快樂小藥師 Im pharmacist nichts glücklich

作者：Brian Hoyle

出處：WebMD醫學新聞

【24drs.com】May 3, 2010 (加拿大溫哥華) — 加拿大魁北克Laval大學於2010小兒科學會年會發表的新研究指出，母親補充omega-3脂肪酸、二十二碳六烯酸(DHA)可增加母乳中的DHA含量。

　　魁北克Laval大學醫學中心小兒科教授Isabelle Marc博士向Medscape Pediatrics表示，研究對象是12名極早產的嬰兒，在出生後的42天中，母親補充較多的DHA，比較這些嬰兒和未服用補充品母親的另22名嬰兒的DHA值。 

　　Marc博士表示，服用補充品的母親比較可以提供DHA給低出生體重的早產兒，甚至在他們達到完整的腸道餵食之前就可以，她指出，研究結果促使在這腦部發育與生長的重要期間提供DHA，但是還須加以證實。

　　Marc博士指出，隨著時間，DHA補充組的母乳中的DHA濃度、嬰兒血漿脂質數值都有正向傾向，支持了此項結論。

　　極早產嬰兒的養分攝取因為胃腸道不成熟和急性健康問題而受到影響，容易缺乏omega-3脂肪酸，特別是DHA。因此，損及腦部發育和生長，來自Laval大學和Sherbrooke與蒙特婁等地的Marc博士等人進行此次研究，以確認哺乳婦女飲食補充DHA是否可以增加妊娠週數小於30週嬰兒的DHA值。

　　排除準則包括母親每週食用超過3份魚、對魚過敏、凝血異常或者使用抗凝血劑。早產且願意哺乳的18-40歲婦女中，10人 (27 ± 4.3歲、共產下12名嬰兒：6男孩與6女孩，妊娠週數為27.6 ± 1.5週)在產後7天內接洽並同意接受補充DHA口服膠囊(每天服用1.2 g直到懷孕後36週)。另外22人(26.9 ± 4.1歲、共產下24名嬰兒：9男孩與15女孩，妊娠週數為27.7 ± 1.1週)，這些人不知道研究方向(DHA補充)，視為對照組。

　　從出生後到產後49天，測量DHA組和對照組嬰兒的每日DHA攝取量，此外，在DHA組，每週檢測母乳中的脂肪酸量，並在開始時、第14天與第49天測量血漿中的磷酸酯。對照組母親則是在開始時與第49天時測量母乳脂肪酸以及血漿磷酸酯。

　　嬰兒們盡量使用母親的新鮮母乳或最近的冷凍母乳，在研究期間，DHA組嬰兒的飲食有87% ± 30%是母乳，對照組嬰兒則是有72% ± 41%的飲食是母乳。DHA組嬰兒和對照組嬰兒的整體乳汁(配方奶加母乳)食用量差不多，DHA組為5555 ± 2930 mL，對照組嬰兒為5273 ± 2888 mL。

　　雖然在49天時的腸道餵食攝取沒有明顯差異，DHA組嬰兒接受的DHA量為55.2 ± 37.6 mg/kg/天，對照組者則是7.2 ± 11.1 mg/kg/天。

　　DHA組嬰兒的血漿DHA值，在這49天中顯著上升(P = .0143)，不過前3週的改變不大，值得一提的是，DHA組在第49天的血漿DHA值(60.3 ± 23.5 ng/mL)顯著高於對照組(31.7 ± 10.7 ng/mL) (P = .0014)。

　　兩組在第49天時的嬰兒體重、身長、頭圍差不多，此外，比較第49天時的血漿脂肪酸發現，補充DHA並不會改變花生四烯酸或EPA的量。 

　　根據Marc博士表示，極早產嬰兒出生後的前兩個月加強DHA可以幫助腦部發育和生長，這段期間相當重要。

　　佛羅里達大學新生兒科、小兒科教授Josef Neu醫師向Medscape Pediatrics表示，我認為Marc博士的資料相當傑出，沒有缺點。

　　不過，他指出，即使母乳中有較高濃度的DHA，這些嬰兒在出生後3-4週時，接受的DHA量相當低，之後才增加。

　　Neu醫師表示，這不是因為母乳中的DHA量不夠，而是因為這些嬰兒實際上喝的母乳量很少，這是因為新生兒科醫師不贊成餵這些嬰兒，他們實際上也喝很少奶。所以，即便母親補充DHA且乳汁中的DHA適度增加，因為嬰兒攝取的乳量有限，導致最初3-4週攝取的DHA很少。

　　SickKids基金會提供資金支持該研究，Mead Johnson Nutrition提供DHA膠囊，作者們皆宣告沒有相關財務關係。

　　小兒科學會2010年會：壁報1355.6。發表於2010年5月1日 。

By Brian Hoyle
Medscape Medical News

May 3, 2010 (Vancouver, Canada) — A new study from Laval University in Quebec, Canada, and presented here at the Pediatric Academic Societies 2010 Annual Meeting indicates that supplementation of mothers with the omega-3 fatty acid docosahexanoic acid (DHA) boosts the DHA level in their breast milk compared with milk from mothers who do not receive supplementation.

During the first 42 days of life of the 12 very premature infants studied, supplementation delivered more DHA to the nursing infants compared with DHA levels in 22 infants fed unsupplemented milk, Isabelle Marc, MD, PhD, a professor of pediatrics, Centre Hospitalier Universitaire de Quebec, Universite Laval, told Medscape Pediatrics.

"Supplementing mothers is a feasible way to provide DHA to low-birth-weight premature infants, even before they reach full enteral feeding," said Dr. Marc. Although yet to be substantiated, the results may enable DHA delivery during the critical period of brain development and growth, she added.

"This conclusion is supported by the positive trends observed over time in the DHA concentrations in breast milk and babies' plasma lipids in the DHA-supplemented group," Dr. Marc pointed out.

Very premature infants, whose intake of nutrients is hampered by gastrointestinal immaturity and acute health problems, are vulnerable to a deficiency of omega-3 fatty acids, and in particular, DHA. As a result, brain development and growth can be compromised. Dr. Marc and colleagues from Laval and the universities of Sherbrooke and Montreal conducted the study to test whether the supplementation of the diet of breastfeeding mothers with DHA could boost the DHA levels in breastfed infants who had been delivered at less than 30 weeks' gestation.

Exclusion criteria included maternal consumption of more than 3 servings of fish weekly, fish allergy, and coagulation disorder or the use of anticoagulants. Of women aged 18 to 40 years who had delivered prematurely and who expressed an intention to breastfeed, 10 (27 ± 4.3 years of age with 12 infants: 6 boys and 6 girls, 27.6 ± 1.5 weeks gestational age) were approached within 7 days of delivery and agreed to receive DHA supplementation in the form of orally ingested capsules (1.2 g/day until 36 weeks postconception). Another 22 mothers (26.9 ± 4.1 years of age with 24 infants: 9 boys and 15 girls, 27.7 ± 1.1 weeks gestational age), who were blinded to the DHA supplementation aspect of the study, formed the reference group.

The daily DHA intake of the infants in the DHA and reference groups was determined from their birth until day 49 after birth. In addition, in the DHA group, the fatty acid profile in the breast milk was determined each week, and blood plasma phospholipid profiles were determined at baseline, day 14, and day 49. The breast milk fatty acid and blood plasma phospholipid profiles of the reference group of mothers were determined at baseline and day 49.

As much as possible, the milk the infants received came fresh from the source or was last-dated frozen breast milk of the mother. During the study period, breast milk made up 87% ± 30% of the diet of the DHA group of infants and 72% ± 41% of the diet of reference infants. The total milk intake (formula + maternal) was comparable between the infants receiving DHA (5555 ± 2930 mL) and the reference infants (5273 ± 2888 mL).

Although no difference was evident in the enteral feeding intake at day 49, the infants in the DHA group had received 55.2 ± 37.6 mg/kg/day of DHA compared with 7.2 ± 11.1 mg/kg/day in the reference group.

DHA plasma levels in the group of infants receiving DHA trended upward significantly (P = .0143) during the entire 49 days, although changes were marginal during the first 3 weeks. Notably, the day 49 plasma DHA level was significantly higher (P = .0014) in the group receiving DHA (60.3 ± 23.5 ng/mL) than in the reference group (31.7 ± 10.7 ng/mL).

Infant weight, length, and head circumference at day 49 were comparable in both groups. Moreover, comparison of the day 49 plasma fatty acid profile determined that DHA supplementation did not alter the content of arachidonic acid or eicopentaenoic acid.

According to Dr. Marc, the boost in DHA within the first 2 months of life among very premature infants may reap benefits in the brain development and growth that are hallmarks of that period.

"I think the data [Dr. Marc] showed is excellent and I have no objection," Josef Neu, MD, professor of pediatrics, Division of Neonatology, University of Florida, Gainesville, told Medscape Pediatrics.

However, he noted, "the amount of DHA these babies were receiving was very low until about 3 to 4 weeks after birth, despite higher concentrations in the breast milk.

"This is not because the level of DHA in the breast milk was low, but because these babies in reality receive very little milk. This is because neonatologists are reluctant to feed these babies, and they actually get very little milk. So, even if the moms are getting DHA and their milk DHA increases nicely, the babies still get very little milk, [and] hence very little DHA for the first 3 to 4 weeks," said Dr. Neu.

The study was supported by a grant from the SickKids Foundation. The DHA capsules were provided by Mead Johnson Nutrition. The authors have disclosed no relevant financial relationships.

Pediatric Academic Societies 2010 Annual Meeting: Poster 1355.6. Presented May 1, 2010.