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Gastric lipolysis and fat absorption in preterm infants: effect of medium-chain triglyceride or long-chain
1Department of Pediatrics, Georgetown University Medical Center, Washington, DC 20007.
Insights
Preterm infants showed significant gastric fat digestion with both medium-chain triglyceride and long-chain triglyceride formulas. Medium-chain fatty acids were likely absorbed directly in the stomach.
Area of Science:
- Neonatal nutrition
- Gastroenterology
- Lipid metabolism
Background:
- Preterm infants have immature digestive systems.
- Fat digestion and absorption are critical for infant growth.
- Understanding formula fat composition impacts nutrient utilization.
Purpose of the Study:
- To investigate gastric lipolysis and fat absorption in preterm infants.
- To compare medium-chain triglyceride (MCT) versus long-chain triglyceride (LCT) formula effects.
- To assess infant weight gain in response to different fat compositions.
Main Methods:
- Crossover study design in 12 preterm infants.
- Analysis of gastric aspirates for lipase activity and lipolysis.
- Fat balance studies over three days for each formula.
- Comparison of MCT (rich in 8:0, 10:0) and LCT formulas.
Main Results:
- Significant gastric hydrolysis of both MCT and LCT formulas (20% and 16%).
- Lower gastric lipase activity during MCT feeding suggested altered lipase secretion or binding.
- Preferential release of medium-chain and unsaturated long-chain fatty acids in the stomach.
- Evidence for direct gastric absorption of medium-chain fatty acids.
Conclusions:
- The preterm stomach actively hydrolyzes dietary fats.
- MCTs may be absorbed directly in the stomach, bypassing intestinal absorption.
- Formula fat composition influences gastric processing and potentially nutrient absorption in preterm infants.
Abstract:
The extent of gastric lipolysis, fat absorption, and infant weight gain was studied in 12 preterm infants (gestational age 28.75 +/- 0.50 weeks, postnatal age 6.08 +/- 0.81 weeks) fed medium-chain triglyceride or long-chain triglyceride formula for 1 week in a crossover design. The former formula contained 42% of 8:0 and 10:0 and 19% of 12:0, 14:0, and 16:0; the latter formula contained only 7% of 8:0 and 10:0 and 46% of 12:0, 14:0, and 16:0. Gastric aspirates were obtained on the second and third day of formula feeding for quantitation of lipase activity and of the extent of gastric lipolysis. Fat balance studies were conducted during the last three days of each feeding regimen. The study showed that (1) there was marked hydrolysis of formula fat in the stomach during feeding of either medium-chain triglyceride formula or long-chain triglyceride formula (20% and 16%, respectively); (2) lipase activity in the gastric aspirates was less during feeding of medium-chain triglyceride formula than before the meal, which suggested stimulation of lipase secretion by long-chain fatty acid released from long-chain triglyceride formula fat or more rapid binding of lipase to ingested lipid in the medium-chain triglyceride formula; (3) fatty acid distribution in glycerides and free fatty acids showed preferential release of medium-chain (8:0, 10:0) and long-chain unsaturated (18:1, 18:2) fatty acids in the stomach. The low content of 8:0 and 10:0 in gastric triglyceride and free fatty acids suggested that medium-chain fatty acids were absorbed directly in the stomach.(ABSTRACT TRUNCATED AT 250 WORDS)