Effects and Reversibility of Pre- and Post-natal Iron and Omega-3 Fatty Acid Deficiency, Alone and in Combination, on Bone Development in Rats

Both iron and omega-3 (n-3) polyunsaturated fatty acids may play an important role in bone development. The aim of this study was to investigate the effects of pre- and post-natal iron and n-3 fatty acid deficiency (FAD), alone and in combination, on bone development in rats, and to determine whether effects are reversible when a sufficient diet is provided post-weaning. Using a 2×2-factorial design, 56 female Wistar rats were allocated to one of four diets: (1) control, (2) iron deficient (ID), (3) n-3 FAD or (4) ID and n-3 FAD, and were maintained on the respective diets throughout gestation and lactation. At weaning (post-natal day [PND] 21), offspring (n = 24/group; male:female=1:1) were randomly allocated to either continue with their respective diets or to switch to the control diet until PND 42-45. Bone mineral density (BMD) and bone strength were determined using dual X-ray absorptiometry and three-point bending tests, respectively. Pre- and post-natal ID resulted in significantly lower BMD in the spine and bone strength in the left femur. Both ID and n-3 FAD resulted in lower BMD in the right femur, with an additive reduction in the combined ID and n-3 FAD group vs. controls. While negative effects of pre- and post-natal ID alone were reversed in offspring switched to a control diet post-weaning, lower BMD and bone strength persisted in offspring with combined ID and n-3 FAD during the prenatal and early post-natal period. Effects were not sex-specific. These results indicate that ID during early life may negatively influence bone development, with potential additive effects of n-3 FAD. While the effects of ID alone seem reversible, a combined ID and n-3 FAD may result in irreversible deficits in bone development.

Biochemical Parameters in Extremely Preterm Infants Receiving Mixed Lipid Emulsions

OBJECTIVE A mixture of soybean, medium-chain triglycerides, olive, and fish oils (SMOF) contains higher α-tocopherol and n-3 polyunsaturated fatty acids and lower phytosterol content compared with conventional soybean oil lipid emulsions (SOLE). We sought to characterize plasma total fatty acid profiles (FAPs) and assess the tolerability of long-term SMOF therapy in extremely preterm infants. METHODS We retrospectively evaluated infants born <28 weeks gestational age who received at least 30 consecutive days of SMOF between July 2016 and June 2019. We evaluated monthly FAPs and biochemical tolerance to SMOF using direct bilirubin (DB) and triglyceride (TG) levels. Growth parameters were evaluated longitudinally until discharge. RESULTS Sixteen patients with median gestational age 24 weeks (IQR, 23–25 weeks) received SMOF for median 76 days (IQR, 52–130 days). Fourteen patients had necrotizing enterocolitis (NEC) requiring surgical intervention and 15 patients received SOLE for median 19 days (IQR, 14–26 days) prior to switching to SMOF. Median docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels were elevated, whereas the remaining fatty acid levels fell within reported reference ranges. There were no incidents of essential fatty acid deficiency (triene to tetraene ratio >0.2) or hypertriglyceridemia (TG >200 mg/dL) with a general downtrend in DB after the first month on SMOF. All growth Z-scores declined throughout hospital stay. CONCLUSIONS Infants who received SMOF had a more pronounced elevation in DHA than EPA, of which the clinical significance remains unknown. Growth Z-scores declined with SMOF but were confounded by a high prevalence of surgically treated NEC.

Parenteral lipid emulsions in the preterm infant: current issues and controversies

Parenteral lipid emulsions are a necessary component of nutrition for extremely low gestational age newborns until adequate levels of enteral intake are established. Historically, Intralipid, a 100% soybean oil emulsion, has filled this role. Newer multicomponent lipid emulsions containing a mixture of other oils, including olive oil and fish oil, are now available as options, although the regulatory approval for use in neonates varies worldwide. When dosed at currently published recommendations, each of these lipid emulsions meets total fat and energy requirements without a risk of essential fatty acid deficiency. Thus, when choosing which lipid emulsion to provide, the answer must be based on the metabolic differences induced as a result of these fatty acid-rich emulsions and whether the emulsions provide a health advantage or pose a health risk. The questions of induced fatty acid profiles, health benefit and health risk are discussed sequentially for multicomponent lipid emulsions. Despite the growing acceptance of multicomponent lipid emulsions, there is concern regarding changes in blood fatty acid levels and potential health risk without strong evidence of benefit. There remains no ideal parenteral lipid emulsion option for the preterm infant. Standardising future animal and human studies in lipid delivery with the inclusion of lipid metabolism data will iteratively provide answers to inform the optimal lipid emulsion for the preterm infant.

A Self-report Oriented Toward Visuoperceptive and Visuomotor Alterations for the Early Identification of Dyslexic Children

Background: Early diagnosis is the main requisite for rehabilitating children suspected to suffer from dyslexia, and self-reports may be as reliable as ordinary screenings, but far less expensive. Research shows that the visual function can be involved in the pathogenesis of dyslexia so that self-reports should inquire about visual signs as well. A questionnaire made of 21 items that provide scores based on the visual signs commonly reported by dyslexics and on the most relevant comorbidities according to the literature has been devised. The aim of this exploratory study is to evaluate its potential for the early identification of dyslexic children. Methods: The AAP-DD is a set of 21 items subdivided into 4 sections that inquire about visual signs (section S), fatty acid deficiency, inheritance of dyslexia, and related conditions in children and parents. Each item is assigned a specific visuomotor and visuosensory weight in the form of a coefficient. The parents of twenty-three dyslexic children (9.34±0.80 years) and twenty-four normal readers filled the questionnaire. To assess the correspondence between the outcome of the questionnaire and the actual visual function of each participant, spatial relationship perception and ocular movements have been tested psychophysically. Results: The score of the dyslexic sample was almost double (i.e. worse) compared to the control group (P <.0001). Sensitivity and specificity were, respectively, 87% and 62%. Section S was the most informative, accounting for up to 41% of the variance of the reading rate. Correlation between the DEM and the AAP-DD scores suggests the questionnaire reflects the actual visuomotor condition of the subject. Conclusion: The AAP-DD seems promising to screen children at risk for dyslexia, and is, therefore, worth to be further investigated in a larger population. The obtained results support the role of the visual function in the pathogenesis of this condition.