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 non-human milk feedings with 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 feeding dietary LCPUFAs for term and preterm infants who receive non-human milk feedings.
This topic will review the evidence regarding whether or not dietary LCPUFAs supplementation of non-human milk feedings is beneficial. The risk and benefits of maternal intake of 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 are configured as n-6 and n-3 structures (also referred to as omega-6 and omega-3 fatty acids, respectively). In an n-6 fatty acid, the first double bond from the methyl end is at the C6 position . In an n-3 fatty acid, the first double bond is at the C3 position .
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].
Docosahexaenoic acid (DHA) and other n-3 LCPUFAs — DHA is the biologically active end product of alpha-linolenic acid, which is an essential fatty acid because it is exclusively attained from the diet. DHA is primarily derived from fish, especially oily fish such as herring, tuna, and salmon, as well as omega-3-fed chickens and their eggs . Eicosapentaenoic acid (EPA) is a precursor of DHA, and is metabolized to DHA in the liver.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Metabolism and function
- - Docosahexaenoic acid (DHA) and other n-3 LCPUFAs
- - Arachidonic acid (ARA) and other n-6 LCPUFAs
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS