Short communicationBreast milk from women living near Lake Malawi is high in docosahexaenoic acid and arachidonic acid☆
Section snippets
Summary
Adequate long-chain polyunsaturated fatty acid (LCPUFA) intake is critical during the fetal and infant periods. We quantified fatty acid content of breast milk (n=718) and plasma from six month old infants (n=412) in southern Malawi, and in usipa (n=3), a small dried fish from Lake Malawi. Compared to global norms, Malawian breast milk fatty acid content (% of total fatty acids) was well above average levels of arachidonic acid [ARA] (0.69% vs. 0.47%) and docosahexaenoic acid [DHA] (0.73% vs.
Study setting and population
The mothers and infants included in this analysis were participants in a randomized, controlled, single-blind, parallel group clinical trial (ClinicalTrials.gov identifier: NCT00524446) of micronutrient fortified lipid-based nutrient supplements conducted in two health facility catchment areas (Lungwena and Malindi) in Mangochi district, southern Malawi [18]. Both sites are primarily rural but the Malindi site is closer to Mangochi town than the Lungwena site (17 vs 32 km distance). The Lungwena
Characteristics of study population
Table 1 presents the characteristics of the Malawian women, their infants and their households in the study population. In general, the characteristics of the subpopulations with analyzed breast milk and plasma samples were very similar to those of the total study population [18]. Among the women whose breast milk samples were analyzed, maternal BMI ranged from 13.9 to 30.2 kg/m2 (mean 20.8 kg/m2). Approximately 17% (n=120) of the women were underweight (BMI<18.5 kg/m2), and 33% (n=235) of the
Discussion and conclusions
In this cross-sectional study, we describe maternal breast milk PUFA content, the plasma PUFA status of breastfed infants also receiving complementary foods at six months of age, and the relationship between these two measures among women and infants participating in a clinical trial in southern Malawi. We also provide information on the LCPUFA content of small fish that are regularly accessible to women in the area.
Overall, the pattern of fatty acids that we observed in the breast milk from
Conclusions
Malawian women living near Lake Malawi have high breast milk ARA and DHA levels compared to global data. This is likely due to having regular access to small freshwater fish that are high in LCPUFAs, such as usipa. Future longitudinal studies should examine the impact on maternal and infant outcomes of adding usipa (or other local fish high in ARA and DHA) to maternal diets.
Contributions
EYJ wrote and revised the manuscript and performed statistical analysis. CM, PA, KM designed, coordinated and supervised the implementation of the LCNI-5 clinical trial, from which the biological samples were drawn. KGD designed the fatty acid sub-study, and WSH oversaw the fatty acid laboratory analysis. All authors provided substantial comments on manuscript drafts and reviewed and approved the final manuscript.
Acknowledgements
We would like to thank the families that participated in the study. We express gratitude to John Phuka, Yin Bun Cheung, Jan Peerson, Andrea Pointe-Eaton and Setti Shahab-Ferdows for their technical assistance with the project implementation and laboratory and statistical analyses. We would also like to acknowledge Jason Polreis and Laura Sanborn at OmegaQuant Analytics for analysis of the fatty acids in plasma, breast milk and usipa. The fatty acid analyses were supported by a grant from the
References (48)
- et al.
Role of omega-3 fatty acids in brain development and function: Potential implications for the pathogenesis and prevention of psychopathology
Prostaglandins Leukot. Essent. Fatty Acids
(2006) Tissue levels of polyunsaturated fatty acids during early human development
J. Pediatr.
(1992)Early determinants of development: a lipid perspective
Am. J. Clin. Nutr.
(2009)- et al.
Docosahexanoic and arachidonic acid concentrations in human breast milk worldwide
Am. J. Clin. Nutr.
(2007) - et al.
The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina
Prog. Lipid Res.
(2001) - et al.
Effect of supplementation of arachidonic acid (AA) or a combination of AA plus docosahexaenoic acid on breastmilk fatty acid composition
Prostaglandins Leukot. Essent. Fatty Acids
(2000) - et al.
Human milk arachidonic acid and docosahexaenoic acid contents increase following supplementation during pregnancy and lactation
Prostaglandins Leukot. Essent. Fatty Acids
(2009) - et al.
A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month old moderately underweight children in rural Malawi
J. Nutr.
(2010) - et al.
Changes in erythrocyte membrane trans and marine fatty acids between 1999 and 2006 in Older Americans
J. Nutr.
(2012) - et al.
The influence of dietary carbohydrates and fat on the fatty acids of mature milk. A study in four ethnic groups
Am. J. Clin. Nutr.
(1965)
A carbohydrate-rich diet not only leads to incorporation of medium-chain fatty acids (6:0-14:0) in milk triglycerides but also in each milk-phospholipid subclass
Am. J. Clin. Nutr.
Estimated biological variation of the mature human milk fatty acid composition
Prostaglandins Leukot. Essent. Fatty Acids
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?
Prostaglandins Leukot. Essent. Fatty Acids
Assessment of essential fatty acid and n-3 fatty acid status by measurement of erythrocyte 20:3 n-9 (Mead acid), 22:5 n-6/20:4 n-6 and 22:5 n-6/22:6 n-3
Prostaglandins Leukot. Essent. Fatty Acids
Fatty acid composition of the milk lipids of Fulani women and the serum phospholipids of their exclusively breastfed infants
Early Hum. Dev.
Supplementing lactating women with flaxseed oil does not increase docosahexaenoic acid in their milk
Am. J. Clin. Nutr.
Biological variability of blood omega-3 biomarkers
Clin. Biochem.
Comparative effects of an acute dose of fish oil on omega-3 fatty acid levels in red blood cells versus plasma: implications for clinical utility
J. Clin. Lipid
Maternal fatty acid status during pregnancy and lactation and relation to newborn and infant status
Matern. Child Nutr.
Perinatal Biochemistry and Physiology of Long-Chain Polyunsaturated Fatty Acids
J. Pediatr.
Animal studies of the functional consequences of suboptimal polyunsaturated fatty acid status during pregnancy, lactation and early post-natal life
Matern. Child Nutr.
Metabolic programming of long-term outcomes due to fatty acid nutrition in early life
Matern. Child Nutr.
Long chain polyunsaturated fatty acid formation in neonates: effect of gestational age and intrauterine growth
Pediatr. Res.
Placental transfer of fatty acids and fetal implications
Am. J. Clin. Nutr.
Cited by (22)
Brain delivery of supplemental docosahexaenoic acid (DHA): A randomized placebo-controlled clinical trial
2020, EBioMedicineCitation Excerpt :After cooling, 0.5 mL of distilled water and hexane (0.25 mL for CSF and 0.5 mL for plasma) were added. Fatty acid analysis was performed by GC MS using a Shimadzu GC2010 Plus with a 100 m SP2560 capillary column as described previously [21]. Other measurements: APOE genotyping was assessed using qPCR with isoform-specific primers as described [22].
Macronutrient and micronutrient composition of breast milk from women of different ages and dietary habits in Shanghai area
2018, International Dairy JournalCitation Excerpt :A relatively constant n-6/n-3 long chain PUFA ratio might be advantageous for the breast fed infant (Koletzko et al., 2001). The levels of LA, ALA and ARA in breast milk were weakly positively associated with maternal age (Jimenez et al., 2015). In our study, the ratio of LA/ALA in the breast milk of mothers in the 30–40 year old groups were higher than that of mothers in 20–30 year old groups.
- ☆
Sources of support: The fatty acid analyses were supported by a grant from the Mathile Institute for the Advancement of Human Nutrition. The field trial was funded by Academy of Finland (grants 200720, 108873, 111685 and 109796), Foundation for Pediatric Research in Finland, Medical Research Fund of Tampere University Hospital, and the American people through the support of the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), under terms of Cooperative Agreement No. GHN-A-00-08-00001-00, through the FANTA-2 Project, and operated by the Academy for Educational Development (AED). The contents are the responsibility of the authors and do not necessarily reflect the views of the funders, USAID or the United States Government.
- 1
Additional affiliation, Health Diagnostic Laboratory, Inc., Richmond, VA, USA.