL; mean +/- SD), they were malnourished (body fat mass: 40 +/- 13% of normal) and presented with PUFA deficiency [plasma phospholipid PUFA: 28.43%w/w (26.56-30.53) in patients vs. 37.02%w/w (34.53-39.58) in controls; median (1st-3rd quartile)] with elevated Mead acid and palmitoleic acid. LCP-supplemented (n = 11) and -nonsupplemented groups (n = 12) did not differ in age, indicators of liver function, and EFA status at baseline. After the intervention, LCP-supplemented infants had higher levels of arachidonic acid [7.2 (5.9-8.8) vs. 4.2 (3.0-5.3) %w/w; P < 0.001] and DHA [2.8 (2.2-3.2) vs. 1.6 (1.0-2.1) %w/w; P < 0.05], accompanied by increased TBARS concentration: 1.9 (1.4-2.2) vs. 1.3 (1.1-1.6) nmol/mL; P < 0.05]. We concluded that LCP-supplemented formulae improve LCP status of infants with severe cholestasis but may enhance lipid peroxidation.