Hypothesis: vitamin E complements polyunsaturated fatty acids in essential fatty acid deficiency in cystic fibrosis

While several studies have demonstrated essential fatty acid (EFA) deficiency in plasma and tissue lipids of cystic fibrosis (CF) patients, the reasons for this deficiency are not well established. It is believed that reduced EFA intake, malabsorption of fat, altered desaturase/lipase activity and defective cystic fibrosis transmembrane conductance regulator (CFTR) altering utilisation of EFA in epithelial cells contribute to the development of EFA deficiency in CF. It is likely that increased metabolism of arachidonic acid to eicosanoids such as leukotrienes, thromboxane and prostaglandins may also be a contributing factor. Evidence is presented that elevated oxidative damage to EFA and impaired antioxidant defences, in particular vitamin E, may contribute to the development of EFA deficiency in CF. Furthermore, antioxidant supplementation in CF may improve EFA status.     

Influence of long-chain polyunsaturated fatty acid formula feeds on vitamin E status in preterm infants

It has been recommended to supplement formulas for preterm infants with n-3 and n-6 long-chain polyunsaturated fatty acids (LCP) to improve growth, visual acuity, and neurodevelopmental performance. However, large amounts of LCP may increase lipid peroxidation and oxidative stress in preterm infants. We investigated if, under high supplementation of natural tocopherols, LCP addition to formula can be performed safely without causing tocopherol depletion in cell membranes. Thirty-one healthy preterm infants with gestational ages from 28 to 32 weeks were evaluated in a prospective, randomized study from birth to day 42. Nine infants received an n-3 and n-6 LCP-enriched formula (A), eleven infants a standard formula (B), and eleven infants breast milk (control group). Alpha- and gamma-tocopherol extracts were added to both formulas, amounting to five times the value in breast milk (2.3 mg/dL in both formulas versus 0.45 mg/dL in breast milk). Erythrocyte arachidonic acid (AA) and docosahexaenoic acid (DHA) in the phosphatidylethanolamine fraction were similar in the three groups over the study period, whereas a significant reduction of erythrocyte AA and DHA could be detected in the phosphatidylcholine fraction in all three groups from day 14 onwards, when compared to respective cord blood values, with lowest values in the standard formula group. Amazingly, levels of alpha- and gamma-tocopherol were higher in plasma, erythrocytes, platelets, monocytes, and polymorphonuclear leukocytes with LCP supplementation as compared to standard formula and breast milk from day 7 onwards, whereas in buccal mucosal cells, this was not the case until day 42. Gammatocopherol uptake in the LCP-supplemented group was also significantly higher in all cell fractions studied from day 7 onwards. We therefore hypothesize that the LCP supplementation used in formula A improves tocopherol solubility and stability in biological membranes. Under high-dose vitamin E addition to n-3 and n-6 LCP-supplemented formula, no evidence for tocopherol depletion and furthermore, high accumulation of tocopherols, can be detected in healthy preterm infants.     

Habitual food intake and polyunsaturated fatty acid deficiency in liver cirrhosis

OBJECTIVE: We compared the habitual food intake and plasma fatty acid composition in cirrhotic patients living in two different regions in Japan, Okayama and Toyama, and evaluated the effects of dietary polyunsaturated fatty acid and alpha-tocopherol intake on serum alanine aminotransferase (ALT) activity. METHOD: A quantitative food-frequency questionnaire method was used. RESULTS: The significantly higher intake of fish in the patients living in Toyama resulted in higher plasma levels of docosahexaenoic acid and lower levels of arachidonic acid. Serum ALT activity correlated negatively with plasma arachidonic acid (r = -0.456, P < 0.05) and alpha-tocopherol (r = -0.505, P < 0.05) levels. Dietary intakes of vitamin E and polyunsaturated fatty acids (mg/g) correlated negatively with serum ALT (r = -0.377, P < 0.05). Dietary intake of linoleic acid and the ratio of polyunsaturated to saturated fatty acid in dietary fat correlated significantly with serum ALT (r = 0.604, P < 0.01, and r = 0.622, P < 0.01, respectively). The amount of vegetable intake correlated with intake of vitamin E and polyunsaturated fatty acid (r = 0.527, P < 0.02). CONCLUSIONS: These findings suggest that habitual food intake affects the plasma fatty acid profile and that elevated serum ALT may be related to arachidonic acid deficiency and vulnerability to lipid peroxidation in cirrhotic patients with hepatitis B and C viruses.     

代谢综合征患者血清三酰甘油多不饱和脂肪酸谱与内脏脂肪的关系

目的 探讨血清三酰甘油中的n-6与n-3必需多不饱和脂肪酸（PUFA）各组分及其比例与代谢综合征患者核磁共振测量的腹腔内脏脂肪面积（MRI-IAF）的关系.方法 比较在体检中新发现的代谢综合征和健康人群的代谢和体脂指标的差异,探讨代谢综合征患者血清三酰甘油脂肪酸谱各组分与MRI-IAF等体脂参数的相关性,并且以相关的血清脂肪酸谱组分为被筛选变量,逐步回归分析以上变量对MRI-IAF、腰围和体质指数（BMI）的影响.结果 代谢综合征组的各项体脂及代谢指标均较对照组差,其中MRI-IAF差距较大[（108.3±13.3）cm2 vs.（63.0±7.1）cm2,t=18.28,P＜0.05）],代谢综合征组血清三酰甘油的n-6/n-3 PUFA比值高于对照组（10.1±3.3vs.7.2±2.1,t=8.564,P＜0.05）,而C18∶3 n-3[（1.4±0.4）％vs.（1.7±0.6）％,t=-3.295]、C20∶5 n-3[（0.2±0.2）％vs.（0.6±0.6）％,t=-3.611]、C22∶6n-3[（0.9±0.5）％vs.（1.2±0.6）％,t=-2.920]及n-3PUFA低于对照组[（2.5±0.6）％vs.（3.7±1.2）％,t=-7.034]（P均＜0.05）,所有n-6 PUFA及C22∶5 n-3的差异无统计学意义;n-6/n-3 PUFA、n-3 PUFA、二十二碳六烯酸和二十碳五烯酸均与MRI-IAF （r=-0.377～0.565,P=0.024）相关,n-6/n-3 PUFA还与腰围（r=0.400,P=0.016）和BMI相关（r=0.357,P=0.033）,而n-6 PUFA与各体脂参数不相关;逐步回归分析提示n-6/n-3PUFA比值与MRI-IAF、腰围、BMI的相关性较强（校正的R2=0.102～0.299,P=0.033）.结论 血清三酰甘油n-6/n-3 PUFA比值和n-3 PUFA与代谢综合征患者MRI-IAF等体脂参数相关,补充膳食n-3 PUFA的同时可能还需要考虑避免n-6 PUFA的过量摄入.     

Dietary polyunsaturated fatty acid intake during late pregnancy affects fatty acid composition of mature breast milk

ObjectiveThe aim of this study was to investigate how maternal polyunsaturated fatty acid intake at different periods during pregnancy affects the composition of polyunsaturated fatty acids in mature human milk.MethodsA prospective study was conducted involving 45 pregnant women, aged between 18 and 35 y, who had full-term pregnancies and practiced exclusive or predominant breast-feeding. Mature breast milk samples were collected after the 5th postpartum week by manual expression; fatty acid composition was determined by gas chromatography. Fatty acid intake during pregnancy and puerperium was estimated through multiple 24-h dietary recalls. Linear regression models, adjusted by postpartum body mass index and deattenuated, were used to determine associations between estimated fatty acids in maternal diet during each trimester of pregnancy and fatty acid content in mature human milk.ResultsA positive association was identified between maternal intake of eicosapentaenoic acid (β, 1.873; 95% confidence interval [CI], 0.545, 3.203) and docosahexaenoic acid (β, 0.464; 95% CI, 0.212–0.714) during the third trimester of pregnancy, as well as the maternal dietary ω-3 to ω-6 ratio (β, 0.093; 95% CI, 0.016–0.170) during the second and third trimesters and postpartum period, with these fatty acids content in mature breast milk.ConclusionsThe maternal dietary docosahexaenoic acid and eicosapentaenoic acid content during late pregnancy may affect the fatty acid composition of mature breast milk. Additionally, the maternal dietary intake of ω-3 to ω-6 fatty acid ratio, during late pregnancy and the postpartum period, can affect the polyunsaturated fatty acid composition of breast milk.     

Effect of dietary polyunsaturated/saturated fatty acid ratio and dietary vitamin E on lipid peroxidation in the rat

The effects of the dietary ratio of polyunsaturated/saturated fatty acids (P/S) and dietary vitamin E on lipid peroxidation (LP) were examined to determine whether the vitamin E requirement is elevated by increased P/S in ratios comparable to those found in human diets. Twelve groups of male weanling rats (six/group) were fed purified diets containing 20% fat with P/S ratios of 0.38, 0.82 or 2.30. At each P/S level, groups of rats received either 0, 10, 40 or 100 IU vitamin E/kg diet supplied as all-rac-alpha-tocopherol. After the diets were fed for 16 wk, in vivo LP was assessed by measuring pentane in expired breath. Pentane levels were significantly elevated in rats fed 0 IU vitamin E at all P/S levels. Both 40 and 100 IU vitamin E decreased pentane production to minimal levels for all P/S groups. Liver malondialdehyde levels and in vitro spontaneous red blood cell hemolysis results also indicated a significant effect of vitamin E in reducing in vitro LP, but no overall effect of P/S. Testicular and epididymal histology showed no effect of dietary P/S on the vitamin E requirement. These data demonstrated 40 IU vitamin E to be adequate for maximal inhibition of LP at the P/S levels tested and indicated that these levels of dietary P/S had no significant impact on the vitamin E requirement for the growing rat.     

Influence of reduced food intake on polyunsaturated fatty acid metabolism in zinc-deficient rats

The influence of reduced food intake on metabolism of liver phospholipids (PL) in zinc-deficient (ZD) rats was measured. Wealing male Long-Evans rats were fed ad libitum zinc-deficient (2 micrograms Zn/g diet) and zinc-adequate (20 micrograms Zn/g diet) diets for 21 days. A pair-fed (PF) group was included. ZD and PF rats displayed significantly increased levels of linoleic (18:2 omega 6) and dihomo-gamma-linolenic acid (20:3 omega 6). Both ZD and PF rats displayed increased levels of gamma-linolenic acid (18:3 omega 6), but the increase was significant only in PF rats. ZD and PF rats displayed decreased levels of arachidonic acid (20:4 omega 6), but the decrease was significant only in PF rats. Both ZD and PF rats displayed significantly reduced levels of 22:5 omega 6. Both ZD and PF rats displayed increased products of delta 6 desaturation and decreased products of delta 5 and delta 4 desaturation. Significantly increased products of delta 9 desaturation were noted in both ZD and PF rats. ZD and PF rats displayed significant increases in C20 elongation products. ZD and PF rats displayed significantly decreased levels of omega 6 metabolites but not total omega 6 acids. ZD rats showed significantly increased levels of total omega 3 acids and omega 3 metabolites. ZD and PF rats showed significant increases in omega 9 acids but not significant changes in omega 9 metabolites. This study does not indicate that zinc affects the delta 6 desaturase in the metabolism of essential fatty acids. The aberrations previously attributed to zinc deficiency are probably due to the accompanying decreased food intake.     

Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review

Evidence from observational studies and randomised trials has suggested a potential association between intake of n-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and certain pregnancy and birth outcomes. Marine foods (e.g. fatty sea fish, algae) and select freshwater fish contain pre-formed n-3 LCPUFA, which serve as precursors for bioactive molecules (e.g. prostaglandins) that influence a variety of biological processes. The main objective of this analysis was to summarise evidence of the effect of n-3 LCPUFA intake during pregnancy on select maternal and child health outcomes. Searches were performed in PubMed, EMBASE, and other electronic databases to identify trials where n-3 LCPUFA were provided to pregnant women for at least one trimester of pregnancy. Data were extracted into a standardised abstraction table and pooled analyses were conducted using RevMan software. Fifteen randomised controlled trials were 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]) and no significant differences in birth length or head circumference. 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. Our review of observational studies revealed mixed findings, with several large studies reporting positive associations between fish intake and birthweight and several reporting no associations. In conclusion, n-3 LCPUFA supplementation during pregnancy resulted in a decreased risk of early preterm delivery and a modest increase in birthweight. More studies in low- and middle-income countries are needed to determine any effect of n-3 LCPUFA supplementation in resource-poor settings, where n-3 PUFA intake is likely low.     

Lower n-3 long-chain polyunsaturated fatty acid values in patients with phenylketonuria: a systematic review and meta-analysis

The mainstream of phenylketonuria (PKU) management is lifelong restriction of protein intake; however, this dietary restriction may be accompanied by insufficient dietary intake of long-chain polyunsaturated fatty acids (LCPUFA). The objective of this review was to assess whether significant depletion of LCPUFA can be detected in PKU patients on low-protein diet and whether LCPUFA supplementation is an effective way to increase the availability of LCPUFA in PKU patients. The method included structured search strategy on Ovid MEDLINE, Scopus, LILACS, and the Cochrane Library CENTRAL databases, with formal inclusion/exclusion criteria, data extraction procedure, and meta-analysis. We evaluated 9 case-control studies and 6 randomized controlled trials, dated from the inception of the databases to 2012. The meta-analysis of the case-control studies showed significantly lower values of both eicosapentaenoic acid and docosahexaenoic acid (DHA) in all biomarkers investigated and that of arachidonic acid in total plasma lipids in PKU patients as compared with healthy controls. There were sufficient data to demonstrate that dietary DHA supplementation of patients with PKU significantly increases the contribution of DHA to total plasma lipids.     

Use of microencapsulated fish oil as a means of increasing n-3 polyunsaturated fatty acid intake

Background: The successful incorporation of fish oil into foods may provide a means of increasing intakes of n-3 polyunsaturated fatty acids (n-3 PUFA). The aim of the present study was to evaluate the bioavailability of n-3 PUFA in microencapsulatd fish oil compared with a fish oil capsule. Methods: Twenty-eight healthy volunteers were recruited to take part in this randomized controlled trial. Volunteers were supplemented with 0.9 g n-3 PUFA daily for 4 weeks, delivered either as microencapsulated fish oil in a milkshake or as a fish oil capsule. Plasma fatty acid composition and plasma total cholesterol levels were measured at baseline and after supplementation. In addition, volunteers completed a questionnaire on fish consumption, use of supplements and exercise. Results: Responses to the questionnaire indicated that the males who took part in this study took more physical exercise, consumed less fish and were less likely than the females to take supplements. Plasma n-3 PUFA concentrations were raised significantly and by a similar level by both fish oil supplements. Furthermore, no significant difference was observed in plasma n-3 PUFA concentrations following supplementation with either form of fish oil. Plasma total cholesterol levels were not significantly altered by n-3 PUFA supplementation in either group. The results of this study indicated that there was no difference in the bioavailability of n-3 PUFA given as microencapsulated fish oil compared with n-3 PUFA delivered as a fish oil capsule. Fortification of foodstuffs with microencapsulated fish oil therefore offers the potential to increase intakes of n-3 PUFA in line with current recommendations.     

Relationship between nutrient intake and vitamin D status in osteoporotic women

Vitamin D is essential for maintaining calcium homeostasis and optimizing bone health. Its inadequacy is related to many factors including dietary intake. The aim of the present study was to evaluate serum 25(OH)D and its relationship with nutrient intakes in postmenopausal Brazilian women with osteoporosis. This cross-sectional study comprised 45 free-living and assisted elderly at S?o Paulo Hospital. Three-day dietary records were used to assess dietary intakes. Bone mineral density was measured with a dual-energy X-ray absorptiometer (DXA). Blood and urine sample were collected for analysis of biochemical markers of bone and mineral metabolism. Insufficiency of vitamin D was observed in 24.4% of the women and optimal levels (> or = 50 nmol/L) were observed in 75.6%. Parathyroid hormone was above the reference range in 51% of the participants. The mean calcium (724 mg/day) and vitamin D (4.2 microg/day) intakes were lower than the value proposed by The Food and Nutrition Board and sodium intake was more than two-fold above the recommendation. Higher levels of serum 25(OH)D were inversely associated with sodium intake. Dietary strategies to improve serum vitamin D must focus on increasing vitamin D intake and should take a reduction of sodium intake into consideration.     

Comparison between habitual intake of polyunsaturated fatty acids and their concentrations in serum lipid fractions

To evaluate the validity of the cross-check dietary history method for the assessment of the habitual intake of polyunsaturated fatty acids, the relationship was investigated between the estimated intake of these fatty acids and their relative amounts in the various serum lipid fractions. Food intake data were obtained from a group of volunteers participating in a long-term epidemiological study in the Dutch town of Zutphen. The fatty acid composition of total lipids, phospholipids, triglycerides and cholesterol esters was determined in fasting serum samples from these volunteers. Although correlations between the calculated dietary intake of timnodonic acid (20:5(n-3), TA) and cervonic acid (22:6(n-3), CA), on the one hand, and the relative amounts of these fatty acids in the various serum lipid fractions, on the other, appeared to be statistically significant, no more than about 20 per cent of the variance in the serum values could be explained on the basis of dietary intake. For linoleic acid (18:2(n-6), LA) this was 55 per cent. It is concluded that the cross-check dietary history method is an acceptable technique for estimating the habitual intake of linoleic acid of a given individual. For the fish-related fatty acids, however, this method is less reliable. This discrepancy most probably results from the large differences in TA and CA contents in the same foods. In addition, a negative association with the calculated LA intake on the proportional amount of TA for most of the serum lipid fractions was demonstrated. This indicates an interference of dietary LA on the metabolism of TA.