ESSENTIALY FATTY ACID ABNORMALITIES AND LOW LINOLEIC ACID INTAKE IS COMMON IN THE SECOND YEAR OF LIFE IN CHILDREN WITH CYSTIC FIBROSIS
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1 ESSENTIALY FATTY ACID ABNORMALITIES AND LOW LINOLEIC ACID INTAKE IS COMMON IN THE SECOND YEAR OF LIFE IN CHILDREN WITH CYSTIC FIBROSIS Lyanne Chin, RD PPC Nutrition Trainee
2 OUTLINE Background FIRST Study Feeding Infants Right from the STart Preliminary Results Summary
3 BACKGROUND 16:0 16:1 Fatty Acids and Triacylglycerols. UW Courses Web Server. Available at: Accessed May 5, 2016.
4 BACKGROUND Essential fatty acids cannot be synthesized by the body n-6 (Omega-6) n-3 (Omega-3) Sources of EFA Omega-6: Safflower, Soybean, Grapeseed, Sunflower oils Omega-3: Flaxseed oil, Salmon, Walnuts Al-Turkmani MR, Freedman SD, Laposata M. Fatty acid alterations and n-3 fatty acid supplementation in cystic fibrosis. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2007;77(5 6):
5 Al-Turkmani MR, Freedman SD, Laposata M. Fatty acid alterations and n-3 fatty acid supplementation in cystic fibrosis. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2007;77(5 6): Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th edition. New York: W H Freeman; Available from: BACKGROUND Decreased levels of linoleic acid Decreased levels of DHA Alterations involving arachidonic acid
6 Does the prevalence of essential fatty acid abnormalities differ among feeding types in infants?
7 OBJECTIVES 1. To determine if similar fatty acid abnormality is present in the first 2 years of life 2. To evaluate feeding type and phenotype at baseline and explore relationships with fatty acid pattern observed Feeding types: exb, exf, mixed (B+F) Phenotypes: MI, PS, PI 3. To assess total dietary fat intake and its association with fatty acid pattern observed in the 2 nd year of life
8 Feeding Infants Right... from the STart (FIRST) Study a prospective multicenter longitudinal study launched in 2012 to investigate the potential benefits & risks of exclusive breastfeeding in CF Milwaukee Salt Lake City Madison Indianapolis Boston Madison Coordinating Center PI: Lai Shoff Laxova Zhang Schuchardt Busche Huebner Chin, Ronne Multi-Site Advisor Farrell Neonatologist Consultant Greer 8
9 FIRST Study Design Enroll 160 infants from 5 CF centers in the US from Systematically collect data on complete feeding history Phase 1: 0-2 years Diagnosed through newborn screening Phase II: 2-6 years
10 Primary outcomes FIRST Study Design Weight gain Incidence of Pseudomonas infection at 2 years of age Secondary outcomes Nutritional Growth measurements, EFA status, fat-soluble vitamin status Pulmonary Inflammatory markers, other respiratory pathogens, respiratory symptoms, CXR scores
11 FIRST Study Design
12 Data Collection Nutrition Feeding, supplements, GI symptoms Pulmonary Acute infections, respiratory symptoms, medication Specimens Feces, blood, sputum
13 Biomarkers Fatty acid composition from erythrocytes Concentrations were quantitated by capillary gas liquid chromatography Elevated Pathologic Triene (mead acid) > 0.1% of total fatty acid concentration EFA Insufficiency Triene:Tetraene ratio > 0.01 EFA Deficiency Triene:Tetraene ratio > 0.02
14 Preliminary Results
15 Characteristics of Study Population 62 infants born during 02/2012 to 05/2014 Diagnosed through newborn screening Enrolled at age 1.4 ± 0.1 months Blood specimen collected at 4, 12, 18, and 24 months Baseline, n=52 (3.5 ± 0.2 months) 12 months, n= months, n=28 Courtesy of parents
16 OBJECTIVES To determine if similar fatty acid abnormality is present in the first 2 years of life To evaluate phenotype at baseline and explore relationships with fatty acid pattern observed Phenotypes: MI, PS, PI
17 EFA abnormalities tended to be highest in MI, followed by PI, lowest in PS, but these differences were not significant At baseline ~ 4 months p>0.09 At 24 months p>0.162 n=7 n=4 n=21 n=4 n=3 n=22
18 No significant age trend in EFAD prevalence Significant age trend in EFAI and elevated triene Prevalence of EFAI and elevated triene is higher at 24 months compared to baseline 4 months (n=38) 12 months (n=19) 24 months (n=21) No EFAD 35 (92%) 19 (100%) 17 (81%) EFAD 3 (8%) 0 4 (19%) p No EFAI 34 (90%) 18 (95%) 8 (38%) < EFAI 4 (11%) 1 (5%) 13 (62%) Triene < 0.1% 26 (68%) 18 (95%) 6 (29%) < Triene > 0.1% 12 (32%) 1 (5%) 15 (71%)
19 What about linoleic acid, DHA, and arachidonic acid concentrations?
20 LA concentration significantly lower at baseline compared to 12 months and at 24 months 16 % Total Fatty Acid Concentration Age (months) p=0.0005
21 DHA concentration was significantly lower at 24 months compared to baseline and at 12 months 12 % Total Fatty Acid Concentration Age (months) P<0.0001
22 No significant age trend in arachidonic acid concentration 25 % Total Fatty Acid Concentration Age (months) p=0.6001
23 12 AA/DHA significantly higher at 24 months compared to baseline and at 12 months % Total Fatty Acid Concentration Age (months) P<0.0001
24 OBJECTIVE 2 To evaluate feeding type at baseline and explore relationships with fatty acid pattern observed Feeding types: exb, exf, mixed (B+F)
25 Feeding type was significant for EFAD prevalence but not EFAI or elevated triene 60% p= % 50% 42% 40% 30% 20% p= p= % 25% exb exf Mixed n=10 n=16 n=12 13% 10% 6% 0% EFAD EFAI Elevated Triene
26 Objective 3 To assess total dietary fat intake and its association with fatty acid pattern observed in the 2 nd year of life
27 No significant differences in total caloric intake & dietary fat intake (18-24 months) 120% EER 130% EER n=13 n=8 37.6% kcal 36.6% kcal Fat (%kcal)
28 No significant differences in LA & ALA intake at 24 months AI: 7g/day AI: 0.7g/day
29 Low dietary LA intake is common at 24 months % 63% 10 g/day Age
30 DHA Intake at 24 months g/day Age (months)
31 CONCLUSIONS EFA abnormalities are common in children with CF More than 60% of PI subjects had EFAI and/or elevated triene Linoleic acid intake is low in the second year of life More than 60% are below the AI Enrich diet to meet AI
32 MCH LEADERSHIP COMPETENCIES
33 MCH Knowledge Base Self-Reflection Ethics & Professionalism Critical Thinking Communication Cultural Competency Family-Centered Care Interdisciplinary Team Building Working with Communities and Systems Policy and Advocacy
34 Acknowledgements PPC Mary Marcus Leslie Lord Erin Seffrood Darci Pfeil Mary Schroth Lai Lab HuiChuan Lai Lisa Davis Ntambi Lab Sabrina Dumas
35
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