Choline Supplementation for Preterm Infants: Metabolism of Four Deuterium-labeled Choline Compounds

Overview

Journal Eur J Nutr

Specialty Nutritional Sciences

Date 2022 Dec 2

PMID 36460779

Authors

Katrin A Bockmann

Wolfgang Bernhard

Michaela Minarski

Anna Shunova

Cornelia Wiechers

Christian F Poets

Axel R Franz

Affiliations

Soon will be listed here.

Abstract

Background: Supply of choline is not guaranteed in current preterm infant nutrition. Choline serves in parenchyma formation by membrane phosphatidylcholine (PC), plasma transport of poly-unsaturated fatty acids (PUFA) via PC, and methylation processes via betaine. PUFA-PC concentrations are high in brain, liver and lung, and deficiency may result in developmental disorders. We compared different deuterated (D9-) choline components for kinetics of D9-choline, D9-betaine and D9-PC.

Methods: Prospective study (1/2021-12/2021) in 32 enterally fed preterm infants (28 0/7-32 0/7 weeks gestation). Patients were randomized to receive enterally a single dose of 2.7 mg/kg D9-choline-equivalent as D9-choline chloride, D9-phosphoryl-choline, D9-glycerophosphorylcholine (D9-GPC) or D9-1-palmitoyl-2-oleoyl-PC(D9-POPC), followed by blood sampling at 1 + 24 h or 12 + 60 h after administration. Plasma concentrations were analyzed by tandem mass spectrometry. Results are expressed as median (25th/75th percentile).

Results: At 1 h, plasma D9-choline was 1.8 (0.9/2.2) µmol/L, 1.3 (0.9/1.5) µmol/L and 1.2 (0.7/1.4) µmol/L for D9-choline chloride, D9-GPC and D9-phosphoryl-choline, respectively. D9-POPC did not result in plasma D9-choline. Plasma D9-betaine was maximal at 12 h, with lowest concentrations after D9-POPC. Maximum plasma D9-PC values at 12 h were the highest after D9-POPC (14.4 (9.1/18.9) µmol/L), compared to the other components (D9-choline chloride: 8.1 [5.6/9.9] µmol/L; D9-GPC: 8.4 (6.2/10.3) µmol/L; D9-phosphoryl-choline: 9.8 (8.6/14.5) µmol/L). Predominance of D9-PC comprising linoleic, rather than oleic acid, indicated fatty-acyl remodeling of administered D9-POPC prior to systemic delivery.

Conclusion: D9-Choline chloride, D9-GPC and D9-phosphoryl-choline equally increased plasma D9-choline and D9-betaine. D9-POPC shifted metabolism from D9-betaine to D9-PC. Combined supplementation of GPC and (PO) PC may be best suited to optimize choline supply in preterm infants. Due to fatty acid remodeling of (PO) PC during its assimilation, PUFA co-supplementation with (PO) PC may increase PUFA-delivery to critical organs. This study was registered (22.01.2020) at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502.

Study Registration: This study was registered at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502.

Citing Articles

Evidence and Perspectives for Choline Supplementation during Parenteral Nutrition-A Narrative Review.

Bernhard W, Bockmann K, Minarski M, Wiechers C, Busch A, Bach D Nutrients. 2024; 16(12).

PMID: 38931230 PMC: 11206924. DOI: 10.3390/nu16121873.

Is choline deficiency an unrecognized factor in necrotizing enterocolitis of preterm infants?.

Drenckpohl D, Christifano D, Carlson S Pediatr Res. 2024; 96(4):875-883.

PMID: 38658665 DOI: 10.1038/s41390-024-03212-5.

Choline and Betaine Levels in Plasma Mirror Choline Intake in Very Preterm Infants.

Minarski M, Maas C, Heinrich C, Bockmann K, Bernhard W, Shunova A Nutrients. 2023; 15(22).

PMID: 38004152 PMC: 10675502. DOI: 10.3390/nu15224758.

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