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Published on: September 20, 2019
Effect of parenteral lipid emulsion on preterm infant PUFAs and their downstream metabolites
Hiroki Suganuma1, Carmel T Collins1, Andrew J McPhee2
1SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Insights
Parenteral lipid emulsion in preterm infants altered fatty acid and oxylipin profiles, potentially increasing omega-6 inflammation. Further research is needed to link these changes to clinical outcomes.
Area of Science:
- Biochemistry
- Neonatal Nutrition
- Lipid Metabolism
Background:
- Oxylipins are bioactive lipid mediators derived from long-chain polyunsaturated fatty acids (LCPUFAs).
- Preterm infants (30-33 weeks' gestation) require specialized nutritional support during the transition to enteral feeding.
- Understanding lipid metabolism and inflammatory markers in this vulnerable population is crucial.
Purpose of the Study:
- To characterize oxylipin profiles in preterm infants receiving peripheral parenteral nutrition (P-PN) with lipid emulsion.
- To compare these profiles with infants receiving 10% glucose during the transition to enteral feeds.
- To investigate the impact of a specific lipid emulsion (SMOFlipid®) on fatty acid and oxylipin levels.
Main Methods:
- Randomized controlled trial comparing P-PN (SMOFlipid®) with 10% glucose in preterm infants.
- Blood samples analyzed for 32 oxylipins and 5 free fatty acids using ultra-high-performance liquid chromatography-tandem mass spectrometry.
- Total LCPUFAs measured using gas chromatography on multiple study days.
Main Results:
- P-PN group showed significantly higher total and free LA, ALA, and EPA compared to controls in the first week.
- Total AA was lower, while free DHA was higher in the P-PN group.
- Elevated levels of LA, ALA, EPA, and DHA-derived oxylipins were observed in the P-PN group, alongside altered AA-derived oxylipins.
Conclusions:
- Parenteral lipid emulsion significantly altered fatty acid and oxylipin profiles in preterm infants.
- Observed profiles suggest a potential increase in omega-6 driven inflammation.
- Further studies are warranted to explore the clinical significance of these oxylipin changes in preterm infants.
Objective:
Oxylipins synthesized by oxidation of long-chain polyunsaturated fatty acids (LCPUFAs) are bioactive downstream lipid mediators. The aim of this study was to describe oxylipin levels in preterm infants born 30 to 33 weeks' gestation who were enrolled in a randomized controlled trial in which peripheral parenteral nutrition (P-PN), including lipid emulsion (containing soy, medium chain triglyceride, olive and fish oil), was compared with 10% glucose on growth during the transition to enteral feeds.
Methods:
Of the 92 infants randomized to the P-PN study, the first 72 (P-PN n = 34, control n = 38) had blood taken for fatty acid analyses. P-PN infants received parenteral nutrition including 3% protein, 8% glucose and 17% SMOFlipid® lipid (containing soy, medium chain triglyceride, olive and fish oil), and control infants 10% glucose. Both groups commenced enteral feeds when clinically stable. 32 oxylipins and 5 free fatty acids were screened (using ultra-high-performance liquid chromatography-tandem mass spectrometry), and 5 total LCPUFA were measured (using gas chromatography), on study days 1 (baseline), 2, 4, 7, 14 and 21.
Results:
Both total and free LA, ALA and EPA were significantly higher in the P-PN group compared with control over the first week of life. Whereas total AA was significantly lower and free DHA significantly higher over the same time period. All LA, ALA, EPA and four DHA derived oxylipins detected were significantly higher in the P-PN group compared with the control group during the first week of life, with three AA derived oxylipins significantly lower and one significantly higher.
Conclusions:
Parenteral lipid emulsion resulted in a change in total and free fatty acids and related oxylipins with the profiles suggesting increased omega-6 driven inflammation. Further studies to investigate the association between the oxylipin levels and nutrition and to determine whether the oxylipin profiles influence the clinical outcome in preterm infants are warranted.
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