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Combined choline and DHA supplementation: a randomized controlled trial.

Wolfgang Bernhard1, Katrin Böckmann2, Christoph Maas2

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Choline and docosahexaenoic acid (DHA) supplementation improves preterm infant nutrition. Combined supplementation enhanced DHA levels more effectively than DHA alone, supporting infant development.

Keywords:
Arachidonic acidCholineCombined supplementationD9-cholineDocosahexaenoic acidLC-PUFANeonateNutritionPEMTPhosphatidylcholinePhospholipidPlasmaPreterm infantStable isotopesTandem mass spectrometry

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Area of Science:

  • Neonatal nutrition and metabolism.
  • Essential fatty acid and choline biochemistry.

Background:

  • Choline and docosahexaenoic acid (DHA) are vital for preterm infant development.
  • Plasma concentrations of choline and DHA-phosphatidylcholine (DHA-PC) decrease post-birth.
  • Understanding their metabolic link is crucial for optimizing infant nutrition.

Purpose of the Study:

  • To evaluate the effects of combined versus exclusive choline and DHA supplementation in preterm infants.
  • To compare supplementation strategies against standard feeding protocols.
  • To assess the impact on plasma choline and DHA homeostasis.

Main Methods:

  • A randomized, partially blinded, single-center trial involving 24 preterm infants (<32 weeks postmenstrual age).
  • Interventions included standard nutrition, or additional enteral choline (30 mg/kg/day), DHA (60 mg/kg/day), or both for 10 days.
  • A deuterated choline tracer was administered to study choline metabolism.

Main Results:

  • Choline supplementation normalized plasma choline levels to near-fetal concentrations.
  • Combined choline and DHA supplementation significantly increased DHA-PC levels compared to DHA alone.
  • Choline supplementation improved DHA homeostasis and influenced phosphatidylcholine synthesis pathways.

Conclusions:

  • Additional choline supplementation (30 mg/kg/day) effectively raises plasma choline in preterm infants.
  • Combined choline and DHA supplementation optimizes DHA homeostasis.
  • These findings support improved nutritional strategies for preterm infants.