Role of Long-Chain Polyunsaturated Fatty Acids in Early Human Neurodevelopment

Impact of Phenylketonuria on the Serum Metabolome and Plasma Lipidome: A Study in Early-Treated Patients

BACKGROUND

Data suggest that metabolites, other than blood phenylalanine (Phe), better and independently predict clinical outcomes in patients with phenylketonuria (PKU).

METHODS

To find new biomarkers, we compared the results of untargeted lipidomics and metabolomics in treated adult PKU patients to those of matched controls. Samples (lipidomics in EDTA-plasma (22 PKU and 22 controls) and metabolomics in serum (35 PKU and 20 controls)) were analyzed using ultra-high-performance liquid chromatography and high-resolution mass spectrometry. Data were subjected to multivariate (PCA, OPLS-DA) and univariate (Mann-Whitney U test, p < 0.05) analyses.

RESULTS

Levels of 33 (of 20,443) lipid features and 56 (of 5885) metabolite features differed statistically between PKU patients and controls. For lipidomics, findings include higher glycerolipids, glycerophospholipids, and sphingolipids species. Significantly lower values were found for sterols and glycerophospholipids species. Seven features had unknown identities. Total triglyceride content was higher. Higher Phe and Phe catabolites, tryptophan derivatives, pantothenic acid, and dipeptides were observed for metabolomics. Ornithine levels were lower. Twenty-six metabolite features were not annotated.

CONCLUSIONS

This study provides insight into the metabolic phenotype of PKU patients. Additional studies are required to establish whether the observed changes result from PKU itself, diet, and/or an unknown reason.

Is there a difference in breast milk fatty acid composition of mothers of preterm and term infants?

OBJECTIVE

Arachidonic acid (ARA) (c20:4 w6) and docosahexanoic acid (DHA) (c22:6 w3) are of major importance for neural maturation and retinal function in infancy. Requirements in preterm infants are increased due to accelerated growth and limited body stores. Data regarding human milk fatty acid composition after preterm and full-term delivery is inconsistent. This study compared fatty acid composition in breast milk from full-term and preterm infants. Findings were correlated with maternal dietary intake.

METHODS

Human milk was obtained 4-5 days after full-term delivery (20 infants) and 4-5, 10-11 and 14-15 days after preterm delivery (21 infants, of whom 6 were born before 30 weeks). For fatty acid analysis, lipids were extracted, transesterified and separated by gas liquid chromatography.

RESULTS

Total fat content was similar in the two groups. FA composition including LCPUFA and specifically ARA & DHA were similar in full-term and preterm infants and in the sub-set born before 30 weeks. In preterm infants, postnatal age did not influence LCPUFA content.

CONCLUSIONS

This study did not detect any effect of gestational age or postnatal age on milk LCPUFA content. Accordingly, the increased demand for LCPUFA and specifically DHA in preterm infants need to be met by other supplementation.

trans Isomeric fatty acids are inversely related to the availability of long-chain PUFAs in the perinatal period

We summarize data on the potential interaction of trans isomeric fatty acids [trans fatty acids (TFAs)] with the availability of long-chain polyunsaturated fatty acids (LC-PUFAs) in the perinatal period. Today, TFA intakes in pregnant and lactating women can be estimated to be ∼1% of energy in the majority of the population. The significant inverse associations seen between TFAs and LC-PUFAs in pregnant women in 3 different European populations investigated in a recent study raise doubts about the nutritional adequacy of high TFA intakes during pregnancy. In a recent study on the TFA content of human milk in a sizable group of mothers at the sixth week of lactation, both arachidonic and docosahexaenoic acids correlated significantly inversely to 18-carbon TFAs but not to 16-carbon TFAs, and at the sixth month of lactation arachidonic acid correlated significantly inversely to 18-carbon TFAs but not to 16-carbon TFAs. Similarly, significant inverse correlations were seen between 18-carbon TFAs and arachidonic and docosahexaenoic acids in both artery and vein wall lipids in a sizable group of healthy term infants. The TFA data obtained in umbilical blood vessel wall lipids were related to the neurologic condition of healthy children at 18 mo of age: children with minimal neurologic dysfunction at age 18 mo had significantly higher cord blood vein wall trans octadecadienoic acid values than did neurologically normal children. Total TFA values as well as total 18-carbon TFA values in umbilical vein wall lipids were significantly inversely associated with neurologic optimality score. Contradictory data renders it impossible to draw firm conclusions on the role of TFAs in modifying fetal growth; however, TFA exposure may be a confounding parameter in studies that investigate the relation between fetal fatty acid supply and intrauterine growth.

Fatty acid composition of erythrocyte membrane lipids in healthy subjects from birth to young adulthood

The fatty acid composition of erythrocyte membrane lipids may better reflect the fatty acid status of the organism than the fatty acid composition of plasma lipids. The present study aimed to provide normal values for erythrocyte fatty acid composition in a sizeable group of healthy subjects throughout the paediatric age group. The fatty acid composition of erythrocyte membrane phosphatidylcholine (PC) and phosphatidylethanolamine (PE) lipids was determined by high-resolution capillary gas chromatography in 188 apparently healthy subjects from birth to young adulthood (newborns: n=17, infants: n=97, children: n=38, young adults: n=36). The values of linoleic acid (C18:2n-6) increased steadily between birth and young adulthood (newborns: 6.49 [2.45], infants: 14.51 [4.32], children: 18.10 [3.25], young adults: 19.87 [2.03], PC lipids, shown as median [interquartile range, IQR], p<0.001]. In contrast, the values of arachidonic acid (C20:4n-6) were significantly higher in children than in young adults (PC: 9.48 [6.64] versus 8.00 [1.85], PE: 26.38 [3.98] versus 24.46 [2.44], p<0.05). The values of alpha-linolenic acid (C18:3n-3) decreased significantly between children and young adults (0.14 [0.11] versus 0.08 [0.07], PE lipids, p<0.05). The values of docosahexaenoic acid (C22:6n-3) increased significantly from infancy through childhood up to young adulthood (PE: 4.20 [2.41] and 4.55 [0.97] and 6.66 [1.81], p<0.05 and 0.001, respectively). We found significantly higher total trans isomeric fatty acid values in newborns than in infants (PC: 0.60 [0.27] versus 0.43 [0.19], p<0.05; PE: 0.66 [0.76] versus 0.30 [0.26], p<0.001). From the results, we conclude that: (1) the data obtained in the present study may serve as reference values in the evaluation of the fatty acid status from birth to young adulthood; (2) the significantly higher values of trans fatty acids at birth than at later stages of life may be of concern, because previous studies suggested that trans fatty acids may interfere with essential fatty acid metabolism during the perinatal period.

Effects of supplementing LCPUFA to the diet of pregnant women: data from RCT

Randomised controlled trials (RCTs) investigating the effect of n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation on pregnancy outcomes were recently systematically reviewed for both low-risk (uncomplicated) and high-risk pregnancies. The duration of pregnancy was found to be significantly enhanced by n-3 LCPUFA supplementation in low-risk (two systematic reviews, weighted mean difference: 2.55 and 1.57 days, 95% CI: 1.13-4.07 and 0.35-2.78 days), but not in high-risk pregnancies. The relative risk of giving birth before the 34th week of gestation was found to be reduced by n-3 LCPUFA supplementation both in low-risk (0.69, 95% CI: 0.49-0.99) and in high-risk (0.39, 95% CI: 0.19-0.84) pregnancies. Recent evidence indicates that enhancement of maternal intake of n-3 LCPUFA prolongs the duration of gestation in low-risk pregnancies and may contribute to the prevention of early preterm birth in both low-risk and high-risk pregnancies.

Systematic review of fatty acid composition of human milk from mothers of preterm compared to full-term infants

BACKGROUND

Fatty acid composition of human milk serves as guidance for the composition of infant formulae. The aim of the study was to systematically review data on the fatty acid composition of human milk of mothers of preterm compared to full-term infants.

METHODS

An electronic literature search was performed in English (Medline and Medscape) and German (SpringerLink) databases and via the Google utility. Fatty acid compositional data for preterm and full-term human milk were converted to differences between means and 95% confidence intervals.

RESULTS

We identified five relevant studies publishing direct comparison of fatty acid composition of preterm versus full-term human milk. There were no significant differences between the values of the principal saturated and monounsaturated fatty acids. In three independent studies covering three different time points of lactation, however, docosahexaenoic acid (DHA) values were significantly higher in milk of mothers of preterm as compared to those of full-term infants, with an extent of difference considered nutritionally relevant.

CONCLUSION

Higher DHA values in preterm than in full-term human milk underlines the importance of using own mother's milk for feeding preterm babies and raises the question whether DHA contents in preterm formulae should be higher than in formulae for full-term infants.

trans Octadecenoic acid and trans octadecadienoic acid are inversely related to long-chain polyunsaturates in human milk: results of a large birth cohort study

BACKGROUND

Several observational studies indicate that trans isomeric fatty acids may interfere with the metabolism of essential fatty acids in the human organism.

OBJECTIVE

The objective was to investigate the relation between trans fatty acids and long-chain polyunsaturates in mature human milk.

DESIGN

Human milk samples (n=769) were obtained at the 6th week of lactation from mothers participating in a birth cohort study in Germany. The fatty acid composition of the milk samples was measured by high-resolution capillary gas-liquid chromatography.

RESULTS

trans Octadecenoic and trans octadecadienoic acids were inversely correlated with linoleic acid (r=-0.32 and -0.33, P<0.0001 for both), alpha-linolenic acid (r=-0.35 and -0.27, P<0.0001), arachidonic acid (r=-0.60 and -0.47, P<0.0001), and docosahexaenoic acid (r=-0.51 and -0.33, P<0.0001). In contrast, no inverse correlations were observed between trans hexadecenoic acid and polyunsaturated fatty acids.

CONCLUSIONS

The data obtained in the present study suggest that the availability of 18-carbon trans isomeric fatty acids may be inversely related to the availability of long-chain polyunsaturated fatty acids in mature human milk.

Effect of fish oil supplementation on fatty acid status, coordination, and fine motor skills in children with phenylketonuria

OBJECTIVE

To investigate effects of long-chain omega-3 polyunsaturated fatty acids (LC-PUFA) on motor skills in patients with phenylketonuria (PKU).

STUDY DESIGN

Thirty-six patients with PKU (1-11 years of age, good metabolic control: plasma phenylalanine < or = 360 micromol/L for > or = 6 months). We determined plasma phospholipid fatty acids, and in patients > 4 years of age (N = 24) the motometric Rostock-Oseretzky Scale (ROS), before and after supplementation with fish oil for 3 months (15 mg docosahexaenoic acid [DHA]/kg body weight daily). ROS was also assessed in 22 age-matched controls.

RESULTS

Patients had low n-3 LC-PUFA in plasma phospholipids (DHA, 2.37 +/- 0.10%; eicosapentaenoic acid [EPA], 0.4 +/- 0.03%) and poorer ROS performance than controls (motor development index [MQ] 107 +/- 3 vs 117 +/- 3, P = .010). Supplementation increased phospholipid n-3 LC-PUFA (DHA 7.05 +/- 0.24%; EPA 3.31 +/- 0.19%; P < .001), decreased n-6 LC-PUFA (arachidonic acid, 9.26 +/- 0.23% vs 6.76 +/- 0.16%; P < .001) and improved ROS (MQ 115 +/- 3.54, P = .011, paired t test). ROS was unchanged in 11 retested controls (MQ 115 +/- 5.16, P = NS, paired t test multivariate analysis of variance [MANOVA] for time by group, P = .027). Patients tolerated fish oil well. Plasma phenylalanine remained unchanged.

CONCLUSION

In patients with PKU, fish oil supplementation enhances n-3 LC-PUFA levels and improves motor skills.

Fatty acids in early human milk after preterm and full-term delivery

BACKGROUND

It has been much debated whether fatty acid composition of human milk differs after preterm as compared to full-term delivery.

SUBJECTS AND METHODS

Human milk samples were obtained from mothers of preterm (n = 8, gestational age: 28.0 [4.2] weeks, birthweight: 1,235 [420] g, median [interquartile range]) and full-term (n = 10, gestational age: 38.5 [2.7] weeks, birthweight: 3375 [282] g) infants every day during the first week and thereafter on the 14th, 21st, and 28th day of lactation. Fatty acid composition was measured by high-resolution capillary gas-liquid chromatography.

RESULTS

Maternal age and body mass index did not differ, and food frequency questionnaire did not reveal significant differences in diet between the two groups. Fat contents of human milk did not differ between the two groups. Values of linoleic acid (C18:2n-6) and alpha-linolenic acid (C18:3n-3) did not differ throughout the study. Values of the metabolites C18:3n-6 and C20:3n-6 as well as C18:4n-3 and C20:3n-3 were significantly higher after preterm as compared with full-term delivery. Values of arachidonic acid (C20:4n-6; e.g., day 4: 0.82 [0.4] vs. 0.44 [0.28]; day 7: 0.61 [0.25] vs. 0.34 [0.25]; day 21: 0.33 [0.18] vs. 0.44 [0.44]; in weight percent, preterm versus full-term, P < 0.05) and docosahexaenoic acid (C22:6n-3; e.g., day 4: 0.33 [0.23] vs. 0.15 [0.14]; day 7: 0.26 [0.16] vs. 0.13 [0.15]; day 21: 0.11 [0.08] vs. 0.21 [0.17]; P < 0.05) were significantly higher in human milk samples of mothers of preterm as compared with full-term infants.

CONCLUSION

In this study, percentage contributions of arachidonic and docosahexaenoic acids as well as the those of the intermediary metabolites of essential fatty acid metabolism were all significantly higher in early human milk samples of mothers giving birth to very low birth weight preterm as compared with full-term infants.

N-3 fatty acids and pregnancy outcomes

PURPOSE OF REVIEW

To discuss new data from the literature on the relationship between the supply of n-3 polyunsaturated fatty acids during pregnancy and pregnancy outcomes, evaluated as the fatty acid composition of blood and breast milk, fetal and infantile development and maternal health.

RECENT FINDINGS

Supplementation of alpha-linolenic acid in high doses or docosahexaenoic acid in low doses did not result in a significant enhancement of the blood docosahexaenoic acid status of the offspring. In contrast, supplementation of docosahexaenoic acid in relatively high doses led to significant increases in infantile docosahexaenoic acid values and to a significant enhancement of breast milk docosahexaenoic acid content. Electroretinogram data obtained during the first week of life and pattern-reversal visual evoked potentials investigated at 50 and 66 weeks postconception were significantly associated with the docosahexaenoic acid status of the infant at birth. Children whose mothers received docosahexaenoic acid supplementation during pregnancy and lactation scored better in mental processing tests carried out at 4 years than children whose mothers received placebo.

SUMMARY

Beneficial health outcomes are more likely to result from supplementation with docosahexaenoic acid itself, rather than its precursor alpha-linolenic acid. Trials have shown that a higher maternal docosahexaenoic acid intake during pregnancy may be favourable for the visual and cognitive development of the offspring. The significant positive association between maternal docosahexaenoic acid intake during pregnancy and the children's mental processing scores at 4 years suggest that optimization of the docosahexaenoic acid status of expectant women may offer long-term developmental benefits to their children.

Effects of alcohol intake during pregnancy on docosahexaenoic acid and arachidonic acid in umbilical cord vessels of black women

OBJECTIVE

Alcohol influences the intake and metabolism of several nutrients including long-chain polyunsaturated fatty acids (LC-PUFAs). The LC-PUFAs docosahexaenoic acid (DHA) and arachidonic acid (AA) are particularly crucial for intrauterine growth and brain development. We hypothesized that alcohol consumption adversely affects LC-PUFA levels in pregnant women and their newborn infants.

METHODS

Pregnant black women (N = 208) presenting at a core city antenatal clinic were screened and recruited. Shortly before delivery, maternal plasma was collected. After delivery, umbilical arteries and veins were dissected from the cords, total lipids were extracted from the vessel tissues and maternal plasma, and fatty acid levels were assayed by gas chromatography. For statistical analysis, subjects were categorized according to absolute alcohol intake per day (AAD) and absolute alcohol intake per drinking day (AADD) around the time of conception, with smoking and other potential confounders included in the analyses.

RESULTS

Significant differences in fatty acid composition of total lipid extracts were detected in umbilical cord vessels among the AADD groups: abstainers (AADD = 0), moderate drinkers (AADD < 130 g), and heavy drinkers (AADD > or = 130 g). DHA and AA content in the arterial umbilical vessel wall was approximately 14% and approximately 10% higher in the moderate (n = 127) and heavy (n = 32) alcohol groups, respectively, than in abstainers (n = 49). A small, nonsignificant increase ( approximately 3%) was seen in the umbilical vein for AA but not for DHA. Alcohol intake was positively correlated to both DHA and AA concentrations in the arterial vessel wall but to neither in the venous wall nor maternal plasma. Maternal plasma DHA was positively correlated with both umbilical arteries and vein DHA, but there were no significant correlations for AA between maternal plasma and either umbilical vessel.

CONCLUSIONS

Our findings indicate that alcohol intake during pregnancy is associated with altered DHA and AA status in fetal tissues. Although differences may be due to either metabolism and/or distribution, it is most likely a result of a direct influence of alcohol on fetal metabolism.

Changes of Fatty Acid Composition of Human Milk during the First Month of Lactation: A Day-to-Day Approach in the First Week

BACKGROUND

Fatty acid composition of human milk (HM) is known to change considerably during lactation. However, we were unable to find data on changes of fatty acid composition of HM during the very early phase of lactation, i.e. in the first week of life.

SUBJECTS AND METHODS

HM samples were obtained from 18 healthy lactating women every day during the first week and thereafter on the 14th and 28th days of lactation. Fatty acid composition of colostrum and mature HM samples was determined by high-resolution capillary gas-liquid chromatography.

RESULTS

Values of the n-6 essential fatty acid, linoleic acid, in HM did not change significantly during the first month of lactation, whereas values of the n-3 essential fatty acid, alpha-linolenic acid, showed significant increases during the first 2 weeks of lactation (1st day: 0.49 [0.12], % weight/weight, median [ranges from the 1st to the 3rd quartile], 14th day: 0.69 [0.31], p < 0.05). In contrast, values of the n-6 long-chain metabolites, eicosadienoic-, dihomo-gamma-linolenic- and arachidonic acid, as well as the values of the n-3 long-chain metabolites, eicosatrienoic-, and eicosapentaenoic acid exhibited significant decreases during the entire period investigated. The principal n-3 long-chain metabolite, docosahexaenoic acid, showed a significant increase between the 3rd and 14th days, but a significant decrease between the 14th and 28th days (3rd day: 0.15 [0.13], 14th day: 0.28 [0.11], p < 0.05, 28th day: 0.19 [0.12], p < 0.01). There were statistically significant positive correlations between arachidonic and docosahexaenoic acid values on the 1st (r = 0.67, p < 0.01), 5th (r = 0.56, p < 0.05) and the 6th (r = 0.53, p < 0.05) days of lactation.

CONCLUSION

Fatty acid composition of HM changes significantly even during the first week of lactation. The lack of positive correlation between essential fatty acids and their long-chain metabolites suggests that it is not only the availability of essential fatty acids that influences the fatty acid composition of human colostrum.

Nutrition and brain function: a multidisciplinary virtual symposium

A few months ago, the Brazilian Society for Neuroscience and Behavior (SBNeC) promoted a "virtual symposium" (by Internet, under the coordination of R.C.A. Guedes) on "Nutrition and Brain Function". The discussions generated during that symposium originated the present text, which analyzes current topics on the theme, based on the multidisciplinary experience of the authors. The way the brain could be non-homogeneously affected by nutritional alterations, as well as questions like early malnutrition and the development of late obesity and hormone abnormalities were discussed. Also, topics like the role of essential fatty acids (EFAs) on brain development, increased seizure susceptibility and changes in different neurotransmitters and in cognitive performance in malnourished animals, as well as differences between overall changes in nutrient intake and excess or deficiency of specific nutrients (e.g. iodine deficiency) were analyzed. It was pointed out that different types of neurons, possibly in distinct brain structures, might be differently affected by nutritional manipulation, including not only lack-but also excess of nutrient intake. Such differences could help in explaining discrepancies between data on humans and in animals and so, could aid in determining the basic mechanisms underlying lesions or changes in brain function and behavior.

Trans isomeric octadecenoic acids are related inversely to arachidonic acid and DHA and positively related to mead acid in umbilical vessel wall lipids

Long-chain PUFA play an important role in early human neurodevelopment. Significant inverse correlations were reported between values of trans isomeric and long-chain PUFA in plasma lipids of preterm infants and children aged 1-15 yr as well as in venous cord blood lipids of full-term infants. Here we report FA compositional data of cord blood vessel wall lipids in 308 healthy, full-term infants (gestational age: 39.7 +/- 1.2 wk, birth weight: 3528 +/- 429 g, mean +/- SD). The median (interquartile range) of the sum of 18-carbon trans FA was 0.22 (0.13) % w/w in umbilical artery and 0.16 (0.10) % w/w in umbilical vein lipids. Nonparametric correlation analysis showed significant inverse correlations between the sum of 18-carbon trans FA and both arachidonic acid and DHA in artery (r = -0.38, P < 0.01, and r = -0.20, P < 0.01) and vein (r = -0.36, P < 0.01, and -0.17, P < 0.01) wall lipids. In addition, the sum of 18-carbon trans FA was significantly positively correlated to Mead acid, a general indicator of EFA deficiency, in both artery (r = +0.35, P < 0.01) and vein (r = +0.31, P< 0.01) wall lipids. The present results obtained in a large group of full-term infants suggest that maternal trans FA intake is inversely associated with long-chain PUFA status of the infant at birth.

Improving mental health through nutrition: the future

Tell me what you eat, and I will tell you what you are (Anthelme Brillat-Savarin). When I behold a fashionable table set out in all its magnificence, I fancy that I see gouts and dropsies, fever and lethargies, with other innumerable distempers, lying in ambuscade among the dishes. Nature delights in the most plain and simple diet. Every animal, but man, keeps to one dish. Herbs are the food of this species, fish of that, and flesh of a third. Man falls upon everything that comes in his way; not the smallest fruit or excrescence of the earth, scarce a berry or a mushroom can escape him (Joseph Addison). The pleasures of the palate deal with us like the Egyptians thieves, who strangle those whom they embrace (Seneca). Let food be your medicine and medicine be your food (Hippocrates).

Inverse association between trans isomeric and long-chain polyunsaturated fatty acids in cord blood lipids of full-term infants

BACKGROUND

Previous studies showed significant inverse correlations between values of trans isomeric and long-chain polyunsaturated fatty acids in plasma lipids of preterm infants and healthy children aged 1-15 y.

OBJECTIVE

We sought to evaluate the same correlations in full-term infants at birth.

DESIGN

We studied healthy full-term infants (n = 42) born after normal pregnancies and deliveries. All infants had a family history of atopy (both parents or one of the parents and a sibling had atopic symptoms). The fatty acid composition of venous cord blood lipids was determined by high-resolution capillary gas-liquid chromatography.

RESULTS

The mean (+/-SEM) sum of trans fatty acids was 0.49 +/- 0.02% by wt in phospholipids, 2.47 +/- 0.20% by wt in cholesterol esters, 1.73 +/- 0.09% by wt in triacylglycerols, and 1.59 +/- 0.07% by wt in nonesterified fatty acids. Linear correlation analysis showed significant inverse correlations between the sum of trans fatty acids and both arachidonic acid and docosahexaenoic acid in phospholipids (r = -0.56, P < 0.001, and r = -0.48, P = 0.01, respectively), cholesterol esters (r = -0.52, P < 0.001, and r = -0.39, P = 0.018, respectively), and nonesterified fatty acids (r = -0.41, P = 0.007, and r = -0.41, P = 0.006, respectively).

CONCLUSION

Because trans fatty acids in the fetal circulation must originate from the maternal diet, our results indicate that maternal exposure to trans fatty acids may represent a previously neglected variable that inversely influences long-chain polyunsaturated fatty acid status in full-term infants at birth.