Location: Children's Nutrition Research CenterTitle: Nutrient fortification of human donor milk affects intestinal function and protein metabolism in preterm pigs
|SUN, JING - University Of Copenhagen|
|LI, YANQI - University Of Copenhagen|
|NGUYEN, DUC NINH - University Of Copenhagen|
|MORTENSEN, MARTIN - University Of Copenhagen|
|VAN DEN AKKER, CHRIS HP - University Of Amsterdam|
|SKEATH, TOM - Royal Victoria Infirmary|
|PORS, SUSZNNE - University Of Copenhagen|
|PANKRATOVA, STANISLAVA - University Of Copenhagen|
|RUDLOFF, SILVIA - Justus-Liebig University|
|SORENSEN, SOREN - University Of Copenhagen|
|Burrin, Douglas - Doug|
|THYMANN, THOMAS - University Of Copenhagen|
|SANGILD, PER - University Of Copenhagen|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/31/2017
Publication Date: 3/12/2018
Citation: Sun, J., Li, Y., Nguyen, D., Mortensen, M.S., Van Den Akker, C., Skeath, T., Pors, S.E., Pankratova, S., Rudloff, S., Sorensen, S.J., Burrin, D.G., Thymann, T., Sangild, P.T. 2018. Nutrient fortification of human donor milk affects intestinal function and protein metabolism in preterm pigs. Journal of Nutrition. 148(3):336-347. https://doi.org/10.1093/jn/nxx033.
Interpretive Summary: The survival rates of very premature infants are increasing but many of these infants experience poor growth in the months after birth. To prevent growth failure, it is important to provide optimal and adequate nutrients for preterm infants. Human milk is critical to maintain health of preterm infants, but must be supplemented to meet their high nutrient needs with processed formula-based fortifiers. There have been concerns raised that some human milk fortifiers increase the risk for intestinal disease. The aim of the current study was to compare pasteurized cow colostrum with a commercial human milk fortifier in preterm piglets as a model of human infants. Newborn piglets were fed donor human milk that was fortified with either cow colostrum or commercial fortifier for 8 days after birth. The results showed that donor human milk that was fortified with cow colostrum vs. commercial fortifier resulted in improved weight gain, higher rates of tissue protein synthesis, less inflammation, lower diarrhea and better gut health. The study suggests that cow colostrum may be an effective alternative to fortify human milk that is fed to newborn preterm infants in the early weeks after birth.
Technical Abstract: Nutrient fortification of human milk is often required to secure adequate growth and organ development for very preterm infants. There is concern that formula-based fortifiers (FFs) induce intestinal dysfunction, feeding intolerance, and necrotizing enterocolitis (NEC). Bovine colostrum (BC) may be an alternative nutrient fortifier, considering its high content of protein and milk bioactive factors. We investigated whether BC was superior to an FF product based on processed bovine milk and vegetable oil to fortify donor human milk (DHM) for preterm pigs, used as a model for infants. Sixty preterm pigs from 4 sows (Danish Landrace x Large White x Duroc, birth weight 944 +/- 29 g) received decreasing volumes of parenteral nutrition (96-72 mL / kg(-1) / d(-1)) and increasing volumes of enteral nutrition (24-132 mL / kg(-1) / d(-1)) for 8 d. Pigs were fed donor porcine milk (DPM) and DHM with or without FF or BC fortification (+4.6 g protein / kg(-1) / d(-1)). DPM-fed pigs showed higher growth (10-fold), protein synthesis (+15-30%), villus heights, lactase and peptidase activities (+30%), and reduced intestinal cytokines (-50%) relative to DHM pigs (all "P" is less than 0.05). Fortification increased protein synthesis (+20-30%), but with higher weight gain and lower urea and cortisol concentrations for DHM+BC compared with DHM+FF pigs (2- to 3-fold differences, all "P" is less than or equal to 0.06). DHM+FF pigs showed more diarrhea and reduced lactase and peptidase activities, hexose uptake, and villus heights relative to DHM+BC or DHM pigs (30-90% differences, "P" is less than 0.05). Fortification did not affect NEC incidence but DHM+BC pigs had lower colonic interleukin (IL)-6 and IL-8 concentrations relative to the remaining pigs (-30%, "P" equals 0.06). DHM+FF pigs had higher stomach bacterial load than did DHM, and higher bacterial density along intestinal villi than did DHM and DHM+BC pigs (2- to 3-fold, "P" is less than 0.05). In conclusion, the FF product investigated in this study reduced growth, intestinal function, and protein utilization in DHM-fed preterm pigs, relative to BC as fortifier. The relevance of BC as an alternative nutrient fortifier for preterm infants should be tested.