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Olejnik A, Gornowicz-Porowska J, Jenerowicz D, Polańska A, Dobrzyńska M, Przysławski J, Sansone A, Ferreri C. Fatty Acids Profile and the Relevance of Membranes as the Target of Nutrition-Based Strategies in Atopic Dermatitis: A Narrative Review. Nutrients 2023; 15:3857. [PMID: 37686888 PMCID: PMC10489657 DOI: 10.3390/nu15173857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Recently, the prevalence of atopic dermatitis has increased drastically, especially in urban populations. This multifactorial skin disease is caused by complex interactions between various factors including genetics, environment, lifestyle, and diet. In eczema, apart from using an elimination diet, the adequate content of fatty acids from foods (saturated, monounsaturated, and polyunsaturated fatty acids) plays an important role as an immunomodulatory agent. Different aspects regarding atopic dermatitis include connections between lipid metabolism in atopic dermatitis, with the importance of the MUFA levels, as well as of the omega-6/omega-3 balance that affects the formation of long-chain (C20 eicosanoic and C22 docosaenoic) fatty acids and bioactive lipids from them (such as prostaglandins). Impair/repair of the functioning of epidermal barrier is influenced by these fatty acid levels. The purpose of this review is to drive attention to membrane fatty acid composition and its involvement as the target of fatty acid supplementation. The membrane-targeted strategy indicates the future direction for dermatological research regarding the use of nutritional synergies, in particular using red blood cell fatty acid profiles as a tool for checking the effects of supplementations to reach the target and influence the inflammatory/anti-inflammatory balance of lipid mediators. This knowledge gives the opportunity to develop personalized strategies to create a healthy balance by nutrition with an anti-inflammatory outcome in skin disorders.
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Affiliation(s)
- Anna Olejnik
- Faculty of Chemistry, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
- Centre for Advanced Technology, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 10, 61-614 Poznań, Poland
| | - Justyna Gornowicz-Porowska
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medicinal Sciences, Rokietnicka 3, 60-806 Poznań, Poland
| | - Dorota Jenerowicz
- Department of Dermatology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-356 Poznań, Poland; (D.J.); (A.P.)
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-356 Poznań, Poland; (D.J.); (A.P.)
| | - Małgorzata Dobrzyńska
- Department of Bromatology, Poznan University of Medical Sciences, Rokietnica 3, 60-806 Poznań, Poland; (M.D.); (J.P.)
| | - Juliusz Przysławski
- Department of Bromatology, Poznan University of Medical Sciences, Rokietnica 3, 60-806 Poznań, Poland; (M.D.); (J.P.)
| | - Anna Sansone
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale Delle Ricerche, Via Piero Gobetti 101, 40129 Bologna, Italy;
| | - Carla Ferreri
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale Delle Ricerche, Via Piero Gobetti 101, 40129 Bologna, Italy;
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2
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Novel Interactions of Myristic Acid and FADS3 Variants Predict Atopic Dermatitis among Indonesian Infants. Nutrients 2022; 14:nu14214676. [DOI: 10.3390/nu14214676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Fatty acids exert a range of different biological activities that could be relevant in the development of atopic dermatitis (AD). This study investigated the association of glycerophospholipid fatty acids (GPL-FA) with AD, and their interactions with single nucleotide polymorphisms (SNP) of the FADS1-3 gene cluster. Among 390 infants of the Indonesian ISADI study, GPL-FA were measured in umbilical plasma (P-0y) and in buccal cells at birth (B-0y), and again in buccal cells at AD onset or one year (B-1y). Prospective and cross-sectional associations with AD were assessed by logistic regression. Interactions of GPL-FA with 14 SNP were tested assuming an additive model. AD was diagnosed in 15.4% of participants. In B-1y, C18:2n-6 was inversely associated with AD; and positive associations were observed for C18:1n-9, C20:4n-6, C22:6n-3 and C20:4n-6/C18:2n-6. There were no prospective associations with AD, however, a significant interaction between the SNP rs174449 and B-0y C14:0 (myristic acid) was observed. This study indicates that Indonesian infants with AD have increased rates of endogenous long-chain polyunsaturated fatty acid production, as well as higher C18:1n-9 levels. GPL-FA measured at birth do not predict later AD incidence; however, genotype interactions reveal novel effects of myristic acid, which are modified by a FADS3 variant.
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Hahn KE, Dahms I, Butt CM, Salem N, Grimshaw V, Bailey E, Fleming SA, Smith BN, Dilger RN. Impact of Arachidonic and Docosahexaenoic Acid Supplementation on Neural and Immune Development in the Young Pig. Front Nutr 2020; 7:592364. [PMID: 33195377 PMCID: PMC7658628 DOI: 10.3389/fnut.2020.592364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/16/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Human milk contains both arachidonic acid (ARA) and docosahexaenoic acid (DHA). Supplementation of infant formula with ARA and DHA results in fatty acid (FA) profiles, neurodevelopmental outcomes, and immune responses in formula-fed infants that are more like those observed in breastfed infants. Consequently, ARA and DHA have been historically added together to infant formula. This study investigated the impact of ARA or DHA supplementation alone or in combination on tissue FA incorporation, immune responses, and neurodevelopment in the young pig. Methods: Male pigs (N = 48 total) received one of four dietary treatments from postnatal day (PND) 2–30. Treatments targeted the following ARA/DHA levels (% of total FA): CON (0.00/0.00), ARA (0.80/0.00), DHA (0.00/0.80), and ARA+DHA (0.80/0.80). Plasma, red blood cells (RBC), and prefrontal cortex (PFC) were collected for FA analysis. Blood was collected for T cell immunophenotyping and to quantify a panel of immune outcomes. Myelin thickness in the corpus callosum was measured by transmission electron microscopy and pig movement was measured by actigraphy. Results: There were no differences in formula intake or growth between dietary groups. DHA supplementation increased brain DHA, but decreased ARA, compared with all other groups. ARA supplementation increased brain ARA compared with all other groups but did not affect brain DHA. Combined supplementation increased brain DHA levels but did not affect brain ARA levels compared with the control. Pigs fed ARA or ARA+DHA exhibited more activity than those fed CON or DHA. Diet-dependent differences in activity suggested pigs fed ARA had the lowest percent time asleep, while those fed DHA had the highest. No differences were observed for immune or myelination outcomes. Conclusion: Supplementation with ARA and DHA did not differentially affect immune responses, but ARA levels in RBC and PFC were reduced when DHA was provided without ARA. Supplementation of either ARA or DHA alone induced differences in time spent asleep, and ARA inclusion increased general activity. Therefore, the current data support the combined supplementation with both ARA and DHA in infant formula and raise questions regarding the safety and nutritional suitability of ARA or DHA supplementation individually.
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Affiliation(s)
- Kaylee E Hahn
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Division of Nutrition Sciences, University of Illinois, Urbana, IL, United States
| | - Irina Dahms
- DSM Nutritional Products, Kaiseraugst, Switzerland
| | | | - Norman Salem
- DSM Nutritional Products, Columbia, MD, United States
| | | | - Eileen Bailey
- DSM Nutritional Products, Columbia, MD, United States
| | - Stephen A Fleming
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Neuroscience Program, University of Illinois, Urbana, IL, United States
| | - Brooke N Smith
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Ryan N Dilger
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Division of Nutrition Sciences, University of Illinois, Urbana, IL, United States.,Neuroscience Program, University of Illinois, Urbana, IL, United States
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4
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Arachidonic Acid in Human Milk. Nutrients 2020; 12:nu12030626. [PMID: 32121018 PMCID: PMC7146261 DOI: 10.3390/nu12030626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
Breastfeeding is universally recommended as the optimal choice of infant feeding and consequently human milk has been extensively investigated to unravel its unique nutrient profile. The human milk lipid composition is unique and supplies specifically long-chain polyunsaturated fatty acids (LC-PUFAs), in particular, arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3). Arachidonic acid (ARA) is the most predominant long-chain polyunsaturated fatty acid in human milk, albeit at low concentrations as compared to other fatty acids. It occurs predominantly in the triglyceride form and to a lesser extent as milk fat globule membrane phospholipids. Human milk ARA levels are modulated by dietary intake as demonstrated by animal and human studies and consequently vary dependent on dietary habits among mothers and regions across the globe. ARA serves as a precursor to eicosanoids and endocannabinoids that also occur in human milk. A review of scientific and clinical studies reveals that ARA plays an important role in physiological development and its related functions during early life nutrition. Therefore, ARA is an important nutrient during infancy and childhood and, as such, appropriate attention is required regarding its nutritional status and presence in the infant diet. Data are emerging indicating considerable genetic variation in encoding for desaturases and other essential fatty acid metabolic enzymes that may influence the ARA level as well as other LC-PUFAs. Human milk from well-nourished mothers has adequate levels of both ARA and DHA to support nutritional and developmental needs of infants. In case breastfeeding is not possible and infant formula is being fed, experts recommend that both ARA and DHA are added at levels present in human milk.
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Koletzko B, Bergmann K, Brenna JT, Calder PC, Campoy C, Clandinin MT, Colombo J, Daly M, Decsi T, Demmelmair H, Domellöf M, FidlerMis N, Gonzalez-Casanova I, van Goudoever JB, Hadjipanayis A, Hernell O, Lapillonne A, Mader S, Martin CR, Matthäus V, Ramakrishan U, Smuts CM, Strain SJJ, Tanjung C, Tounian P, Carlson SE. Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation. Am J Clin Nutr 2020; 111:10-16. [PMID: 31665201 DOI: 10.1093/ajcn/nqz252] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
Abstract
Recently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from February 2020 onwards, all such products marketed in the European Union must contain 20-50 mg omega-3 DHA (22:6n-3) per 100 kcal, which is equivalent to about 0.5-1% of fatty acids (FAs) and thus higher than typically found in human milk and current infant formula products, without the need to also include ω-6 arachidonic acid (AA; 20:4n-6). This novel concept of infant formula composition has given rise to concern and controversy because there is no accountable evidence on its suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and AA, and to discuss the questions arising from the new European regulatory standards. Based on the available information, we recommend that infant and follow-on formula should provide both DHA and AA. The DHA should equal at least the mean content in human milk globally (0.3% of FAs) but preferably reach 0.5% of FAs. Although optimal AA intake amounts remain to be defined, we strongly recommend that AA should be provided along with DHA. At amounts of DHA in infant formula up to ∼0.64%, AA contents should at least equal the DHA contents. Further well-designed clinical studies should evaluate the optimal intakes of DHA and AA in infants at different ages based on relevant outcomes.
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Affiliation(s)
- Berthold Koletzko
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany.,Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Karin Bergmann
- Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - J Thomas Brenna
- Dell Pediatric Research Institute, Departments of Pediatrics, Chemistry, and Nutrition, University of Texas at Austin, Austin, TX, USA.,Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Philip C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Cristina Campoy
- Department of Pediatrics, University of Granada, Granada, Spain
| | - M Tom Clandinin
- Departments of Agriculture, Food and Nutritional Science and of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John Colombo
- Department of Psychology and Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Mandy Daly
- Irish Neonatal Health Alliance, Bray, Ireland
| | - Tamás Decsi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Hans Demmelmair
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Magnus Domellöf
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Nataša FidlerMis
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Johannes B van Goudoever
- Amsterdam Academic Medical Center, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | - Adamos Hadjipanayis
- Pediatric Department, Larnaca General Hospital, Larnaca, Cyprus.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Olle Hernell
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France.,Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Valerie Matthäus
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Usha Ramakrishan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sean J J Strain
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | | | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
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6
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Serafim V, Chirita-Emandi A, Andreescu N, Tiugan DA, Tutac P, Paul C, Velea I, Mihailescu A, Șerban CL, Zimbru CG, Puiu M, Niculescu MD. Single Nucleotide Polymorphisms in PEMT and MTHFR Genes are Associated with Omega 3 and 6 Fatty Acid Levels in the Red Blood Cells of Children with Obesity. Nutrients 2019; 11:nu11112600. [PMID: 31671528 PMCID: PMC6893426 DOI: 10.3390/nu11112600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 01/17/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs) play important roles in health and disease. PUFA levels are influenced by nutrition and genetic factors. The relationship between PUFA composition in red blood cells (RBCs) and genetic variations involved in PUFA metabolism has not been investigated in children with obesity. This study evaluated the association between several genetic variations and PUFA levels in RBCs in children with obesity. One hundred ninety-six children with obesity (101 females, 95 males) were evaluated using anthropometric measurements, dietary intakes, plasma and RBC PUFA quantification, blood biochemistry, and 55 single nucleotide polymorphisms within 14 genes. phosphatidylethanolamine N-methyltransferase (PEMT) rs1109859 and methylenetetrahydrofolate reductase gene (MTHFR) rs4846052 genotypes were associated with PUFA levels in RBCs. PUFA intake did not influence the RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. Higher RBC DHA and EPA levels were observed for PEMT rs1109859 GG and GA genotypes versus the AA genotype. Higher levels of RBC DHA, EPA, arachidonic acid (ARA), and linoleic acid (LA) and were observed for MTHFR rs4846052 TT genotype versus TC and CC genotypes. Genetic variations in PEMT rs1109859 and MTHFR rs4846052 were associated with different PUFA levels in RBC membranes and are estimators for PUFA species in RBCs. Further research is needed to establish whether these genotype-specific alterations are specific to overweight children.
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Affiliation(s)
- Vlad Serafim
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- The National Institute of Research and Development for Biological Sciences, Bucharest 060031, Romania.
| | - Adela Chirita-Emandi
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- "Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara 300011, Romania.
| | - Nicoleta Andreescu
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- "Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara 300011, Romania.
| | - Diana-Andreea Tiugan
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- "Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara 300011, Romania.
| | - Paul Tutac
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- "Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara 300011, Romania.
| | - Corina Paul
- Paediatrics Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- 2nd Paediatrics Clinic, Clinical Emergency County Hospital, Timisoara 300041, Romania.
| | - Iulian Velea
- Paediatrics Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- 2nd Paediatrics Clinic, Clinical Emergency County Hospital, Timisoara 300041, Romania.
| | - Alexandra Mihailescu
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
| | - Costela Lăcrimioara Șerban
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timișoara 300041, Romania.
| | - Cristian G Zimbru
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- Faculty of Automation and Computer Science, Politehnica University of Timisoara, Timisoara 300223, Romania.
| | - Maria Puiu
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- "Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara 300011, Romania.
| | - Mihai Dinu Niculescu
- Centre of Genomic Medicine, Genetics Discipline, "Victor Babes" University of Medicine and Pharmacy, Timisoara 300041, Romania.
- Advanced Nutrigenomics, 130 Rainbow Ct, Cary, NC 27511, USA.
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7
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Koletzko B, Reischl E, Tanjung C, Gonzalez-Casanova I, Ramakrishnan U, Meldrum S, Simmer K, Heinrich J, Demmelmair H. FADS1 and FADS2 Polymorphisms Modulate Fatty Acid Metabolism and Dietary Impact on Health. Annu Rev Nutr 2019; 39:21-44. [PMID: 31433740 DOI: 10.1146/annurev-nutr-082018-124250] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Variants in the FADS gene cluster modify the activity of polyunsaturated fatty acid (PUFA) desaturation and the lipid composition in human blood and tissue. FADS variants have been associated with plasma lipid concentrations, risk of cardiovascular diseases, overweight, eczema, pregnancy outcomes, and cognitive function. Studies on variations in the FADS genecluster provided some of the first examples for marked gene-diet interactions in modulating complex phenotypes, such as eczema, asthma, and cognition. Genotype distribution differs markedly among ethnicities, apparently reflecting an evolutionary advantage of genotypes enabling active long-chain PUFA synthesis when the introduction of agriculture provided diets rich in linoleic acid but with little arachidonic and eicosapentaenoic acids. Discovering differential effects of PUFA supply that depend on variation of FADS genotypes could open new opportunities for developing precision nutrition strategies based either on an individual's genotype or on genotype distributions in specific populations.
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Affiliation(s)
- Berthold Koletzko
- Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilians-Universität München, 80337 Munich, Germany;
| | - Eva Reischl
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München (German Research Center for Environmental Health), 85764 Neuherberg, Germany
| | - Conny Tanjung
- Jakarta and Indonesian Medical Education and Research Institute, Hubert Pantai Indah Kapuk Hospital, Jakarta 14460, Indonesia
| | - Ines Gonzalez-Casanova
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA
| | - Suzanne Meldrum
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center (CPC) Munich, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Hans Demmelmair
- Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilians-Universität München, 80337 Munich, Germany;
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