n-3 long-chain polyunsaturated fatty acids (LCPUFA) for preterm and term infants
- Steven A Abrams, MD
Steven A Abrams, MD
- Section Editor — Neonatology
- Professor, Department of Pediatrics
- Dell Medical School at the University of Texas at Austin
- Section Editors
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
Supplementation of n-3 long-chain polyunsaturated fatty acids (LCPUFAs) has been proposed to improve outcome in infants, particularly neurodevelopmental outcome. However, it remains uncertain whether there is benefit in supplemental dietary n-3 LCPUFAs (also referred to as omega-3 LCPUFAs) for term and preterm infants.
This topic will review the evidence regarding whether or not dietary n-3 LCPUFAs supplementation for infants is beneficial. The risk and benefits of maternal intake of n-3 LCPUFAs through fish intake during pregnancy and the potential benefits of LCPUFAs consumed as dietary seafood or fish oil in adults are discussed separately. (See "Fish consumption and docosahexaenoic acid (DHA) supplementation in pregnancy" and "Fish oil and marine omega-3 fatty acids".)
Metabolism and function — LCPUFAs can be divided into n-6 and n-3 fatty acids (also referred to as omega-6 and omega-3 fatty acids, respectively). Arachidonic acid (AA) is an n-6 fatty acid because of the placement of its first double bond from the methyl end at the C6 position , whereas docosahexaenoic acid (DHA) is an n-3 fatty acid because of its first double bond at the third position . Both AA and DHA are biologically active end products of the essential fatty acids, linoleic (precursor for AA) and alpha-linolenic (precursor for DHA), which are exclusively attained from the diet. The LCPUFAs are synthesized in the liver endoplasmic reticulum and peroxisomes by a series of desaturase and elongase enzymes, and the n-6 and n-3 LCPUFAs compete for these enzymes in their biosynthesis (figure 1) [3,4]. Biosynthesis depends on precursor availability and enzyme activity, which may be limiting in ill or preterm newborns [5,6].
AA can be derived directly from meat sources, whereas DHA is derived from oily fish such as herring, tuna, and salmon, and vegetarian-fed chickens and their eggs . In the United States, the typical diet is higher in n-6 compared with n-3 LCPUFA, due to higher intake of meat over fish. This shift may have implications on the balance between proinflammatory (AA) and antiinflammatory prostaglandin (DHA and other n-3 LCPUFAs such as eicosapentaenoic acid) synthesis.
Docosahexaenoic acid — DHA is an integral component of the phospholipid membrane of brain and retinal cells, and also plays a role in antiinflammatory prostaglandin synthesis, signaling events, gene expression, and cytokine expression. It is preferentially incorporated into the rapidly developing brain and retina during the last trimester of pregnancy and the first six months of life, with ongoing accumulation into early childhood [8-11].
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- Metabolism and function
- - Docosahexaenoic acid
- Suggested dietary requirements
- LCPUFA content in milk
- - Human milk
- - Infant formula
- OUR APPROACH
- RATIONALE FOR LCPUFA SUPPLEMENTATION
- CLINICAL TRIALS
- Term or preterm infants
- Very low birth weight infants
- KNOWLEDGE GAPS AND FUTURE RESEARCH
- SUMMARY AND RECOMMENDATIONS