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Amza M, Haj Hamoud B, Sima RM, Dinu MD, Gorecki GP, Popescu M, Gică N, Poenaru MO, Pleș L. Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA)-Should They Be Mandatory Supplements in Pregnancy? Biomedicines 2024; 12:1471. [PMID: 39062044 PMCID: PMC11274850 DOI: 10.3390/biomedicines12071471] [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: 05/14/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are essential fatty acids for the human body. Seafood and microalgae are the most important sources of omega-3 fatty acids. Supplementation with 200 mg/day of DHA during pregnancy and breastfeeding has been suggested for women and infants in countries with low seafood consumption. Maternal concentration of DHA and EPA was associated with concentration in cord blood and breast milk. High concentrations of DHA and EPA were identified at the level of retinal photoreceptors and neuronal cell membranes. It was observed that supplementation with DHA and EPA during pregnancy had beneficial effects on the neurological development of the fetus and infant by improving language, memory, attention, and hand coordination, affecting sleep patterns, and improving visual acuity. Beneficial effects on the development of the infant were also associated with the maternal intake of omega-3 fatty acids during breastfeeding. Supplementation with DHA and EPA may reduce the risk of preterm birth but also of preeclampsia in low-risk pregnancies. Women of childbearing age should have an intake of 250 mg/day of DHA + EPA from their diet or supplements. To reduce the risk of premature birth, pregnant women must additionally receive at least 100-200 mg of DHA every day. It is recommended that supplementation with omega-3 fatty acids starts before 20 weeks of pregnancy. Beneficial effects on the mother have been identified, such as the reduction of postpartum depression symptoms, the decrease of cardiovascular risk, and the anti-inflammatory role.
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Affiliation(s)
- Mihaela Amza
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.A.); (N.G.); (M.-O.P.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
- Department PhD, IOSUD, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany;
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.A.); (N.G.); (M.-O.P.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Mihai-Daniel Dinu
- Department PhD, IOSUD, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - Mihai Popescu
- Department of Anaesthesia and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Anaesthesia and Intensive Care, Bucharest University Emergency Hospital, 050098 Bucharest, Romania
| | - Nicolae Gică
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.A.); (N.G.); (M.-O.P.); (L.P.)
- Filantropia Clinical Hospital Bucharest, 011132 Bucharest, Romania
| | - Mircea-Octavian Poenaru
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.A.); (N.G.); (M.-O.P.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.A.); (N.G.); (M.-O.P.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
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Shahabi B, Hernández-Martínez C, Voltas N, Canals J, Arija V. The Maternal Omega-3 Long-Chain Polyunsaturated Fatty Acid Concentration in Early Pregnancy and Infant Neurodevelopment: The ECLIPSES Study. Nutrients 2024; 16:687. [PMID: 38474815 DOI: 10.3390/nu16050687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Omega-3 Long-Chain Polyunsaturated Fatty Acids (n-3 LCPUFAs) play a key role in early neurodevelopment, but evidence from observational and clinical studies remains inconsistent. This study investigates the association between maternal n-3 LCPUFA, Docosahexaenoic Acid (DHA), and eicosapentaenoic acid (EPA) concentrations during pregnancy and infant development functioning at 40 days. This study includes 348 mother-infant pairs. Maternal serum concentrations were assessed in the first and third trimesters alongside sociodemographic, clinical, nutritional, psychological, and obstetrical data. At 40 days, the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was administered. An adjusted analysis revealed that lower first-trimester n-3 LCPUFA and DHA concentrations are associated with better infant motor development. These results underscore the potential significance of the maternal n-3 LCPUFA status in early pregnancy for influencing fetal neurodevelopment. However, the complexity of these associations necessitates further investigation, emphasizing the urgent need for additional studies to comprehensively elucidate the nuanced interplay between the maternal n-3 LCPUFA status and infant neurodevelopment.
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Affiliation(s)
- Behnaz Shahabi
- Research Group in Nutrition and Mental Health (NUTRISAM), Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Carmen Hernández-Martínez
- Research Group in Nutrition and Mental Health (NUTRISAM), Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain
- Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Núria Voltas
- Research Group in Nutrition and Mental Health (NUTRISAM), Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain
- Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, 43003 Tarragona, Spain
- Serra Húnter Fellow, Department of Psychology, Faculty of Education Sciences and Psychology, Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Josefa Canals
- Research Group in Nutrition and Mental Health (NUTRISAM), Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain
- Research Center for Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Victoria Arija
- Research Group in Nutrition and Mental Health (NUTRISAM), Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain
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Oken E, Musci RJ, Westlake M, Gachigi K, Aschner JL, Barnes KL, Bastain TM, Buss C, Camargo CA, Cordero JF, Dabelea D, Dunlop AL, Ghassabian A, Hipwell AE, Hockett CW, Karagas MR, Lugo-Candelas C, Margolis AE, O’Connor TG, Shuster CL, Straughen JK, Lyall K. Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme. Public Health Nutr 2024; 27:e94. [PMID: 38410088 PMCID: PMC10993063 DOI: 10.1017/s136898002400051x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake. DESIGN Pooled pregnancy cohort studies. SETTING Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020. PARTICIPANTS A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use. RESULTS Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1-2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35-40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never). CONCLUSIONS One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease research across the Lifecourse, Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, 401 Park Drive, Suite 401 East, Boston,
MA, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD,
USA
| | | | - Kennedy Gachigi
- Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Judy L Aschner
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital,
Hackensack Meridian School of Medicine, Nutley,
NJ, USA
- Albert Einstein College of Medicine, Bronx,
NY, USA
| | | | - Theresa M Bastain
- Department of Population and Public Health Sciences,
University of Southern California, Los Angeles,
CA, USA
| | - Claudia Buss
- Department of Medical Psychology, Charité University of
Medicine Berlin, Berlin, Germany
- Development, Health, Disease Research Program, University of
California Irvine, Irvine, CA,
USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA,
USA
| | - Jose F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, GA,
USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University
School of Medicine, Atlanta, GA,
USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman
School of Medicine, New York, NY,
USA
| | - Alison E Hipwell
- Department of Psychiatry, University of
Pittsburgh, Pittsburgh, PA,
USA
| | | | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at
Dartmouth, Lebanon, NH, USA
| | | | - Amy E Margolis
- Columbia University Irving Medical center, New York,
NY, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and
Gynecology, University of Rochester, Rochester,
NY, USA
| | - Coral L Shuster
- Brown Center for the Study of Children at Risk, Women and
Infants Hospital, Providence, RI,
USA
| | - Jennifer K Straughen
- Department of Public Health Sciences, Henry Ford Health
System, Detroit, MI, USA
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Mahadevan J, Gautam M, Benegal V. Mental health and well-being for the prevention of substance use disorders. Indian J Psychiatry 2024; 66:S272-S282. [PMID: 38445279 PMCID: PMC10911324 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_716_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Jayant Mahadevan
- Department of Psychiatry, Centre for Addiction Medicine, NIMHANS, Bangalore, Karnataka, India E-mail:
| | - Manaswi Gautam
- Consultant Psychiatrist, Gautam Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, NIMHANS, Bangalore, Karnataka, India E-mail:
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Cáceres A, Cruz SM, de León C, Méndez R. Yield and Chemical Characteristics of Salvia hispanica L. (Chia) Oil from Native Seeds from Four Provenances of Guatemala. Comb Chem High Throughput Screen 2024; 27:555-561. [PMID: 37183473 DOI: 10.2174/1386207326666230512124457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Chia (Salvia hispanica L.) is a plant from the Lamiaceae family that has been used as ancestral food, medicine, and oil, with culinary, artistic, and religious purposes by most of the Mesoamerican civilizations. Native from Mesoamerica, introduced into South America, Australia, and Europe, it is presently consumed as a nutritional and functional food. OBJECTIVE This research aims to characterize ancient native cultivars from four provenances in Guatemala to recommend their direct consumption by the population as well as to establish its trade. METHODS Seed samples were collected in four places where they have been cultivated for several generations. The oil was obtained by expression and analyzed chemically by gas chromatography following standard qualitative and quantitative methods. RESULTS Variations in oil yield and some of the characteristic parameters of the phytochemical analysis were obtained. In general, the profile was similar to most of the reported data in the literature, with the saturated fatty acids (8.54-9.25%) relatively lower than the references (7.95-11.45%) but a higher concentration of unsaturated fatty oils, particularly of omega-3 (64.68-68.62%). CONCLUSION The oil from native cultivars contains high quantities of omega-3, which might help pregnant women during gestation and to control other conditions such as metabolic syndrome, particularly in low- and middle-income populations where these seeds are consumed regularly. The suggestion is made to encourage the cultivation and use of these ancestral seeds with the possibility of commercialization abroad with an appellation of origin label.
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Affiliation(s)
- Armando Cáceres
- Laboratorio de Investigación de Productos Naturales (Lipronat), Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos, Cdad. de Guatemala, 01002, Guatemala
- Laboratorio de Productos Naturales Farmaya, Guatemala
| | - Sully M Cruz
- Laboratorio de Investigación de Productos Naturales (Lipronat), Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos, Cdad. de Guatemala, 01002, Guatemala
| | - Claudia de León
- Instituto de Investigaciones Químicas, Biológicas, Biomédicas y Biofísicas, Universidad Mariano Gálvez, Cdad. de Guatemala, Guatemala
| | - Rebeca Méndez
- Instituto de Investigaciones Químicas, Biológicas, Biomédicas y Biofísicas, Universidad Mariano Gálvez, Cdad. de Guatemala, Guatemala
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Klievik BJ, Tyrrell AD, Chen CT, Bazinet RP. Measuring brain docosahexaenoic acid turnover as a marker of metabolic consumption. Pharmacol Ther 2023:108437. [PMID: 37201738 DOI: 10.1016/j.pharmthera.2023.108437] [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: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Docosahexaenoic acid (DHA, 22:6n-3) accretion in brain phospholipids is critical for maintaining the structural fluidity that permits proper assembly of protein complexes for signaling. Furthermore, membrane DHA can by released by phospholipase A2 and act as substrate for synthesis of bioactive metabolites that regulate synaptogenesis, neurogenesis, inflammation, and oxidative stress. Thus, brain DHA is consumed through multiple pathways including mitochondrial β-oxidation, autoxidation to neuroprostanes, as well as enzymatic synthesis of bioactive metabolites including oxylipins, synaptamide, fatty-acid amides, and epoxides. By using models developed by Rapoport and colleagues, brain DHA loss has been estimated to be 0.07-0.26 μmol DHA/g brain/d. Since β-oxidation of DHA in the brain is relatively low, a large portion of brain DHA loss may be attributed to synthesis of autoxidative and bioactive metabolites. In recent years, we have developed a novel application of compound specific isotope analysis to trace DHA metabolism. By the use of natural abundance in 13C-DHA in food supply, we are able to trace brain phospholipid DHA loss in free-living mice with estimates ranging from 0.11 to 0.38 μmol DHA/g brain/d, in reasonable agreement with previous methods. This novel fatty acid metabolic tracing methodology should improve our understanding of the factors that regulate brain DHA metabolism.
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Affiliation(s)
- Brinley J Klievik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Aidan D Tyrrell
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Chuck T Chen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
| | - Richard P Bazinet
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8.
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Marc I, Boutin A, Pronovost E, Guillot M, Bergeron F, Moore L, Makrides M. High doses of enteral docosahexaenoic acid omega-3 supplementation for prevention of bronchopulmonary dysplasia in very preterm infants: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e064515. [PMID: 36253040 PMCID: PMC9577938 DOI: 10.1136/bmjopen-2022-064515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Docosahexaenoic acid (DHA) supplementation in the neonatal period has been proposed to prevent bronchopulmonary dysplasia (BPD) in very preterm infants. We aim to determine the effects of an enteral supplementation with high doses of DHA on the risk for BPD at 36 weeks' postmenstrual age (PMA) in very preterm infants born less than 29 weeks' gestation compared with a control. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) searching PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, MedRxiv, ClinicalTrials.gov (up to 1 November 2021) as well as reference lists and citations of included articles and previous reviews. RCTs targeting infants born less than 29 weeks' gestation and evaluating the effect of high doses of DHA enteral supplementation in the neonatal period compared with a control will be eligible. Primary outcome will be BPD defined as the need for oxygen and/or ventilation at 36 weeks' PMA. Two authors will independently screen for inclusion, extract data and assess data quality using the Cochrane instrument (risk-of-bias tool 2.0). We will perform meta-analysis using random effects models. Prespecified subgroup analyses are planned for the infant gestational age and sex, the marine source of DHA, mode of administration and duration of exposure. Sensitivity analysis will be performed according to the accuracy of the BPD definition (ie, physiological definition) and according to the risk of bias of the RCTs. ETHICS AND DISSEMINATION This protocol for a systematic review and meta-analysis does not require ethics approval, as no primary data are collected. This study will assess the effectiveness of high doses of enteral DHA supplementation on BPD and provide evidence to clinicians and families for decision-making. Findings will be disseminated through conferences, media interviews and publications to peer review journals. PROSPERO REGISTRATION NUMBER CRD42021286705.
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Affiliation(s)
- Isabelle Marc
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Amélie Boutin
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Mireille Guillot
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Frédéric Bergeron
- Department of Consulting Services, Library, Université Laval, Quebec, Quebec, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Impact of DHA from Algal Oil on the Breast Milk DHA Levels of Lactating Women: A Randomized Controlled Trial in China. Nutrients 2022; 14:nu14163410. [PMID: 36014916 PMCID: PMC9415549 DOI: 10.3390/nu14163410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Population research on the intervention of docosahexaenoic acid (DHA) supplementation in lactating women is in its infancy in China. This study investigated the effect of DHA supplementation on DHA concentrations in the breast milk of lactating women, and the intervention effect, with respect to different dietary patterns. In this trial, 160 healthy lactating women in Nanjing (30−50 days postpartum) were recruited and randomly divided into control (one placebo capsule of similar appearance per day) and supplement (one capsule with 200 mg of DHA from algal oil per day) groups for 8 weeks. Before and after the intervention, all subjects were asked to maintain basic information, maternal anthropometric parameters, breast milk (10−15 mL) sample collection, and a dietary survey using a food frequency questionnaire. The concentrations of DHA and other fatty acids in breast milk were detected using capillary gas chromatography. This study was completed by 137 subjects, with 60 in the control group and 77 in the supplement group. Compared with the DHA concentrations in the breast milk at enrollment, the absolute concentrations of the control group showed a significant decrease at the end of the trial (p = 0.037). In addition, after intervention, the absolute and relative DHA concentrations in the supplement group (10.07 mg/100 mL and 0.40%, respectively) were higher than those in the control group (7.57 mg/100 mL and 0.28%, respectively), being statistically significant (p = 0.012 and p = 0.001). Furthermore, the maternal diet in the supplement group was divided into four dietary patterns. Pattern 1 mainly included fruits and livestock meat. Pattern 2 was dominated by milk and its products, eggs, fish, shrimp and shellfish, and soybeans and its products. Pattern 3 chiefly comprised cereal and beans other than soybeans, potatoes, and nuts. Pattern 4 was high in poultry meat and low in cooking oils. The change in the absolute concentration of DHA in Pattern 3 was lower than that in other patterns (p < 0.05). In conclusion, DHA supplementation in lactating mothers increased breast milk DHA concentrations. The dietary pattern mainly characterized by cereal and beans other than soybeans, potatoes, and nuts may contribute to the poor intervention effect.
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Guillot M, Robitaille CA, Turner L, Pronovost E, Caouette G, Matte-Gagné C, Olivier F, Bartholomew J, Massé É, Morin A, Mohamed I, Marc I. Effects of maternal docosahexaenoic acid supplementation on brain development and neurodevelopmental outcomes of breastfed preterm neonates: protocol for a follow-up at preschool age of a randomised clinical trial (MOBYDIckPS). BMJ Open 2022; 12:e057482. [PMID: 35508343 PMCID: PMC9073400 DOI: 10.1136/bmjopen-2021-057482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Docosahexaenoic acid (DHA), an omega-3 fatty acid, is important for brain development with possible implications in neurodevelopmental outcomes. In the two-arm, randomised, double-blind, placebo-controlled Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants trial, very preterm infants (<29 weeks' gestation) were supplemented in high doses of DHA or placebo until they reached 36 weeks' postmenstrual age. We propose a long-term neurodevelopmental follow-up of these children. This protocol details the follow-up at 5 years of age, which aims to (1) confirm our long-term recruitment capacity and (2) determine the spectrum of neurodevelopmental outcomes at preschool age following neonatal DHA supplementation. METHODS AND ANALYSIS This long-term follow-up involves children (n=194) born to mothers (n=170) randomised to DHA (n=85) or placebo (n=85) from the five sites in Quebec when they will be 5 years' corrected age. The primary outcome measure is related to the long-term recruitment capacity, which we determined as successful if 75% (±10%, 95% CI) of the eligible children consent to the 5-year follow-up study. Interviews with mothers will be conducted to assess various aspects of neurodevelopment at preschool age (executive functions, behavioural problems, global development and health-related quality of life), evaluated with standardised neurodevelopmental questionnaires. In addition, a semistructured interview conducted in a subset of the mothers will be used to determine their acceptability and identify barriers and enablers to their eventual participation to the next phase of the trial. This follow-up study will require approximately 22 months to be completed. ETHICS AND DISSEMINATION This study was approved by the CHU de Québec-Université Laval Research Ethics Board (MP-20-2022-5926). Mothers will provide informed consent before participating in this study. Findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02371460.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | | | - Laurence Turner
- Department of Pediatrics, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Georges Caouette
- Department of Pediatrics, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | | | - François Olivier
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, Montreal, Québec, Canada
| | - Édith Massé
- Department of Pediatrics, Hôpital Fleurimont, Sherbrooke, Québec, Canada
| | - Alyssa Morin
- Department of Pediatrics, Hôpital Fleurimont, Sherbrooke, Québec, Canada
| | - Ibrahim Mohamed
- Departments of Pediatrics and Nutrition, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Isabelle Marc
- Department of Pediatrics, CHU de Québec-Université Laval, Québec City, Québec, Canada
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Hortensius LM, Hellström W, Sävman K, Heckemann RA, Björkman-Burtscher IM, Groenendaal F, Andersson MX, Nilsson AK, Tataranno ML, van Elburg RM, Hellström A, Benders MJNL. Serum docosahexaenoic acid levels are associated with brain volumes in extremely preterm born infants. Pediatr Res 2021; 90:1177-1185. [PMID: 34392310 DOI: 10.1038/s41390-021-01645-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/04/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for fetal brain growth and development. Our aim was to evaluate the association between serum DHA and AA levels and brain volumes in extremely preterm infants. METHODS Infants born at <28 weeks gestational age in 2013-2015, a cohort derived from a randomized controlled trial comparing two types of parenteral lipid emulsions, were included (n = 90). Serum DHA and AA levels were measured at postnatal days 1, 7, 14, and 28, and the area under the curve was calculated. Magnetic resonance (MR) imaging was performed at term-equivalent age (n = 66), and volumes of six brain regions were automatically generated. RESULTS After MR image quality assessment and area under the curve calculation, 48 infants were included (gestational age mean [SD] 25.5 [1.4] weeks). DHA levels were positively associated with total brain (B = 7.966, p = 0.012), cortical gray matter (B = 3.653, p = 0.036), deep gray matter (B = 0.439, p = 0.014), cerebellar (B = 0.932, p = 0.003), and white matter volume (B = 3.373, p = 0.022). AA levels showed no association with brain volumes. CONCLUSIONS Serum DHA levels during the first 28 postnatal days were positively associated with volumes of several brain structures in extremely preterm infants at term-equivalent age. IMPACT Higher serum levels of DHA in the first 28 postnatal days are positively associated with brain volumes at term-equivalent age in extremely preterm born infants. Especially the most immature infants suffer from low DHA levels in the first 28 postnatal days, with little increase over time. Future research is needed to explore whether postnatal fatty acid supplementation can improve brain development and may serve as a nutritional preventive and therapeutic treatment option in extremely preterm infants.
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Affiliation(s)
- Lisa M Hortensius
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - William Hellström
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rolf A Heckemann
- Department of Medical Radiation Sciences, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Mats X Andersson
- Department of Biology and Environmental Sciences, The Faculty of Science, University of Gothenburg, Gothenburg, Sweden
| | - Anders K Nilsson
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Ruurd M van Elburg
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
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11
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Tandon S, Gonzalez-Casanova I, Barraza-Villarreal A, Romieu I, Demmelmair H, Jones DP, Koletzko B, Stein AD, Ramakrishnan U. Infant Metabolome in Relation to Prenatal DHA Supplementation and Maternal Single-Nucleotide Polymorphism rs174602: Secondary Analysis of a Randomized Controlled Trial in Mexico. J Nutr 2021; 151:3339-3349. [PMID: 34494106 PMCID: PMC8562085 DOI: 10.1093/jn/nxab276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/23/2021] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although DHA (22:6n-3) is critical for fetal development, results from randomized controlled trials (RCTs) of prenatal DHA supplementation report inconsistent effects on offspring health. Variants in fatty acid desaturase (FADS) genes that regulate the conversion of n-3 and n-6 essential fatty acids into their biologically active derivatives may explain this heterogeneity. OBJECTIVES We investigated the effect of prenatal DHA supplementation on the offspring metabolome at age 3 mo and explored differences by maternal FADS single-nucleotide polymorphism (SNP) rs174602. METHODS Data were obtained from a double-blind RCT in Mexico [POSGRAD (Prenatal Omega-3 Fatty Acid Supplementation and Child Growth and Development)] in which women (18-35 y old) received DHA (400 mg/d) or placebo from mid-gestation until delivery. Using high-resolution MS with LC, untargeted metabolomics was performed on 112 offspring plasma samples. Discriminatory metabolic features were selected via linear regression (P < 0.05) with false discovery rate (FDR) correction (q = 0.2). Interaction by SNP rs174602 was assessed using 2-factor ANOVA. Stratified analyses were performed, where the study population was grouped into carriers (TT, TC; n = 70) and noncarriers (CC; n = 42) of the minor allele. Pathway enrichment analysis was performed with Mummichog (P < 0.05). RESULTS After FDR correction, there were no differences in metabolic features between infants whose mothers received prenatal DHA (n = 58) and those whose mothers received placebo (n = 54). However, we identified 343 differentially expressed features in the interaction analysis after FDR correction. DHA supplementation positively enriched amino acid and aminosugars metabolism pathways and decreased fatty acid metabolism pathways among offspring of minor allele carriers and decreased metabolites within the tricarboxylic acid cycle and galactose metabolism pathways among offspring of noncarriers. CONCLUSIONS Our findings demonstrate differences in infant metabolism in response to prenatal DHA supplementation by maternal SNP rs174602 and further support the need to incorporate genetic analysis of FADS polymorphisms into DHA supplementation trials.This trial was registered at clinicaltrials.gov as NCT00646360.
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Affiliation(s)
- Sonia Tandon
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Ines Gonzalez-Casanova
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
- Indiana University Bloomington School of Public Health, Bloomington, IN, USA
| | | | - Isabelle Romieu
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
- National Institute of Public Health, Cuernavaca, Mexico
| | - Hans Demmelmair
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, (LMU - Ludwig-Maximilians-Universität Munich), Munich, Germany
| | - Dean P Jones
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Berthold Koletzko
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, (LMU - Ludwig-Maximilians-Universität Munich), Munich, Germany
| | - Aryeh D Stein
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
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12
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Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial. Sci Rep 2021; 11:21492. [PMID: 34728723 PMCID: PMC8564506 DOI: 10.1038/s41598-021-01017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022] Open
Abstract
Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.
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13
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Gould JF, Anderson PJ, Yelland LN, Gibson RA, Makrides M. The Influence of Prenatal DHA Supplementation on Individual Domains of Behavioral Functioning in School-Aged Children: Follow-Up of a Randomized Controlled Trial. Nutrients 2021; 13:nu13092996. [PMID: 34578873 PMCID: PMC8472059 DOI: 10.3390/nu13092996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Docosahexaenoic acid (DHA) accumulates in the fetal brain during pregnancy and is thought to have a role in supporting neurodevelopment. We conducted a multicenter, double-blind, randomized controlled trial in women with a singleton pregnancy who were <21 weeks’ gestation at trial entry. Women were provided with 800 mg DHA/day or a placebo supplement from trial entry until birth. When children reached seven years of age, we invited parents to complete the Strengths and Difficulties Questionnaire (SDQ), the Behavior Rating Inventory of Executive Function (BRIEF), and the Conners 3rd Edition Attention-Deficit Hyperactivity Disorder (ADHD) Index to assess child behavior and behavioral manifestations of executive dysfunction. There were 543 parent–child pairs (85% of those eligible) that participated in the follow-up. Scores were worse in the DHA group than the placebo group for the BRIEF Global Executive, Behavioral Regulation and Metacognition Indexes, and the Shift, Inhibit, Monitor, Working Memory, and Organization of Materials scales, as well as for the Conners 3 ADHD index, and the SDQ Total Difficulties score, Hyperactivity/Inattention score, and Peer Relationship Problems score. In this healthy, largely term-born sample of children, prenatal DHA supplementation conferred no advantage to childhood behavior, and instead appeared to have an adverse effect on behavioral functioning, as assessed by standardized parental report scales.
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Affiliation(s)
- Jacqueline F. Gould
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
- Correspondence: ; Tel.: +618-128-4423
| | - Peter J. Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne 3800, Australia;
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Lisa N. Yelland
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
| | - Robert A. Gibson
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Agriculture, Food and Wine, Waite Campus, University of Adelaide, Adelaide 5000, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
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14
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Sikka P, Behl T, Sharma S, Sehgal A, Bhatia S, Al-Harrasi A, Singh S, Sharma N, Aleya L. Exploring the therapeutic potential of omega-3 fatty acids in depression. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:43021-43034. [PMID: 34121162 DOI: 10.1007/s11356-021-14884-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
Omega-3 fatty acids have been acknowledged for their number of holdings on an individual's health. Not only in physical valuation but also in managing psychiatric disorders, omega-3 fatty acids have been found to be a powerful formula. It is proclaimed that depressive patients suffer anomaly with the levels of omega-3 polyunsaturated fatty acids in the body, coupled with insignificant EPA and DHA. Enhancement in brain functioning, neuronal functions, and paying attention in interacting with the brain cells are some of the additional tasks, being performed by the supplementation of omega-3 fatty acids. The leading and primary source via dietary supplementation involves the involvement of fish and fish products. These are hypothesized to be the best and dominant source for omega-3 fatty acids. Consumption of omega-3 fatty acid is well safe, that physician highly favors intake of these supplements, remarkably in the case of pregnant women. However, treating this serious life-threatening mental disorder leads to many adverse effects when treated with antidepressants. The dose range includes 1g/d to 10g/d, which is to be incorporated by the patient. It is also tested that the combination of EPA and DHA is found to be more efficacious for a person in treating and preventing depressive symptoms. Some studies verify the supplementation of omega-3 fatty acids in diet was coequally productive and successful with minimal side effects when analyzed with antidepressants. Despite these facts, much research is still needed and presently in process for long-term safety and studying the role of omega-3 fatty acids in human health.
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Affiliation(s)
- Priyanshi Sikka
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Sanchay Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Saurabh Bhatia
- Amity Institute of Pharmacy, Amity University, Gurugram, Haryana, India
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Nizwa, Oman
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Nizwa, Oman
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
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15
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Best KP, Collins CT. Protocol for assessing if behavioural functioning of infants born <29 weeks' gestation is improved by omega-3 long-chain polyunsaturated fatty acids: follow-up of a randomised controlled trial. BMJ Open 2021; 11:e044740. [PMID: 33952546 PMCID: PMC8103387 DOI: 10.1136/bmjopen-2020-044740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks' gestation, without the in-utero provisions of DHA. Infants born <29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. METHODS AND ANALYSIS Infants born <29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/16/WCHN/184). Results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology and Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Department Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeanie L Y Cheong
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Peter G Davis
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Mary Sharp
- Neonatal Follow up, King Edward Memorial Hospital for Women Perth, Perth, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Scott Morris
- Paediatric Neonatal Clinic, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kei Lui
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Srinivas Bolisetty
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Helen Liley
- Mater Research - The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Karen P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
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16
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Ilardi L, Proto A, Ceroni F, Morniroli D, Martinelli S, Mosca F, Giannì ML. Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus. Life (Basel) 2021; 11:331. [PMID: 33920163 PMCID: PMC8069002 DOI: 10.3390/life11040331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/10/2023] Open
Abstract
Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms' health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms' metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.
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Affiliation(s)
- Laura Ilardi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Alice Proto
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Federica Ceroni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
| | - Daniela Morniroli
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
| | - Stefano Martinelli
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
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