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Is choline deficiency an unrecognized factor in necrotizing enterocolitis of preterm infants?

Pediatric Research (2024)Cite this article

Abstract

We undertook this review to determine if it is plausible that choline or phosphatidylcholine (PC) deficiency is a factor in necrotizing enterocolitis (NEC) after two clinical trials found a dramatic and unexpected reduction in NEC in an experimental group provided higher PC compared to a control group. Sources and amounts of choline/PC for preterm infants are compared to the choline status of preterm infants at birth and following conventional nutritional management. The roles of choline/PC in intestinal structure, mucus, mesenteric blood flow, and the cholinergic anti-inflammatory system are summarized. Low choline/PC status is linked to prematurity/immaturity, parenteral and enteral feeding, microbial dysbiosis and hypoxia/ischemia, factors long associated with the risk of developing NEC. We conclude that low choline status exists in preterm infants provided conventional parenteral and enteral nutritional management, and that it is plausible low choline/PC status adversely affects intestinal function to set up the vicious cycle of inflammation, loss of intestinal barrier function and worsening tissue hypoxia that occurs with NEC. In conclusion, this review supports the need for randomized clinical trials to test the hypothesis that additional choline or PC provided parenterally or enterally can reduce the incidence of NEC in preterm infants.

Impact statement

  • Low choline status in preterm infants who are managed by conventional nutrition is plausibly linked to the risk of developing necrotizing enterocolitis.

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Authors and Affiliations

  1. Department of Food & Nutrition, OSF Healthcare Saint Francis Medical Center, Peoria, IL, 61637, USA

    Douglas C. Drenckpohl

  2. Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, 66106, USA

    Douglas C. Drenckpohl, Danielle N. Christifano & Susan E. Carlson

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  1. Douglas C. Drenckpohl
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  3. Susan E. Carlson
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Contributions

D.C.D. and S.E.C. developed the review question and conducted the literature search. D.C.D. and S.E.C. wrote the first draft with input from DNC. All three authors participated in writing and approve the final edited version of the review.

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Correspondence to Susan E. Carlson.

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Competing interests

D.C.D., D.N.C. and S.E.C. declare no conflicts of interest related to choline. S.E.C. has received NIH funding for research on docosahexaenoic acid (DHA) and cognitive development of preterm and term infants, and, more recently, for a randomized clinical trial to test the effect of DHA dose on preterm birth.

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Given the large body of literature on NEC and intestinal function, it is impossible to cite all excellent published work. We apologize if we have unintentionally omitted references to original work that should have been cited in preference to other citations.

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Drenckpohl, D.C., Christifano, D.N. & Carlson, S.E. Is choline deficiency an unrecognized factor in necrotizing enterocolitis of preterm infants?. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03212-5

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  • DOI: https://doi.org/10.1038/s41390-024-03212-5

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