Intestinal absorption of long-chain polyunsaturated fatty acids in preterm infants fed breast milk or formula

Abstract

The importance of long-chain polyunsaturated fatty acids (LCPs) in the development of preterm infants is now well accepted but the source of dietary LCPs to be added to infant formulas remains controversial. We measured dietary intakes, fecal output, and percentages of intestinal absorption of n-6 and n-3 LCPs in healthy preterm infants fed exclusively preterm breast milk (PBM; n = 20), formula without LCPs added (NLCPs; n = 19), formula with LCPs derived from phospholipids (PL-LCPs; n = 19), or formula with LCPs from triacylglycerols (TG-LCPs; n = 19). Intestinal absorption of arachidonic acid was not different in the four groups but docosahexaenoic acid was better absorbed from PL-LCPs than from PBM (88.3 +/- 1.8% compared with 78.4 +/- 4.0%, P < 0.05) Total absorption of n-6 LCPs was not different between groups but total n-3 LCPs were better absorbed from PL-LCPs than from PBM or TG-LCPs (88.7 +/- 1.9%, 79.2 +/- 4.4%, and 80.4 +/- 2.2%, respectively). In conclusion, docosahexaenoic acid and arachidonic acid were absorbed as efficiently from TG-LCPs formula as from breast milk fat. Absorption of docosahexaenoic acid and n-3 LCPs was greater from PL-LCPs formula than from PBM or TG-LCPs formula.

Efficacy of Dietary Arachidonic Acid Provided as Triglyceride or Phospholipid as Substrates for Brain Arachidonic Acid Accretion in Baboon Neonates

“…In this study, we included equal amounts of exogenous PC in both TG-AA* and PC-AA* doses to avoid any confounding effects of exogenous PC on intestinal assembly of lipoproteins and plasma PC content. Absorption of dietary AA provided as PL has been shown to be similar to breast milk AA, which is predominantly found as TG-AA (38,39) and also similar to formula AA provided primarily as TG-AA (39). However, dietary source has been shown to alter the distribution of fatty acids into lipoproteins and lipid fractions (40).…”

“…PL as a carrier of AA is reported to be absorbed at least as efficiently as human breast milk AA and as formula AA provided primarily in the form of TG in preterm infants (38,39). Dietary TG and PL derived PUFA were differently distributed into lipoprotein lipids and transported to target organs in rats (40) and in adult humans (41,42).…”

Linking fat intake, the intestinal microbiome, and necrotizing enterocolitis in premature infants

“…Higher temperatures may cause a larger reduction in bile salt-stimulated lipase and thus greater impairment in fat absorption. Commercial formulas lack bile salt-stimulated lipase, a partial explanation of decreased triglyceride cleavage and fat absorption in formula fed infants (42,45). Chappell et al (46) documented reductions in total fat absorption and coefficients of absorptions for medium and long chain FA in very-low-birth-weight infants fed formula as compared with a breast milk-fed group with comparable fat intake.…”

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“…The absorption of PUFA is influenced by the lipid form in which these fatty acids are eaten (Carnielli et al, 1998). In particular, the fatty acid composition of the triacylglycerol (TG) strongly reflected that of the diet, implying that TG acts as a nutritional storage site in the fish body (Shirai et al, 2002).…”