Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations
Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations
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DOI：
10.1007/s00394-012-0438-x
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发表时间：
2013-04-01
影响因子：
5
通讯作者：
Franz, Axel R.
中科院分区：
文献类型：
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作者：
Bernhard, Wolfgang;Full, Anna;Franz, Axel R.
胆碱构成了磷脂酰胆碱的头组，包括40- 50%的细胞膜和70- 95%的表面活性剂、胆汁和脂蛋白中的磷脂。此外，胆碱是乙酰胆碱的前体，对大脑的分化和功能起重要作用。虽然被认为是胎儿和新生儿发育的必要条件，但它在早产儿营养中的作用尚未得到太多关注。早产儿胆碱摄取量是根据国际上对婴儿、儿童和成人的建议来估计的。回顾性测定2006年和2007年在我科收治的所有小于1000 g（极低出生体重）或小于28周胎龄的新生儿（N = 93）相对于其他营养素的胆碱摄入量。对足够摄入量的估计表明，290克体重的儿童比1200克体重的儿童需要更多的胆碱（分别为31.4毫克/公斤/天和25.2毫克/公斤/天）。包括胆碱在内的所有营养素摄入量每天的变化都很高。与连续宫内输送胆碱相比，中位供给在第11天达到平稳（21.7 mg/kg/天；第25 /75百分位：19.6;23.9）。100%和69%的婴儿在第0-d1和d2-d3阶段的个体胆碱供应分别< 10 mg/kg/天。此外，在第11天以后，经常观察到摄入量< 10 mg/kg/天。中位充足摄入量（735 g体重时27.4 mg/kg/天）在< 2%的人群中达到。在这组早产儿中，胆碱的营养摄入量经常低于估计的足够摄入量，特别是在出生后10。由于胆碱对大脑发育很重要，因此需要进一步研究摄入足够的营养胆碱对VLBW婴儿长期神经发育的影响。
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.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).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 %.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.