Post on 21-Apr-2018
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ωω--3 fatty acids:3 fatty acids:
The Effects during Pregnancy and The Effects during Pregnancy and
Breast feedingBreast feeding
Antonis ZampelasAntonis Zampelas
Professor, of Human Nutrition
Director, Laboratory of Food Chemistry and Human Nutrition,
Department of Food Science and Human Nutrition,
Agricultural University of Athens
Visiting Professor, Department of Life Sciences, University of Nicosia
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γ-linolenic acid (18:3 ω-6) eicosapentaenoic acid (20:5 ω-3)( fish oils )
arachidonic acid (20:4 ω-6) docosahexaenoic acid (22:6 ω-3)(meat) (fish oils)
Eicosanoids from ω-6 Eicosanoids from ω-3Thromboxane Α2 (pro-aggregatory) Prostacycline (anti-aggrega tory)
Leukotriene Β4 (promotes aggregation Thromboxane Α3 (less active)of leukocytes) Leukotriene Β5 (< 5-10% active compared to Β4)
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1
1,5
2
Mixed oilCorn Oil
Postprandial plasma TG and LPL responses following ac ute test meals of different fatty acid composition
Plasma TG (mmol/L)
150
200
250
LPL (nmol oleate released/min/ml plasma )
0
0,5
Fish oil
Time postprandially (min)
Zampelas A et al Eur J Clin Nutr 1994, 48: 842-848
0
50
100
5 15
Mixed oil Corn oil Fish oil
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Fish consumption
No < 150 g/w 150–300 g/w > 300 g/w P ⊥
N
(%) 319 (11%)
1719
(56%)
745
(24%)
259
(9%)
-
CRP (mg/L) 2.7±1.2 2.0±1.1** 2.0±2.1** 1.8±1.1** 0.004
Inflammatory markers and fish consumption: Inflammatory markers and fish consumption:
the ATTICA Study the ATTICA Study
CRP (mg/L) 2.7±1.2 2.0±1.1 2.0±2.1 1.8±1.1 0.004
IL – 6 (ng/ml) 1.5 ±0.5 1.3±0.6* 1.2±1.1** 1.0±0.3** 0.03
TNF–α (mg/dl) 5.3 ±3 5.1±2 4.7±3** 4.2±2** < 0.001
Amyloid A (mg/dl) 6.4 ±4 5.9±4 5.1±4* 4.6±3** 0.004
No gender differences were observed.* P < 0.05 and ** P < 0.01 (Bonferroni corrected) for the differences between fish consumption groups vs. noconsumption. Probability values derived from the ANOVA test.⊥ P – values derived from ANOVA test that evaluated the associations between inflammatory markers(dependent) and fish intake (independent factor).
Zampelas A et al J Am Coll Cardiol 2005;46:120-4
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Calder PC, Ann Nutr Metab 2016;69(suppl 1):8–21
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• The brain weight in the newborn corresponds to approximately
10% of the total body weight
• Following adipose tissue, brain is the 2nd richer organ in fat
• 50-60% of the dry weight is fat
The brain
The fatty acids AA and DHA are main constituents
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�The human brain growth spurt occurs from approximately
the beginning of the third trimester of pregnancy to 18
months after birth.
�The amount of DHA in the brain increases dramatically
during the brain growth spurt.
�In humans, brain weight increases from about 100 g at 30 �In humans, brain weight increases from about 100 g at 30
weeks of gestation to about 1,100 g at 18 months of age
�Over this period, the DHA content of the brain increases
from 900 μg/g (90 mg in total) to 3,000 μg/g (3,300 mg
total). This represents a 35-fold increase in total brain DHA.
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� Photoreceptor outer segments
have the highest DHA segment
of any cell
� Prolonged dietary deprivation
required to reduce DHA
contentcontent
- only then functional
impairment occur
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Calder PC, Ann Nutr Metab 2016;69(suppl 1):8–21
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METHODS: RCTs assessing the efficacy of LCPUFA supplementation of
infant formulas on infant visual acuity. RCTs assessing the effects of
LCPUFA supplementation on visual acuity in the first year of life were LCPUFA supplementation on visual acuity in the first year of life were
included in this meta-analysis
RESULTS: Nineteen studies involving 1949 infants were included
Qawasmi A et al Pediatrics 2013;131:e262–e272
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A, Difference in visual acuity as assessed by
Visual Evoked Potential (VEP) at the age of 2
months between infants fed formula
supplemented with LCPUFAs and
nonsupplemented formula
B, Difference in visual acuity as assessed by
VEP at the age of 4 months between infants fed
formula supplemented with LCPUFAs and
nonsupplemented formula
C, Difference in visual acuity as assessed by VEP
at the age of 12 months between infants fed at the age of 12 months between infants fed
formula supplemented with LCPUFAs and
nonsupplemented formula
Qawasmi A et al Pediatrics 2013;131:e262–e272
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� Objectives: To assess the effectiveness and safety of supplementation with
LCPUFA in breastfeeding mothers in the cognitive and physical development of
their infants as well as safety for the mother and infant.their infants as well as safety for the mother and infant.
� Selection Criteria: Randomised controlled trials or cluster-randomised
controlled trials evaluating the effects of LCPUFA supplementation on
breastfeeding mothers (including the pregnancy period) and their infants.
� Conclusion: Based on the available evidence, LCPUFA supplementation did not
appear to improve children’s neurodevelopment, visual acuity or growth. In
child attention at five years of age, weak evidence was found (one study)
favouring the supplementation.
Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD007901
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�Maternal plasma and erythrocyte arachidonic acid and total �Maternal plasma and erythrocyte arachidonic acid and total
erythrocyte omega-6 fatty acid levels at T2 were higher (p<0.05
for both) in the LBW group.
�Total erythrocyte omega-3 fatty acid levels were lower (p<0.05)
while total erythrocyte omega-6 fatty acid levels were
higher(p<0.05) in the LBW group at delivery.
PLoS ONE 11(1): e0147359
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• 15 RCTs eligible for inclusion in the meta-analysis, and 14 observational
studies were included in the general review.
• n-3 LCPUFA supplementation during pregnancy resulted in a modest increase
in birthweight (mean difference = 42.2 g; [95% CI 14.8, 69.7])
Effect of nEffect of n--3 Long3 Long--chain Polyunsaturated Fatty chain Polyunsaturated Fatty Acid Intake during Pregnancy on Maternal, Acid Intake during Pregnancy on Maternal,
Infant, and Child Health Outcomes: A Systematic Infant, and Child Health Outcomes: A Systematic ReviewReview
• Women receiving n-3 LCPUFA had a 26% lower risk of early preterm delivery
(<34 weeks) (RR = 0.74; [95% CI 0.58, 0.94]) and there was a suggestion of
decreased risk of preterm delivery (RR = 0.91; [95% CI 0.82, 1.01]) and low
birthweight (RR = 0.92; [95% CI 0.83, 1.02]).
• n-3 LCPUFA in pregnancy did not influence the occurrence of pre-eclampsia,
high blood pressure, infant death, or stillbirth.
Imhoff-Kunsch B et al Paediatric and Perinatal Epidemiol 2012;26 (Suppl 1): 91–107
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Effect of n-3 LCPUFA supplementation during pregnancy on risk of early pre-term birth.
Effect of n-3 LCPUFA supplementation during pregnancy on birthweight.
Imhoff-Kunsch B et al Paediatric and Perinatal Epidemiol 2012;26 (Suppl 1):91–107
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Palmer DJ et al BMJ 2012;344:e184
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Palmer DJ et al BMJ 2012;344:e184
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� Objectives: To assess the effect of n-3 LCPUFA supplementation in pregnant
and/or breastfeeding women on allergy outcomes (food allergy, atopic
dermatitis (eczema), allergic rhinitis (hay fever) and asthma/wheeze) in their dermatitis (eczema), allergic rhinitis (hay fever) and asthma/wheeze) in their
children.
� Selection criteria: Randomised controlled trials (RCTs) evaluating the effect of
n-3 LCPUFA supplementation of pregnant and/or lactating women (compared
with placebo or no treatment) on allergy outcomes of the infants or children.
� Conclusion: Overall, there is limited evidence to support maternal n-3 LCPUFA
supplementation during pregnancy and/or lactation for reducing allergic
disease in children.
Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010085.
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METHODS: Randomized controlled clinical trials assessing the efficacy of LCPUFA
supplementation of infant formulas on cognition. Analysis was restricted
to randomized controlled clinical trials that examined the effect of LCPUFA
supplementation on infant cognition using Bayley Scales of Infant Development.
Primary outcome was the weighted mean difference in Bayley Scales of Infant
Development score between infants fed formula supplemented with LCPUFA
compared with unsupplemented formula.
RESULTS: Twelve trials involving 1802 infants met inclusion criteria.
Qawasmi A et al Pediatrics 2012;129:1141–1149
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Qawasmi A et al Pediatrics 2012;129:1141–1149
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Qawasmi A et al
Pediatrics 2012;Pediatrics 2012;
129:1141–1149
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� Despite the positive findings from some observational studies, many
randomized controlled intervention trials have failed to demonstrate a
conclusive benefit of maternal DHA supplementation on infant
neurodevelopment.
� Few trials have evaluated supplementation during the lactation period. In
contrast, many trials have been conducted on LCPUFA supplementation of contrast, many trials have been conducted on LCPUFA supplementation of
infant formula.
� Regardless of the time period of the intervention, there is a large degree
of heterogeneity between the studies with respect to the DHA dose, the
intervention period and outcomes assessed
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� Fat intake during pregnancy and lactation does not differ from the
recommended for the general population
� During pregnancy and lactation women should aim at an intake of
DHA at least 200 – 500 mg/d.
� When breastfeeding is not - infant formulae should contain DHA 0.2 � When breastfeeding is not - infant formulae should contain DHA 0.2
up to 0.5% of total fatty acids
� Caution to fish that may contain methyl-mercury, such as shark and
sword fish
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Common Variables mg of n-3 Fatty Acids EPA and DHA
Per 4 Ounces of Cooked Fish
Micrograms of Mercury
Per 4 Ounces of Cooked
Fish
Salmon
Anchovies, Herring
Mackerel
Tuna
1200-2400
2300-2400
1350-2100
1700
2
5-10
8-13
54-58Tuna
Sardines
Trout
Shark
Swordfish
Mackerel, King
1700
1100=1700
1000-1100
1250
1000
450
54-58
2
11
151
147
110
FDA, 2014
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Paediatric Perinatal Epidemiol 2012;
26 (Suppl. 1):91–107
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Imhoff-Kunsch B et al Paediatric Perinatal Epidemiol 2012;226 (Suppl. 1):91–107
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Imhoff-Kunsch B et al Paediatric Perinatal Epidemiol 2012;226 (Suppl. 1):91–107
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Imhoff-Kunsch B et al Paediatric Perinatal Epidemiol 2012;226 (Suppl. 1):91–107
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Imhoff-Kunsch B et al Paediatric Perinatal Epidemiol 2012;226 (Suppl. 1):91–107