title: Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations.
abstract: BACKGROUND
  Choline forms the head group of phosphatidylcholines, comprising 40-50 % of cellular membranes and 70-95 % of phospholipids in surfactant, bile, and lipoproteins. Moreover, choline serves as the precursor of acetylcholine and is important for brain differentiation and function. While accepted as essential for fetal and neonatal development, its role in preterm infant nutrition has not yet gained much attention.
  
  
  METHODS
  The adequate intake of choline of preterm infants was estimated from international recommendations for infants, children, and adults. Choline intake relative to other nutrients was determined retrospectively in all inborn infants below 1,000 g (extremely low birth weight) or below 28 weeks gestational age, admitted to our department in 2006 and 2007 (N = 93).
  
  
  RESULTS
  Estimation of adequate intake showed that children with 290 g body weight need more choline than those with 1,200 g (31.4 and 25.2 mg/kg/day, respectively). Day-by-day variability was high for all nutrient intakes including choline. In contrast to the continuous intrauterine choline delivery, median supply reached a plateau at d11 (21.7 mg/kg/day; 25th/75th percentile: 19.6; 23.9). Individual choline supply at d0-d1 and d2-d3 was <10 mg/kg/day in 100 and 69 % of infants, respectively. Furthermore, intakes <10 mg/kg/day were frequently observed beyond day 11. Median adequate intakes (27.4 mg/kg/day at 735 g body weight) were achieved in <2 %.
  
  
  CONCLUSIONS
  Nutritional intake of choline in this cohort of preterm infants was frequently less than the estimated adequate intake, with particular shortage until postnatal d10. Because choline is important for brain development, future studies are needed to investigate the effects of adequate nutritional choline intake on long-term neurodevelopment in VLBW infants.
authors.affiliation: Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Strasse 7, 72076, Tübingen, Germany. wolfgang.bernhard@med.uni-tuebingen.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bernhard
authors.forename: Anna
authors.initials: A
authors.lastname: Full
authors.forename: Jörg
authors.initials: J
authors.lastname: Arand
authors.forename: Christoph
authors.initials: C
authors.lastname: Maas
authors.forename: Christian F
authors.initials: CF
authors.lastname: Poets
authors.forename: Axel R
authors.initials: AR
authors.lastname: Franz
mesh_terms: D002657:Child Development; D002794:Choline / Q000008:administration & dosage*; D002796:Choline Deficiency / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017408:Guidelines as Topic; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007227:Infant Nutritional Physiological Phenomena; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D007363:Intensive Care Units, Neonatal; D008297:Male; D009751:Nutritional Requirements; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
chemical_list: D002794:Choline