Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants

Dietary arachidonic acid in perinatal nutrition: a commentary

Arachidonic acid (AA) is supplied together with docosahexaenoic acid (DHA) in infant formulas, but we have limited knowledge about the effects of supplementation with either of these long-chain polyunsaturated fatty acids (LCPUFA) on growth and developmental outcomes. AA is present in similar levels in breast milk throughout the world, whereas the level of DHA is highly diet dependent. Autopsy studies show similar diet-dependent variation in brain DHA, whereas AA is little affected by intake. Early intake of DHA has been shown to affect visual development, but the effect of LCPUFA on neurodevelopment remains to be established. Few studies have found any functional difference between infants supplemented with DHA alone compared to DHA+AA, but some studies show neurodevelopmental advantages in breast-fed infants of mothers supplemented with n-3 LCPUFA alone. It also remains to be established whether the AA/DHA balance could affect allergic and inflammatory outcomes later in life. Disentangling effects of genetic variability and dietary intake on AA and DHA-status and on functional outcomes may be an important step in the process of determining whether AA-intake is of any physiological or clinical importance. However, based on the current evidence we hypothesize that dietary AA plays a minor role on growth and development relative to the impact of dietary DHA.

Dietary DHA during development affects depression-like behaviors and biomarkers that emerge after puberty in adolescent rats

DHA is an important omega-3 PUFA that confers neurodevelopmental benefits. Sufficient omega-3 PUFA intake has been associated with improved mood-associated measures in adult humans and rodents, but it is unknown whether DHA specifically influences these benefits. Furthermore, the extent to which development and puberty interact with the maternal diet and the offspring diet to affect mood-related behaviors in adolescence is poorly understood. We sought to address these questions by 1) feeding pregnant rats with diets sufficient or deficient in DHA during gestation and lactation; 2) weaning their male offspring to diets that were sufficient or deficient in DHA; and 3) assessing depression-related behaviors (forced swim test), plasma biomarkers [brain-derived neurotrophic factor (BDNF), serotonin, and melatonin], and brain biomarkers (BDNF) in the offspring before and after puberty. No dietary effects were detected when the offspring were evaluated before puberty. In contrast, after puberty depressive-like behavior and its associated biomarkers were worse in DHA-deficient offspring compared with animals with sufficient levels of DHA. The findings reported here suggest that maintaining sufficient DHA levels throughout development (both pre- and postweaning) may increase resiliency to emotional stressors and decrease susceptibility to mood disorders that commonly arise during adolescence.

Comparison of free fatty acid content of human milk from Taiwanese mothers and infant formula

OBJECTIVE

Few studies on the free fatty acid (FFA) content of milk from non-Caucasian mothers have been published. We compared the FFA concentrations in human milk (HM) from Taiwanese mothers of preterm (PTHM) and full-term infants (FTHM) and in infant formula (IF).

MATERIALS AND METHODS

Thirty-eight HM samples were collected from 23 healthy lactating mothers and 15 mothers who gave birth prematurely (range 29-35 weeks, mean 33 weeks). The regular formula and preterm infant formula (PTIF) for three brands of powdered IF were also evaluated. Milk samples were extracted and methylated for analysis by gas chromatography/mass spectrometry (GC/MS).

RESULTS

Reference values for individual FFAs in breast milk from Taiwanese mothers were determined. The mean total FFAs were significantly higher in IF (21,554 μmol/L) and PTIF (19,836 μmol/L) than in FTHM (8,540 μmol/L) and PTHM (9,259 μmol/L) (p < 0.05). Saturated FAs were predominant in all types of milk (43.1% for FTHM, 42.8% for PTHM, 45.5% for IF and 45.3% for PTIF). Monounsaturated FAs were significantly higher in IF and PTIF (42.6% and 43.9%) than in FTHM and PTHM (37.7% and 39.5%), and polyunsaturated FAs in FTHM and PTHM (20% and 18.2%) were higher than in IF and PTIF (11.9% and 10.9%). HM had a more desirable linoleic acid/α-linolenic acid ratio than IF. No significant differences in individual FFAs in FTHM were observed among three lactating periods.

CONCLUSION

FFA levels in HM from Taiwanese mothers are in agreement with results for different geographically distinct populations. Nevertheless, the FFA content in IF did not meet well with HM, particularly, the excess additives of saturated and monounsaturated FAs, and the shortage of polyunsaturated FAs. The effect of variations in FFA content in IF on future unfavorable outcomes such as obesity, atopic syndrome, and less optimal infant neurodevelopment should be further investigated.

Liquid human milk fortifier significantly improves docosahexaenoic and arachidonic acid status in preterm infants

We report the fatty acid composition of mother׳s own human milk from one of the largest US cohorts of lactating mothers of preterm infants. Milk fatty acid data were used as a proxy for intake at enrollment in infants (n=150) who received human milk with a powder human milk fortifier (HMF; Control) or liquid HMF [LHMF; provided additional 12mg docosahexaenoic acid (DHA), 20mg arachidonic acid (ARA)/100mL human milk]. Mothers provided milk samples (n=129) and reported maternal DHA consumption (n=128). Infant blood samples were drawn at study completion (Study Day 28). Human milk and infant PPL fatty acids were analyzed using capillary column gas chromatography. DHA and ARA were within ranges previously published for US term and preterm human milk. Compared to Control HMF (providing no DHA or ARA), human milk fortified with LHMF significantly increased infant PPL DHA and ARA and improved preterm infant DHA and ARA status.

Comparing enfant and PowerDiva sweep visual evoked potential (sVEP) acuity estimates

PURPOSE

Many studies have examined different variables that affect the outcome of sVEP estimated acuity. However, no studies have compared the estimated sVEP acuity between different instruments. The primary purpose of this study was to compare sVEP acuity estimates obtained with two different sVEP systems: the Enfant and the PowerDiva.

METHODS

Twenty-five normal adults with monocular acuities of 0.10 logMAR or better took part in this study. The sVEP acuities were determined with the two instruments in a single visit with the same electrode placement. For both systems, the stimuli were horizontal sine wave gratings of 80 % contrast, counterphased at 7.5 Hz, with a screen mean luminance of 100 cd/m(2). The sweep presented spatial frequencies from 3 to 36 cpd with each spatial frequency presented for 1 s. Ten presentations of the stimuli were averaged together for one acuity measurement. The acuity estimate was made with the specific instruments standard software. Two acuity measurements were made for each system and averaged together for further comparison. The acuity estimates were compared using an ANOVA, paired t tests, and Bland-Altman plots.

RESULTS

The average estimated logMAR acuities with the Enfant (0.064 ± 0.069 logMAR) and PowerDiva (0.065 ± 0.115 logMAR) were not significantly different (t = 0.04, p = 0.97). Consistent with previous studies, the logMAR chart acuity (-0.086 ± 0.089 logMAR) was significantly different from the Enfant (t = 8.10, p < 0.001) and PowerDiva (t = 5.77, p < 0.001) acuity estimates. The Bland-Altman analysis for the two instruments did not indicate a bias (-0.001), and the limit of agreement was 0.227 logMAR.

CONCLUSIONS

Acuity estimates with the Enfant and PowerDiva are not significantly different for patients with normal acuity. Thus, direct comparisons between the two instruments can be made for patients with normal acuity.

Transgenerational healing: Educating children in genesis of healthy children, with focus on nutrition, emotion, and epigenetic effects on brain development

Although our continuing evolution can never achieve our perfection, we long for our children's birth and health to be near-perfect. Many children are born healthy, though fewer than is possible. Birthing and health rapidly improved generally due to modern housing, sanitation and medicine, as well as birth interventions. Arguably interventions have exceeded the optimal level, without enough regard for natural physical and intuitive resources. Conception, often too easy, receives too little personal preparation unless a couple has problems. Nurturing the health of sperm and ovum seems hard to focus on, yet is needed by both parents - and even by the four grandparents. What are the key factors? Positive: The fields of hormones/emotions and of nutrition/metabolism. Negative: stress, poor nutrition, toxins, diseases; much being due to poverty. Positive and negative both have structural and also epigenetic effects. Interventions, essential or inessential, are seldom without negative side effects. Health can best, and most economically, be generated at the beginning of life, through healthy conception, gestation and birth. Understanding prime needs improves initial health. It also informs therapy of any early-life problems. Healing is therefore more efficient when transgenerational, and much more powerful than individual healing. My vision of healing is safeguarding our evolution in progress. Children's choices - eating, exercise, emotional attitudes and relationships - are already profoundly affecting any children they may have, their mental and physical health. The most practical starting point seems to be educating boys as well as girls. Childhood is therefore the time to educate them in choices. The correction of often unnoticed problems- nutrient deficits, toxins, uro-genital disease - has enabled nearly nine out of ten couples to bear fully healthy babies, even following severe problems - infertility, miscarriages, stillbirths and malformations. Correcting problems before conception prevents both structural faults and wrong setting of gene-switches. Children's habits set. Once courting most are preoccupied and many pregnant unintentionally. Childhood is the time to be adopting a healthy lifestyle, the way to healthy babies The mother's nutritional and emotional status throughout pregnancy continues to affect her child's future physical and mental health, behaviour and ability. Before conception a woman needs to build her appropriate body stores - vitamins and minerals, proteins, docosahexaenoic acid. Before bearing another child, a replenishment time of 3 years is desirable. A return to childbearing in the 20s and early 30s could reduce risks that have risen with the recent shift towards conception by school children and by women in their late 30s or more. Governments, schoolteachers, health professionals, need to adopt this policy of transgenerational health. Empowerment with knowledge is the one way to fend off the growing pandemic of mental ill health and related disorders and to make the most of a nation's genetic potential. Financially there could be no better investment, let alone in enhancing people's lives. Childhood is the most appropriate time for education in this way to generating a healthy, able and peaceful human race. Essential to our amazing genetic systems are the resources of land, sea and air. We are one with our biosphere. We need urgently to follow up the vital work of Developmental Origins of Health and Disease, and of Far East initiatives in sea-bed and sea husbandry.

Dietary omega-3 fatty acids modulate large-scale systems organization in the rhesus macaque brain

Omega-3 fatty acids are essential for healthy brain and retinal development and have been implicated in a variety of neurodevelopmental disorders. This study used resting-state functional connectivity MRI to define the large-scale organization of the rhesus macaque brain and changes associated with differences in lifetime ω-3 fatty acid intake. Monkeys fed docosahexaenoic acid, the long-chain ω-3 fatty acid abundant in neural membranes, had cortical modular organization resembling the healthy human brain. In contrast, those with low levels of dietary ω-3 fatty acids had decreased functional connectivity within the early visual pathway and throughout higher-order associational cortex and showed impairment of distributed cortical networks. Our findings illustrate the similarity in modular cortical organization between the healthy human and macaque brain and support the notion that ω-3 fatty acids play a crucial role in developing and/or maintaining distributed, large-scale brain systems, including those essential for normal cognitive function.

Growth and fatty acid profiles of VLBW infants receiving a multicomponent lipid emulsion from birth

OBJECTIVES

Very-low-birth-weight (VLBW) infants are dependent on parenteral nutrition after birth. A parenteral lipid emulsion with a multicomponent composition may improve growth and neurodevelopment and may prevent liver injury, which is often observed in association with long-term parenteral nutrition with pure soybean oil. Our aim was to evaluate the safety and efficacy of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triacylglycerol, 25% olive oil, and 15% fish oil compared with a conventional pure soybean oil emulsion in VLBW infants.

METHODS

We conducted a double-blind randomized controlled trial in VLBW infants randomized to parenteral nutrition with the multicomponent (study group) or pure soybean oil emulsion (control group) from birth at a dose of 2 to 3 g · kg(-1) · day(-1) until the infants were receiving full enteral nutrition. We assessed efficacy by growth rates and measuring plasma fatty acid profiles (representative subset). Safety was evaluated by assessing hematologic and biochemical parameters, potentially harmful phytosterol concentrations (same subset), and clinical neonatal outcome parameters.

RESULTS

Ninety-six infants were included (subsets n = 21). The multicomponent emulsion was associated with higher weight and head circumference z scores during admission. Plasma eicosapentaenoic acid and docosahexaenoic acid concentrations were higher in the study group. The hematological, biochemical, and neonatal outcomes were not different between groups, whereas the plasma concentrations of phytosterols were higher in the control group.

CONCLUSIONS

The multicomponent lipid emulsion was well tolerated and associated with improved growth and higher plasma fatty acid profiles in VLBW infants in comparison with the pure soybean oil emulsion.

An update on adding docosahexaenoic acid (DHA) and arachidonic acid (AA) to baby formula

Human milk is the ideal food providing optimal nutrition for healthy term infants. Its complex lipid composition is critical for infant growth and serves as a golden standard for baby formula development. Docosahexaenoic acid (C22:6 n- 3, DHA) and arachidonic acid (C20:4 n- 6, AA) are the two major long chain polyunsaturated fatty acids (PUFAs) in human milk. In humans, they are fundamental components of the cell membrane and play an important role in neurite growth and signal transmission. Their importance for both preterm and term infants has been demonstrated by various clinical trials. DHA and AA supplementation shows desirable influences on visual and cognitive development in early life and is additionally associated with potential benefits on later health. Further clinical data revealed that supplementing both DHA and AA instead of DHA alone during infancy is important to deliver the optimal outcome. In this review, we summarize current research and scientific evidence of DHA and AA on baby development.

Can we define an infant's need from the composition of human milk?

Human milk is recommended as the optimal nutrient source for infants and is associated with several short- and long-term benefits for child health. When accepting that human milk is the optimal nutrition for healthy term infants, it should be possible to calculate the nutritional needs of these infants from the intake of human milk. These data can then be used to design the optimal composition of infant formulas. In this review we show that the composition of human milk is rather variable and is dependent on factors such as beginning or end of feeding, duration of lactation, diet and body composition of the mother, maternal genes, and possibly infant factors such as sex. In particular, the composition of fatty acids in human milk is quite variable. It therefore seems questionable to estimate the nutritional needs of an infant exclusively from the intake of human milk. The optimal intake for infants must be based, at least in part, on other information-eg, balance or stable-isotope studies. The present recommendation that the composition of infant formulas should be based on the composition of human milk needs revision.

Plasma oxylipin profiling identifies polyunsaturated vicinal diols as responsive to arachidonic acid and docosahexaenoic acid intake in growing piglets

The dose-responsiveness of plasma oxylipins to incremental dietary intake of arachidonic acid (20:4n-6; ARA) and docosahexaenoic acid (22:6n-3; DHA) was determined in piglets. Piglets randomly received one of six formulas (n = 8 per group) from days 3 to 27 postnatally. Diets contained incremental ARA or incremental DHA levels as follows (% fatty acid, ARA/DHA): (A1) 0.1/1.0; (A2) 0.53/1.0; (A3-D3) 0.69/1.0; (A4) 1.1/1.0; (D1) 0.66/0.33; and (D2) 0.67/0.62, resulting in incremental intake (g/kg BW/day) of ARA: 0.07 ± 0.01, 0.43 ± 0.03, 0.55 ± 0.03, and 0.82 ± 0.05 at constant DHA intake (0.82 ± 0.05), or incremental intake of DHA: 0.27 ± 0.02, 0.49 ± 0.03, and 0.81 ± 0.05 at constant ARA intake (0.54 ± 0.04). Plasma oxylipin concentrations and free plasma PUFA levels were determined at day 28 using LC-MS/MS. Incremental dietary ARA intake dose-dependently increased plasma ARA levels. In parallel, ARA intake dose-dependently increased ARA-derived diols 5,6- and 14,15-dihydroxyeicosatrienoic acid (DiHETrE) and linoleic acid-derived 12,13-dihydroxyoctadecenoic acid (DiHOME), downstream metabolites of cytochrome P450 expoxygenase (CYP). The ARA epoxide products from CYP are important in vascular homeostatic maintenance. Incremental DHA intake increased plasma DHA and most markedly raised the eicosapentaenoic acid (EPA) metabolite 17,18-dihydroxyeicosatetraenoic acid (DiHETE) and the DHA metabolite 19,20-dihydroxydocosapentaenoic acid (DiHDPE). In conclusion, increasing ARA and DHA intake dose-dependently influenced endogenous n-6 and n-3 oxylipin plasma concentrations in growing piglets, although the biological relevance of these findings remains to be determined.

Long-chain PUFA supplementation in rural African infants: a randomized controlled trial of effects on gut integrity, growth, and cognitive development

BACKGROUND

Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries. Evidence has suggested that supplementary omega-3 (n-3) long-chain PUFAs (LC-PUFAs) might ameliorate this damage by reducing gastrointestinal inflammation. LC-PUFA supplementation may also benefit cognitive development.

OBJECTIVE

We tested whether early n-3 LC-PUFA supplementation improves infant intestinal integrity, growth, and cognitive function.

DESIGN

A randomized, double-blind, controlled trial [200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo] was conducted in a population of 172 rural Gambian infants aged 3-9 mo. The primary endpoints were anthropometric measures and gut integrity [assessed by using urinary lactulose:mannitol ratios (LMRs)]. Plasma fatty acid status, intestinal mucosal inflammation (fecal calprotectin), daily morbidity, and cognitive development (2-step means-end test and an attention assessment) were secondary endpoints.

RESULTS

PUFA supplementation resulted in a significant increase in plasma n-3 LC-PUFA concentrations (P < 0.001 for both DHA and EPA) and midupper arm circumference (MUAC) (effect size: 0.31 z scores; 95% CI: 0.06, 0.56; P = 0.017) at 9 mo of age. At 12 mo, MUAC remained greater in the intervention group, and we observed significant increases in skinfold thicknesses (P ≤ 0.022 for all). No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes.

CONCLUSIONS

Fish-oil supplementation successfully increased plasma n-3 fatty acid status. However, in young, breastfed Gambian infants, the intervention failed to improve linear growth, intestinal integrity, morbidity, or selected measures of cognitive development. The trial was registered at www.isrctn.org as ISRCTN66645725.

Meta-analysis of LCPUFA supplementation of infant formula and visual acuity

BACKGROUND AND OBJECTIVE

Long-chain polyunsaturated fatty acids (LCPUFAs) are hypothesized to affect visual acuity development in infants. Randomized controlled trials (RCTs) have been conducted to assess whether supplementation of LCPUFAs of infant formulas affects infant visual acuity. This meta-analysis was conducted to evaluate whether LCPUFA supplementation of infant formulas improves infants' visual acuity.

METHODS

PubMed and PsycInfo were searched for RCTs assessing the efficacy of LCPUFA supplementation of infant formulas on infant visual acuity. RCTs assessing the effects of LCPUFA supplementation on visual acuity (by using either visual evoked potential or behavioral methods) in the first year of life were included in this meta-analysis. Our primary outcome was the mean difference in visual resolution acuity (measured in logarithm of minimum angle of resolution [logMAR]) between supplemented and unsupplemented infants. We also conducted secondary subgroup analyses and meta-regression examining the effects of LCPUFA dose and timing, preterm versus term birth status, and trial methodologic quality.

RESULTS

Nineteen studies involving 1949 infants were included. We demonstrated a significant benefit of LCPUFA supplementation on infants' visual acuity at 2, 4, and 12 months of age when visual acuity was assessed by using visual evoked potential and at 2 months of age by using behavioral methods. There was significant heterogeneity between trials but no evidence of publication bias. Secondary analysis failed to show any moderating effects on the association between LCPUFA supplementation and visual acuity.

CONCLUSIONS

Current evidence suggests that LCPUFA supplementation of infant formulas improves infants' visual acuity up to 12 months of age.

Metabolomics of dietary fatty acid restriction in patients with phenylketonuria

Background

Patients with phenylketonuria (PKU) have to follow a lifelong phenylalanine restricted diet. This type of diet markedly reduces the intake of saturated and unsaturated fatty acids especially long chain polyunsaturated fatty acids (LC-PUFA). Long-chain saturated fatty acids are substrates of mitochondrial fatty acid oxidation for acetyl-CoA production. LC-PUFA are discussed to affect inflammatory and haemostaseological processes in health and disease. The influence of the long term PKU diet on fatty acid metabolism with a special focus on platelet eicosanoid metabolism has been investigated in the study presented here.

Methodology/Principal Findings

12 children with PKU under good metabolic control and 8 healthy controls were included. Activated fatty acids (acylcarnitines C6–C18) in dried blood and the cholesterol metabolism in serum were analyzed by liquid chromatographic tandem mass spectrometry (LC-MS/MS). Fatty acid composition of plasma glycerophospholipids was determined by gas chromatography. LC-PUFA metabolites were analyzed in supernatants by LC-MS/MS before and after platelet activation and aggregation using a standardized protocol. Patients with PKU had significantly lower free carnitine and lower activated fatty acids in dried blood compared to controls. Phytosterols as marker of cholesterol (re-) absorption were not influenced by the dietary fatty acid restriction. Fatty acid composition in glycerophospholipids was comparable to that of healthy controls. However, patients with PKU showed significantly increased concentrations of y-linolenic acid (C18:3n-6) a precursor of arachidonic acid. In the PKU patients significantly higher platelet counts were observed. After activation with collagen platelet aggregation and thromboxane B₂ and thromboxane B₃ release did not differ from that of healthy controls.

Conclusion/Significance

Long-term dietary fatty acid restriction influenced the intermediates of mitochondrial beta-oxidation. No functional influence on unsaturated fatty acid metabolism and platelet aggregation in patients with PKU was detected.

Association of complex lipids containing gangliosides with cognitive development of 6-month-old infants

BACKGROUND

Human breastmilk contains gangliosides which may play an important role in infant neurodevelopment.

AIM

A pilot study was conducted to assess the impact of infant formula supplemented with gangliosides from complex milk lipid on cognitive functions of normal healthy infants.

STUDY DESIGN

The study was a double-blind, randomized, controlled, parallel group clinical trial in which infants received the treatment or control product from 2 to 8 weeks of age until 24 weeks of age. The control group (n=30) received standard infant formula and the treatment group (n=29) received the same formula supplemented with complex milk lipid to increase the ganglioside content to approximately 11 to 12 μg/ml. A reference group (n=32) consisted of normal healthy exclusively breast-fed infants.

OUTCOME MEASURES

Cognitive development using the Griffith Scales and serum gangliosides was measured before (2-8 weeks of age) and after intervention (24 weeks of age).

RESULTS

Ganglioside supplementation using complex milk lipids significantly increased ganglioside serum levels (control group vs treatment group, P=0.002) and resulted in increased scores for Hand and Eye coordination IQ (P<0.006), Performance IQ (P<0.001) and General IQ (P=0.041). Cognitive development scores and serum ganglioside levels for the treatment group did not differ from the reference group.

CONCLUSIONS

Supplementation of infant formula with complex milk lipid to enhance ganglioside content appears to have beneficial effects on cognitive development in healthy infants aged 0-6 months, which may be related to increased serum ganglioside levels.

Growth and tolerance of infants fed formula supplemented with polydextrose (PDX) and/or galactooligosaccharides (GOS): double-blind, randomized, controlled trial

Background

To ensure the suitability of an infant formula as the sole source of nutrition or provide benefits similar to outcomes in breastfed infants, advancements in formula composition are warranted as more research detailing the nutrient composition of human milk becomes available. This study was designed to evaluate growth and tolerance in healthy infants who received one of two investigational cow’s milk-based formulas with adjustments in carbohydrate, fat, and calcium content and supplemented with a prebiotic blend of polydextrose (PDX) and galactooligosaccharides (GOS) or GOS alone.

Methods

In this multi-center, double-blind, parallel-designed, gender-stratified prospective study 419 infants were randomized and consumed either a marketed routine cow’s milk-based infant formula (Control; Enfamil® LIPIL®, Mead Johnson Nutrition, Evansville, IN) (n = 142) or one of two investigational formulas from 14 to 120 days of age. Investigational formulas were supplemented with 4 g/L (1:1 ratio) of a prebiotic blend of PDX and GOS (PDX/GOS; n = 139) or 4 g/L of GOS alone (GOS; n = 138). Anthropometric measurements were taken at 14, 30, 60, 90, and 120 days of age. Daily recall of formula intake, tolerance, and stool characteristics was collected during study weeks 1 and 2 and 24-h recall was collected at 60, 90, and 120 days of age. Medically-confirmed adverse events were recorded throughout the study.

Results

There were no group differences in growth rate from 14 to 120 days of age. Discontinuation rates were not significantly different among study groups. No differences in formula intake or infant fussiness or gassiness were observed. During study weeks 1 and 2 and at 60 days of age stool consistency ratings were higher (i.e. softer stools) for infants in the PDX/GOS and GOS groups versus Control and remained higher at 120 days for the PDX/GOS group (all P < 0.05). The overall incidence of medically-confirmed adverse events was similar among groups.

Conclusions

Investigational routine infant formulas supplemented with 4 g/L of either a prebiotic blend of PDX and GOS or GOS alone were well-tolerated and supported normal growth. Compared to infants who received the unsupplemented control formula, infants who received prebiotic supplementation experienced a softer stooling pattern similar to that reported in breastfed infants.

Trial registration

ClinicalTrials.gov Identifier: NCT00712608

Omega 3 fatty acids on child growth, visual acuity and neurodevelopment

The aim of this review is to evaluate the effects of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in pregnant and lactating women and infants during postnatal life, on the visual acuity, psychomotor development, mental performance and growth of infants and children. Eighteen publications (11 sets of randomized control clinical trial [RCTs]) assessed the effects of the n-3 LCPUFA supplementation duringpregnancyon neurodevelopment and growth, in the same subjects at different time points; 4 publications (2 data sets from RCTs) addressed physiological responses to n-3 LCPUFA supplementation duringpregnancy & lactationand 5 publications (3 data sets from RCTs) exclusively duringlactation. Some of these studies showed beneficial effects of docosahexaenoic acid (DHA) supplementation during pregnancy and/or lactation especially on visual acuity outcomes and some on long-term neurodevelopment; a few, showed positive effects on growth. There were also 15 RCTs involving term infants who received infant formula supplemented with DHA, which met our selection criteria. Many of these studies claimed a beneficial effect of such supplementation on visual, neural, or developmental outcomes and no effects on growth. Although new well designed and conducted studies are being published, evidence from RCTs does not demonstrate still a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on term infants growth, neurodevelopment and visual acuity. These results should be interpreted with caution due to methodological limitations of the included studies.

Effect ofn-3 long chain polyunsaturated fatty acids during the perinatal period on later body composition

A systematic review to identify studies reporting the effects ofn-3 long chain polyunsaturated fatty acids (LCPUFA) intake, during pregnancy and postnatally, on infants and young children's body composition was performed. A structured search strategy was performed in the MEDLINE (PubMed), EMBASE, and LILACS databases. Inclusion and exclusion criteria were defined according to the research question. Only those studies addressing the relationship betweenn-3 LCPUFA exposure during the perinatal period and later adiposity measured in terms of weight, height, body mass index (BMI), skinfold thickness and/or circumferences were included regardless of the study design. Studies quality was scored and were thereafter categorised into those reporting on maternal intake ofn-3 LCPUFA during pregnancy or lactation (6 publications) or on infant'sn-3 LCPUFA intake (7 publications). Two studies showed inverse associations between maternaln-3 LCPUFA intake and children's later body composition (lower adiposity, BMI or body weight), two showed direct associations and no effects were observed in the remaining two studies. Among those studies focusing onn-3 LCPUFA intake through enriched infant formulas; three observed no effect on later body composition and two showed higher weight and adiposity with increased amounts ofn-3 LCPUFA. Reversely, in two studies weight and fat mass decreased. In conclusion, reported body composition differences in infants and young children were not clearly explained by perinataln-3 LCPUFA intake via supplemented formulas, breastfeeding or maternal intakes ofn-3 LCPUFA during pregnancy and lactation. Associated operational mechanisms includingn-3 LCPUFA doses and sources applied are not sufficiently explained and therefore no conclusions could be made.

Depressive symptoms during pregnancy and the concentration of fatty acids in breast milk

The aim of the present study was to examine the association between depressive symptoms in pregnancy and the concentration of long-chain polyunsaturated fatty acids (LCPUFAs) in breast milk. Women (n = 287) enrolled in the Pregnancy, Infection, and Nutrition Study completed the Center for Epidemiologic Studies Depression Scale in pregnancy (< 20 and 24-29 weeks) and had LCPUFAs measured in breast milk (4 months postpartum). Multiple linear regression was used to examine associations between depressive symptoms and breast milk LCPUFAs. Increasing depressive symptoms at < 20 weeks were associated with lower docosahexaenoic acid concentrations (adjusted β = -1.15, 95% confidence interval = -2.12, -0.19). No similar associations were observed with other fatty acids nor between symptoms at 24-29 weeks and LCPUFAs. Depressive symptoms, even in the subclinical range, early in pregnancy are inversely associated with breast milk docosahexaenoic acid. This may have implications for the timing of screening and interventions for perinatal depression and the nutritional value of breast milk.

The diversity of sex steroid action: novel functions of hydroxysteroid (17β) dehydrogenases as revealed by genetically modified mouse models

Disturbed action of sex steroid hormones, i.e. androgens and estrogens, is involved in the pathogenesis of various severe diseases in humans. Interestingly, recent studies have provided data further supporting the hypothesis that the circulating hormone concentrations do not explain all physiological and pathological processes observed in hormone-dependent tissues, while the intratissue sex steroid concentrations are determined by the expression of steroid metabolising enzymes in the neighbouring cells (paracrine action) and/or by target cells themselves (intracrine action). This local sex steroid production is also a valuable treatment option for developing novel therapies against hormonal diseases. Hydroxysteroid (17β) dehydrogenases (HSD17Bs) compose a family of 14 enzymes that catalyse the conversion between the low-active 17-keto steroids and the highly active 17β-hydroxy steroids. The enzymes frequently expressed in sex steroid target tissues are, thus, potential drug targets in order to lower the local sex steroid concentrations. The present review summarises the recent data obtained for the role of HSD17B1, HSD17B2, HSD17B7 and HSD17B12 enzymes in various metabolic pathways and their physiological and pathophysiological roles as revealed by the recently generated genetically modified mouse models. Our data, together with that provided by others, show that, in addition to having a role in sex steroid metabolism, several of these HSD17B enzymes possess key roles in other metabolic processes: for example, HD17B7 is essential for cholesterol biosynthesis and HSD17B12 is involved in elongation of fatty acids. Additional studies in vitro and in vivo are to be carried out in order to fully define the metabolic role of the HSD17B enzymes and to evaluate their value as drug targets.

Short-term use of parenteral nutrition with a lipid emulsion containing a mixture of soybean oil, olive oil, medium-chain triglycerides, and fish oil: a randomized double-blind study in preterm infants

BACKGROUND

For premature neonates needing parenteral nutrition (PN), a balanced lipid supply is crucial. The authors hypothesized that a lipid emulsion containing medium-chain triglycerides (MCTs) and soybean, olive, and fish oils would be as safe and well tolerated as a soybean emulsion while beneficially influencing the fatty acid profile.

METHODS

Double-blind, controlled study in 53 neonates (<34 weeks' gestation) randomized to receive at least 7 days of PN containing either an emulsion of MCTs and soybean, olive, and fish oils or a soybean oil emulsion. Target lipid dosage was 1.0 g fat/kg body weight [BW]/d on days 1-3, 2 g/kg BW/d on day 4, 3 g/kg BW/d on day 5, and 3.5 g/kg BW/d on days 6-14.

RESULTS

Test emulsion vs control, mean ± SD: baseline triglyceride concentrations were 0.52 ± 0.16 vs 0.54 ± 0.19 mmol/L and increased similarly in both groups to 0.69 ± 0.38 vs 0.67 ± 0.36 on day 8 of treatment (P = .781 for change). A significantly higher decrease in total and direct bilirubin vs baseline was seen in the test group compared with the control group P < .05 between groups). In plasma and red blood cell phospholipids, eicosapentaenoic acid and docosahexaenoic acid were higher, and the n-6/n-3 fatty acid ratio was lower in the test group (P < .05 vs control).

CONCLUSIONS

The lipid emulsion, based on a mixture of MCTs and soybean, olive, and fish oils, was safe and well tolerated by preterm infants while beneficially modulating the fatty acid profile.

Long-chain polyunsaturated fatty acid supplementation in infants born at term

BACKGROUND

The n-3 and n-6 fatty acids linolenic acid and linoleic acid are precursors of the n-3 and n-6 long chain fatty acids (LCPUFA). Infant formula has historically only contained the precursor fatty acids. Over the last few years, some manufacturers have added LCPUFA to formulae and marketed them as providing an advantage for the development of term infants.

OBJECTIVES

To assess whether supplementation of formula with LCPUFA is safe and of benefit to term infants.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, April, 2011), MEDLINE (1966 to April 2011), EMBASE (1980 to April 2011), CINAHL (December 1982 to April 2011) and abstracts of the Society for Pediatric Research (1980 to 2010). No language restrictions were applied.

SELECTION CRITERIA

Randomised and quasi randomised trials comparing LCPUFA supplemented vs. non-supplemented formula milk and with clinical endpoints were reviewed.

DATA COLLECTION AND ANALYSIS

Methodological quality of studies was assessed using the guidelines of Cochrane neonatal review group. Data were sought regarding effects on visual acuity, neurodevelopmental outcomes and physical growth. When appropriate, meta-analysis was conducted to provide a pooled estimate of effect.

MAIN RESULTS

Twenty-five randomised studies were identified; fifteen were included (n = 1889) and ten excluded.Visual acuity was assessed by nine studies. Visual evoked potential was used in six studies, two used Teller cards and one used both. Four studies reported beneficial effects while the remaining five did not.Neurodevelopmental outcome was measured by eleven studies. Bayley scales of infant development (BSID) was used in nine studies; only two showed beneficial effects. Meta-analysis did not show significant benefits of supplementation. One study followed the infants up to nine years of age and did not find benefit of supplementation. One study reported better novelty preference measured by Fagan Infant test at nine months. Another study reported better problem solving at 10 months. One study used Brunet and Lezine test to assess the developmental quotient and did not find beneficial effects.Physical growth was measured by thirteen studies; none found beneficial or harmful effects of supplementation. Meta-analysis found that supplemented group may have marginally lower weight at one year of age.

AUTHORS' CONCLUSIONS

Majority of the RCTS have not shown beneficial effects of LCPUFA supplementation on the neurodevelopmental outcomes of term infants. The beneficial effects on visual acuity have not been consistently demonstrated. Routine supplementation of term infant milk formula with LCPUFA can not be recommended.

Heart arachidonic acid is uniquely sensitive to dietary arachidonic acid and docosahexaenoic acid content in domestic piglets

This study determined the sensitivity of heart and brain arachidonic acid (ARA) and docosahexaenoic acid (DHA) to the dietary ARA level in a dose-response design with constant, high DHA in neonatal piglets. On day 3 of age, pigs were assigned to 1 of 6 dietary formulas varying in ARA/DHA as follows (% fatty acid, FA/FA): (A1) 0.1/1.0; (A2) 0.53/1.0; (A3-D3) 0.69/1.0; (A4) 1.1/1.0; (D2) 0.67/0.62; and (D1) 0.66/0.33. At necropsy (day 28) higher levels of dietary ARA were associated with increased heart and liver ARA, while brain ARA remained unaffected. Dietary ARA had no effect on tissue DHA accretion. Heart was particularly sensitive, with pigs in the intermediate groups having different ARA (A2, 18.6±0.7%; A3, 19.4±1.0%) and a 0.17% increase in dietary ARA resulted in a 0.84% increase in heart ARA. Further investigations are warranted to determine the clinical significance of heart ARA status in developing neonates.

A randomized controlled intervention with fish oil versus sunflower oil from 9 to 18 months of age: exploring changes in growth and skinfold thicknesses

n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA), from fish oil (FO), in rodents have been shown to reduce adipogenesis. Evidence of an effect on adipose tissue mass in humans is limited, and no studies have specifically aimed to elucidate this in infancy. To explore whether n-3 LCPUFA intake affects adipose tissue growth, we randomly allocated 154 healthy infants to daily supplementation with FO or sunflower oil (SO) from 9 to 18 mo of age and measured z-score changes in various anthropometric assessments of body size and skinfold thicknesses and plasma adipokine concentrations. Among the 133 completing infants, erythrocyte n-3 PUFA increased more in those receiving FO than in infants receiving SO [12.2 ± 0.7 (mean ± SE) versus 2.0 ± 0.4 fatty acid percentage (FA%), p < 0.001] with a concomitant larger decrease in n-6 PUFA (-8.9 ± 0.7 versus -0.9 ± 0.6 FA%, p < 0.001). We found no association between FO consumption relative to SO consumption and any of the anthropometric measures related to the size of the fat mass, but infants in the FO group had a lower skinfold ratio (triceps/subscapular) at 18 mo than those in SO group (p = 0.02). Our findings do not support the hypothesis that dietary n-3 LCPUFA is important for infant fat mass, but future studies testing this specifically are warranted.

Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention

A double-blind, randomized, controlled, parallel-group prospective trial was conducted to determine whether a dose-response existed for four different levels of docosahexaenoic acid (DHA) supplementation on the cognitive performance of infants. A total of 122 term infants were fed one of four different formulas varying in their DHA composition (0.00, 0.32, 0.64, and 0.96% of total fatty acids as DHA) from birth to 12 mo. The three DHA-supplemented formulas also contained 0.64% of total fatty acids as arachidonic acid (ARA, 20:4n-6). Infants were tested at 4, 6, and 9 mo of age on a visual habituation protocol that yielded both behavioral and psychophysiological indices of attention. Infants in all DHA+ARA-supplemented conditions had lower heart rates than those in the unsupplemented condition; there was no dose-response for this effect. The distribution of time that infants spent in different phases of attention (a cognitive index derived from the convergence of behavioral and cardiac responses) varied as a function of dosage. Infants supplemented at the two lower DHA doses spent proportionately more time engaged in active stimulus processing than infants fed the unsupplemented formula, whereas infants fed the highest dose were intermediate and did not differ from any other group.

Maternal supplementation of omega 3 fatty acids to micronutrient-imbalanced diet improves lactation in rat

The present study aims to examine the effect of maternal supplementation of omega 3 fatty acids to a micronutrient (folic acid and vitamin B(12))-imbalanced diet on gastric milk volume and long-chain polyunsaturated fatty acid composition. Pregnant female rats were divided into 6 groups at 2 levels of folic acid in both the presence and absence of vitamin B(12). Both vitamin B(12)-deficient groups were supplemented with omega 3 fatty acid. Gastric milk volume and long-chain polyunsaturated fatty acids were analyzed. Our results for the first time indicate that imbalance in maternal micronutrients reduces gastric milk volume and milk docosahexaenoic acid levels (P < .01 for both) as compared with control. Supplementation with omega 3 fatty acids to this diet imbalanced in micronutrients increases (P < .01) milk docosahexaenoic acid level as compared with control. Imbalance in maternal micronutrients during pregnancy can alter milk fatty acid composition, which may ultimately affect infant growth and development.

Maternal supplementation with docosahexaenoic acid during pregnancy does not affect early visual development in the infant: a randomized controlled trial

BACKGROUND

The docosahexaenoic acid (DHA) intake of pregnant women is lower than estimates of the DHA accretion by the fetus, and recommendations were made to increase the DHA intake of pregnant women.

OBJECTIVE

The objective of this study was to determine whether the supplementation of pregnant women with DHA improved the visual acuity of infants at 4 mo.

DESIGN

We conducted a blinded assessment of a subset of healthy, full-term infants born to women enrolled in a double-blind, randomized controlled trial called the DHA for Maternal and Infant Outcomes (DOMInO) trial. Women were randomly assigned to consume DHA-rich fish-oil capsules (≈800 mg DHA/d in the treatment group) or vegetable oil capsules (control group) from midpregnancy to delivery. The primary outcome was the sweep visual evoked potential (VEP) acuity at 4 mo. The VEP latency at 4 mo was a secondary outcome.

RESULTS

Mean (±SD) VEP acuity did not differ between treatment and control groups [treatment group: 8.37 ± 2.11 cycles per degree (cpd), n = 89; control group: 8.55 ± 1.86 cpd, n = 93; P = 0.55]. VEP latencies also did not differ between groups. Irrespective of the group, maternal smoking in pregnancy was independently associated with poorer VEP acuity in the infant.

CONCLUSIONS

DHA supplementation in women with singleton pregnancies does not enhance infant visual acuity in infants at 4 mo of age. Visual acuity in infancy is adversely associated with maternal smoking in pregnancy. This trial was registered at www.anzctr.org.au as ACTRN12606000327583. The DOMInO trial was registered at www.anzctr.org.au as ACTRN12605000569606.

Breastfeeding and long-chain polyunsaturated fatty acid intake in the first 4 post-natal months and infant cognitive development: an observational study

The aim of this study was to examine infant feeding and the long-chain polyunsaturated fatty acid (LCPUFA) concentration of breast milk and formulas in relation to infant development. The prospective Pregnancy, Infection and Nutrition Study (n=358) collected data on breastfeeding, breast milk samples and the formulas fed through 4months post-partum. At 12months of age, infants' development was assessed (Mullen Scales of Early Learning). Linear regression was used to examine development in relation to breastfeeding, breast milk docosahexaenoic acid (DHA) and arachidonic acid (AA) concentration, and DHA and AA concentration from the combination of breast milk and formula. The median breast milk DHA concentration was 0.20% of total fatty acids [interquartile range (IQR)=0.14, 0.34]; median AA concentration was 0.52% (IQR=0.44, 0.63). Upon adjustment for preterm birth, sex, smoking, race and ethnicity and education, breastfeeding exclusivity was unrelated to development. Among infants exclusively breastfed, breast milk LCPUFA concentration was not associated with development (Mullen composite, DHA: adjusted β=-1.3, 95% confidence interval: -10.3, 7.7). Variables combining DHA and AA concentrations from breast milk and formula, weighted by their contribution to diet, were unassociated with development. We found no evidence of enhanced infant development related to the LCPUFA content of breast milk or formula consumed during the first four post-natal months.

Achieving definitive results in long-chain polyunsaturated fatty acid supplementation trials of term infants: factors for consideration

Numerous randomized controlled trials (RCTs) have been undertaken to determine whether supplementation with long-chain polyunsaturated fatty acids (LCPUFAs) in infancy would improve the developmental outcomes of term infants. The results of such trials have been thoroughly reviewed with no definitive conclusion as to the efficacy of LCPUFA supplementation. A number of reasons for the lack of conclusive findings in this area have been proposed. This review examines such factors with the aim of determining whether an optimal method of investigation for RCTs of LCPUFA supplementation in term infants can be ascertained from previous research. While more research is required to completely inform a method that is likely to achieve definitive results, the findings of this literature review indicate future trials should investigate the effects of sex, genetic polymorphisms, the specific effects of LCPUFAs, and the optimal tests for neurodevelopmental assessment. The current literature indicates a docosahexaenoic acid dose of 0.32%, supplementation from birth to 12 months, and a total sample size of at least 286 (143 per group) should be included in the methodology of future trials.

Docosahexaenoic acid (DHA): an ancient nutrient for the modern human brain

Modern humans have evolved with a staple source of preformed docosahexaenoic acid (DHA) in the diet. An important turning point in human evolution was the discovery of high-quality, easily digested nutrients from coastal seafood and inland freshwater sources. Multi-generational exploitation of seafood by shore-based dwellers coincided with the rapid expansion of grey matter in the cerebral cortex, which characterizes the modern human brain. The DHA molecule has unique structural properties that appear to provide optimal conditions for a wide range of cell membrane functions. This has particular implications for grey matter, which is membrane-rich tissue. An important metabolic role for DHA has recently been identified as the precursor for resolvins and protectins. The rudimentary source of DHA is marine algae; therefore it is found concentrated in fish and marine oils. Unlike the photosynthetic cells in algae and higher plants, mammalian cells lack the specific enzymes required for the de novo synthesis of alpha-linolenic acid (ALA), the precursor for all omega-3 fatty acid syntheses. Endogenous synthesis of DHA from ALA in humans is much lower and more limited than previously assumed. The excessive consumption of omega-6 fatty acids in the modern Western diet further displaces DHA from membrane phospholipids. An emerging body of research is exploring a unique role for DHA in neurodevelopment and the prevention of neuropsychiatric and neurodegenerative disorders. DHA is increasingly being added back into the food supply as fish oil or algal oil supplementation.

Nutritional influences on visual development and function

Experiments conducted on many different species reveal a fundamental paradox about the vertebrate eye; it is damaged by its own operation. This vulnerability stems from the need to respond to visible light, often actinic, but also from the intrinsic metabolic and structural state of the eye's internal structures. Photoreceptor outer segments, for instance, have high concentrations of diet-derived long-chain polyunsaturated fatty acids and these membrane lipids are highly prone to peroxidation due to the high oxygen tension of the outer retina. Such a high diathesis for damage would be catastrophic if it were not balanced by an equally impressive system for responding to such stressors. The retina (and to a lesser extent the crystalline lens), for instance, is especially rich in dietary antioxidants such as vitamin E, vitamin C and the macular carotenoids (lutein and zeaxanthin) putatively to retard light-induced oxidative damage. The nutrients that support both essential function (e.g., retinal, the vitamin form of vitamin A, in photopigment) and protection operate in a highly integrated manner. For instance, Vitamin E is a lipophillic chain-breaking anti-oxidant (protecting DHA-rich outer segment membranes) that regenerates itself through reaction with vitamin C (a primary anti-oxidant against aqueous radicals) and is spatially distributed in complement with the carotenoids lutein and zeaxanthin. Nor are these interactions relegated to simply providing protection and the basic elements needed for transduction. Macular lutein and zeaxanthin, for example, improve visual performance (e.g., reduce glare disability and discomfort, speed photostress recovery, and enhance chromatic contrast) through purely optical means (by absorbing short-wave light anterior to the foveal cones). The vulnerability of the eye to exogenous insult, and the sensitivity of the eye to dietary components, is not static: infants have more vulnerable retinas due to clearer lenses and higher metabolic activity; the elderly are more vulnerable due to such factors as increased inflammatory stress and a higher content of photosensitizers (such as lipofuscin) creating cascading oxidative effects. Hence, optimal dietary prophylaxis changes as the eye ages. The eye, perhaps more than most other biological structures, has evolved an exquisite and shifting sensitivity to dietary intake throughout the lifespan, not just for its basic operation (e.g., Vitamin A for transduction), but also for its very preservation.

Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants

OBJECTIVE

We previously reported better psychomotor development at 30 months of age in infants whose mothers received a docosahexaenoic acid (DHA) (22:6n-3) supplement for the first 4 months of lactation. We now assess neuropsychological and visual function of the same children at 5 years of age.

STUDY DESIGN

Breastfeeding women were assigned to receive identical capsules containing either a high-DHA algal oil (∼200 mg/d of DHA) or a vegetable oil (containing no DHA) from delivery until 4 months postpartum. Primary outcome variables at 5 years of age were measures of gross and fine motor function, perceptual/visual-motor function, attention, executive function, verbal skills, and visual function of the recipient children at 5 years of age.

RESULTS

There were no differences in visual function as assessed by the Bailey-Lovie acuity chart, transient visual evoked potential or sweep visual evoked potential testing between children whose mothers received DHA versus placebo. Children whose mothers received DHA versus placebo performed significantly better on the Sustained Attention Subscale of the Leiter International Performance Scale (46.5 ± 8.9 vs 41.9 ± 9.3, P < .008) but there were no statistically significant differences between groups on other neuropsychological domains.

CONCLUSIONS

Five-year-old children whose mothers received modest DHA supplementation versus placebo for the first 4 months of breastfeeding performed better on a test of sustained attention. This, along with the previously reported better performance of the children of DHA-supplemented mothers on a test of psychomotor development at 30 months of age, suggests that DHA intake during early infancy confers long-term benefits on specific aspects of neurodevelopment.

Effect of docosahexaenoic acid supplementation on the macular function of patients with Best vitelliform macular dystrophy: randomized clinical trial

OBJECTIVE

Best disease is a slowly progressive macular dystrophy that typically has an onset in early childhood. Multiple lines of evidence suggest that dietary docosahexaenoic acid (DHA) protects against the development of macular degeneration. Our trial tested the effect of an oral supplement of DHA on visual function in patients with Best disease.

DESIGN

Double-masked, randomized, placebo-controlled, crossover clinical trial.

PARTICIPANTS

Eight patients with Best disease.

METHODS

Patients were given either an oral supplement of DHA (20 mg/kg daily) or placebo. Primary outcome measures were the multifocal electroretinogram (mfERG) and electro-oculogram (EOG). Plasma DHA was tracked along with visual acuity (Early Treatment Diabetic Retinopathy Study chart), VF-14 scores, and Humphrey visual fields.

RESULTS

All 8 patients had increased plasma DHA levels (2-3 fold) during periods of DHA supplementation compared with periods without supplementation. Differences in visual acuity, VF-14 scores, and EOG Arden ratios during periods with and without DHA supplementation were all statistically insignificant. A positive correlation was found between the plasma concentration of DHA and mfERG amplitudes, but amplitude changes during the treatment periods were not significant. A carryover effect of DHA supplementation was a confounding error.

CONCLUSIONS

Our pilot trial of DHA supplementation in 8 patients with Best disease did not demonstrate an improvement in macular function. An expanded trial would be needed to examine the full effects of DHA supplementation on visual function in Best disease.

Erythrocyte membrane fatty acid content in infants consuming formulas supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA): an observational study

In this observational study, we compared erythrocyte membrane fatty acids in infants consuming formula supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA) with those consuming other types of milks. In 110 infants who were participants in a cohort study of otherwise healthy children at risk for developing type 1 diabetes, erythrocytes were collected at approximately 9 months of age, and fatty acid content was measured as a percentage of total lipids. Parents reported the type of milk the infants consumed in the month of and prior to erythrocyte collection: infant formula supplemented with ARA and DHA (supplemented formula), formula with no ARA and DHA supplements (non-supplemented formula), breast milk, or non-supplemented formula plus breast milk. Membrane DHA (4.42 versus 1.79, P < 0.001) and omega-3 fatty acid (5.81 versus 3.43, P < 0.001) levels were higher in infants consuming supplemented versus non-supplemented formula. Omega-6 fatty acids were lower in infants consuming supplemented versus non-supplemented formula (26.32 versus 29.68, P = 0.023); ARA did not differ between groups. Infants given supplemented formula had higher DHA (4.42 versus 2.81, P < 0.001) and omega-3 fatty acids (5.81 versus 4.45, P = 0.008) than infants drinking breast milk. In infants whose mothers did not receive any dietary advice, use of supplemented formula is associated with higher omega-3 and lower omega-6 fatty acid status.

Compartmental analyses of 2H5-alpha-linolenic acid and C-U-eicosapentaenoic acid toward synthesis of plasma labeled 22:6n-3 in newborn term infants

BACKGROUND

During early postnatal development, the nervous system accretes docosahexaenoic acid (DHA; 22:6n-3), a highly unsaturated n-3 (omega-3) fatty acid (FA) used in the formation of neural cell membranes. DHA, which is present in human breast milk, may also be biosynthesized from n-3 FAs such as 18:3n-3 [alpha-linolenic acid (ALA)] or 20:5n-3 [eicosapentaenoic acid (EPA)]. An important concern is to what extent these precursors can supply DHA to the developing infant.

OBJECTIVE

We analyzed measurements of fractional percentages of plasma (2)H(5)-ALA and (13)C-U-EPA directed toward the synthesis of labeled 22:6n-3 in 11 newborn infants by using compartmental modeling procedures.

DESIGN

One-week-old infants received doses of (2)H(5)-ALA and (13)C-U-EPA ethyl esters enterally. We drew blood from the infants periodically and analyzed the plasma for endogenous and labeled n-3 FAs. From the time-course concentrations of the labeled FAs, we determined rate constant coefficients, fractional synthetic rates, and plasma turnover rates of n-3 FAs.

RESULTS

In infants, approximately 0.04% of the (2)H(5)-ALA dose converted to plasma (2)H(5)-EPA. Plasma (2)H(5)-EPA and (2)H(5)-22:5n-3 [docosapentaenoic acid (DPA)] efficiently converted to (2)H(5)-DPA and (2)H(5)-DHA, respectively. The percentage of plasma (13)C-U-EPA directed toward the synthesis of (13)C-DHA was lower than the percentage of plasma (2)H(5)-EPA that originated from (2)H(5)-ALA.

CONCLUSIONS

Endogenously synthesized EPA was efficiently converted to DHA. In comparison, preformed EPA was less efficiently used for DHA biosynthesis, which suggests a differential metabolism of endogenous EPA compared with exogenous EPA. However, on a per mole basis, preformed EPA was 3.6 times more effective toward DHA synthesis than was ALA. Newborns required an intake of approximately 5 mg preformed DHA. kg(-1) x d(-1) to maintain plasma DHA homeostasis.