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Response to ‘May be the formula supplementation with lutein actually be effective on visual development in preterm infants?’

Journal of Perinatology volume 32, page 564 (2012)Cite this article

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We thank Costa et al.1 for their comments. They question how we explain that lutein supplementation affects retinal development and the severity of retinopathy of prematurity (ROP). The first issue raised is whether the lutein supplementation was sufficient to produce effects. Certainly, an ‘optimal’ amount of dietary lutein for the preterm infant remains unknown. Nevertheless, lutein supplementation in our clinical trial2 establishes three things.

First, our study shows supplementation raises plasma lutein to levels approximating those observed in healthy human milk-fed term infants, that is, dietary lutein was absorbed and made available to tissues. Of the four randomized clinical trials in which lutein and zeaxanthin were given to preterm infants,2, 3, 4 we provided carotenoids as a part of the ingredient matrix of infant formula. The daily dietary lutein was derived from the lutein levels found in human milk and colostrum. The three Italian trials3, 4, 5 provided a single daily dose of 0.5 ml of lutein drops (containing 0.14 mg of lutein and 0.006 mg of zeaxanthin). Nutritional studies indicate that lutein, like other carotenoids, is better absorbed from a lipid-containing diet, for example, milk; delivery can be less certain when oral or orogastric tube drops are provided. In any case, our results show earlier and higher levels than were obtained in Romagnoli et al.'s3 trial, the other study where blood levels were measured. As expected, that trial found no differences between groups on plasma cholesterol or triglyceride levels.3 It is highly unlikely that there would be an unexplained systematic difference in plasma lipids in our larger study populations.

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References

  1. Costa S, Giannantonio C, Cota F, Romagnoli C . May be the formula with lutein actually be effective on visual development in preterm infants? J Perinatol 2012 (this issue).

  2. Rubin LP, Chan GM, Barrett-Reis BM, Fulton AB, Hansen RM, Ashmeade TL et al. Effect of carotenoid supplementation on plasma carotenoids, inflammation and visual development in preterm infants. J Perinatol 2012 (this issue).

  3. Romagnoli C, Giannantonio C, Cota F, Papacci P, Vento G, Valente E et al. A prospective, randomized, double blind study comparing lutein to placebo for reducing occurrence and severity of retinopathy of prematurity. J Matern Fetal Neonatal Med 2011; 24S: 147–150.

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  4. Dani C, Lori I, Favelli F, Frosini S, Messner H, Wanker P et al. Lutein and zeaxanthin supplementation in preterm infants to prevent retinopathy of prematurity: a randomized controlled study. J Matern Fetal Neonatal Med 2011; e-pub ahead of print 18 November 2011.

  5. Manzoni P, Biban M, Bellettato M, Guardione R, Bonetti P, Maestri A . Lutein and zeaxanthin supplementation in preterm VLBW neonates in NICU: a multicentre RCT. Pediatr Acad Soc 2011; 3535.6A (abstract).

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Authors and Affiliations

  1. Department of Pediatrics, University of South Florida, Tampa, FL, USA

    L P Rubin

  2. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    A B Fulton

  3. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    G M Chan

Authors
  1. L P Rubin
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  2. A B Fulton
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  3. G M Chan
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Correspondence to L P Rubin.

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Rubin, L., Fulton, A. & Chan, G. Response to ‘May be the formula supplementation with lutein actually be effective on visual development in preterm infants?’. J Perinatol 32, 564 (2012). https://doi.org/10.1038/jp.2011.200

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