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


CONCLUSIONS
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.
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark; Diabetes Pharmacology, Novo Nordisk A/S, Denmark.
Andreas
A
Vegge
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
Thomas
T
Thymann
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
Lotte
L
Lauritzen
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
Stine B
SB
Bering
Department of Veterinary Clinical and Animal Science, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Haemophilia Pharmacology, Novo Nordisk A/S, Denmark.
Bo
B
Wiinberg
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark. Electronic address: psa@life.ku.dk.
Per T
PT
Sangild
D000821:Animal Feed / Q000009:adverse effects; D000818:Animals; D000831:Animals, Newborn; D003126:Colostrum; D004195:Disease Models, Animal; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D020345:Enterocolitis, Necrotizing / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D015525:Fatty Acids, Omega-3 / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000097:blood; D005395:Fish Oils / Q000008:administration & dosage / Q000009:adverse effects; D006168:Guinea Pigs; D050356:Lipid Metabolism / Q000187:drug effects*; D008099:Liver / Q000187:drug effects / Q000378:metabolism*; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D047928:Premature Birth / Q000178:diet therapy; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005395:Fish Oils
Enteral nutrition; Intestine; Liver; Newborn; Premature