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Nutrient Fortification of Human Donor Milk Affects Intestinal Function and Protein Metabolism in Preterm Pigs.
J Nutr. 2018 03 01; 148(3):336-347.JN

Abstract

Background

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.

Objective

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.

Methods

Sixty preterm pigs from 4 sows (Danish Landrace × Large White × 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).

Results

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 < 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 ≤ 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 < 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 = 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 < 0.05).

Conclusions

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.

Authors+Show Affiliations

Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences.Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences.Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences.Section of Microbiology, Faculty of Science.Department of Pediatrics, AMC, University of Amsterdam, Amsterdam, The Netherlands.Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.Department of Veterinary and Animal Sciences; and Laboratory of Neural Plasticity, Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark.Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences. Department of Laboratory of Neural Plasticity, Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark. Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.Institute of Nutritional Science, Justus-Liebig-University Giessen, Giessen, Germany.Section of Microbiology, Faculty of Science.USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences.Section of Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences. Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29462356

Citation

Sun, Jing, et al. "Nutrient Fortification of Human Donor Milk Affects Intestinal Function and Protein Metabolism in Preterm Pigs." The Journal of Nutrition, vol. 148, no. 3, 2018, pp. 336-347.
Sun J, Li Y, Nguyen DN, et al. Nutrient Fortification of Human Donor Milk Affects Intestinal Function and Protein Metabolism in Preterm Pigs. J Nutr. 2018;148(3):336-347.
Sun, J., Li, Y., Nguyen, D. N., Mortensen, M. S., van den Akker, C. H. P., Skeath, T., Pors, S. E., Pankratova, S., Rudloff, S., Sørensen, 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. The Journal of Nutrition, 148(3), 336-347. https://doi.org/10.1093/jn/nxx033
Sun J, et al. Nutrient Fortification of Human Donor Milk Affects Intestinal Function and Protein Metabolism in Preterm Pigs. J Nutr. 2018 03 1;148(3):336-347. PubMed PMID: 29462356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutrient Fortification of Human Donor Milk Affects Intestinal Function and Protein Metabolism in Preterm Pigs. AU - Sun,Jing, AU - Li,Yanqi, AU - Nguyen,Duc Ninh, AU - Mortensen,Martin S, AU - van den Akker,Chris H P, AU - Skeath,Tom, AU - Pors,Susanne E, AU - Pankratova,Stanislava, AU - Rudloff,Silvia, AU - Sørensen,Søren J, AU - Burrin,Douglas G, AU - Thymann,Thomas, AU - Sangild,Per T, PY - 2017/08/06/received PY - 2017/10/31/accepted PY - 2018/2/21/pubmed PY - 2019/3/12/medline PY - 2018/2/21/entrez SP - 336 EP - 347 JF - The Journal of nutrition JO - J. Nutr. VL - 148 IS - 3 N2 - Background: 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. Objective: 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. Methods: Sixty preterm pigs from 4 sows (Danish Landrace × Large White × 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). Results: 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 < 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 ≤ 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 < 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 = 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 < 0.05). Conclusions: 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. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/29462356/Nutrient_Fortification_of_Human_Donor_Milk_Affects_Intestinal_Function_and_Protein_Metabolism_in_Preterm_Pigs_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.1093/jn/nxx033 DB - PRIME DP - Unbound Medicine ER -