Breast milk docosahexaenoic acid (DHA) correlates with DHA status of malnourished infants

AIM—To investigate whether low docosahexaenoic acid (22:6ω3; DHA) status of malnourished, mostly breast fed infants is a result of low ω3 fatty acid intake via breast milk.METHODS—Fatty acid composition of breast milk of eight Pakistani mothers, and of the erythrocytes of their malnourished children was analysed.RESULTS—The milk of the Pakistani mothers contained low percentages of all ω3 and most ω6 fatty acids, compared with milk of Dutch mothers. Breast milk DHA was positively correlated with infant erythrocyte DHA and arachidonic acid (20:4ω6).CONCLUSION—DHA status of these malnourished children is strongly dependent on the ω3 fatty acid intake from breast milk. Augmentation of the infants'' ω3 long chain polyunsaturated fatty acid status, or the ω3 and ω6 fatty acid status in general, by supplementation is indicated in deprived circumstances where access to fresh fish is difficult. However, in terms of prevention, maternal supplementation of these long chain polyunsaturated fatty acids, preferably from early pregnancy onwards, may be a better option.     

Breast milk docosahexaenoic acid (DHA) correlates with DHA status of malnourished infants.

AIM: To investigate whether low docosahexaenoic acid (22:6omega3; DHA) status of malnourished, mostly breast fed infants is a result of low omega3 fatty acid intake via breast milk. METHODS: Fatty acid composition of breast milk of eight Pakistani mothers, and of the erythrocytes of their malnourished children was analysed. RESULTS: The milk of the Pakistani mothers contained low percentages of all omega3 and most omega6 fatty acids, compared with milk of Dutch mothers. Breast milk DHA was positively correlated with infant erythrocyte DHA and arachidonic acid (20:4omega6). CONCLUSION: DHA status of these malnourished children is strongly dependent on the omega3 fatty acid intake from breast milk. Augmentation of the infants' omega3 long chain polyunsaturated fatty acid status, or the omega3 and omega6 fatty acid status in general, by supplementation is indicated in deprived circumstances where access to fresh fish is difficult. However, in terms of prevention, maternal supplementation of these long chain polyunsaturated fatty acids, preferably from early pregnancy onwards, may be a better option.     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants.

AIM: To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation. METHODS: Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314 mg) long chain polyunsaturated fatty acids of the omega3 series (LCPUFAomega3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end. RESULTS: FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAomega6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%. CONCLUSION: FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.     

Essential fatty acid metabolism and requirements for LBW infants

Humans are unable to synthesize linoleic acid (LA) (18: 2ω-6) and α-linolenic acid (LNA) (18: 3ω-3). Most formulas provide ample LA, yet infants are at risk for ω-3 deficiency unless they are fed human milk. Neonates born at 30 weeks received human milk or were randomized to three formulas: formula A, based on corn oil, similar to old commercial formula; formula B, based on soy oil supplied LNA; or formula C, a product similar to B with added marine oil to provide docosahexaenoic acid (22:6 ω-3). The fatty acids of plasma and red blood cells had marked diet-induced differences. The rod photoreceptor tests demonstrated higher threshold and decreased sensitivity in the ω-3-deficient infants. Visual acuity also showed improved function of the brain cortex in the human milk and group C infants at follow-up at 57 weeks. These results suggest that ω-3 fatty acids are needed for optimal development of visual function.     

Fatty acid composition of plasma lipids in Nigerian children with protein-energy malnutrition

The fatty acid (FA) composition of the main plasma lipids was analysed in eight well-nourished, generally healthy Nigerian children aged 14.1±7.2 months and in 17 malnourished children (8 marasmus, 9 kwashiorkor) aged 14.6±3.8 months within the first 2 days of admission at the Dept. of Child Health, University of Benin. In comparison to the control group, the malnourished children showed a marked decrease of polyunsaturated FA with low linoleic acid, mainly in sterolesters (STE), and severely reduced linoleic acid metabolites, including arachidonic acid, in all lipid fractions. -3-FA were not altered except for a reduction of docosapentaenoic and docosahexaenoic acids in phospholipids. Clearly increased values were found for saturated FA in STE and for the non-essential monoenoic FA in all lipid classes. This pattern indicates the presence of essential fatty acid deficiency in the malnourished children. There was no significant difference between marasmus and kwashiorkor. Eight malnourished children were followed up in the early phase of recovery during hospital treatment 14.0±3.1 days after obtaining the first sample. Linoleic acid had increased again in STE, but its metabolites were as low or even lower than before. An impaired activity of delta-6-desaturase, the rate limiting enzyme of linoleic acid metabolism, in suggested by elevated substrate-product-ratios of this enzyme in untreated children with protein energy malnutrition and in the early phase of recovery, which may be due to low insulin levels, protein and zinc deficiency. The trientetraen-ratio (2039/2046) thus is not a reliable indicator of essential FA status in protein-energy malnutrition.Abbreviations EFA essential fatty acids - FA fatty acids - PEM protein energy malnutrition - PL phospholipids - STE sterolesters - TG triglycerides - PUFA polyunsaturated fatty acids Presented in part at the XIII. International Congress of Nutrition, Brighton, August 18–23, 1985     

Selenium and vitamin E in mucoviscidosis

Selenium and vitamin E are two important components which protect membrane lipids from oxidative damage. Recently an abnormal fatty acid turnover in the membrane phospholipids was found in cystic fibrosis (CF). We studied vitamin E and selenium status in 26 CF children compared to a control group. we measured selenium concentration in plasma and erythrocytes using flameless atomic absorption. The measure of erythrocyte glutathione peroxidase activity allowed a functional assessment of selenium. Total plasma tocopherol concentrations (HPLC) were referred to total lipids. The vitamin E and selenium levels in not yet treated children (n = 6) were very low, with an important decrease in glutathione peroxydase activity. The antioxidative agents deficiency was mild in children with pancreatic enzyme replacement and vitamin E supplementation (n = 20). In the 2 groups, this deficiency was combined and may play a role in CF membrane abnormalities.     

Erythrocyte lipid abnormalities in Reye's syndrome

Previous studies have demonstrated alterations in plasma free fatty acid content in Reye's syndrome (RS). We have therefore studied erythrocyte membrane lipids to determine if there are concomitant structural and functional modifications attributable to RS. Erythrocyte lipids were measured in children with RS and in critically ill children also requiring intensive care (ICU). In comatose RS patients erythrocyte phospholipid arachidonate was increased 2-fold relative to control ICU patients: 20.46 +/- 2.14 versus 10.41 +/- 2.32% of total erythrocyte phospholipid, p less than 0.05. RS coma patients also demonstrated an increased ratio of erythrocyte phospholipid polyunsaturated/saturated fatty acids (0.76 +/- 0.10) compared to ICU controls (0.48 +/- 0.08, p less than 0.05). Erythrocyte cholesterol was higher in RS patients (79.00 +/- 6.61 micrograms/mg protein) than in ICU controls (59.74 +/- 6.09, p less than 0.05). Erythrocyte malondialdehyde generation was decreased in comatose RS patients (404 +/- 28 nmol malondialdehyde/g hemoglobin) versus ICU (517 +/- 29, p less than 0.05). Although plasma vitamin E was depressed in RS patients, the erythrocyte vitamin E concentrations were no different in RS patients than in ICU patients. All RS patients had a typical viral prodrome and either a history of aspirin intake and/or measurable serum salicylate on admission. All of the biochemical abnormalities in RS patients listed above returned to values comparable to those of healthy RS siblings on recovery. The transient nature of these phenomena suggests that they were related to viral infection and/or aspirin rather than to intrinsic differences in lipid metabolism between RS patients and controls.     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants

AIM—To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation.
METHODS—Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314mg) long chain polyunsaturated fatty acids of the ω3 series (LCPUFAω3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end.
RESULTS—FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAω6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%.
CONCLUSION—FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.

     

Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein–energy malnutrition

The fatty acid composition of plasma cholesterol esters, plasma phospholipids, erythrocyte phosphatidylcholine and erythrocyte phosphatidylethanolamine was investigated in severely malnourished Nigerian children with kwashiorkor (n = 12) and marasmus (n = 32). Normally nourished children from the same area (n = 23) served as controls. The malnourished children showed a significant reduction of highly polyunsaturated fatty acids in cholesterol esters, phospholipids and phosphatidylcholine. No differences between the groups were found in erythrocyte phosphatidylethanolamine. Children with kwashiorkor had lower levels of linoleic acid metabolites and docosahexaenoic acid than marasmic children. The results suggest that the kwashiorkor syndrome is associated with impaired desaturation and elongation of PUFA and/or increased lipid peroxidation.     

Plasma lipid and apolipoprotein concentrations in full term infants fed formula supplemented with long-chain polyunsaturated fatty acids and cholesterol

Recent data indicate that supplementation of infant formula with ω-3 and ω-6 long-chain polyunsaturated fatty acids might offer developmental benefits for full term infants. We investigated biochemical consequences of feeding formula supplemented with egg lipids to provide long-chain polyunsaturated fatty acids and compared triglyceride, cholesterol, lipoprotein cholesterol (HDL₂-cholesterol, HDL₃-cholesterol, non-HDL-cholesterol) and apolipoprotein A-I, A-II and B concentrations in full term infants fed either conventional formula (n = 10) or a formula supplemented with ω-3 and ω-6 long-chain polyunsaturated fatty acids and cholesterol in amounts similar to those found in mature human milk (n = 12). At the age of 5 days, cholesterol, non-HDL-cholesterol and triglyceride concentrations were significantly higher in infants fed supplemented than in those receiving conventional formula. At the age of 30 days, triglyceride concentrations were significantly higher with supplemented than with conventional formula. Thereafter throughout the study, no significant differences were seen between the two groups. Conclusion Full term infants fed formula supplemented with ω-3 and ω-6 long-chain polyunsaturated fatty acids and cholesterol showed significantly higher plasma cholesterol and triglyceride concentrations than infants receiving conventional formula on day 5 and on days 5 and 30, respectively. Thereafter no appreciable effect of diet on plasma phospholipid, triglyceride, cholesterol, lipoprotein cholesterol and apolipoprotein concentrations were seen. Received: 13 March 1996 / Accepted: 21 October 1996     

Maternal plasma homocysteine, placenta status and docosahexaenoic acid concentration in erythrocyte phospholipids of the newborn

The enhanced transport of long-chain polyunsaturated fatty acids, in particular docosahexaenoic acid (22:6 ω-3) (DHA), to the fetus is a placental function important for adequate membrane phospholipid formation and herewith decisive for the quality of fetal CNS myelination. A compromised placental function is correlated with signs of vascular pathology. As elevated plasma total homocysteine (tHcy) concentrations are considered an independent risk for premature occlusive vascular disease, the influence of maternal plasma tHcy concentrations on placental function was indirectly studied, determining the DHA content in erythrocyte membrane phospholipids of the newborn. A total of 60 unselected pregnant women (age range: 21 to 39 years) were investigated at delivery. Gestational age ranged from 26 to 41 weeks. Prior to delivery a placental ultrasound scan was performed. Complete sets of data could be obtained from 43 mothers and their offspring. tHcy concentrations were determined in the plasma of cord and maternal blood. The fatty acid pattern of erythrocyte membrane phospholipids was determined in the mothers and their newborns. Z-scores of the birth weights ranged from −3.4 to 2.1 and of the placental weights from −3.8 to 4.7. The mean maternal plasma tHcy concentration was 6.29 ± 3.34 μmol/l ranging from below our limit of detection up to 15 μmol/l. These maternal concentrations were correlated with those of their infants (r = 0.71; P < 0.0001). The tHcy concentrations were significantly higher in mothers with pregnancies complicated by gestosis or placental calcifications. The Z-scores of birth weights as well as placental weights showed a significant negative correlation with maternal plasma tHcy concentrations. The mean DHA percentage of total fatty acids in erythrocyte phospholipids was 3.2 ± 2.2% in the mothers and 3.4 ± 2.3% in their newborns. Most importantly the maternal plasma tHcy levels and the erythrocyte phospholipid DHA concentrations of their offspring were significantly correlated (r = −0.51; P < 0.0003). Conclusion In this study, total homocysteine concentrations were elevated in the plasma of pregnant women with signs of placental vasculopathy. Maternal plasma total homocysteine concentrations were positively correlated with erythrocyte phospholipid docosahexaenoic acid of their offspring and may be an indicator for the integrity of placental vascular function. The nutritional status as well as predisposing genetic factors of pregnant mothers need to be investigated more thoroughly. Received: 17 May 1998 / Accepted in revised form: 10 September 1998     

Significance of long-chain polyunsaturated fatty acids (PUFAs) for the development and behaviour of children

ω-6 and ω-3 polyunsaturated fatty acids (PUFAs) play a central role in the normal development and functioning of the brain and central nervous system. Long-chain PUFAs (LC-PUFAs) such as eicosapentaenoic acid (EPA, C20:5ω-3), docosahexaenoic acid (DHA, C22:6ω-3) and arachidonic acid (AA, C20:4ω-6), in particular, are involved in numerous neuronal processes, ranging from effects on membrane fluidity to gene expression regulation. Deficiencies and imbalances of these nutrients, not only during the developmental phase but throughout the whole life span, have significant effects on brain function. Numerous observational studies have shown a link between childhood developmental disorders and ω-6:ω-3 fatty acid imbalances. For instance, neurocognitive disorders such as attention-deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia and autism spectrum disorders are often associated with a relative lack of ω-3 fatty acids. In addition to a high ω-6 fatty acid intake and, in many cases, an insufficient supply of ω-3 fatty acids among the population, evidence is increasing to suggest that PUFA metabolism can be impaired in individuals with ADHD. In this context, PUFA imbalances are being discussed as potential risk factors for neurodevelopmental disorders. Another focus is whether the nutritive PUFA requirements—especially long-chain ω-3 fatty acid requirements—are higher among some individuals. Meanwhile, several controlled studies investigated the clinical benefits of LC-PUFA supplementation in affected children and adolescents, with occasionally conflicting results.     

Fatty acid deficiency profile in children with food allergy managed with elimination diets

Aim: To evaluate plasma fatty acid (FA) composition of children with food allergy undergoing elimination diets that avoided the offending antigens. Methods: Twenty‐five children (14 male, 11 female) aged 3.8 ± 1.6 years (range 2–7 years) affected of multiple food allergy and managed with elimination diets participated in a cross‐sectional study. Results of plasma fatty acids were compared with data obtained in 61 healthy children. Results: The patients had significantly lower values for plasma content in total polyunsaturated fatty acids, ω3 polyunsaturated fatty acids and long‐chain ω3 polyunsaturated fatty acids (p < 0.001) and particularly, in eicosapentaenoic acid (EPA) (20:5ω3) and docosahexaenoic acid (DHA) (22:6ω3) (p < 0.001). Moreover, all established indices (essential fatty acid [EFA] index ((ω3 +ω6)/(ω7 +ω9)) (p < 0.001) and sufficiency of docosahexaenoic acid index (C22:6ω3/C22:5ω6) (p < 0.001)) confirmed the presence of EFA deficiency. Conclusion: Children with food allergy managed with restricted intake of foods such as milk, egg, fish and vegetables are at risk of developing a deficiency in EFA and particularly in ω3 long‐chain polyunsaturated fatty acids, which are especially necessary for adequate growth, neurological development and cardiovascular health.     

Growth, fatty acid composition of plasma lipid classes, and plasma retinol and a-tocopherol concentrations in full-term infants fed formula enriched with Zω-6 and u-3 long-chain polyunsaturated fatty acids

Full-term infants fed formula without dietary long-chain polyunsaturated fatty acids (LCF) exhibit significantly lower plasma LCP values than breast-fed infants. We studied prospectively two groups of healthy full-term infants fed conventional infant formula without LCP (F, n = 10) or the same formula enriched with both ω-6 and ω- 3 LCP (LCP-F, n = 12). Anthropometric data were obtained and fatty acid (FA) compositions of plasma phospholipids, triglycerides and sterol esters as well as plasma retinol and α-tocopherol concentrations were determined at 5 days and 1, 2, 3 and 4 months of age. Gains in weight, length and head circumference did not differ between the two groups throughout the study period. Plasma FA values did not differ at 5 days of age. Between 1 and 4 months of age, plasma phospholipids of infants fed LCP-F consistently had significantly (p < 0.05) higher percentages of arachidonic acid (1 month: 9.7 (0.8) versus 7.0 (1.3) %wt/wt, 4 months: 8.7 (0.5) versus 6.6 (1.0) %wt/ wt, median (interquartile range), LCP-F versus F) and docosahexaenoic acid (1 month: 2.9 (0.5) versus 1.6 (0.3) %wt/wt; 4 months: 2.9 (0.4) versus 0.9 (0.3) % wt/wt). Plasma retinol and a-tocopherol concentrations did not differ between the two groups throughout the study. We conclude that this form of LCP enrichment of formula for full-term infants effectively enhances plasma LCP contents without detectable adverse effects. The potential effects on functional outcome need to be studied carefully in prospective clinical trials. Growth, infant formula, infant nutrition, long-chain polyunsaturated fatty acids, retinol, α-tocopherol     

Abnormalities in plasma fatty acid composition in human immunodeficiency virus-infected children treated with protease inhibitors

Aim: To study plasma fatty acid composition in human immunodeficiency virus-infected children treated with protease inhibitors and its relation with other components of the metabolic syndrome observed after this therapy. Design: Cross-sectional study from collected clinical database. Subjects: 17 children with HIV infection treated with protease inhibitors. Nine patients received ritonavir (20-30 mg/kg/d) and the remaining eight received nelfinavir (60-90 mg/kg/d). Duration of protease inhibitors treatment was 711±208 d. As controls, we used 112 matched blood samples from apparently healthy children admitted for minor surgical procedures. Methods: Plasma fatty acids were determined using a Hewlett Packard GC 5890 gas chromatograph. Results: Plasma levels of cholesterol and triglycerides and insulin-like growth factor 1 (IGF-1) tended to be high in protease inhibitor-treated patients. Plasma content of ω6 long-chain polyunsaturated fatty acids and, in particular, of the highly unsaturated 22:4ω6 and 22:5ω6, was significantly increased. Also, infected children had increased Δ6 and Δ4 desaturase activities and decreased Δ5 desaturase activity. Significant correlations were present between plasma IGF-1 level and plasma triglycerides, plasminogen activator inhibitor-1 activity and Δ6 desaturase activity.

Conclusion: HIV-infected, protease inhibitor-treated children exhibit a metabolic syndrome which is associated with significant changes in plasma fatty acid composition. These changes are similar to those observed in situations of insulin resistance and are linked to variations in plasma IGF-1 concentration.     

Investigation of the nutritional state of children in a Congolese village

The fatty acid status of an unselected group of 84 Congolese children was determined by estimating the fatty acid composition of the plasma phospholipid (PL) and cholesterolester (CE) fractions using capillary gas chromatography. In comparison with North American and European children a wide range of values and low mean percentages (related to the fatty acids of a chain length of 14–24 carbon atoms) were found for the following fatty acids (mean±SD): linoleic acid (LA) (PL: 17.19±3.85; CE: 40.13±7.72); arachidonic acid (AA) (PL: 6.60±2.28; CE 4.32±1.71); dihomo-gammalinolenic acid (DHLA) (PL: 1.80±0.68; CE 0.41±0.22). On average, 3 fatty acids were higher than in reference groups, while similar values were found for the monoenoic and 9 fatty acids. No sample contained eicosatrienoic acid, 20:39 (ETA) which, dependent on analytical methods, may be difficult to separate from behenic acid (22:0). Changes in the relation between the two lipid fractions occurred when the LA content in CE was less than 35%. Also the correlation between LA and AA in CE, which was significant below 35% LA (r=0.84), changed with higher values for LA (r=0.01). These findings may indicate that alterations in fatty acid metabolism occur when LA values in CE — which are supposed to be directly related to the dietary intake of polyunsaturated fatty acids — fall below 35% of all fatty acids in this lipid fraction.Abbreviations AA arachidonic acid, 20:46 - CE cholesterol ester - DHA docosahexaenoic acid, 20:36 - DHLA dihomo--linolenic acid, 20:63 - EFA essential fatty acids - EPA eicosapentaenoic acid, 20:53 - ETA eicosatrienoic acid, 20:39 - FA fatty acids - LA linoleic acid, 18:26 - LLA linolenic acid, 18:33 - OA oleic acid, 18:19 - PL phospholipids - P/S quotient polyunsaturated to saturated fatty acids - PUFA polyunsaturated fatty acids This work was supported by a grant from the Deutsche Forschungsgemeinschaft, Br 282/13-1)     

Plasma vitamin E concentrations of older infants fed cow's milk or infant formula.

Nutrition of older infants, though important for optimal brain development, is inadequately studied. The beverage choice markedly influences nutrient intake, but little is known regarding nutrition status of older infants, particularly for vitamin E. This study assessed vitamin E intakes and plasma tocopherol concentrations in two groups of healthy infants, 8 to 13 months of age, who had consumed either cow's milk (n = 45) or milk-based formula (n = 55) for a minimum of the 3 preceding months. Mean (+/- SEM) vitamin E intake was significantly lower (p < or = 0.001) by the infants who had consumed cow's milk (CMF) than by infants who had consumed formula (FF); 4.1 +/- 0.25 mg/day and 10.9 +/- 0.57 mg/day, respectively. Mean (+/- SEM) intake of linoleic plus linolenic acids was significantly lower (p < or = 0.005) by CMF infants (3.4 +/- 0.2 g) than by FF infants (9.9 +/- 1.0 g), although mean (+/- SEM) dietary vitamin E to polyunsaturated fat ratio (E/PUFA ratio) was the same in both FF and CMF infants (1.3 +/- 0.1). Plasma alpha-tocopherol concentration (mean +/- SD) was significantly lower (p < or = 0.005) in CMF than in FF infants (0.86 +/- 0.28 mg/dl vs. 1.14 +/- 0.42 mg/dl, respectively). Dietary vitamin E intakes were positively correlated (p < or = 0.05) with plasma alpha-tocopherol concentrations. No correlations were found between plasma alpha-tocopherol concentrations and total fat intake, dietary E/PUFA ratios, erythrocyte polyunsaturated fatty acids > or = C18:2, or number of hours postprandial that blood was drawn.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma ferritin concentration in relation to vitamin A and E status of children with severe oedematous malnutrition.

The association between plasma ferritin concentration and vitamin A and E status was studied in 17 children aged 15-72 months with severe oedematous malnutrition. The controls were 10 children of similar age who were apparently well and with no obvious signs of clinical malnutrition. Plasma ferritin concentration in the patients was significantly higher than that in the control children. Conversely, the plasma concentrations of beta-carotene, alpha-tocopherol and retinol in patients were significantly lower than those in plasma of control children. The median (interquartile range) plasma alpha-tocopherol concentration of patients, 6.03 (5.29-9.50) mumol/l, is below the threshold of vitamin E deficiency (11.6 mumol/l). Fifteen of 17 (88%) malnourished patients were found to have plasma tocopherol concentrations below the normal threshold. However, all the patients had a tocopherol: cholesterol ratio greater than 2.22, indicating adequate vitamin E status for the level of cholesterol present in plasma. Twelve of 17 patients (70.5%) had plasma retinol concentration less than 0.70 mumol/l, indicative of marginal vitamin A status, while 3 patients had plasma retinol concentrations less than 0.35 mumol/l, indicating vitamin A deficiency. The median (interquartile range) plasma retinol concentration of patients, 0.51 (0.41-0.93) mumol/l, is significantly less than that of control children, 0.96 (0.74-1.09) mumol/l; p less than 0.01 Mann Whitney U test. Furthermore, anaemia (Hb less than 110 g/l) was widespread in the patients. The results also indicate no significant correlation between elevated ferritin concentration and the concentrations of beta-carotene, retinol and alpha-tocopherol in the patients' plasma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Macrocytosis and pseudoalbinism: manifestations of selenium deficiency

Selenium levels were low in four children receiving long-term total parenteral nutrition (TPN) who developed erythrocyte macrocytosis (3/4), loss of pigmentation of hair and skin (2/4), elevated transaminase and creatine kinase activities (2/4), and profound muscle weakness (1/4). Initial mean selenium levels in serum and hair were 38 +/- 11 (SEM) ng/mL and 0.34 +/- 0.13 micrograms/g, respectively. Mean serum vitamin B12, folate, and vitamin E levels were normal. Intravenous supplementation with selenium was begun daily at 2 micrograms/kg/day. After 3 to 6 months, serum selenium levels rose almost threefold to 81 +/- 22 ng/mL. During this same time, erythrocyte mean corpuscular volume fell from 115 +/- 8 fL to 88 +/- 7 fL in the three children with macrocytosis. After 6 to 12 months of supplementation, hair selenium content had increased threefold to 1.02 +/- 0.19 micrograms/g. The two children with decreased pigmentation became darker skinned and their hair color changed from blonde to dark brown; a third child's hair, which had been blonde, also became darker. Transaminase and creatine kinase activities returned to near normal in those affected and, in the one child with severe myopathy, muscle weakness improved. Erythrocyte macrocytosis and loss of skin and hair pigmentation are previously undescribed manifestations of selenium deficiency. We recommend routine supplementation of TPN solution with selenium to avoid the clinical and biochemical syndrome of selenium deficiency in patients receiving long-term TPN.     

Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy

Maternal intake of omega- 3 (ω-3) polyunsaturated fatty acids (PUFAs) during pregnancy has decreased, possibly contributing to a current increased risk of childhood allergy.
Aim:  To describe the effects of maternal ω-3 long-chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy.
Methods:  One hundred and forty-five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo-controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25^th gestational week to average 3–4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed.
Results:  The period prevalence of food allergy was lower in the ω-3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE-associated eczema (ω-3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05).
Conclusion:  Maternal ω-3 fatty acid supplementation may decrease the risk of food allergy and IgE-associated eczema during the first year of life in infants with a family history of allergic disease.