Study: Cholin supplementation in children with fetal alcohol spectrum disorders

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Bezug Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Cholin-Supplementierung bei Kindern mit fetalen Alkoholspektrumstörungen: eine randomisierte, doppelblinde, placebokontrollierte Studie. Bin J Clin Nutr. 2015; 102(5):1113-1125. Studienziel Um zu bestimmen, ob eine postnatale Cholin-Supplementierung das Potenzial hat, die neurokognitive Funktion zu verbessern, insbesondere das Hippocampus-abhängige Gedächtnis bei Kindern mit FASDs Design Doppelblinde, randomisierte, Placebo-kontrollierte Pilotstudie Teilnehmer Diese Studie umfasste 60 Kinder mit fetalen Alkoholsyndromstörungen (FASDs), die zum Zeitpunkt der Aufnahme 2,5 bis 5 Jahre alt waren. Zu den Ausschlusskriterien gehörten eine andere Entwicklungsstörung, eine neurologische Störung, eine traumatische Hirnverletzung oder andere Erkrankungen, die das Gehirn betreffen. Psychiatrische Komorbiditäten, die bei …
Reference to Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled study. Am jlin nutr. 2015; 102 (5): 1113-1125. Study target to determine whether postnatal choline supplementation has the potential to improve the neurocognitive function, in particular the hippocampus-dependent memory in children with FASDS design double-blind, randomized, placebo-controlled pilot study. the recording were 2.5 to 5 years old. The exclusion criteria included a different developmental disorder, a neurological disorder, a traumatic brain injury or other diseases that affect the brain. Psychiatric comorbidities that at ... (Symbolbild/natur.wiki)

reference

Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled study. am j Clin nutr . 2015; 102 (5): 1113-1125.

Study goal

to determine whether postnatal choline supplementation has the potential to improve the neurocognitive function, in particular the hippocampus-dependent memory in children with FASDS

Design

double-blind, randomized, placebo-controlled pilot study

participant

This study included 60 children with fetal alcohol syndrome disorders (FASDs), who were 2.5 to 5 years old at the time of admission. The exclusion criteria included a different developmental disorder, a neurological disorder, a traumatic brain injury or other diseases that affect the brain. Psychiatric comorbidities that are common at FASD, such as ADHD or learning disorders, have not been excluded. 83 % of the participants had a confirmed prenatal alcohol exposure, which was found by a self -report from the biological mother or social service documents. The other participants with unconfirmed alcohol exposure had dysmorphs faces and cognitive deficits that indicated prenatal alcohol exposure.
modified criteria of the Institute of Medicine (IOM) were applied to the data collected in the clinic on growth, facial dysmorphology and alcohol exposure. Of the participants, 17 % met the criteria for a fetal alcohol syndrome (FAS), 40 % met the criteria for a partial FAS (PFAS) and 40 % met the criteria for alcohol -related neurological developmental disorder.
The results of this study are significant because very few medical interventions have proven to be effective.
The criteria of the central nervous system (CNS) of the Center for Disease Control and Prevention for FASD were used to assess the cognitive function. 32 % of the participants met the criteria for the FASD diagnosis based on poor brain development, 25 % had a global cognitive impairment and 95 % had deficits in 3 or more areas (i.e. intellectual, linguistic, motor, visual-perceptive functioning, behavior).

study parameters evaluated

The participants received 500 mg choline (1.25 g cholin biartate) or a placebo for 9 months. The content was delivered in foil packs, which contained a powder form with fruit taste.

target parameter

primary result

The mulled scales of early learning were used to evaluate the global cognitive function. This test evaluates visual perception, fine motor skills, receptive language and expressive language skills.

Secondary result

The hippocampus-dependent function was assessed using the excited imitation (egg) memory. The egg measures the memory with behavioral imitation of the action sequencing that requires the hippocampus.

important knowledge

The initial analysis showed no significant difference between the treatment and placebo group in both results measurements (mulled scales or egg). The data was re-evaluated taking into account the age, and the analysis showed that the egg improvement was different depending on the age of the child. The investigators then divided the sample based on the average age in two groups. The younger group consisted of participants aged 4 years or younger; The older group was> 4 to 5 years.
After checking the immediate memory performance, the analysis showed that choline supplementation improved the delayed memory measurements and that age influenced the effect. The younger cholin group showed a 12 to 14 percentage point larger increase than the younger placebo group in the delayed call. There was a negative effect of choline supplementation on the immediate egg recall of ordered couples-the young placebo group showed an increase of 8 to 17 percentage points more than the young treatment group. The only disadvantageous effect of choline supplementation was a fishing body odor. The smell is the result of the conversion of choline into trimethylamine through intestinal microbes; Trimethylamine is further converted into trimethylamine n-oxide in the liver. Overall, the choline supplementation was well tolerated.

practice implications

The prevalence of fetal alcohol syndrome disorders (FASDs) in the United States is 2 % to 5 %, and FASDs are among the most common causes of mental disability. 1 Studies have shown that alcohol in the womb has teratogenic effects on the hippocampus and the prefrontal cortex that learns, memory and executive Functions are involved. 2
The results of this study are significant because very few medical interventions at FASD have proven to be effective.
The observed effect of choline on the hippocampus-dependent memory agrees with the existing research on the effects of choline on the synaptogenesis and the hippocampus growth if it is added postnatal. 3 The results of this study showed a significant benefit of choline support only for participants under 4 years. This can be related to the development stages of the hippocampus among the youngest participants, although this is speculation.
In addition to postnatal choline supplementation, maternal choline supplementation influences brain development during the prenatal phase. Cholin can pass the placenta and the concentration in amniotic fluid is 10 times higher than the concentration in maternal blood. 4 Thomas et al. reported that prenatal choline supplementation alleviates the adverse effects of a prenatal alcohol exposure on the development in rats. 5 Column rats were exposed to 6.0 g/kg/day of ethanol on the days 5 to 20, which corresponds to the third trimester in humans. In addition, the rats were treated with 250 mg/kg/day cholinchloride. The choline supplementation reduced the adverse effects on the birth weight, the occurrence of the incisors and behavioral measures caused by ethanol exposure. The behavioral performance of the ethanol-exposed rats, which were supplemented with choline, did not differ from that of the controls. This study came to the conclusion that supplementation with a motherly choline has the potential to reduce the symptoms of fetal alcohol exposure during pregnancy and should be considered as an intervention for women who drink alcohol during pregnancy.
Another clinical application of choline is that it increases acetylcholine (oh), which reinforces the cholinergic neurotransmission and improves memory. Napoli et al. Measures the release of Ach from Hippocampi from rats that received prenatal a choline supplement. 6 The insulin-like growth factor 2 (IGF-2) and its receptor (IGF2R) have been monitored, since they have proven to be mediators of the endogenous oh release. Choline supplementation increases the expression of IFG-23. 8 The rats in this study were divided into 3 groups: cholin-fueled, control and cholin deficient. During the days 11 to 17 of pregnancy, the control group received 7.9 mmol/kg/day cholin, the group supplemented with choline received 35.6 mmol/kg/day and the group with a cholin deficiency received no choline. Hippocampus fabric was examined Postnatal on the days 18, 24, 34 and 80. In this study, the prenatal choline supplementation had a significant effect on the Ach-2/depolarization caused by IGF-2/depolarization. The mirrors of IGF-2-MRNA, IGF-2 protein and IGF2R protein in the Hippocampus rose in the group supplemented with choline. These results suggest that prenatal choline supplementation has a positive impact on the cholinergic system, which should improve memory, since oh is released by cholinergic neurons that project into the hippocampus and the cerebral cortex.
In summary, it can be said that indications indicate that early intervention with a choline supplementation in children with FASD is to develop the development of the hippocampus and the memory function. Smaller cholindoses that are administered several times during the day can reduce the potential of the side effect of fishy body odor. Further studies are necessary to determine the optimal dosage - one that brings the improved memory performance into harmony with the negative effect of unpleasant body odor - as well as the optimal treatment time.

restrictions

This review is restricted by the lack of recent research results for choline supplementation in children. In addition, most available studies are animal studies.

  1. May PA, Gossage JP, Kalberg where, et al. Prevalence and epidemiological features of FASD from various research methods with a focus on current school studies. DEV disabil res rev . 2009; 15 (3): 176-192.
  2. Otero N, Thomas J, Saski C, Xia X, Kelly S. Cholin supplementation and DNA methylation in the hippocampus and in the prefrontal cortex of rats that were exposed to alcohol during development. alcohol Clin Exp. Res . 2012; 36 (10): 1701-1709.
  3. Zeisel Sh. The fetal origins of memory: the role of dietary choline for optimal brain development. j Ped . 2006; 149 (5 Suppl): 131-136.
  4. Zeisel SH, Niculescu Md. Nutr Rev . 2006; 64 (4): 197-203.
  5. Thomas JD, Abou ej, Dominguez Hd. A prenatal choline supplementation alleviates the adverse effects of prenatal alcohol exposure on the development of rats. neurotoxicol teratol . 2009; 31 (5): 303-311.
  6. Napoli I, Blusztajn JK, Mellot TJ. A prenatal choline supplementation in rats increases the expression of IGF2 and its receptor IGF2R and strengthens the IGF2-induced acetylcholine release in the hippocampus and frontal cortex. brain . 2008; 1237: 124-135.
  7. Hawkes C, Jhamandas JH, Harris KH, FU W, MacDonald RG, Kar S. The insulin-like growth factor II/mannose-6-phosphate receptor with a single transmembrandomane regulates the central cholinergic function by activating a G-protein sensitive protein-sensitive protein-related way. J Neurosci . 2006; 26 (2): 585-596.
  8. Mellot TJ, Folettie Mt, Diesl V, Hill Aa, Lopez-Coviella I, Blusztajn JK. The prenatal availability of choline modulates gene expression in the hippocampus and in the brain bark. faseb j . 2007; 21 (7): 1311-1323.