Christine Henriksen

Improved Cognitive Development Among Preterm Infants Attributable to Early Supplementation of Human Milk With Docosahexaenoic Acid and Arachidonic Acid

OBJECTIVE. The objective of our study was to evaluate the effect of supplementation with docosahexaenoic acid and arachidonic acid for human milk-fed preterm infants. The primary end point was cognitive development at 6 months of age. METHODS. The study was a randomized, double-blind, placebo-controlled study among 141 infants with birth weights of <1500 g. The intervention with 32 mg of docosahexaenoic acid and 31 mg of arachidonic acid per 100 mL of human milk started 1 week after birth and lasted until discharge from the hospital (on average, 9 weeks). Cognitive development was evaluated at 6 months of age by using the Ages and Stages Questionnaire and event-related potentials, a measure of brain correlates related to recognition memory. RESULTS. There was no difference in adverse events or growth between the 2 groups. At the 6-month follow-up evaluation, the intervention group performed better on the problem-solving subscore, compared with the control group (53.4 vs 49.5 points). There was also a nonsignificant higher total score (221 vs 215 points). The event-related potential data revealed that infants in the intervention group had significantly lower responses after the standard image, compared with the control group (8.6 vs 13.2). There was no difference in responses to novel images. CONCLUSIONS. Supplementation with docosahexaenoic acid and arachidonic acid for very preterm infants fed human milk in the early neonatal period was associated with better recognition memory and higher problem-solving scores at 6 months.

Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalisation.

Postnatal growth failure in preterm infants is due to interactions between genetic and environmental factors, which are not fully understood. We assessed dietary supply of nutrients in very-low-birth-weight (VLBW, < 1500 g) infants fed fortified human milk, and examined the association between nutrient intake, medical factors and growth during hospitalisation lasting on average 70 d. We studied 127 VLBW infants during the early neonatal period. Data were obtained from medical records on nutrient intake, growth and growth-related factors. Extra-uterine growth restriction was defined as body weight < 10th percentile of the predicted value at discharge. Using logistic regression, we evaluated nutrient intake and other relevant factors associated with extra-uterine growth restriction in the subgroup of VLBW infants with adequate weight for gestational age at birth. The proportion of growth restriction was 33 % at birth and increased to 58 % at discharge from hospital. Recommended values for energy intake (>500 kJ/kg per d) and intra-uterine growth rate (15 g/kg per d) were not met, neither in the period from birth to 28 weeks post-conceptional age (PCA), nor from 37 weeks PCA to discharge. Factors negatively associated with growth restriction were energy intake (Ptrend = 0.002), non-Caucasian ethnicity (P = 0.04) and weight/predicted birth weight at birth (Ptrend = 0.004). Extra-uterine growth restriction is common in VLBW infants fed primarily fortified human milk. Currently recommended energy and nutrient intake for growing preterm infants was not achieved. Reduced energy supply and non-Caucasian ethnicity were risk factors for growth restriction at discharge from hospital.

Attention among very low birth weight infants following early supplementation with docosahexaenoic and arachidonic acid

Aim:  To investigate the effect of supplementation with docosahexaenoic acid (DHA) and arachidonic acid (AA) in early neonatal life on cognitive functions among human milk fed very low birth weight infants (<1500 g) at 20 months chronological age.

First year growth among very low birth weight infants.

Aim:  The aim of this study was to describe first‐year growth among very low birth weight infants and the effect of growth restriction at hospital discharge on first year growth.

Fat-soluble vitamins in breast-fed preterm and term infants

Objective:To examine the supply and status of fat-soluble vitamins in very low birth weight (VLBW) infants compared to a reference group of normal birth weight (NBW) infants.Design:A longitudinal study of VLBW infants in the early neonatal period. Blood samples were drawn at 1 week of age and at discharge from hospital. Plasma was analyzed for the fat-soluble vitamins: retinol, 25-OH-vitamin D, α-tocopherol and phylloquinone (vitamin K1) using high-performance liquid chromatography.Subjects:A total of 40 VLBW infants were included in the study. A reference group of 33 NBW infants was randomly selected from one of our previous studies.Results:The VLBW infants received fortified human milk, and daily oral vitamin supplement (Multibionta). In VLBW infants, plasma retinol concentrations decreased and plasma 25-OH-vitamin D increased during the study period. VLBW infants had significantly lower plasma retinol (0.3 vs 0.7 μ M) and higher plasma 25-OH-vitamin D (166 vs 25 nM) at discharge compared to NBW infants. Plasma phylloquinone concentration in VLBW infants was very high (53 ng/ml) at one week of age, especially in the youngest infants (192 ng/ml), but decreased rapidly during the study period resulting in low/normal plasma concentrations (0.9 ng/ml) at discharge.Conclusions:We observed alterations in plasma concentration of retinol and 25-OH-vitamin D in VLBW infants in the early neonatal period, resulting in marked differences between VLBW at discharge and NBW. Further trials are needed to evaluate whether changes in vitamin supplementation may improve clinical outcome in VLBW infants.Sponsorship:Norwegian Foundation for Health and Rehabilitation, the Johan Throne Holst Foundation for Nutrition Research and the Research Council of Norway.

Long-Chain Polyunsaturated Fatty Acids and Cognition in VLBW Infants at 8 years: an RCT

OBJECTIVE: To test the hypothesis that supplementation with the long chain polyunsaturated fatty acids docosahexaenoic acid (DHA) and arachidonic acid (AA) to very low birth weight (VLBW) infants would improve long-term cognitive functions and influence neuroanatomical volumes and cerebral cortex measured by MRI. METHODS: The current study is a follow-up of a randomized, double-blinded, placebo-controlled study of supplementation with high-dose DHA (0.86%) and AA (0.91%) to 129 VLBW infants fed human milk. Ninety-eight children participated at 8 years follow-up and completed a broad battery of cognitive tests. Eighty-one children had cerebral MRI scans of acceptable quality. RESULTS: There were no significant differences between the intervention group and the control group on any of the cognitive measures. Equally, MRI data on segmental brain volumes and cerebral cortex volume, area, and thickness suggested no overall group effect. CONCLUSIONS: This study is the first long-term follow-up of a randomized controlled trial with supplementation of DHA and AA to human milk fed VLBW infants investigating both cognitive functions and brain macrostructure measured by MRI. No cognitive or neuroanatomical effects of the supplementation were detected at 8 years of age.

Non-celiac gluten sensitivity: A work-in-progress entity in the spectrum of wheat-related disorders

Non-celiac gluten sensitivity is an undefined syndrome with gastrointestinal and extra-intestinal manifestations triggered by gluten in patients without celiac disease and wheat allergy. The pathogenesis involves immune-mediated mechanisms requiring further research. Symptoms disappear in a few hours or days after gluten withdrawal and recur rapidly after gluten ingestion. Besides gluten, other wheat proteins as well as fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may contribute to this syndrome. This syndrome occurs mainly in young women, being rare in children. Its prevalence ranges from 0.6% to 6%, based on primary or tertiary care center estimates. No biomarker is available, but half of patients tests positive for IgG anti-gliadin antibodies, which disappear quickly after gluten-free diet together with symptoms. Also, genetic markers are still undefined. Although currently limited to a research setting, double-blind, placebo-controlled, cross-over trial strategy is recommended to confirm the diagnosis. Treatment is based on dietary restriction with special care to nutrient intake.

Iron deficiency among pregnant Pakistanis in Norway and the content of phytic acid in their diet

Background. To test the hypothesis that iron deficiency is more common among pregnant Pakistani than pregnant Norwegian women in Oslo; and to determine whether differences in the diet can explain some of the differences in stored iron.

Improved vitamin A supplementation regimen for breastfed very low birth weight infants.

Objective: Preterm infants usually have low retinol status at birth and at discharge from hospital. We have evaluated a new protocol designed to improve plasma retinol in very low birth weight infants (VLBW, birth weight < 1500 g).

Iodine Status and Growth In 0-2-Year-Old Infants With Cow's Milk Protein Allergy.

Objectives: The aim of the present article was to investigate iodine status and growth in cows milk protein allergic infants and to identify potential predictors of iodine status and growth. Methods: Fifty-seven infants under 2 years of age were included in an observational cross-sectional study. Two spot urine samples were collected and analyzed for iodine, together with a 3-day food record and a food frequency questionnaire. Urine iodine concentrations were compared with the WHO cut-off values for iodine deficiency. Measurements of weight, length, and head circumference at birth and study inclusion were converted to standard deviation scores. Subgroup analyses were performed on different feeding patterns, according to weaning status. Results: Median age was 9 months. Median urinary iodine concentration was 159 ug/L. One third of the children had urine iodine concentrations indicating iodine deficiency. Infants who were mainly breastfed were at highest risk and 58% were classified as deficient. Dietary factors positively associated with iodine excretion were intake of enriched baby cereals and meeting the dietary requirement for iodine. Stunting was present in 5%. Underweight and wasting was frequent at 11% and this was associated with food refusal and poor appetite, but not with iodine status. Growth failure was detected among boys. Conclusions: The present study suggests that cows milk protein allergy children have high prevalence of iodine deficiency and poor growth, however the 2 conditions were not associated. The subgroup of mainly breastfed infants was at higher risk of iodine deficiency compared to weaned infants. Subjects with feeding problems had increased risk of malnutrition.