Dietary DHA, bioaccessibility, and neurobehavioral development in children

Bioaccessibility of docosahexaenoic acid in naturally and artificially enriched milk

This study aimed to compare the bioaccessibility of docosahexaenoic acid (DHA) in naturally and artificially enriched milk and investigate the potential mechanisms involved. The results indicated that the DHA in naturally enriched milk (NEM) had a higher bioaccessibility (76.9 %) and a lower digestive loss rate (18.1 %) compared to artificially enriched milk (ArEM). Moreover, NEM contained a higher proportion of DHA-containing glycerophospholipids and sn-2 DHA, with fewer long-chain fatty acids and more saturated fatty acids adjacent to DHA in the same lipid molecule. During simulated intestinal digestion, NEM had a higher free fatty acid release and lipid digestion rate than ArEM. These findings suggested that the bioaccessibility of endogenous DHA in milk was superior to that of externally added DHA due to its more easily digestible and absorbable chemical binding form and lower digestive loss rate. The easy digestibility of milk lipids in NEM also contributed to its high DHA bioaccessibility.

Dietary Nucleotides Promote Neonatal Rat Microbiota-Gut-Brain Axis Development by Affecting Gut Microbiota Composition and Metabolic Function

A variety of active factors in milk and foods have been proven to serve as microbial nutrients that regulate the formation of early gut microbiota (GM), thereby ensuring the healthy development of infants. This study demonstrated that dietary nucleotides (NTs), one of the main nitrogen-containing substances in human milk, promoted the neurodevelopment of neonatal rats and the expression of Sox2, Dcx, Tuj1, and NeuN in the prefrontal cortex and hippocampus, but had no significant regulatory effects in the striatum. 16s rRNA sequencing and metabolomics of the colon contents of neonatal rats at different developmental stages showed that the early intake of NTs promoted an increase in the abundance of beneficial microorganisms related to neurodevelopment, digestion, and gut absorption, such as g_Romboutsia and g_Akkermansia. Changes in the ability of the GM to regulate folate synthesis, riboflavin metabolism, and other processes were also observed. Further analysis revealed significant correlations between the level of characteristic metabolites, namely, trans-3-indoleacrylic acid, urocanic acid, inosine, and adenosine, in the gut with neurodevelopment and characteristic GM components. These findings suggest that NTs in milk may affect neurodevelopment and maturation in early life by regulating the GM composition-gut-brain axis.

Omega-3 index as risk factor in psychiatric diseases: a narrative review

Numerous studies have described associations between the omega-3 index (defined as the RBC percentage of EPA and DHA) and mental conditions, but no risk stratification or target value has gathered consensus so far. This narrative review aims to summarize the published data on the association between omega-3 index and mental illness and to contribute to the concept of an omega-3 index in the field of mental health. The bibliographic searches have been carried out in PubMed, Scopus and Web of Science databases to find relevant English language original research studies related to that association. The study search and selection process were registered in a PRISMA flow. Thirty-six studies were included in this review examining the links between omega-3 index and postpartum depression (3), major depression (15), major depression and bipolar disorder (1), bipolar disorder (4), schizophrenia and major depression (1), schizophrenia and other psychosis (5) and dementia (7). Thirty of these studies found either significant differences in omega-3 index between patients and controls or inverse relationships between omega-3 index and disease severity. The published evidence is compelling enough to suggest omega-3 index as a risk factor for some psychiatric diseases, specifically, major depression, postpartum depression, psychosis, and dementia. In occidental populations, we propose a risk threshold of (a) 4-5% in major depression and dementia, (b) 5% in postpartum depression, and (c) 4% for psychosis transition.

DHA supplementation and pregnancy complications

Docosahexaenoic acid (DHA) supplementation is recommended for women during pregnancy because of its neurological, visual, and cognitive effects. Previous studies have suggested that DHA supplementation during pregnancy may prevent and treat certain pregnancy complications. However, there are contradictions in the current related studies, and the specific mechanism by which DHA acts remains unclear. This review summarizes the research on the relationship between DHA intake during pregnancy and preeclampsia, gestational diabetes mellitus, preterm birth, intrauterine growth restriction, and postpartum depression. Furthermore, we explore the impact of DHA intake during pregnancy on the prediction, prevention, and treatment of pregnancy complications as well as its impact on offspring neurodevelopment. Our results suggest that there is limited and controversial evidence for the protective effect of DHA intake on pregnancy complications, with the exception of preterm birth and gestational diabetes mellitus. However, additional DHA supplementation may improve long-term neurodevelopmental outcomes in the offspring of women with pregnancy complications.

Maternal High-Dose DHA Supplementation and Neurodevelopment at 18-22 Months of Preterm Children

OBJECTIVES

To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age (CA).

METHODS

Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex.

RESULTS

Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval [CI] -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex.

CONCLUSIONS

Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA.

Resolvins, Protectins, and Maresins: DHA-Derived Specialized Pro-Resolving Mediators, Biosynthetic Pathways, Synthetic Approaches, and Their Role in Inflammation

Marine organisms are an important source of natural products with unique and diverse chemical structures that may hold the key for the development of novel drugs. Docosahexaenoic acid (DHA) is an omega-3 fatty acid marine natural product playing a crucial regulatory role in the resolution of inflammation and acting as a precursor for the biosynthesis of the anti-inflammatory specialized pro-resolving mediators (SPMs) resolvins, protectins, and maresins. These metabolites exert many beneficial actions including neuroprotection, anti-hypertension, or anti-tumorigenesis. As dysregulation of SPMs is associated with diseases of prolonged inflammation, the disclosure of their bioactivities may be correlated with anti-inflammatory and pro-resolving capabilities, offering new targets for drug design. The availability of these SPMs from natural resources is very low, but the evaluation of their pharmacological properties requires their access in larger amounts, as achieved by synthetic routes. In this report, the first review of the total organic syntheses carried out for resolvins, protectins, and maresins is presented. Recently, it was proposed that DHA-derived pro-resolving mediators play a key role in the treatment of COVID-19. In this work we also review the current evidence on the structures, biosynthesis, and functional and new-found roles of these novel lipid mediators of disease resolution.

Identification of Resolvin D1 and Protectin D1 as Potential Therapeutic Agents for Treating Kidney Stones

Intrarenal calcium oxalate (CaOx) crystals induce renal tubular epithelial cell (TEC) inflammatory and oxidative injury. This study is aimed at exploring potential therapeutic lipid components in kidney stones because lipids are involved in the development of several diseases and indicate the risk of kidney stones. Serum specimens were collected from 35 kidney stone patients and 35 normal controls. The lipid components in serum were measured, and differences were analyzed. The documented biological importance was comprehensively reviewed to identify lipids that differed significantly between the two groups to find potential agents associated with kidney stones. CaOx nephrocalcinosis mouse model was established to examine the therapeutic effects of specific lipids on CaOx deposition and CaOx-induced oxidative renal injury. Several lipids with significantly different levels were present in the serum of patients with stones and normal controls. Resolvin D1 (RvD1) (4.93-fold change, P < 0.001) and protectin D1 (PD1) (5.06-fold change, P < 0.001) were significantly decreased in the serum of patients with kidney stones, and an integrative review suggested that these factors might be associated with inflammatory responses, which is a crucial mechanism associated with stone damage. The administration of RvD1 and PD1 significantly inhibited kidney CaOx deposition and suppressed CaOx-induced renal tubular cell inflammatory injury and necrosis in a CaOx nephrocalcinosis mouse model. Furthermore, RvD1 and PD1 facilitated the expression of the oxidative indicator superoxide dismutase 2 (SOD2), inhibited NADPH oxidase 2 (NOX2) expression, and diminished intracellular reactive oxygen species (ROS) levels. This study preliminarily elucidated the role of lipids in kidney stones. The inhibitory effects of RvD1 and PD1 on oxidative damage induced by CaOx deposition provide a promising perspective for kidney stone treatment strategies.

Dietary ω-3 polyunsaturated fatty acids are protective for myopia

Myopia is a leading cause of visual impairment and blindness worldwide. However, a safe and accessible approach for myopia control and prevention is currently unavailable. Here, we investigated the therapeutic effect of dietary supplements of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on myopia progression in animal models and on decreases in choroidal blood perfusion (ChBP) caused by near work, a risk factor for myopia in young adults. We demonstrated that daily gavage of ω-3 PUFAs (300 mg docosahexaenoic acid [DHA] plus 60 mg eicosapentaenoic acid [EPA]) significantly attenuated the development of form deprivation myopia in guinea pigs and mice, as well as of lens-induced myopia in guinea pigs. Peribulbar injections of DHA also inhibited myopia progression in form-deprived guinea pigs. The suppression of myopia in guinea pigs was accompanied by inhibition of the "ChBP reduction-scleral hypoxia cascade." Additionally, treatment with DHA or EPA antagonized hypoxia-induced myofibroblast transdifferentiation in cultured human scleral fibroblasts. In human subjects, oral administration of ω-3 PUFAs partially alleviated the near-work-induced decreases in ChBP. Therefore, evidence from these animal and human studies suggests ω-3 PUFAs are potential and readily available candidates for myopia control.

DHA bioaccessibility in infant formulas and preschool children milks

Docosahexaenoic acid (DHA, 22:6n-3) is an essential long chain polyunsaturated fatty acid associated with the development of the nervous system that has to be consumed by infants through breast milk or complementary food sources and which consumption is also usually inadequate in preschoolers. In this work, the in vitro bioaccessibility of DHA from two commercial infant formulas (8.9 and 9.1%) and two preschool children milks (6.9 and 7.2%), with similar DHA contents but formulated with different ingredients, was not improved by the presence of egg phospholipids in the product formulation. In addition, the importance of the choice of an age-appropriate in vitro digestion method was demonstrated by comparing the DHA bioaccessibility from the infant formulas by the Infogest 2.0 standardized method and a simulated digestion method specific for infants.

The Influence of Prenatal DHA Supplementation on Individual Domains of Behavioral Functioning in School-Aged Children: Follow-Up of a Randomized Controlled Trial

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.

The development of a novel functional food: bioactive lipids in yogurts enriched with Aurantiochytrium sp. biomass

Western diets are poor in healthy n3 polyunsaturated fatty acids, such as docosahexaenoic acid. Since microalga Aurantiochytrium sp. is rich in docosahexaenoic acid, a functional food based on lean yogurt and this microalga was tested. This study entailed characterizing the lipid fraction and determining the fatty acid bioaccessibility. The tested yogurts (control and 2% w/w, Aurantiochytrium sp.) had differences. Docosahexaenoic acid was not detected in the control product, but it was the second most important fatty acid in Aurantiochytrium sp. and Aurantiochytrium yogurt, 29.7 ± 0.4% and 18.7 ± 2.0%, respectively. Based on the fatty acid profile only, an amount of 158.7 g of Aurantiochytrium yogurt in wet weight terms would be required to ensure an appropriate intake of healthy fatty acids. Generally, the fatty acid bioaccessibility was not high, remaining below 60-70% in almost all cases. Considering the docosahexaenoic acid bioaccessibility (44 ± 3%), an amount of 360.7 g of Aurantiochytrium yogurt would be advisable. A reasonable dietary prescription would be a daily consumption of 125 ml of Aurantiochytrium yogurt.

Functional Doxorubicin-Loaded Omega-3 Unsaturated Fatty Acids Nanoparticles in Reversing Hepatocellular Carcinoma Multidrug Resistance

Background

This study investigated a nanoparticle drug delivery system to reverse multidrug resistance (MDR) and assessed its anticancer efficacy in hepatocellular carcinoma (HCC).

Material/Methods

Docosahexaenoic acid (DHA) was used as the functional excipient and doxorubicin (DOX) as the chemotherapeutic drug to synthesize DOX nanoparticles (DOX-nano). The human HCC cell line HepG2 was used for experiments. HepG2/DOX, HepG2+DOX, HepG2+DOX-nano, HepG2/DOX+DOX, and HepG2/DOX+DOX-nano groups cells were treated with DOX or DOX-nano (5 μg/mL). Nude mice bearing a HepG2/DOX xenograft were divided into model, DOX, vector-nano, and DOX-nano groups and injected with saline, DOX reagent, vector-nano, and DOX-nano (2 mg/kg), respectively. Next, cytotoxicity, cellular uptake, cell apoptosis and migration, fluorescence imaging, TUNEL assay, and tumor inhibition effects were assessed in vitro and in vivo. Furthermore, expression of MDR-related proteins was also detected using western blotting.

Results

Fluorescence imaging showed that the DOX uptake in the DOX-nano-treated group was the strongest in the HCC cells or tumors. Cell apoptosis was significantly increased in DOX-nano-treated HepG2/DOX cells and tumors, and cell migration was significantly inhibited in the DOX-nano-treated HepG2/DOX cells compared with the other groups. The tumor inhibitory rate in DOX-nano-injected tumors was also significantly higher than in other groups. The expression of breast cancer resistance protein, B-cell lymphoma 2, lung resistance protein, multidrug resistance protein, and protein kinase C alpha was significantly decreased in DOX-nano-treated HepG2/DOX cells and xenograft tumors. Significantly better antitumor and MDR-reversing effects were also observed in the HepG2+DOX group compared with the HepG2/DOX group.

Conclusions

This study revealed the potential efficacy of a DOX-nano drug delivery system for the treatment of HCC, using HepG2/DOX cells and nude mice bearing HepG2/DOX xenografts.

The Influence of Omega-3 Long-Chain Polyunsaturated Fatty Acid, Docosahexaenoic Acid, on Child Behavioral Functioning: A Review of Randomized Controlled Trials of DHA Supplementation in Pregnancy, the Neonatal Period and Infancy

This is a review of randomized controlled trials using docosahexaenoic acid (DHA) interventions in the first 1000 days of life with assessments of behavioral functioning in childhood. Electronic databases were searched for trials with a DHA intervention (compared with a placebo group that received no or less DHA) at any time to either women or infants during the first 1000 days, with a subsequent assessment of child behavior. There were 25 trials involving 10,320 mother–child pairs, and 71 assessments of behavior in 6867 of the children (66.5% of those originally enrolled). From the 71 assessments administered, there were 401 comparisons between a DHA group and a control group, with most reporting a null effect. There were no findings of a positive effect of DHA, and 23 instances where the DHA group had worse scores compared with the control group. There was limited evidence that DHA supplementation had any effect on behavioral development, although two of the largest trials with behavioral measures detected adverse effects. Future trials, and future follow-ups of existing trials, should make an effort to evaluate the effect of DHA intervention on behavioral functioning.

Comprehensive Lipidomics Analysis Reveals the Effects of Different Omega-3 Polyunsaturated Fatty Acid-Rich Diets on Egg Yolk Lipids

Dietary supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFAs) for laying hens enriches eggs with these essential fatty acids. However, the enrichment patterns and changes to intact lipids in egg yolk have not been sufficiently revealed. Herein, egg yolk lipids from hens fed with diets supplemented with flaxseed, Schizochytrium sp. residue, or their mixture were comprehensively analyzed using ultraperformance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). A total of 335 individual lipid species covering 23 (sub)classes were identified and quantified. Distinct n-3 PUFA-lipid profiles were revealed among different groups. Dietary α-linolenic acid (ALA) was mainly deposited in the TAG fraction, whereas synthesized or preformed docosahexaenoic acid (DHA) predominantly existed in the glycerophospholipid form. Furthermore, different lipid species were identified and related lipid pathways after dietary supplementation were analyzed. Collectively, these findings provide us with new knowledge for production, nutritional evaluation, authentication, and application of n-3 PUFA-enriched eggs.

Microalgal solutions in the cultivation of rotifers and artemia: scope for the modulation of the fatty acid profile

The microalgae Aurantiochytrium sp. (AUR), Isochrysis sp. (ISO), and Nannochloropsis sp (NAN) were studied as possible alternative feeds to well established commercial compound feeds for both rotifers (Brachionus plicatilis) and Artemia franciscana. Fatty acid (FA) composition —relative (in % of total FAs) and absolute (in mg/g dw)—was determined in order to assess their potential for providing essential FAs. The FA profiles showed relevant differences between the four feeds (compound feed and the three microalgal species), but less stark than in the feeds themselves. Whereas Isochrysis sp. was relatively rich in DHA and poor in EPA, 18.6 ± 1.7% vs 0.6 ± 0.0%, respectively, Nannochloropsis sp. had the opposite pattern, 0.2 ± 0.3% vs 28.3 ± 0.7%. Aurantiochytrium sp. was rich in DHA (19.1 ± 0.2% corresponding to 89.8 ± 0.2 mg/g dw), but posed difficulties as a feed for both rotifers and artemia, given its low lipid incorporation and, in particular, poor DHA deposition. Rotifers fed the compound feed had the best combination of n3 PUFA levels (22.1 ± 0.1 mg/g dw), DHA contents (13.6 ± 0.4 mg/g dw), and DHA/EPA ratios (~3), being rotifers fed AUR and ISO feeds second best. Hence, these microalgae may deserve to be further explored as potential sources of specific FAs in rotifers and artemia.

No effect of 6-month supplementation with 300 mg/d docosahexaenoic acid on executive functions among healthy school-aged children: a randomized, double-blind, placebo-controlled trial

PURPOSE

Docosahexaenoic acid (DHA) plays an essential role in brain, and its status is dependent on dietary intakes. School-aged children in rural China, who consume diets low in omega-3 polyunsaturated fatty acids, may benefit from DHA supplementation. Therefore, this trial was performed to examine the effect of 6-month DHA supplementation on executive functions (EFs) among healthy school-aged children in rural China.

METHODS

A randomized, double-blind, placebo-controlled trial was conducted among 106 primary school children aged 7-12 years in rural China. Participants were randomized to receive either 300 mg/d DHA or placebo for 6 months. EFs including working memory and cognitive flexibility were evaluated at baseline, at 3 months and at 6 months, using Digit Span Backwards and Wisconsin card sorting test, respectively. Socio-demographic data were collected at baseline, and erythrocyte membrane fatty acids and serum neurotransmitters were measured at baseline and after 6-month intervention.

RESULTS

Ninety-four children (88.7%) completed the study according to the protocol. Changes in erythrocyte membrane fatty acids indicated good compliance of the participants. There was no significant intervention effect on serum neurotransmitters. In two-factor ANCOVA, both groups showed a significant improvement in the Digit Span Backwards and the Wisconsin card sorting test from baseline to endpoint. However, no significant intervention effect was found on any EF scores. Linear regression analysis suggested no significant association between changes in erythrocyte DHA level with changes in any EF scores.

CONCLUSIONS

Supplementation with 300 mg/d DHA for 6 months had no benefit on EFs including working memory and cognitive flexibility among healthy school-aged children. This trial was registered at clinicaltrials.gov as NCT02308930 on December 5, 2014.

DHA rich algae oil delivered by O/W or gelled emulsions: strategies to increase its bioaccessibility

BACKGROUND

The bioaccessibility of bioactive compounds for functional food deserves evaluation. An in vitro gastrointestinal digestion model was applied to provide information about the extent of lipid hydrolysis, oxidative stability and bioaccessibility of algae oil (42% of docosahexaenoic acid; DHA), comparing three lipid delivery systems: bulk oil, soy protein stabilized O/W emulsion and carrageenan gelled emulsion.

RESULTS

Lipid digestion kinetics was slightly influenced by the delivery systems. Nevertheless, at the end of intestinal digestion, lipolysis in the three samples ranged between 49% and 52%, showing a partial oil digestion. Lipid oxidation, measured by malondialdehyde, was significantly lower (P < 0.01) in both emulsified oils after intestinal digestion compared to the bulk oil. Bioaccessibility of DHA was 58%, 71% and 84% for bulk oil, O/W emulsion and gelled emulsion, respectively.

CONCLUSION

These results suggest that both emulsified delivery systems used in the present study enhanced the solubilization of free fatty acids, in particular omega-3 fatty acids, and therefore their potential intestinal absorption. © 2018 Society of Chemical Industry.

Portuguese preschool children: Benefit (EPA+DHA and Se) and risk (MeHg) assessment through the consumption of selected fish species

This study aimed to assess the risk-benefit balance associated to fish consumption by Portuguese preschool children. For this purpose, databases (from IPMA and literature) were mined and mathematically processed by a model based on the Extreme Value Theory assuming consumption scenarios. Eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) and selenium (Se) and methylmercury (MeHg) were selected as critical components of fish, given their health impact and significant contents in some fish species. Assessment also took into account that Se may protect against MeHg toxicity. With exception of blue shark, Se Health Benefit Value (Se-HBV), was always positive (ranging between 3.3 and 14.9) and Se:MeHg ratio was always higher than one (3.8 to 32.3). It was also estimated that the deleterious effects of MeHg on children IQ were offset by the beneficial impact of EPA+DHA in fish except for grilled black scabbardfish consumed every day. Blue shark, regardless of the culinary treatment, yielded very high probabilities of exceeding MeHg TWI (higher than 84 % with a single weekly meal), thus raising serious concerns. EPA+DHA benefits were high in salmon regardless of culinary treatment (> 84 %). Fish consumption by children is advisable with exception of blue shark and boiled and grilled tuna.