Specific Dietary Interventions

Nucleotides

Dietary nucleotides build blocks of RNA, DNA, ATP, and therefore a supplemented formula may improve growth and immunity, optimize the maturation, recovery and function of rapidly dividing tissue, such as the gastrointestinal tract mucosa. Infant studies have shown that the addition of nucleotides decreases the incidence of diarrhea and upper (but not lower) respiratory tract infections, affects NK cell activity, increases serum IgA, T cell maturation and antibody level after Haemophilus influenzae type B (but not hepatitis B) vaccination [27, 28]. 'Most' dietary nucleotides are rapidly metabolized and excreted. However, 'some' are incorporated in tissue, probably depending on many factors such as age at supplementation. In infants with severe intrauterine growth retardation nucleotides enhance catch-up growth. The supplementation of nucleotides in infant feeding can be regarded as very safe; therefore the cost/benefit ratio is of major importance. As a consequence, the addition of nucleotides in infant feeding should be considered in 'at risk'

infants such as the preterm and immature infant, or after severe intestinal injury.

Glutamine

Glutamine supplementation is reported as safe, and tends to be associated with less infectious morbidity and mortality. However, glutamine-enriched EN did not improve feeding tolerance or short-term outcome in very low birth weight infants and the available data from good quality randomized controlled trials suggest that preterm infants do not clinically significantly benefit from glutamine supplementation [29].

Lipids

Increasing evidence has demonstrated that adequate dietary lipids are extremely important not just for their caloric value but also for their immune-modulatory effects. Lipids may prevent allergic sensitization by downregulat-ing inflammatory response (n-3 but not n-6 long-chain fatty acids) whilst protecting the epithelial barrier, regulate immune function and modify the adherence of microbes to the mucosa, thereby contributing to host-microbe interactions. Medium-chain (8-12 carbons) fatty acids (MCT) seem to have more strongly antiviral and antibacterial properties (against Rous sarcoma virus, herpes simplex virus, H. influenzae and group B streptococcus) than long-chain triglycerides [30]. According to a recent Cochrane review, there is no evidence of differences between MCT and long-chain triglycerides in short-term growth, gastrointestinal intolerance, or necrotizing enterocolitis [31].

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