Association between essential fatty acid source and Holman index in preterm infants: A prospective cohort study

Preterm infants are at risk for altered essential fatty acid status due to limited nutrient stores, immature metabolism, and variable nutritional exposures. The impact of enteral and parenteral fat sources on fatty acid profiles in this population remains poorly understood. We hypothesized that preterm infants receiving donor breast milk would demonstrate altered fatty acid profiles, higher Holman indices, and a greater prevalence of essential fatty acid deficiency compared with infants receiving maternal breast milk, formula, or parenteral nutrition.

We conducted a prospective cohort study comparing fatty acid profiles of 49 preterm infants born between 23 weeks 0 days and 36 weeks 6 days gestation who received maternal breast milk, donor breast milk, formula, or parenteral nutrition with a multi-lipid intravenous emulsion (soybean, medium-chain triglyceride, olive, and fish oils) from 2023 to 2024. Essential fatty acid deficiency was defined as a Holman index (triene:tetraene ratio of Mead acid to arachidonic acid) >0.2.

Infants receiving donor breast milk demonstrated a higher Holman Index compared with maternal breast milk and formula groups, although most values remained below the threshold for essential fatty acid deficiency. Biochemical essential fatty acid deficiency was identified in six infants: three received donor breast milk and three received a multi-lipid intravenous emulsion of 3 g/kg.

Exposure to donor breast milk and multi-lipid intravenous emulsion of 3 g/kg were associated with altered essential fatty acid status. Further studies are needed to determine the clinical significance of subthreshold alterations in Holman index values in preterm infants.