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Effect of human milk or formula on gastric function and fat digestion in the premature infant
M Armand1, M Hamosh, N R Mehta
1Division of Developmental Biology and Nutrition, Georgetown University Medical Center, Washington, DC 20007, USA.
Insights
Human milk and infant formulas show similar gastric enzyme activity in preterm infants. However, human milk fat is more accessible to gastric lipase, suggesting a greater role in newborn fat digestion.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Infant Nutrition
Background:
- Preterm infants have immature digestive systems.
- Gastric lipase and pepsin are key enzymes for fat digestion.
- Dietary fat absorption is crucial for infant growth and development.
Purpose of the Study:
- To compare gastric function and fat digestion in preterm infants fed human milk versus two infant formulas.
- To assess the impact of diet on gastric lipase and pepsin activity, pH, and volume.
- To determine the efficiency of intragastric fat digestion based on feeding type.
Main Methods:
- 28 preterm infants (gestational age 28.9-29.5 weeks) were divided into three feeding groups: human milk, SMA Super Preemie formula, and Similac Special Care formula.
- Gastric lipase and pepsin activity, pH, and volume were measured before or during 50 minutes after gavage feeding.
- Intragastric fat digestion was assessed by measuring fat hydrolysis.
Main Results:
- No significant differences were observed in gastric enzyme activity, pH, or volume among the feeding groups.
- Gastric lipase output was comparable to that of healthy adults.
- Pepsin output was significantly lower in all infant groups compared to adults.
- Fat hydrolysis was 1.7-2.5 times higher in infants fed human milk compared to formula-fed infants.
Conclusions:
- Dietary fat composition (fatty acid profiles, emulsions, particle size) does not affect gastric enzyme activity in preterm infants.
- Triglycerides in human milk fat globules are more accessible to gastric lipase than those in formula.
- Gastric lipase may play a more significant role in fat digestion in newborns than in adults, especially during periods of pancreatic insufficiency.
Abstract:
The effect of diet, human milk or formula, on gastric function (lipase and pepsin activity, pH, and volume) and intragastric digestion of fat was assessed in 28 appropriate for gestational age preterm infants (gestational age, 28.9 +/- 1.4, 29.1 +/- 0.9, 29.5 +/- 0.6 wk; birth weight, 1.00 +/- 0.14 to 1.18 +/- 0.07 kg). The infants were fed either human milk (n = 11), SMA Super Preemie formula (n = 9), or Similac, Special Care formula (n = 8). Fasting and postprandial activity of digestive enzymes, pH, and gastric volume (measured before or during 50 min after gavage feeding) did not differ as a function of diet among the three groups of infants. Gastric lipase output, 23.1 +/- 5.1, 28.3 +/- 6.6, and 22.5 +/- 6.4 (U/kg of body weight) in human milk-, SMA SP-, or Similac SC-fed infants was comparable to the gastric lipase output of healthy adults fed a high fat diet (22.6 +/- 3.0). Pepsin output was, however, significantly lower (597 +/- 77, 743 +/- 97, and 639 +/- 142 U/kg of body weight) in human milk-, SMA SP-, and Similac SC-fed infants) than in healthy adults (3352 +/- 753 U/kg). The hydrolysis of dietary fat was 1.7-2.5-fold higher (p < 0.01) in human milk-fed infants than in infants fed either formula. We conclude that differences in type of feeding, i.e. different fatty acid profiles (long chain or medium chain triglycerides), different emulsions (natural or artificial), and different fat particle sizes do not affect the level of activity of gastric enzymes. However, the triglyceride within milk fat globules appears to be more accessible to gastric lipase than that within formula fat particles. We suggest that the contribution of gastric lipase to overall fat digestion might be greater in the newborn (a period of pancreatic insufficiency) than in the adult.