SUPPLEMENTATION OF PRETERM FORMULAS (PTF) WITH A LOW‐EPA FISH OIL : EFFECT ON POLYUNSATURATED FATTY ACIDS (PUFAs) STATUS AND GROWTH.

Docosahexaenoic acid (DHA) is a conditionally essential nutrient for the visual and early cognitive development in preterm infants. Previous studies has been performed using a fish oil source of DHA containing eicosapentaenoic acid (EPA) as arount 0.3% of total fatty acid. These studies demonstrated that high-EPA fish oil maintained DHA status in the range of human milk feeding and improved visual acuity, but unfortunatly decreased arachidonic acid (AA) status and growth achievement. The aim of this study was to evaluate the growth and the PUFAs status of healthy preterm infants fed with a PTF enriched with a low-EPA fish oil. Patients and methods: 33 appropriate for gestational age preterm infants (mean GA±SD= 29.3±1.6 weeks, mean BW±SD= 1276±158 grams) were included in this monocentric, prospective, randomized (for the infants receiving a formula) and longitudinal study. Twelve infants received a standard PTF from inclusion until 40 weeks corrected age (CA) then a standard TF until 4 months CA; 11 infants were fed with a PTF enriched with the fish oil (FO-PTF) containing 0.37% of DHA and 0.05% of EPA until 40 weeks CA and then with a FO-TF containing 0.45% of DHA and 0.09% of EPA until 4 months CA. The third group of 10 infants received their own mother's milk (OMM) until discharge (35 weeks CA) and then as long as possible. After 4 months CA, all infants received a standard formula. Growth parameters were measured and red blood cell (RBC) phospholipids (%wt/wt) were analysed at 40 weeks CA, 3 months and 6 months CA. Results: In the group fed with the standard formula, EPA and AA levels were not significantly different from the OMM group whereas the DHA level decreased significantly from 5.9% at inclusion to 2.8% at 6 m CA. In the group fed the supplemented formula, AA, EPA, and DHA were stable from inclusion to 40 weeks CA (17.1%, 0.45% and 6.9% at 40 weeks respectively). At 3 m CA, AA significantly decreased to reach a mean value of 15.1% whereas DHA and EPA significantly increased to mean values of 9.2% and 0.69% respectively. After the end of supplementation (6 m CA) all values tended to normalize. Conclusions: The use of a low-EPA fish oil for supplementing PTF is efficient to maintain high DHA level in RBC lipids of premature infants. No significant impairement of PUFAs status has been observed up to 40 weeks CA in the supplemented group. However continuing this supplementation with a TF up to 4 months could prevent neither the significant increase of EPA level in RBC phospholipids nor the significant decrease of AA level. Nevertheless no influence of the biochemical indices on growth parameters could be found.