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Sigh S, Lauritzen L, Wieringa FT, Laillou A, Chamnan C, Stark KD, Roos N. Changes in polyunsaturated fatty acids during treatment of malnourished children may be insufficient to reach required essential fatty acid levels - A randomised controlled trial. Clin Nutr 2023; 42:1778-1787. [PMID: 37572581 DOI: 10.1016/j.clnu.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND & AIMS Severe acute malnutrition (SAM) is a global concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on polyunsaturated fatty acids (PUFA) are almost non-existent. The aim was to investigate the change in whole-blood PUFA and nutrition and health markers among Cambodian children with SAM after treatment with RUTFs. METHODS The trial was an 8-week randomised clinical trial of the effectiveness of locally produced fish-based RUTF (L-RUTF) vs standard milk-based RUFT (S-RUTF). Whole-blood fatty acids were analysed using dried blood spots. Nutrition and health markers were assessed using anthropometric assessment and blood samples for markers of inflammation. The trial was conducted at the National Pediatric Hospital, Phnom Penh, Cambodia, with one hundred and twenty-one 6-59-month-old children in treatment for SAM. RESULTS L-RUTF had a higher content of n-3 PUFA and a higher content of arachidonic acid (AA) and docosahexaenoic acid (DHA), while S-RUTF had the highest content of n-6 PUFA. At baseline, the children presented with a Mead acid level in whole-blood of around 0.08% of total fatty acids (FA%) and an omega-3 index of ∼0.91 ± 0.44. After eight weeks of S-RUTF treatment, linoleic acid (LA), AA, n-6/n-3 PUFA ratio, and Mead acid levels were increased. The L-RUTF intervention did not change the whole-blood PUFAs from baseline. At discharge, the children in the L-RUTF group had a lower n-6/n-3 PUFA ratio than the children in the S-RUTF group, driven by a lower alpha-linolenic acid (ALA) (0.20 vs 0.27 FA%, p = 0.004) and lower LA (15.77 vs 14.21 FA%, p = 0.018) with no significant differences in AA or DHA levels. Weight-for-height z-score at discharge was negatively associated with total PUFA (β -1.4 FA%, 95%CI. -2.7; -0.1), n-6 LCPUFA (β -1.3 FA%, 95%CI. -1.3; -0.3), and AA (β -0.6 FA%, 95%CI. -1.0; -0.2). Age-adjusted height was negatively associated with the Mead acid:AA ratio (β -1.2 FA%, 95%CI. -2.2; -0.2). No significant change was seen in inflammation markers within groups or between groups during treatment, and n-3 and n-6 PUFAs were not associated with markers of inflammation or haemoglobin status at discharge. CONCLUSION The trial found that whole-blood markers of PUFA status were low in children at admission and discharge from SAM treatment, indicating that the currently recommended composition of RUTFs are not able to correct their compromised essential fatty acid status. The higher content of DHA and AA in L-RUTF did not give rise to any improvement in PUFA status. No changes in health markers or associations between PUFA and health markers were found. TRIAL REGISTRATION ClinicalTrials.gov: NCT02907424.
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Affiliation(s)
- Sanne Sigh
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, #186 Preah Norodom Boulevard, 12101 Phnom Penh, Cambodia.
| | - Lotte Lauritzen
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark.
| | - Frank T Wieringa
- UMR QualiSud, Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France.
| | - Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar 29720, Senegal.
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, #186 Preah Norodom Boulevard, 12101 Phnom Penh, Cambodia.
| | - Ken D Stark
- University of Waterloo, Department of Kinesiology and Health Sciences, 200 University Avenue, Waterloo, ON N2L3G1, Canada.
| | - Nanna Roos
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark.
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Cardino VN, Goeden T, Yakah W, Ezeamama AE, Fenton JI. New Perspectives on the Associations between Blood Fatty Acids, Growth Parameters, and Cognitive Development in Global Child Populations. Nutrients 2023; 15:nu15081933. [PMID: 37111152 PMCID: PMC10143140 DOI: 10.3390/nu15081933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Malnutrition is prevalent in low-middle-income countries (LMICs), but it is usually clinically diagnosed through abnormal anthropometric parameters characteristic of protein energy malnutrition (PEM). In doing so, other contributors or byproducts of malnutrition, notably essential fatty acid deficiency (EFAD), are overlooked. Previous research performed mainly in high-income countries (HICs) shows that deficiencies in essential fatty acids (EFAs) and their n-3 and n-6 polyunsaturated fatty acid (PUFA) byproducts (also known as highly unsaturated fatty acids or HUFAs) lead to both abnormal linear growth and impaired cognitive development. These adverse developmental outcomes remain an important public health issue in LMICs. To identify EFAD before severe malnutrition develops, clinicians should perform blood fatty acid panels to measure levels of fatty acids associated with EFAD, notably Mead acid and HUFAs. This review demonstrates the importance of measuring endogenous fatty acid levels for measuring fatty acid intake in various child populations in LMICs. Featured topics include a comparison of fatty acid levels between global child populations, the relationships between growth and cognition and PUFAs and the possible mechanisms driving these relationships, and the potential importance of EFAD and HUFA scores as biomarkers of overall health and normal development.
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Affiliation(s)
- Vanessa N Cardino
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Travis Goeden
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - William Yakah
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Amara E Ezeamama
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA
| | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
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Syrén ML, Turolo S, de Marco EA, De Cosmi V, Risé P, Marangoni F, Minoli DG, Manzoni G, Agostoni C. Whole blood fatty acid profile of young subjects and adherence to the Mediterranean diet: an observational cohort study. Lipids Health Dis 2022; 21:23. [PMID: 35177087 PMCID: PMC8851752 DOI: 10.1186/s12944-022-01633-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Relatively little is known about the physiological whole blood fatty acid composition in young people. Likewise, few studies have addressed the question of correlations between Mediterranean diet (MedDiet) adherence and blood fatty acids in childhood. Methods The fatty acid profile in whole blood from subjects, 46 days-19 years old (n = 152), without acute, chronic, or inflammatory diseases was analysed by gas chromatography. Dietary data was extracted from a 24-h recall in a subgroup of subjects (n = 60) into a modified Diet Quality Index for Children (KIDMED) questionnaire to evaluate MedDiet adherence. The cohort was divided into three age groups: < 2, 2- < 10, and 10–19 years. Kruskal-Wallis test and Bonferroni post hoc test were used to check for age group fatty acid differences. For correlations, Spearman’s correlation coefficient and partial Spearman’s correlation coefficient were used. Results Linoleic acid, EPA, DHA, palmitic acid, and total saturated fatty acids were stable over age groups. Dihomo-gamma-linolenic acid (DGLA), arachidonic acid (AA), total polyunsaturated FAs (PUFA), and total omega-6 PUFA increased from age group < 2 years; alpha-linolenic acid, total omega-3 PUFA, oleic acid, and total monounsaturated FAs decreased. Adherence to the MedDiet was at low-medium level in 91.7% of the subjects. In the age group 2- < 10 yrs., the degree of adherence correlated positively with total MUFA and PUFA balance, negatively with total PUFA, total n6-PUFA, AA/DHA, AA/EPA, and n6/n3. Age did not influence the correlations as to PUFA balance and AA/EPA. Conclusions Increased FA proportions with age were seen in the n6-series of PUFA. The n3-FA species decreased or were stable. The vast majority of the subjects with dietary data, 92%, obtained a KIDMED score indicative of low-medium adherence to the MedDiet. The score correlated negatively with various n6-species, i.e. the MedDiet suppressed circulating n6-PUFA. Whole blood may be used to investigate FAs and MedDiet adherence correlations which may be applied in the study of health issues in childhood.
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Affiliation(s)
- Marie-Louise Syrén
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 9, 20122, Milan, Italy.
| | - Stefano Turolo
- Pediatric Nephrology, Dialysis and Transplant unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Erika Adalgisa de Marco
- Pediatric Urology unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 9, 20122, Milan, Italy.,Pediatric Intermediate Care unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Patrizia Risé
- Department of Pharmaceutical Sciences, University of Milan, Via Balzaretti 13, 20133, Milan, Italy
| | - Franca Marangoni
- NFI, Nutrition Foundation of Italy, Viale Tunisia 38, 20124, Milan, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 9, 20122, Milan, Italy.,Pediatric Intermediate Care unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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Madrigal C, Soto-Méndez MJ, Leis R, Hernández-Ruiz Á, Valero T, Lara Villoslada F, Martínez de Victoria E, Moreno JM, Ortega RM, Ruiz-López MD, Varela-Moreiras G, Gil Á. Dietary Intake, Nutritional Adequacy and Food Sources of Total Fat and Fatty Acids, and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Results of the EsNuPI Study. Nutrients 2020; 12:E2467. [PMID: 32824377 PMCID: PMC7468841 DOI: 10.3390/nu12082467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022] Open
Abstract
We aimed to determine the usual intake of total fat, fatty acids (FAs), and their main food sources in a representative cohort of the Spanish pediatric population aged 1 to <10 years (n = 707) who consumed all types of milk and an age-matched cohort who consumed adapted milk over the last year (including follow-on formula, toddler's milk, growing-up milk, and fortified and enriched milks) (n = 741) who were participants in the EsNuPI study (in English, Nutritional Study in the Spanish Pediatric Population). Dietary intake, measured through two 24 h dietary recalls, was compared to the European Food Safety Authority (EFSA) and the Food and Agriculture Organization of the United Nations (UN-FAO) recommendations. Both cohorts showed a high intake of saturated fatty acids (SFAs), according to FAO recommendations, as there are no numerical recommendations for SFAs at EFSA. Also, low intake of essential fatty acids (EFAs; linoleic acid (LA) and α-linolenic acid (ALA)) and long-chain polyunsaturated fatty acids (LC-PUFA) of the n-3 series, mainly docosahexaenoic acid (DHA) were observed according to EFSA and FAO recommendations. The three main sources of total fat and different FAs were milk and dairy products, oils and fats, and meat and meat products. The consumption of adapted milk was one of the main factors associated with better adherence to the nutritional recommendations of total fat, SFAs, EFAs, PUFAs; and resulted as the main factor associated with better adherence to n-3 fatty acids intake recommendations. Knowledge of the dietary intake and food sources of total fat and FAs in children could help in designing and promoting effective and practical age-targeted guidelines to promote the consumption of EFA- and n-3 PUFA-rich foods in this stage of life.
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Affiliation(s)
- Casandra Madrigal
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain; (C.M.); (M.D.R.-L.)
- Iberoamerican Nutrition Foundation (FINUT), Av. del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - María José Soto-Méndez
- Iberoamerican Nutrition Foundation (FINUT), Av. del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - Rosaura Leis
- Department of Pediatrics, Unit of Pediatric Gastroenterology, Hepatology and Nutrition University Clinical Hospital of Santiago, 15706 Santiago de Compostela, Spain;
- Instituto de Investigación Sanitaria de Santiago, IDIS, Santiago de Compostela, University Clinical Hospital of Santiago, 15706 Santiago de Compostela, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ángela Hernández-Ruiz
- Iberoamerican Nutrition Foundation (FINUT), Av. del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - Teresa Valero
- Spanish Nutrition Foundation (FEN), c/General Álvarez de Castro 20, 1ªpta, 28010 Madrid, Spain;
| | | | - Emilio Martínez de Victoria
- Department of Physiology, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain;
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
| | - José Manuel Moreno
- Pediatric Department, University of Navarra Clinic, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain;
| | - Rosa M. Ortega
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain;
| | - María Dolores Ruiz-López
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain; (C.M.); (M.D.R.-L.)
- Iberoamerican Nutrition Foundation (FINUT), Av. del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
| | - Gregorio Varela-Moreiras
- Department of Pediatrics, Unit of Pediatric Gastroenterology, Hepatology and Nutrition University Clinical Hospital of Santiago, 15706 Santiago de Compostela, Spain;
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, Urb. Montepríncipe, crta. Boadilla km. 5.3, Boadilla del Monte, 28668 Madrid, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Av. del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
- CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
- Department of Biochemistry and Molecular Biology II University of Granada, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain
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Whole-blood PUFA and associations with markers of nutritional and health status in acutely malnourished children in Cambodia. Public Health Nutr 2020; 23:974-986. [PMID: 31973779 DOI: 10.1017/s1368980019003744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status. DESIGN PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts. SETTING Cambodia. PARTICIPANTS The study was conducted with 174 children aged 0·5-18 years with acute malnutrition. RESULTS Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA. CONCLUSIONS Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.
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Jain R, Ezeamama AE, Sikorskii A, Yakah W, Zalwango S, Musoke P, Boivin MJ, Fenton JI. Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status-A Cross-Sectional Study. Nutrients 2019; 11:nu11061268. [PMID: 31167445 PMCID: PMC6628545 DOI: 10.3390/nu11061268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022] Open
Abstract
Fatty acids (FAs) are crucial in child growth and development. In Uganda, antiretroviral therapy (ART) has drastically reduced perinatal human immunodeficiency virus (HIV) infection of infants, however, the interplay of FAs, ART, and HIV in relation to child growth is not well understood. To investigate this, serum was collected from 240 children between 6–10 years old in Uganda and analyzed for FAs using gas-chromatography mass-spectrometry. HIV status and anthropometric measurements were taken, and relationships with FAs were assessed. No significant differences in growth parameters or serum FAs were found between HIV uninfected children with and without exposure to ART. HIV positive children had significantly lower height-for-age-z-scores (HAZ) than uninfected children (p < 0.001). HIV-positive children had higher arachidonic acid than uninfected children (p = 0.003). Total omega-6 FAs were significantly associated with HAZ regardless of HIV status (p = 0.035). Mean total omega-3 FAs (2.90%) were low in this population compared to other cohorts in Africa. These results provide reference serum FA values for 6–10-year-old children in Uganda and may be used to inform lipid supplementation programs to promote child growth. Future studies should investigate the relationships between child growth trajectories in relation to HIV status and serum FAs.
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Affiliation(s)
- Raghav Jain
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
| | - Amara E Ezeamama
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA.
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA.
| | - William Yakah
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
| | - Sarah Zalwango
- Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala 00256, Uganda.
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala 00256, Uganda.
| | - Michael J Boivin
- Departments of Psychiatry, Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
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