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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #343048
Title: Minimal enteral nutrition to improve adaptation after intestinal resection in piglets and infants

Author
item AUNSHOLT, LISE - Odense University Hospital
item QVIST, NIELS - Odense University Hospital
item SANGLID, PER - Rigshospitalet - Copenhagen University Hospital
item VEGGE, ANDREAS - Rigshospitalet - Copenhagen University Hospital
item STOLL, BARBARA - Children'S Nutrition Research Center (CNRC)
item Burrin, Douglas - Doug
item JEPPESEN, PALLE - Rigshospitalet - Copenhagen University Hospital
item ERICKSEN, THOMAS - Rigshospitalet - Copenhagen University Hospital
item HUSBY, STEFFEN - Odense University Hospital
item THYMANN, THOMAS - Rigshospitalet - Copenhagen University Hospital

Submitted to: Journal of Parenteral and Enteral Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/1/2017
Publication Date: 6/27/2017
Publication URL: https://handle.nal.usda.gov/10113/5801813
Citation: Aunsholt, L., Qvist, N., Sanglid, P.T., Vegge, A., Stoll, B., Burrin, D.G., Jeppesen, P.B., Ericksen, T., Husby, S., Thymann, T. 2017. Minimal enteral nutrition to improve adaptation after intestinal resection in piglets and infants. Journal of Parenteral and Enteral Nutrition. doi:10.1177/0148607117690527.

Interpretive Summary: Infants sometimes are born with defects in gastro intestinal (GI) development or experience disease early in life that requires surgical removal of part of the intestine. Although many infants recover from this surgery, the inability for the remaining intestine to function normally and support adequate growth is known as short bowel syndrome (SBS). How these SBS infants are fed after surgery can impact how quickly they recover to normal gut function. The recommended diet for infants up to the age of six months is breast milk. When breast milk is not available, cow's milk–based formulas are fed. Bovine colostrum is considered to be a possible replacement to human milk since it contains many of the same bioactive factors and has been shown in piglet studies to promote gut growth. The aims of this study were to test in newborn piglets with SBS whether feeding minimal amounts of formula or bovine colostrum would best promote intestinal growth. Secondly we conducted a clinical study to test whether bovine colostrum is safe and effective in a small group of SBS human infants. Results showed that both formula and bovine colostrum were effective in promoting intestinal growth and absorption. We also showed that bovine colostrum was well tolerated in the SBS infants with no clinical signs of allergy or feeding intolerance related to colostrum were observed such as diarrhea or vomiting.

Technical Abstract: Minimal enteral nutrition (MEN) may induce a diet-dependent stimulation of gut adaptation following intestinal resection. Bovine colostrum is rich in growth factors, and we hypothesized that MEN with colostrum would stimulate intestinal adaptation, compared with formula, and would be well tolerated in patients with short bowel syndrome. In experiment 1, 3-day-old piglets with 50% distal small intestinal resection were fed parenteral nutrition (PN, n = 10) or PN plus MEN given as either colostrum (PN-COL,n = 5) or formula (PN-FORM, n = 9) for 7 days. Intestinal nutrient absorption and histomorphometry were performed. In experiment 2, tolerance and feasibility of colostrum supplementation were tested in a pilot study on 5 infants who had undergone intestinal resection, and they were compared with 5 resected infants who served as controls. In experiment 1, relative wet-weight absorption and intestinal villus height were higher in PN-COL vs PN (53% vs 23% and 362 +/- 13 vs 329 +/- 7 µm, P < .05). Crypt depth and tissue protein synthesis were higher in PN-COL (233 +/- 7 um, 22%/d) and PN-FORM (262 +/- 13 um, 22%/d) vs PN (190 +/- 4 um, 9%/d, both P < .05). In experiment 2, enteral colostrum supplementation was well tolerated, and no infants developed clinical signs of cow's milk allergy. Minimal enteral nutrition feeding with bovine colostrum and formula induced similar intestinal adaptation after resection in piglets. Colostrum was well tolerated by newly resected infants, but the clinical indication for colostrum supplementation to infants subjected to intestinal resection remains to be determined.