Parenteral lipids and partial enteral nutrition affect hepatic lipid composition but have limited short term effects on formula-induced necrotizing enterocolitis in preterm piglets

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 34; no. 2; pp. 219 - 228
• Main Authors: Vegge, Andreas, Thymann, Thomas, Lauritzen, Lotte, Bering, Stine B, Wiinberg, Bo, Sangild, Per T
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2015
• Subjects: Animal Feed - adverse effects; Animals; Animals, Newborn; Colostrum; Disease Models, Animal; Enteral nutrition; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Enterocolitis, Necrotizing - diet therapy; Enterocolitis, Necrotizing - metabolism; Enterocolitis, Necrotizing - pathology; Fatty Acids, Omega-3 - blood; Fatty Acids, Omega-6 - blood; Fish Oils - administration & dosage; Fish Oils - adverse effects; Gastroenterology and Hepatology; Guinea Pigs; Intestine; Lipid Metabolism - drug effects; Liver; Liver - drug effects; Liver - metabolism; Newborn; Parenteral Nutrition - adverse effects; Parenteral Nutrition - methods; Premature; Premature Birth - diet therapy; Treatment Outcome; Premature; Newborn; Enteral nutrition; Intestine; Liver
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2014.03.004

Summary Background & aims Rapid transition from total parenteral nutrition (TPN) to enteral feeding is a risk factor for necrotizing enterocolitis (NEC) in preterm infants. We hypothesized that partial enteral nutrition with colostrum, increased proportion of n-3 polyunsaturated fatty acids (PUFA), or exclusion of lipid in TPN would affect short term NEC sensitivity and liver function. Methods Preterm piglets were fed for three days after birth: 1) TPN with a standard lipid emulsion (Nutriflex Lipid Plus, TPN control group, n  = 19), 2) PN plus bovine colostrum as partial enteral nutrition (PN/COL, n  = 18), 3) TPN with fish oil (FO) lipids (Omegaven, TPN/FO, n  = 19), or 4) TPN with no lipid (TPN/NL, n  = 22). After TPN, piglets were fed formula for two days before tissue collection. Results None of the treatments had consistent effect on NEC incidence (∼40–50% across all groups), intestinal morphology and function, relative to TPN. In the liver, there were no signs of steatosis but PN/COL decreased the n-6 PUFA levels, leading to higher n-3/n-6 ratio, GGT activity, and plasma cholesterol and albumin levels, relative to TPN (all p  < 0.05). TPN/FO increased the hepatic n-3 levels and n-3/n-6 ratio. TPN/NL treatment led to decreased hepatic n-6 level, n-3/n-6 ratio and bilirubin, albumin and triglycerides, and lowered blood clotting strength (−30%, TPN/NL vs. TPN/COL, p  < 0.05). Conclusion Partial enteral nutrition with colostrum, increased n-3 PUFAs in TPN, or removal of lipid from the TPN, all affect hepatic lipids and proteins in preterm neonates. These effects do not translate into improved hepatic function or NEC resistance, at least not short term.