Effect of Total Parenteral Nutrition with Intravenous Fat on Lipids and High Density Lipoprotein Heterogeneity in Neonates

Plasma lipid concentrations and high density lipoprotein (HDL) sublcass distributions were evaluated in 22 newborn infants nourished with intravenous (iv)-fat. The majority of infants were premature with respiratory distress syndrome. Based on baseline (prior to iv-fat) HDL subclass profiles determined by gradient gel electrophoresis (GGE), infants fell into two classes, one with two or more pronounced peaks within the normal HDL spectrum (group I, 17 subjects) and the other with highly unusual HDL distribution (group II, five subjects). Total plasma cholesterol increased in both groups during low and high fat intravenous feeding. HDL-cholesterol, however, did not change with iv-fat where mean values for groups I and II at baseline, iv-low fat and -high fat were: group I, 31.2 ± 7.1, 30.0 ± 8.8, and 36.6 ± 16.7 mg/dl, respectively; and group II, 20.0 ± 7.8, 20.2 ± 7.4, and 19.8 ± 8.8 mg/dl, respectively. Unlike HDL-cholesterol levels that remained constant with iv-fat, apolipoprotein (apo)AI concentrations increased significantly: group I, 73.0 ± 11.0, 88.3 ± 15.9, and 93.1 ± 21.9 mg/dl, respectively; and group II, 31.8 ± 10.5, 41.0 ± 12.8, and 59.3 ± 18.5 mg/dl, respectively. In group I infants, iv-fat is associated with an increase in larger-sized particles, particularly in the (HDL_2b)_gge range; in group II there is an increase in (HDL_3b)_gge and (HDL _3c)_gge components and a disappearance of particles that fall outside of the size range of normal HDL. In both groups, enteral feeding is associated with a further normalization of HDL subclass distribution. The aberrant GGE profiles and very low apoAI levels of group II infants at baseline were associated with unusual HDL morphology determined by electron microscopy where discoidal structures were prominent. With iv-fat, discoidal particles decline in number while normal spherical structures increase. Prevalence of discoidal HDL at baseline was associated with low concentrations of lecithin:cholesterol acyltransferase (LCAT) (1.12 ± 0.5 μg/ml); with iv-fat this enzyme rose to 1.61 ± 0.18 μg/ml. Increased LCAT is associated with the normalization of HDL morphology. It is likely that iv-fat improves the nutritional status of premature infants, thereby stimulating increased liver synthesis of important proteins, including apoAI and LCAT, associated with HDL metabolism. (Journal of Parenteral and Enteral Nutrition 13:490-500, 1989)