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Lipid Composition, Digestion, and Absorption Differences among Neonatal Feeding Strategies: Potential Implications
Kathryn Burge1, Frederico Vieira1, Jeffrey Eckert1
1Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 North Everett Dr., Oklahoma City, OK 73104, USA.
Insights
Necrotizing enterocolitis (NEC) in preterm infants may be linked to how well lipids are digested. Formula and pasteurized donor milk may hinder lipid digestion, potentially increasing NEC risk.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a major cause of illness and death in newborns.
- Formula feeding is a risk factor for NEC, especially in preterm infants who often require it.
- The digestive capacity of premature infants' gastrointestinal systems is limited, particularly for fat digestion.
Purpose of the Study:
- To review differences in lipid composition and digestion between breast milk, formula, and pasteurized donor milk.
- To explore how lipid digestion and absorption impact NEC risk in preterm neonates.
- To highlight the role of bile salt-stimulated lipase (BSSL) in neonatal lipid assimilation.
Main Methods:
- Literature review comparing lipid structures and digestive enzyme content.
- Analysis of factors affecting lipid digestion and absorption in preterm infants.
- Discussion of the potential inflammatory effects of undigested lipids in the neonatal gut.
Main Results:
- Breast milk lipids are structured for easier digestion by neonates compared to formula lipids.
- Formula lacks bile salt-stimulated lipase (BSSL), a key enzyme for fat digestion.
- Pasteurization inactivates BSSL in donor milk, potentially impairing lipid digestion.
Conclusions:
- Incompletely digested lipids may accumulate and oxidize in the neonatal gut.
- These lipid fragments are implicated in inducing intestinal inflammation, potentially contributing to NEC.
- Optimizing lipid digestion and absorption is crucial for preventing NEC in high-risk preterm infants.
Abstract:
Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in the neonatal population. Formula feeding is among the many risk factors for developing the condition, a practice often required in the cohort most often afflicted with NEC, preterm infants. While the virtues of many bioactive components of breast milk have been extolled, the ability to digest and assimilate the nutritional components of breast milk is often overlooked. The structure of formula differs from that of breast milk, both in lipid composition and chemical configuration. In addition, formula lacks a critical digestive enzyme produced by the mammary gland, bile salt-stimulated lipase (BSSL). The gastrointestinal system of premature infants is often incapable of secreting sufficient pancreatic enzymes for fat digestion, and pasteurization of donor milk (DM) has been shown to inactivate BSSL, among other important compounds. Incompletely digested lipids may oxidize and accumulate in the distal gut. These lipid fragments are thought to induce intestinal inflammation in the neonate, potentially hastening the development of diseases such as NEC. In this review, differences in breast milk, pasteurized DM, and formula lipids are highlighted, with a focus on the ability of those lipids to be digested and subsequently absorbed by neonates, especially those born prematurely and at risk for NEC.
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