Docosahexaenoic acid (DHA) and the developing central nervous system (CNS) - Implications for dietary recommendations

The accretion of docosahexaenoic acid (DHA) in membranes of the central nervous system is required for the optimum development of retina and brain functions. DHA status is determined by the dietary intake of n-3 polyunsaturated fatty acids (PUFA), both the metabolic precursor α-linolenic acid (α-LNA) and DHA. Clinical studies have shown that feeding term or premature infants with formula low in total n-3 PUFA may alter the maturation of visual acuity. Moreover, feeding infants over the first 6 mon of life with formula containing adequate α-LNA, but no DHA, did not sustain the same cerebral accretion of DHA as that of breast-fed infants. Whether lower DHA accretion in brain of formula-fed term infants impairs neurophysiological performances is not clearly established. Contradictory data have been published, possibly owing to confounding factors such as maternal intakes and/or genetic variations in PUFA metabolism. Nevertheless, a large corpus of data is in favor of the recommendation of regular dietary intakes of DHA (during at least the first 6 mon of life) and suggest that DHA should be added in formulas at the level generally found in human milk (0.2-0.3 wt% of total fatty acids). The maternal intake of n-3 PUFA during pregnancy and lactation is also crucial, since the n-3 PUFA are provided during perinatal development through placental transfer and maternal milk, which determines the DHA status of the newborn and consequently impacts on post-natal development of brain and visual functions. Whether more clinical studies are needed to control and improve the impact of DHA maternal intakes on the progeny’s neurodevelopment, several commissions recommended by precaution that DHA average intake for pregnant and lactating women should be of 200-300 mg/day.     

Fish intake reflects on DHA level in breast milk among lactating women in Latvia

Background

Docosahexaenoic acid (DHA) is an essential fatty acid required for proper growth and development. DHA levels in breast milk vary worldwide. Higher levels are observed among coastal populations and are associated with marine food consumption. Latvia is located in Northern Europe, on the eastern shore of the Baltic Sea. Nevertheless, fish consumption among women of reproductive age is low. The aim of this study was to determine DHA levels in breast milk among lactating women in Latvia.

Methods

Invitation to participate in the study was posted on a social media member group for breastfeeding mothers. In total, 71 women were enrolled from November 2016 until December 2017. DHA levels (% of total fatty acids) in breast milk were measured by gas chromatography. Information about food consumed during the three consecutive days prior to the milk sampling was obtained and a food frequency questionnaire (FFQ) was completed. Information about maternal and infant characteristics, current breastfeeding pattern and milk expression method was also collected.

Results

The mean age of participants was 31?±?4 years and the mean BMI was 22.1?±?3.2. 27 participants were primiparas. The average age and birth weight for infants (34 males, 33 females) was 6?±?4 months and 3.46?±?0.55 kg, respectively. The median DHA level in breast milk (n?=?60) was 0.30?±?0.18% of total fatty acids and it was not influenced by any of the maternal or infant’s characteristics nor current breastfeeding pattern or milk expression manner (p?>?0.05). Fish intake was a positive predictor for DHA levels in breast milk (r?=?0.318, p?=?0.013). Average maternal DHA intake was 136?±?26, 137?±?33 and 178?±?49 (SEM – standard error of the mean) mg, for the third, second and last day prior to sampling day, respectively.

Conclusions

DHA levels in breast milk among lactating women in Latvia correspond to the suggested target DHA value in breast milk (0.30%). Fish consumption is a significant positive predictor for DHA levels in breast milk, however, daily DHA intake among the participants was lower than recommended (200 mg).

     

Dietary Iodine Sufficiency and Moderate Insufficiency in the Lactating Mother and Nursing Infant: A Computational Perspective

The Institute of Medicine recommends that lactating women ingest 290 μg iodide/d and a nursing infant, less than two years of age, 110 μg/d. The World Health Organization, United Nations Children’s Fund, and International Council for the Control of Iodine Deficiency Disorders recommend population maternal and infant urinary iodide concentrations ≥ 100 μg/L to ensure iodide sufficiency. For breast milk, researchers have proposed an iodide concentration range of 150–180 μg/L indicates iodide sufficiency for the mother and infant, however no national or international guidelines exist for breast milk iodine concentration. For the first time, a lactating woman and nursing infant biologically based model, from delivery to 90 days postpartum, was constructed to predict maternal and infant urinary iodide concentration, breast milk iodide concentration, the amount of iodide transferred in breast milk to the nursing infant each day and maternal and infant serum thyroid hormone kinetics. The maternal and infant models each consisted of three sub-models, iodide, thyroxine (T4), and triiodothyronine (T3). Using our model to simulate a maternal intake of 290 μg iodide/d, the average daily amount of iodide ingested by the nursing infant, after 4 days of life, gradually increased from 50 to 101 μg/day over 90 days postpartum. The predicted average lactating mother and infant urinary iodide concentrations were both in excess of 100 μg/L and the predicted average breast milk iodide concentration, 157 μg/L. The predicted serum thyroid hormones (T4, free T4 (fT4), and T3) in both the nursing infant and lactating mother were indicative of euthyroidism. The model was calibrated using serum thyroid hormone concentrations for lactating women from the United States and was successful in predicting serum T4 and fT4 levels (within a factor of two) for lactating women in other countries. T3 levels were adequately predicted. Infant serum thyroid hormone levels were adequately predicted for most data. For moderate iodide deficient conditions, where dietary iodide intake may range from 50 to 150 μg/d for the lactating mother, the model satisfactorily described the iodide measurements, although with some variation, in urine and breast milk. Predictions of serum thyroid hormones in moderately iodide deficient lactating women (50 μg/d) and nursing infants did not closely agree with mean reported serum thyroid hormone levels, however, predictions were usually within a factor of two. Excellent agreement between prediction and observation was obtained for a recent moderate iodide deficiency study in lactating women. Measurements included iodide levels in urine of infant and mother, iodide in breast milk, and serum thyroid hormone levels in infant and mother. A maternal iodide intake of 50 μg/d resulted in a predicted 29–32% reduction in serum T4 and fT4 in nursing infants, however the reduced serum levels of T4 and fT4 were within most of the published reference intervals for infant. This biologically based model is an important first step at integrating the rapid changes that occur in the thyroid system of the nursing newborn in order to predict adverse outcomes from exposure to thyroid acting chemicals, drugs, radioactive materials or iodine deficiency.     

High contents of both docosahexaenoic and arachidonic acids in milk of women consuming fish from lake Kitangiri (Tanzania): targets for infant formulae close to our ancient diet?

Current recommendations for arachidonic (AA) and docosahexaenoic (DHA) acids in infant formulae are based on milk of Western mothers. Validity may be questioned in view of the profound dietary changes in the past 100 years, as opposed to our slowly adapting genome. Hominin evolution occurred in the proximity of East-African freshwater lakes and rivers and early homo sapiens had higher intakes of AA and DHA from a predominantly lacustrine-based diet. In search of milk AA and DHA contents of our African ancestors, we investigated the milk of 29 lactating women living in Doromoni near lake Kitangiri (Tanzania). They consumed sunflower oil-fried local fish as only animal lipid sources, maize and local vegetables. AA and DHA contents of Doromoni milk may be close to that of early homo sapiens, because of the similarity of their life-long consumption of East-African lacustrine-based foods. Human milk fatty acid relationships from our historical worldwide database and the literature revealed that disparities between the Doromoni diet and the presumed ancient diet (i.e. higher carbohydrate and linoleic acid intakes) are unlikely to affect milk AA and DHA contents. Doromoni milk had high contents of AA (median 0.70 mol%), DHA (0.75) and eicosapentaenoic acid (EPA, 0.17), and low AA/DHA ratios (median 0.91; 0.55-2.61). This tracks down to consumption of fish with high AA and DHA contents, and AA/EPA ratios. We conclude that the milk AA, DHA and EPA contents of Doromoni women might provide us with clues to optimize infant formulae and perhaps the milk of Western women.     

Docosahexaenoic acid transfer into human milk after dietary supplementation: a randomized clinical trial

Docosahexaenoic acid (DHA) is important for infant development. The DHA transfer from maternal diet into human milk has not been investigated in detail. We studied the effects of DHA supplementation on the fatty acid composition of human milk and the secretion of dietary (13)C-labeled fatty acids, including DHA, into human milk. Ten lactating women were randomized to consume, from 4 to 6 weeks postpartum, an oil rich in DHA (DHASCO, 200 mg of DHA/day) (n = 5) or a placebo oil (n = 5). Dietary intakes were followed by 7-day protocols. On study day 14 a single dose of [U-(13)C]DHASCO was given orally, milk samples were collected over 48 h, and milk production was recorded. Milk fatty acid composition was determined by gas-liquid chromatography and isotopic enrichment was determined by gas chromatography- combustion-isotope ratio mass spectrometry (GC-C-IRMS). Milk DHA content did not differ between the supplemented and placebo group at study entry (0.29 vs. 0.28 wt%, median). After 2 weeks of supplementation the milk DHA content was almost 2-fold higher in the supplemented versus placebo group (0.37 vs. 0.21 wt%, P = 0.003). Cumulative recovery of [(13)C]palmitic, [(13)C]oleic, and [(13)C]docosahexaenoic acids in human milk at 48 h was similar between supplemented and placebo groups (palmitic acid 7.40 vs. 8. 14%, oleic acid 9.14 vs. 9.97%, and docosahexaenoic acid 9.09 vs. 8. 03% of dose, respectively). Notable lower recovery was observed for [(13)C]myristic acid in both the supplemented and placebo groups, 0. 62 versus 0.77% of dose.Dietary DHA supplementation increases the DHA content in human milk. DHA transfer from the diet into human milk is comparable to palmitic and oleic acid transfer.     

Association Between Zinc, Copper, and Iron Concentrations in Breast Milk and Growth of Healthy Infants in Tabriz, Iran

The aims of this study were to determine the effect of breast milk zinc, copper, and iron concentrations on infants’ growth and their possible correlations with maternal dietary intake. Milk samples and information on food intake were collected from 182 lactating women. Concentrations of zinc, copper, and iron in milk were analyzed using atomic absorption spectrophotometry. The infant’s weight for age Z-score (WAZ) and height for age Z-score (HAZ) were calculated. The mean milk zinc, copper, and iron concentrations were 1.85?±?0.5, 0.53?±?0.3, and 0.85?±?0.2 mg/l, respectively. Only zinc mean level was lower than the recommended range. Association between zinc, copper, and iron concentrations of milk and WAZ or HAZ of infants were not significant. However, the WAZ of infants whose mothers' milk zinc was more than 2 mg/l was significantly (P?<?0.039) higher than for others. The mean dietary zinc (5.31?±?2.3 mg/day) and copper (1.16?±?0.7 mg/day) intake of mothers was significantly less than the required daily intake (RDA) recommendations (P?<?0.05). The mean dietary iron intake (11.8?±?8.2 mg/day) was significantly higher than RDA recommendation (P?<?0.001). No significant association was found between maternal mean dietary zinc, copper, and iron intakes with their concentrations in milk. Dietary consultation or/and zinc supplementation is suggested for lactating women and infants.     

Maternal Milk Concentration of Zinc,Iron, Selenium,and Iodine and Its Relationship to Dietary Intakes

The dietary intake of zinc (Zn), iron (Fe), selenium (Se), and iodine (I) of 31 lactating Mexican–American women attending the Hidalgo County WIC program in Rio Grande Valley (RGV), Texas was estimated from 24-h dietary recall interviews. Milk samples were obtained from lactating mothers who had infants 3 months of age and younger. Milk samples were collected in two visits to assess change in breast milk composition after 1–3 months postpartum: group A—after 30–45 days and group B—75–90 days. Dietary intakes indicated that the study participants had significantly inadequate percent energy intakes than the DRI (Dietary Recommended Intakes) percent recommended kilocalorie values but protein intakes were substantially higher than the percent recommended values. The estimated percent Zn, Fe, Se, and I intakes were also significantly lower than the DRI percent recommended values. The lactating mothers consumed significantly less Zn, Se, and I when compared to the Recommended Dietary Allowances (RDA) even though Fe intake was higher than the RDA value. Breast milk concentration of Zn, Fe, and Se were in agreement within the range of representative values for Constituents of Human Milk but I has significantly less concentration than the representative value. There was no statistically significant correlation observed between dietary intake and milk concentration of Zn, Fe, Se, and I. This study compares the estimated dietary intake of zinc, iron, selenium, and iodine to the concentration of these trace elements in the maternal milk of lactating women of Mexican–American heritage who attend the Rio Grande Valley WIC clinic.     

Iodine nutrition and breast feeding

A survey of the databanks Medline and Web of science identified studies dealing with maternal and infant iodine nutrition during breast feeding. The iodine concentration of human milk varies widely due to maternal iodine intake. Mean breast milk iodine concentrations are reported as ranging from 5.4 to 2170 μg/L (median 62 μg/L) in worldwide studies. In the few studies that compared length of lactation, gestation length, and parity number, these factors did not significantly affect milk-iodine concentrations. In studies of maternal iodine deficiency, untreated goiter had no impact on breast milk iodine when compared with controls. Iodine in human milk responds quickly to dietary iodine intake, either supplemented or consumed in natural foods. Easily absorbable iodine from foods, supplemental sources, iodine-based medication or iodine-based antiseptic solutions used during parturition, is taken up by the maternal thyroid and mammary glands through the Na⁺/I⁻ symporter system. This transmembrane carrier protein transports iodine against a high concentration gradient. Hormonal iodine in breast milk occurs mainly as T-4, but depending on maternal iodine intake, high concentrations of the inorganic form (iodide) are found. In less developed countries, where natural-food-iodine intake is low, adequate maternal iodine nutritional status depends exclusively on enforcement of food iodination. In industrialized countries, maternal iodine intake has increased as a function of increasing consumption of dairy products. The human infant is sensitive to maternal iodine nutrition during fetal development and later during breast feeding. Environmental factors, not directly related to maternal iodine intake, such as intake of selenium and organochlorine pollutants, can affect thyroid hormone homeostasis in breast-fed infants. In spite of low iodine concentrations found in milk of mothers consuming low-iodine natural foods, long lasting or even life-lasting benefits to the breast-fed infant are demonstrable.     

Is there a dietary requirement for DHA in pregnancy?

The metabolic demand for docosahexaenoic acid (22:6 n-3, DHA) is increased during pregnancy because of the extra needs of the fetus, expanded maternal cell mass and placenta. In Western countries maternal dietary DHA intake in pregnancy is low and it is not clear whether adaptive metabolic mechanisms, such as increased DHA synthesis from precursor fatty acids, are capable of meeting the increased DHA need in pregnancy. Consequently randomized controlled trials are important to determine whether additional dietary DHA in pregnancy modifies maternal or infant health outcomes. The available randomized comparisons of DHA supplements vs placebo have assessed outcomes as diverse as maternal depression, infant visual acuity and development, and infant growth and allergy. The outcomes of these trials have not been conclusive because they have often been limited by small sample size. On the other hand, large-scale trials assessing marine oil supplementation with large doses indicate that DHA supplementation in pregnancy is safe.     

Estimating daily intakes of manganese due to breast milk,infant formulas,or young child nutritional beverages in the United States and France: Comparison to sufficiency and toxicity thresholds

BackgroundAlthough manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment.MethodsWe estimated daily total Mn intake due to breast milk at average body weights by reviewing reported concentrations of breast milk Mn and measurements of body weight and breast milk intake at 3 weeks, 4.25 months, 7 months, and 18 months. We compared these figures to the Mn content measured in 44 infant, follow-up, and toddler formulas purchased in the United States and France. We calculated Mn content of formula products made with ultra-trace elemental analysis grade water (0 μg Mn/L) and with water containing 250 μg Mn/L, a concentration which is relatively high but less than the World Health Organization Health-based value of 400 μg Mn/L or the United States Environmental Protection Agency Health Advisory of 350 μg Mn/L.ResultsEstimated mean daily Mn intake from breast milk ranged from 1.2 μg Mn/kg/day (3 weeks) to 0.16 μg Mn/kg/day (18 months), with the highest intakes at the youngest age stage we considered, 3 weeks. Estimated daily Mn intake from formula products reconstituted with 0 μg Mn/L water ranged from 130 μg Mn/kg/day (3 weeks) to 4.8 μg Mn/kg/day (18 months) with the highest intakes at 3 weeks. Formula products provided 28–520 times greater than the mean daily intake of Mn from breast milk for the 4 age stages that we considered. Estimated daily Mn intake from formula products reconstituted with water containing 250 μg Mn/L ranged from 12 μg Mn/kg/day to 170 μg Mn/kg/day, which exceeds the United States Environmental Protection Agency Reference Dose of 140 μg Mn/kg/day for adults.ConclusionsMn deficiency is highly unlikely with exclusive breast milk or infant formula feeding, but established tolerable daily intake levels for Mn may be surpassed by some of these products when following labeled instructions.     

The intake and digestion of maize silage-based diets by dairy cows and sheep

Six lactating cows, 6 dry cows and 6 wether sheep were fed ad libitum on diets of maize silage, maize silage plus lucerne, or maize silage plus lucerne plus wheat. Faeces and urine collections allowed for the determination of digestibility of dry matter, organic matter and nitrogen, and balances of nitrogen and water.

Voluntary feed intakes were highest and digestibility values were lowest in lactating cows. The addition of lucerne reduced organic matter digestibility in dry cows, but not in lactating cows or sheep. The addition of wheat decreased intake in dry cows and sheep, but not in lactating cows. Production of milk, protein, solids-not-fat and total solids increased with dietary quality, but there was a depression in milk fat content as a result of wheat supplementation.

The ranking of the 3 diets on the basis of feed intake differed with each class of livestock, but lactating cows and sheep gave the same ranking on the basis of organic matter digestibility.     

Determinants of DHA levels in early infancy: differential effects of breast milk and direct fish oil supplementation

IntroductionAlthough omega (n)-3 long-chain polyunsaturated fatty acids (LCPUFA), particularly docosahexaenoic acid (DHA), intakes are important during infancy, the optimal method of increasing infant status remains unclear. We hypothesized that high-dose infant fish oil supplementation would have greater relative effects upon n-3 LCPUFA status at six months of age than breast milk fatty acids.Patients and methodsInfants (n=420) were supplemented daily from birth to six months with fish oil or placebo. In a subset of infants, LCPUFA levels were measured in cord blood, breast milk and in infant blood at 6 months.ResultsDHA levels increased in the fish oil group relative to placebo (p<05). Breast milk DHA was the strongest predictor of infant erythrocyte DHA levels (p=<001). This remained significant after adjustment for cord blood DHA, supplementation group and adherence.ConclusionIn this cohort, breast milk DHA was a greater determinant of infant erythrocyte n?3 LCPUFA status, than direct supplementation with fish oil.     

Selenium intake and status of postpartum women and postnatal depression during the first year after childbirth in New Zealand – Mother and Infant Nutrition Investigation (MINI) study

BackgroundSelenium (Se) plays an important role in selenoproteins as an antioxidant, and is involved in thyroid function, mental health and child development. Selenium is low in the local food supplies in NZ. Low selenium intake has been reported in women of childbearing age and postmenopausal women, however, there is little research relating to breastfeeding women and their infants.PurposeThe study investigates maternal and infant selenium intake and status during the first year postpartum, and possible relationships to postnatal depression and anxiety.Basic proceduresThe Mother and Infant Nutrition Investigation (MINI) study is an observational longitudinal cohort study. In total 87 breastfeeding mother-infant pairs were recruited and followed up at 3, 6 and 12 months postpartum. Maternal selenium intake was estimated from a four-day diet diary (4DDD). Selenium concentrations were measured in maternal spot urine, breastmilk and plasma; and infant spot urine samples. Postnatal depression was screened by the Edinburgh Postnatal Depression Scale (EPDS) questionnaire.Main findingsMedian maternal selenium intake was 62 (50, 84) μg/day, with 56 % below the Estimated Average Requirement (EAR) of 65 μg/day. At 3, 6, and 12 months postpartum, median maternal urinary selenium:creatinine ratios were 29.0 (22.4, 42.0), 29.5 (23.1, 28.4), and 30.9 (24.3, 35.3) μg/g; median infant urinary selenium concentrations (IUSC) were 8 (6,13), 11 (6, 15), and 24 (10, 40) μg/L; median breastmilk selenium concentrations (BMSC) were 13 (11, 14), 11 (9, 11) and 12 (11, 13) μg/L; 18 %, 11 % and 14 % of women reported probable minor depression based on the EPDS scores equal or above 10. Estimated median infant selenium intake at 3 and 6 months were 9 (8, 11) and 8 (7, 10) μg/day with 85 % and 93 % below the Adequate Intake of 12 μg/day. Median maternal plasma selenium was 105.8 μg/L at 6 months postpartum. Minor depression at three months postpartum was significantly different across tertiles of plasma selenium concentrations (p = 0.041).Principle conclusionsSuboptimal selenium intake was observed among breastfeeding mothers and their infants in the MINI study. Potentially, some women had insufficient selenium status. Relation between selenium status and risk of postnatal depression and anxiety was inconclusive.Further research is required to explore effects on maternal thyroid function and infant neurodevelopment among women with inadequate selenium intake and status.     

Early second trimester maternal plasma choline and betaine are related to measures of early cognitive development in term infants

Background

The importance of maternal dietary choline for fetal neural development and later cognitive function has been well-documented in experimental studies. Although choline is an essential dietary nutrient for humans, evidence that low maternal choline in pregnancy impacts neurodevelopment in human infants is lacking. We determined potential associations between maternal plasma free choline and its metabolites betaine and dimethylglycine in pregnancy and infant neurodevelopment at 18 months of age.

Methodology

This was a prospective study of healthy pregnant women and their full-term, single birth infants. Maternal blood was collected at 16 and 36 weeks of gestation and infant neurodevelopment was assessed at 18 months of age for 154 mother-infant pairs. Maternal plasma choline, betaine, dimethylglycine, methionine, homocysteine, cysteine, total B12, holotranscobalamin and folate were quantified. Infant neurodevelopment was evaluated using the Bayley Scales of Infant Development–III. Multivariate regression, adjusting for covariates that impact development, was used to determine the associations between maternal plasma choline, betaine and dimethylglycine and infant neurodevelopment.

Results

The maternal plasma free choline at 16 and 36 weeks gestation was median (interquartile range) 6.70 (5.78–8.03) and 9.40 (8.10–11.3) µmol/L, respectively. Estimated choline intakes were (mean ±SD) 383±98.6 mg/day, and lower than the recommended 450 mg/day. Betaine intakes were 142±70.2 mg/day. Significant positive associations were found between infant cognitive test scores and maternal plasma free choline (B = 6.054, SE = 2.283, p = 0.009) and betaine (B = 7.350, SE = 1.933, p = 0.0002) at 16 weeks of gestation. Maternal folate, total B12, or holotranscobalamin were not related to infant development.

Conclusion

We show that choline status in the first half of pregnancy is associated with cognitive development among healthy term gestation infants. More work is needed on the potential limitation of choline or betaine in the diets of pregnant women.     

Essential fatty acid supplementation of DHA and ARA and effects on neurodevelopment across animal species: a review of the literature

Docosahexanoic acid (DHA) and arachidonic acid (ARA) are long chain essential fatty acids used as supplements in commercial infant formula. DHA/ARA deficient states are associated with adverse neurological outcomes in animals and humans. Preterm infants are at risk for DHA/ARA deficiency. A few clinical reports on the effects of fatty acid supplementation have shown benefit in preterm, low birth weight, and normal infants in the first year of life, whereas others did not. Studies in animals have reported shortened gestation, fetal growth retardation, reduced infant body mass, and increased fetal mortality with consumption of fatty acids during pregnancy. To understand the data that support fatty acid supplementation in infant formula, a review of the animal model literature was undertaken, to examine the effects of DHA/ARA on neurodevelopment, including the effects on visual acuity. Several points emerged from this review. (1) Animal studies indicate that requirements for DHA/ARA vary depending on developmental age. Alterations of the ratio of DHA/ARA can impact developmental outcome. (2) The available studies suggest that while supplementation of DHA/ARA in an appropriate ratio can increase tissue levels of these fatty acids in the brain and retina, tissues sensitive to depletion of fatty acids, the benefit of routine supplementation remains unclear. Few studies measure functional outcome relative to changes in physiologic pools of DHA/ARA after supplementation. (3) Animal literature does not support a clear long-term benefit of replenishing DHA/ARA tissue levels and administration of these fatty acids at concentrations above those in human milk suggests adverse effects on growth, survival, and neurodevelopment.     

How much energy does the breast fed infant consume and expend?

Energy intake in breast fed infants is uncertain. The doubly labelled water method was used to measure, simultaneously and non-invasively, energy expenditure, energy intake, milk volume intake, energy deposition, and the energy content of breast milk in 12 "free living" breast fed babies at 5 and 11 weeks of age. The validity of this new approach was assessed in a parallel study in 12 formula fed infants. The babies who were exclusively breast fed expended 1.28 and 1.68 MJ/day at five and 11 weeks and had intakes of 1.81 and 2.22 MJ/day; these intakes were associated with normal growth but were well below those recommended previously. At five and 11 weeks the calculated energy content of breast milk was 0.24 and 0.25 MJ/100 ml, which is substantially lower than that commonly reported in milk obtained unphysiologically by expression of the breast. These data cast doubt on the widely used published standards for infant feeding.     

Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults

The principal biological role of alpha-linolenic acid (alphaLNA; 18:3n-3) appears to be as a precursor for the synthesis of longer chain n-3 polyunsaturated fatty acids (PUFA). Increasing alphaLNA intake for a period of weeks to months results in an increase in the proportion of eicosapentaenoic acid (EPA; 20:5n-3) in plasma lipids, in erythrocytes, leukocytes, platelets and in breast milk but there is no increase in docosahexaenoic acid (DHA; 22:6n-3), which may even decline in some pools at high alphaLNA intakes. Stable isotope tracer studies indicate that conversion of alphaLNA to EPA occurs but is limited in men and that further transformation to DHA is very low. The fractional conversion of alphaLNA to the longer chain n-3 PUFA is greater in women which may be due to a regulatory effect of oestrogen. A lower proportion of alphaLNA is used for beta-oxidation in women compared with men. Overall, alphaLNA appears to be a limited source of longer chain n-3 PUFA in humans. Thus, adequate intakes of preformed long chain n-3 PUFA, in particular DHA, may be important for maintaining optimal tissue function. Capacity to up-regulate alphaLNA conversion in women may be important for meeting the demands of the fetus and neonate for DHA.     

Soluble form of ICAM-1, VCAM-1, E- and L-selectin in human milk

In breast milk and paired serum from 70 lactating women and 40 of their term, infection-free neonates, on the 2nd and 5th day postpartum slCAM-1, sVCAM-1, sE- and sL-selectin were measured by ELISA and compared with those in 26 healthy adults (controls). Seven infant formulas and fresh milk from five cows were also analyzed. Human colostrum values of slCAM-1, sVCAM-1 (similar to those in maternal and control serum), sE-selectin and sL-selectin (-10 and -100 times lower than in maternal and control serum) were significantly higher than those in milk, while they varied widely. None of the adhesion molecules was detected in fresh cow's milk or infant formulas. Exclusively breast-fed infants showed significantly higher values of slCAM-1 and sL-selectin on the 2nd day of life than those supplemented also with formula. Only slCAM-1 values correlated positively between colostrum and time-matched maternal serum. These findings show in human milk important amounts of slCAM-1 and sVCAM-1 but minimal amounts of sE- and sL-selectin, which could affect the immune system of the neonate.