Metabolic Effects of Choline and Docosahexaenoic Acid Supplementation in Preterm Infants

NCT ID: NCT02509728

Last Updated: 2018-05-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-07-31

Study Completion Date

2017-12-31

Brief Summary

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To explore the effects of enteral choline and DHA supplementation on plasma choline and DHA-PC concentrations and metabolism, this randomized controlled study will assign 40 preterm infants to 1 of 4 groups: standard care, choline supplementation, DHA supplementation, and choline and DHA supplementation.

After 7 days of supplementation, a single dose of stable isotope labelled choline will be administered and the kinetics of newly synthesized DHA-PC determined to assess plasma levels, uptake and distribution of choline and DHA.

This study is designed to inform larger studies evaluating this approach of enteral co-application of choline and DHA on clinical important outcomes.

Detailed Description

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In utero, there is a constant high supply of choline to the fetus. Preterm delivery disrupts this maternal-fetal choline-transfer. We have shown that choline plasma levels rapidly half after preterm delivery. We also demonstrated that plasma DHA-PC rapidly falls after preterm delivery. DHA supplementation has been evaluated and found safe, however the clinical benefits have been smaller than expected. We speculate that choline deficiency may have contributed to the smaller than expected benefit of DHA supplementation in the past.

This study verifies the hypothesis that concomitant supply of choline and DHA will improve DHA-PC availability and turn-over. This is important because DHA-PC is the transport molecule for the DHA transport to the brain and the retina.

To explore the effects of enteral choline and DHA supplementation on plasma choline and DHA-PC concentrations, this randomized controlled study will assign 40 preterm infants to 1 of 4 groups: standard care, choline supplementation, DHA supplementation, and choline and DHA supplementation.

After 7 days of supplementation, a single dose of stable isotope labelled choline will be administered and the kinetics of newly synthesized DHA-PC determined to assess plasma levels, uptake and distribution of choline and DHA.

This study is designed to inform future larger studies evaluating this approach of enteral co-application of choline and DHA on important clinical outcomes.

Conditions

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Infant, Premature

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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standard nutrition

standard nutrition

Group Type ACTIVE_COMPARATOR

standard nutrition

Intervention Type DIETARY_SUPPLEMENT

standard nutrition

choline supplementation

in addition to standard nutrition: enteral supplementation with 30mg/kg choline chloride for 10 days

Group Type EXPERIMENTAL

choline supplementation

Intervention Type DIETARY_SUPPLEMENT

in addition to standard nutrition: enteral supplementation with 30mg/kg choline chloride for 10 days

standard nutrition

Intervention Type DIETARY_SUPPLEMENT

standard nutrition

DHA supplementation

in addition to standard nutrition: enteral supplementation with 60mg/kg DHA for 10 days

Group Type EXPERIMENTAL

DHA supplementation

Intervention Type DIETARY_SUPPLEMENT

in addition to standard nutrition: enteral supplementation with 60mg/kg DHA for 10 days

standard nutrition

Intervention Type DIETARY_SUPPLEMENT

standard nutrition

choline and DHA supplementation

in addition to standard nutrition: enteral supplementation with 30mg/kg choline chloride and 60mg/kg of DHA for 10 days

Group Type EXPERIMENTAL

choline supplementation

Intervention Type DIETARY_SUPPLEMENT

in addition to standard nutrition: enteral supplementation with 30mg/kg choline chloride for 10 days

DHA supplementation

Intervention Type DIETARY_SUPPLEMENT

in addition to standard nutrition: enteral supplementation with 60mg/kg DHA for 10 days

standard nutrition

Intervention Type DIETARY_SUPPLEMENT

standard nutrition

Interventions

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choline supplementation

in addition to standard nutrition: enteral supplementation with 30mg/kg choline chloride for 10 days

Intervention Type DIETARY_SUPPLEMENT

DHA supplementation

in addition to standard nutrition: enteral supplementation with 60mg/kg DHA for 10 days

Intervention Type DIETARY_SUPPLEMENT

standard nutrition

standard nutrition

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* preterm infants with a gestational age at birth between 24 and 32 weeks
* on almost complete enteral feeding (\>75% of total fluid intake)

Exclusion Criteria

* insufficient enteral intake,
* gastrointestinal disease,
* missing parental consent
Minimum Eligible Age

1 Week

Maximum Eligible Age

2 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital Tuebingen

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Axel Franz, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Tuebingen

Locations

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University Hospital of Tuebingen

Tübingen, , Germany

Site Status

Countries

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Germany

References

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Bernhard W, Raith M, Kunze R, Koch V, Heni M, Maas C, Abele H, Poets CF, Franz AR. Choline concentrations are lower in postnatal plasma of preterm infants than in cord plasma. Eur J Nutr. 2015 Aug;54(5):733-41. doi: 10.1007/s00394-014-0751-7. Epub 2014 Aug 23.

Reference Type BACKGROUND
PMID: 25148882 (View on PubMed)

Bernhard W, Raith M, Koch V, Kunze R, Maas C, Abele H, Poets CF, Franz AR. Plasma phospholipids indicate impaired fatty acid homeostasis in preterm infants. Eur J Nutr. 2014 Oct;53(7):1533-47. doi: 10.1007/s00394-014-0658-3. Epub 2014 Jan 24.

Reference Type BACKGROUND
PMID: 24464176 (View on PubMed)

Bernhard W, Full A, Arand J, Maas C, Poets CF, Franz AR. Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations. Eur J Nutr. 2013 Apr;52(3):1269-78. doi: 10.1007/s00394-012-0438-x. Epub 2012 Sep 9.

Reference Type BACKGROUND
PMID: 22961562 (View on PubMed)

Bernhard W, Bockmann K, Maas C, Mathes M, Hovelmann J, Shunova A, Hund V, Schleicher E, Poets CF, Franz AR. Combined choline and DHA supplementation: a randomized controlled trial. Eur J Nutr. 2020 Mar;59(2):729-739. doi: 10.1007/s00394-019-01940-7. Epub 2019 Mar 11.

Reference Type DERIVED
PMID: 30859363 (View on PubMed)

Other Identifiers

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Choline and DHA for Preemies 2

Identifier Type: -

Identifier Source: org_study_id

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