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Best KP, Sullivan TR, Gunaratne AW, Gould JF, Gibson RA, Collins CT, Makrides M, Green TJ. Effect of Docosahexaenoic Acid (DHA) Supplementation of Preterm Infants on Growth, Body Composition, and Blood Pressure at 7-Years Corrected Age: Follow-Up of a Randomized Controlled Trial. Nutrients 2023; 15:nu15020335. [PMID: 36678206 PMCID: PMC9867194 DOI: 10.3390/nu15020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
Aim: To determine if supplementation of infants born <33 weeks’ gestation with higher dose docosahexaenoic acid (DHA) affects growth, body composition, and blood pressure at 7 y corrected age (CA) and if treatment effects differed by infant sex at birth and birth weight strata (<1250 and ≥1250 g). Methods: Seven-year follow-up of an Australian multicenter randomized controlled trial in which 657 infants were fed high-DHA (≈1% total fatty acids) enteral feeds or standard-DHA (≈0.3% total fatty acids) from age 2−4 d until term CA. Seven-year CA outcomes were growth (weight, height), body composition (lean body mass, fat mass, waist, and hip circumference), and blood pressure. Results: There was no effect of high-DHA enteral feeds compared with standard-DHA on growth, body composition, and blood pressure at 7-year CA either overall or in subgroup analysis by sex. There was a significant interaction between high-DHA and birthweight strata on height at 7-y CA (p = 0.03). However, the post-hoc analyses by birthweight strata did not reach significance (p > 0.1). High-DHA group infants were more likely to be classified as obese (relative risk 1.6 (95% CI 1.0, 2.6); p = 0.05). Conclusions: DHA supplementation of premature infants did not affect growth, body composition, or blood pressure at 7-year CA overall by sex and birthweight strata. The finding of a higher risk of obesity in children who receive high-DHA needs to be interpreted with caution due to the small number of children classified as obese.
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Affiliation(s)
- Karen P. Best
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Public Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Anoja W. Gunaratne
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Jacqueline F. Gould
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Robert A. Gibson
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- School of Agriculture Food and Wine, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Maria Makrides
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Tim J. Green
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-8161-6179
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Wu S, Li C. Influence of Maternal Fish Oil Supplementation on the Risk of Asthma or Wheeze in Children: A Meta-Analysis of Randomized Controlled Trials. Front Pediatr 2022; 10:817110. [PMID: 35265563 PMCID: PMC8898822 DOI: 10.3389/fped.2022.817110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022] Open
Abstract
Background Previous studies evaluating the influences of maternal fish oil supplementation on the risk of asthma or wheeze in children showed inconsistent results. We performed a meta-analysis or randomized controlled trials (RCTs) to systematically evaluate the efficacy of maternal fish oil supplementation for asthma or wheeze. Methods Relevant RCTs were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effects model incorporating the potential publication bias was used to pool the results. Results Ten RCTs with 3,676 infants were included. Compared to control, maternal supplementation with fish oil was not associated with a reduced risk of asthma or wheeze [odds ratio (OR): 0.91, 95% confidence interval (CI): 0.72-1.14, P = 0.40] with mild heterogeneity (I 2 = 28%). Subgroup analyses showed that maternal fish oil supplementation significantly reduced the risk of asthma (OR: 0.56, 95% CI: 0.35-0.91, P = 0.02; I 2 = 0%), but not the risk of wheeze (OR: 1.12, 95% CI: 0.90-1.41, P = 0.32; I 2 = 0%). In addition, maternal fish oil supplementation was associated with reduced risk of asthma or wheeze in high-dose studies (≥1,200 mg/d, OR: 0.65, 95% CI: 0.48-0.87, P = 0.003; I 2 = 0%), but not in low-dose studies (<1,200 mg/d, OR: 1.10, 95% CI: 0.88-1.38, P = 0.39; I 2 = 0%, P for subgroup difference = 0.005). Study characteristics such as the risk of the infants, timing of supplementation, and follow-up duration did not significantly affect the results. Conclusions Maternal fish oil supplementation may reduce the risk of clinically diagnosed asthma in children, particularly with high-dose fish oil.
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Affiliation(s)
- Shaojing Wu
- Department of Clinical Nutrition, Hainan Maternal and Children's Medical Center, Changbin Road Children's Hospital, Haikou, China
| | - Changhong Li
- Department of Obstetrics, Hainan Maternal and Children's Medical Center, Changbin Road Children's Hospital, Haikou, China
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Ekström S, Sdona E, Klevebro S, Hallberg J, Georgelis A, Kull I, Melén E, Risérus U, Bergström A. Dietary intake and plasma concentrations of PUFAs in childhood and adolescence in relation to asthma and lung function up to adulthood. Am J Clin Nutr 2021; 115:886-896. [PMID: 34964829 PMCID: PMC8895221 DOI: 10.1093/ajcn/nqab427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND PUFAs may influence the risk of asthma; however, long-term prospective studies including objective biomarkers of PUFA intake are lacking. OBJECTIVES The objective was to investigate the role of dietary intake and plasma concentrations of n-3 and n-6 (ω-3 and ω-6) PUFAs in childhood and adolescence for the development of asthma and lung function up to young adulthood. METHODS The study included participants from the Swedish prospective birth cohort BAMSE. Dietary intake of PUFAs was calculated from FFQs (n = 1992) and plasma proportions of PUFAs were measured in phospholipids (n = 831). We analyzed the n-3 PUFA α-linolenic acid (ALA; 18:3n-3); the sum of very-long-chain (VLC) n-3 PUFAs: EPA (20:5n-3), DHA (22:6n-3), and docosapentaenoic acid (22:5n-3); and the n-6 PUFAs linoleic acid (LA; 18:2n-6) and arachidonic acid (AA; 20:4n-6). Asthma was assessed by questionnaires at 8, 16, and 24 y and lung function was measured by spirometry at 24 y. RESULTS A high (≥median) self-reported dietary intake of LA at 8 y and AA at 16 y was associated with increased risk of prevalent asthma at 24 y (OR: 1.41; 95% CI: 1.10, 1.82 and OR: 1.32; 95% CI: 1.02, 1.70, respectively). In contrast, plasma proportions of ALA, ∑VLC n-3 PUFAs, and AA at 8 y, as well as LA at 16 y, were inversely associated with prevalent asthma at 24 y (e.g., OR: 0.55; 95% CI: 0.38, 0.81 for ∑VLC n-3 PUFAs). No consistent associations were observed with lung function. CONCLUSIONS High dietary intake of certain n-6 PUFAs in childhood or adolescence may be associated with increased risk of asthma up to young adulthood, whereas dietary biomarkers of certain n-3 and n-6 PUFAs in plasma may be associated with decreased risk. Thus, the role of diet compared with altered metabolism of PUFAs needs further investigation to improve dietary preventive strategies for asthma.
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Affiliation(s)
| | - Emmanouela Sdona
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Susanna Klevebro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Antonios Georgelis
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Ulf Risérus
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Bergström
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Comitini F, Peila C, Fanos V, Coscia A. The Docosahexanoic Acid: From the Maternal-Fetal Dyad to Early Life Toward Metabolomics. Front Pediatr 2020; 8:538. [PMID: 33102402 PMCID: PMC7555995 DOI: 10.3389/fped.2020.00538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 02/05/2023] Open
Abstract
Docosahexaenoic acid (DHA) is an essential ω-3 long-chain polyunsaturated fatty acid (LCPUFA) and represents the dominant structural fatty acid in the retina and in the brain's gray matter. Due to its active participation in the development of the nervous system, DHA is one of the most studied LCPUFA and is currently considered a critical nutrient during pregnancy and breastfeeding. Increasing evidence in literature suggests that an adequate concentration of DHA is required from the fetal stage through to early life to ensure optimal neurological development. Likewise, many studies in literature demonstrated that an adequate supply of DHA during pregnancy and lactation is essential to promote proper brain development in utero and in early life. Daily supplementation of DHA in newborns has potentially stronger effects compared to maternal supplementation during pregnancy. Supplementation initiated in the second year of life in children born preterm did not result in global cognitive development improvements. Preliminary findings arising from metabolomics has reported that mother's milk and infant formula supplementation of Vitamin D associated with DHA results in a higher antioxidant and protective action, with a possible positive influence on renal function and body fat on preterm infants compared to those receiving only vitamin D. Recent applications of metabolomic studies on newborns may lead to a better understanding of the metabolic process linked to early nutrition and, subsequently, to the development of targeted and personalized nutritional strategies.
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Affiliation(s)
- Federica Comitini
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University Hospital and University of Cagliari, Monserrato, Italy
| | - Chiara Peila
- Complex Structure Neonatology Unit, Department of Public Health and Paediatric, University of Turin, Turin, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University Hospital and University of Cagliari, Monserrato, Italy
| | - Alessandra Coscia
- Complex Structure Neonatology Unit, Department of Public Health and Paediatric, University of Turin, Turin, Italy
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Collins CT, Gibson RA, McPhee AJ, Makrides M. The role of long chain polyunsaturated fatty acids in perinatal nutrition. Semin Perinatol 2019; 43:151156. [PMID: 31326100 DOI: 10.1053/j.semperi.2019.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The importance of omega-3 long chain polyunsaturated fatty acids in the perinatal period has been the focus of research for several decades. Infants born preterm miss out on the last trimester in utero transfer of omega-3 fatty acids and consequently have lower blood levels than infants born at term. Preterm infant formula was supplemented with the omega-3 docosahexaenoic acid and the omega-6 arachidonic acid from 2000 (to the level found in the breast milk of women consuming a western diet) based on trials reporting improvements in visual acuity. Docosahexaenoic acid supplementation beyond this level has not shown improvements in clinical or developmental outcomes, however the effect on childhood development in the most preterm infants remains to be resolved. Maternal omega-3 supplementation during pregnancy has the potential to reduce the incidence of preterm birth but may also, in some pregnancies, prolong gestation beyond term and increase fetal size.
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Affiliation(s)
- Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, 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, The University of Adelaide, Adelaide, 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, North Adelaide, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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