Fat absorption in neonates: comparison of long-chain-fatty-acid and triglyceride compositions of formula, feces, and blood

Verkade, Henkjan J.; Hoving, Eb; Muskiet, Frits A. J.; Martini, Ia; Jansen, Gijsbert J.; Okken, A; Vonk, Roelf; Bijleveld, Cma

doi:10.1093/ajcn/53.3.643

Cited by 39 publications

(25 citation statements)

References 31 publications

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“…The efficacy of fat absorption increased with either PCA (Table 1) or postnatal age (data not shown) in preterm and term infants, which was consistent with previously reported data (3,4). It appeared that the infants seemed to reach mature levels of fat absorption already at the PCA of approximately 46 wk ( Table 1).…”

Section: Discussionsupporting

confidence: 90%

“…At the neonatal age, and particularly in the case of prematurity, a considerable part of dietary fat is not absorbed from the intestine, but is excreted via the feces (2)(3)(4)(5). Fat absorption involves digestion, requiring lipolysis by lipolytic enzymes, and the subsequent intestinal absorption of the hydrolyzed fatty acids and monoacylglycerols (6).…”

mentioning

confidence: 99%

“…Other studies, however, suggest uptake of lipolytic products could be rate-limiting. In one study on fecal fat composition of formula-fed neonates, more than 95% of the fatty acids were present in hydrolyzed, free form (3). Also, despite the presence of this additional lipase in human milk, human milk-fed neonates still have an increased fecal loss of dietary fat, especially with respect to LCFA.…”

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confidence: 99%

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Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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Our goal for this study was to determine whether the maturation of fat absorption in neonatal life is functionally related to an increased ability to hydrolyze dietary fat, to absorb long-chain fatty acids, or to do both. In 16 preterm and in eight term neonates, the intestinal ability to hydrolyze triacylglycerols and the capacity to absorb long-chain fatty acids were determined at several times between birth and 5 mo after the term age. These processes were compared with the percentage of fat absorption (formula-fed infants) or with fecal fat excretion (breast-fed infants). The functional capacity to digest triacylglycerols and to absorb the lipolytic products was evaluated by measuring serum concentrations of the lipolytic product [1-13 C]palmitate after the enteral administration of tri-1-13 C palmitoyl-glycerol. Longchain fatty acids absorption (i.e. independent of lipolysis) was determined by measuring serum concentrations of [1-13 C]stearate after its enteral administration. The efficacy of fat absorption increased in preterm infants (formula-fed) from 91.2 Ϯ 1.1% (mean Ϯ SEM) at 32. Efficient absorption of fat from the diet is important for energy supply, growth, and development, especially during development (1). At the neonatal age, and particularly in the case of prematurity, a considerable part of dietary fat is not absorbed from the intestine, but is excreted via the feces (2-5). Fat absorption involves digestion, requiring lipolysis by lipolytic enzymes, and the subsequent intestinal absorption of the hydrolyzed fatty acids and monoacylglycerols (6). The uptake of lipolytic products encompasses intraluminal solubilization of lipolytic products, their subsequent translocation across the small intestine, and their incorporation into chylomicrons that are subsequently secreted into the lymph (7). The importance and relative contribution of incomplete digestion and a decreased ability for fatty acid absorption to the causes of increased fecal fat loss during (preterm) infancy is only partly understood. Several studies suggest that lipolysis of fats could be the rate-limiting step in (preterm) neonatal dietary fat absorption. In the human gastrointestinal system several lipases are active on dietary triacylglycerols: gastric lipase (8, 9), pancreatic (colipase-dependent) lipase (10, 11), and bile salt-stimulated lipase (12). Several investigators have demonstrated a decreased intraduodenal concentration of both pan-

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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confidence: 99%

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Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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“…This can be a controversial point because many clinical experiences showed a good fat absorption when palmitic acid is in the sn-1 and=or sn-3 position (Verkade et al, 1991). On the other hand there is the breastmilk model with 70% of palmitic acid in the sn-2 position, the proven good absorption when using lard (80% sn-2) as a source of lipids (Brooke, 1985), or fats enzymatically interesterified (Christensen et al, 1995), or even LA being better absorbed when in an sn-2 position (Hamosh et al, 1991).…”

Section: Fa Location In Intramolecular Triacylglycerol Structurementioning

confidence: 99%

Fatty acid absorption in preterms on formulas with and without long-chain polyunsaturated fatty acids and in terms on formulas without these added

et al. 2001

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Background=objective: Long chain polyunsaturated fatty acids have beneficial effects in preterm neurophysiological development and are semi-essential. Their levels and variation in plasma and red cells in term and preterms are better known than their intestinal absorption. In this paper the absorption of supplemented arachidonic acid (AA) and docosahexaenoic acid (DHA) is evaluated in a preterm group. Design: Four newborn randomized groups were studied. Group T comprised 11 terms on regular formula. Preterms: group P (n ¼ 9) was on a classic preterm formula. Intervention: groups PA (n ¼ 9) and PB (n ¼ 13) were on the same formula but PB contained AA and DHA in similar proportion to breast milk. At 20 days a 3 day metabolic balance was taken for Ca, P i , Mg, total fat and individual fatty acids (C8 -C24, saturated unsaturated). Results: Calcium absorption was (mean AE s.d.) 51 AE 13% in terms. In preterms it was respectively 45 AE 18, 38 AE 11 and 37 AE 21%. Total fat absorption was 92.0AE 8.0% in terms, and from 95.0 AE 2.0 to 91.0 AE 8.0% in preterms. Absorption of 8:0, 10:0 and 12:0 showed a very high and constant rate despite significant intake differences (715 -33 mg=kg=day). Linoleic acid and a-linolenic acid were absorbed in the three groups at around 94% regardless of a greater LA intake in group P. Details of absorption (mg=kg=day) were: for AA, intake 17 AE 7, fecal excretion 5 AE 4, net retention 12 AE 5 (75.0 AE 18%); for DHA, intake 10 AE 3, fecal excretion 3 AE 2, net retention 6 AE 4 (62.3AE 30%). Conclusion: Intestinal absorption of fatty acids is high and is comparable in terms and preterms as regards the studied acids. Longer acids were less well absorbed. The supplemented amounts of AA and DHA were less well absorbed and probably not impairing calcium absorption. Sponsorship: University of Alicante, University of Miguel Hernández.

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“…Hamosh et al [12] and Jensen et al [13] studied the absorption of different fatty acids in preterm infants fed formula containing pre dominantly long-chain triacylglycerols but no LCP, and Verkade et al [14] studied the fatty acid absorption of a lard-modified infant for mula containing some LCP. In all these stud ies, fecal fatty acid composition was highly correlated with the corresponding fatty acid composition of the formula.…”

Section: Introductionmentioning

confidence: 99%

Docosahexaenoic and Arachidonic Acid Absorption in Preterm Infants Fed LCP-Free or LCP-Supplemented Formula in Comparison to Infants Fed Fortified Breast Milk

Boehm¹,

Müller²,

Kohn³

et al. 1997

Ann Nutr Metab

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The absorption of long-chain polyunsaturated fatty acids (LCP) with particular respect to docosahexaenoic (DHA) and arachidonic acid (AA) has been studied in 39 very-low-birth-weight infants appropriate for gestational age after a 10-day feeding period. The infants were fed either a LCP-supplemented formula (n = 11), or a LCP-free formula (n = 11) or breast milk fortified with protein and carbohydrates to have similar protein and energy intakes as in the formula-fed infants (n = 17). Total fat content and fatty acid profile were measured in the human milk, the two formulas, and in the stool samples. After a 10-day feeding period, the fecal excretions of total fat, DHA and AA were measured during a 3-day balance period. The total fat apparent absorption rates were similar in all groups (84.1, 82.1 and 80.6% of intake, respectively). The DHA and AA intakes were significantly (p < 0.01) higher in the group fed the fortified breast milk than in the group fed the LCP-supplemented formula (DHA: 75.5 ± 12.4 vs. 50.2 ± 4.2 mg/72 h; AA: 45.5 ± 5.8 vs. 30.2 ± 2.7 mg/72 h). There was a tendency for lower apparent absorption rates for both LCPs studied in the group fed fortified breast milk when compared to the group fed LCP-supplemented formula (AA: 70.6 ± 10.9 vs. 73.0 ± 8.7% of intake, DHA: 69.0 ± 10.6 vs. 74.2 ± 9.5% of intake), but the differences were not significant. As consequence of the different intakes, the net absorption of the two studied LCP fatty acids were significantly (p < 0.01) higher in the breast milk group than in the group fed the LCP-supplemented formula (DHA: 52.6 ± 6.1 vs. 36.8 ± 4.5 mg/72 h; AA: 31.4 ± 3.1 vs. 22.4 ± 2.3 mg/72 h). The data demonstrate that DHA and AA are absorbed from the studied LCP-supplemented formula at least as effectively as from human milk. The net absorption of these LCP depend on the amount of dietary intake, and seems to be influenced by the dietary LCP source.

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Fat absorption in neonates: comparison of long-chain-fatty-acid and triglyceride compositions of formula, feces, and blood

Cited by 39 publications

References 31 publications

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Fatty acid absorption in preterms on formulas with and without long-chain polyunsaturated fatty acids and in terms on formulas without these added

Docosahexaenoic and Arachidonic Acid Absorption in Preterm Infants Fed LCP-Free or LCP-Supplemented Formula in Comparison to Infants Fed Fortified Breast Milk

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