Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Other
Publication Acceptance Date: 7/19/2003
Publication Date: 1/12/2004
Citation: Agostoni, C., Heird, W.C. 2004. Long-chain polyunsaturated fatty acids in chronic childhood disorders: panacea, promising, or placebo. Journal of Pediatric Gastroenterology and Nutrition. 38(1):2-3. Interpretive Summary:
Technical Abstract: Long-chain polyunsaturated fatty acids (LCPUFA, or LCP) include the essential fatty acids alpha-linolenic acid (ALA, 18:3 n-3) and linoleic acid (LA, 18:2 n-6) as well as a number of metabolites of both, including eicosapentaenoic acid (EPA, 20:5n-3), docosahexaenoic acid (DHA, 22:6n-3), and arachidonic acid (AA, 20:4 n-6). Of these, DHA has received the greatest attention, primarily because it appears to be necessary for normal growth and development of the infant brain and visual system. Indeed, it is the predominant n-3 fatty acid in the developing brain and the predominant fatty acid in the retinal photoreceptor membrane. AA is the predominant n-6 fatty acid in the developing brain and is a precursor of biologically important eicosanoids. Although infants can synthesize DHA and AA from ALA and LA, respectively, formula-fed infants who receive no dietary DHA and AA have lower plasma and erythrocyte levels of DHA and AA than do breast-fed infants who presumably receive adequate amounts of these fatty acids or infants fed formulas supplemented with DHA and AA. In addition, breast-fed infants and infants fed formulas supplemented with DHA and AA have better neurofunctional outcomes than do those fed unsupplemented formulas, particularly over the short term. Because of this, formulas throughout the world are now fortified with DHA and AA, and these appear to be safe. More recently, there has been interest in supplementing pregnant women and breastfeeding women with DHA to improve early developmental outcome of the offspring. However, data concerning this issue are scarce. Infants or children with fetal alcohol syndrome, attention deficit hyperactivity disorder, cystic fibrosis, phenylketonuria, unipolar depression, aggressive hostility, and congenital peroxisomal disorders, particularly adrenoleukodystrophy, also have low plasma or erythrocyte levels of DHA, suggesting a relationship between low DHA status and symptoms of these disorders. In addition, EPA and DHA are thought to be anti-inflammatory, and their use in a variety of such disorders in both adults and children has been proposed. To date, it is difficult to justify supplementation of DHA in patients with most of these disorders. Those in which the effects of DHA alone or together with other LCP have been investigated are considered.