Fatty acid balance studies in premature infants fed human milk or formula: Effect of calcium supplementation*

https://doi.org/10.1016/S0022-3476(86)80893-9Get rights and content

During the first 4 neonatal weeks, serial total fatty acid and individual fatty acid balance studies were completed in 35 healthy premature infants with appropriate weight for gestational age. Infants weighed <1500 gm at birth, were descriptively similar, and were receiving similar volumes of either preterm mothers' milk (PTM) or formula (S-M-A 20). Total fatty acid and major fatty acid contents of the two feeding regimens were similar. Total fecal output and total fatty acid excretion were higher, whereas subsequent total fat absorption and coefficient of absorption were significantly lower, in the group fed S-M-A 20 (P<0.001). Administration of oral calcium supplements fed as calcium lactate (1.5 to 2.0 mmol/kg/day) decreased total fatty acid absorption in both the PTM (P<0.01) and S-M-A 20 (P<0.001) groups. Furthermore, the effect of feeding (P<0.0001) and oral calcium (P<0.001) independently influenced coefficients of absorption for major fatty acids fed (C12:0, C14:0, C16:0, C18:0, and C18:1). Although the main indices for growth were similar in both feeding groups, infants with inefficient rates of total fatty acid absorption attained slower rates of weight gain and increased skinfold thickness. We conclude that oral calcium supplements significantly alter the efficiency of lipid absorption in enterally fed preterm infants.

References (59)

  • AtkinsonSA et al.

    Macromineral balances in premature infants fed their own mothers' milk or formula

    J Pediatr

    (1983)
  • ClandininMT et al.

    Fatty acid utilization in perinatal de novo synthesis of tissues

    Early Hum Dev

    (1981)
  • PutnamJC et al.

    The effect of variations in dietary fatty acids on the fatty acid composition of erythrocyte phosphatidylcholine and phosphaytidyl-ethanolamine in human infants

    Am J Clin Nutr

    (1982)
  • JonesPJH et al.

    Whole body oxidation of dietary fatty acids: implications for energy utilization

    Am J Clin Nutr

    (1985)
  • WatkinsJB

    Mechanisms of fat absorption and the development of gastrointestinal function

    Pediatr Clin North Am

    (1975)
  • LebenthalE et al.

    Impact of development of the gastrointestinal tract on infant feeding

    J Pediatr

    (1983)
  • KatzL et al.

    Fat absorption in infants of birth weight less than 1300 gm

    J Pediatr

    (1974)
  • FilerLJ et al.

    Triglyceride configuration and fat absorption by the human infant

    J Nutr

    (1969)
  • WilliamsML et al.

    Calcium and fat absorption in neonatal period

    Am J Clin Nutr

    (1970)
  • BustamanteSA et al.

    Body weight, static and dynamic skinfold thickness in small premature infants during the first month of life

    Early Hum Dev

    (1983)
  • GompertzSM et al.

    The origin of faecal lipids: the composition of faecal fats in human subjects

    Clin Chim Acta

    (1963)
  • RaihaNC et al.

    Milk protein quantity and quality of low-birthweight infants. I. Metabolic responses and effects on growth

    Pediatrics

    (1976)
  • DaviesDP

    Adequacy of expressed breast milk for early growth of preterm infants

    Arch Dis Child

    (1977)
  • FomonSJ et al.

    Human milk and the small premature infant

    Am J Dis Child

    (1977)
  • BrookeOG et al.

    Energy balance, nitrogen balance, and growth in preterm infants fed expressed breast milk, a premature infant formula, and two low-solute adapted form

    Arch Dis Child

    (1982)
  • JarvenpaaAL et al.

    Preterm infants fed human milk attain intrauterine weight gain

    Acta Pediatr Scand

    (1983)
  • AlemiB et al.

    Fat digestion in very low-birth-weight infants: effect of addition of human milk to low-birth-weight formula

    Pediatrics

    (1981)
  • JarvenpaaAL et al.

    Feeding the low-birth-weight infant. III. Diet influences bile acid metabolism

    Pediatrics

    (1983)
  • MendelsonRA et al.

    Trace mineral balances in preterm infants fed their own mother's milk

    J Pediatr Gastroenterol Nutr

    (1983)
  • Cited by (97)

    • Effects of higher protein formula with improved fat blend on growth, feeding tolerance and nutritional biomarkers in preterm infants: A double-blind, randomized, controlled clinical trial

      2022, Pediatrics and Neonatology
      Citation Excerpt :

      Fats consisting of palmitic acid in the second position on the glycerol molecule (sn-2 palmitate) are resistant to digestion by pancreatic lipase and are therefore more easily absorbed in the intestinal tract. This can help promote feeding tolerance by preventing the formation of calcium soaps in stools and thereby improving calcium absorption.37,38 In this study, there was no apparent effect of the EF on stool consistency, except on FEF Day 21, when infants in the EF group had significantly softer stools compared to the CF group (P = 0.045, PP analysis set only but not ITT set).

    • Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review

      2019, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      Although the fat amount and type subtopic did have a large proportion of older articles, there has also been recent research, including nine articles in the last 10 years. Fifty-two observational articles73,88,92,107,108,111-157 examined outcomes associated with human milk vs formula intake in VLBW preterm infants in countries with developed economies (Figure 5). The literature on this topic was published consistently throughout this period.

    • ISSFAL Editorial (PLEFA)

      2013, Prostaglandins Leukotrienes and Essential Fatty Acids
    • Accretion of Lipid in the Fetus and Newborn

      2011, Fetal and Neonatal Physiology E-Book, Fourth Edition
    • The effects of enzymatic interesterification on the physical-chemical properties of blends of lard and soybean oil

      2009, LWT
      Citation Excerpt :

      Due to the formation of such calcium soaps, stool hardness, constipation and, in some cases, bowel obstructions may occur. Thus, presence of palmitic acid acyl residues at the sn-2 position of HMF increases absorption of 16:0 in the infant and reduces calcium losses in the faeces (Chappel, Clandinin, Kearny-Volpe, Reichman, & Swyer, 1986). Therefore, such unique TAG molecules with palmitic acid esterified at the sn-2 position has a significant function in the development of infants.

    View all citing articles on Scopus
    *

    Supported by the Hospital for Sick Children Foundation, the Natural Sciences and Engineering Research Council of Canada, and the Annie L. Shields Fellowship program. Dr. Clandinin is a scholar of the Alberta Heritage Foundation for Medical Research.

    View full text