Association of serum PUFA and linear growth over 12 months among 6–10 years old Ugandan children with or without HIV

Abstract

Objective: To quantify PUFA-associated improvement in linear growth among children aged 6–10 years. Design: Serum fatty acids (FA), including essential FA (EFA) (linoleic acid (LA) and α-linolenic acid (ALA)) were quantified at baseline using GC-MS technology. FA totals by class (n-3, n-6, n-9, PUFA and SFA) and FA ratios were calculated. Height-for-age Z-score (HAZ) relative to WHO population reference values were calculated longitudinally at baseline, 6 and 12 months. Linear regression models estimated PUFA, HIV status and their interaction-associated standardised mean difference (SMD) and 95 % CI in HAZ over 12 months. Setting: Community controls and children connected to community health centre in Kampala, Uganda, were enrolled. Participants: Children perinatally HIV-infected (CPHIV, n 82), or HIV-exposed but uninfected (CHEU, n 76) and community controls (n 78). Results: Relative to highest FA levels, low SFA (SMD = 0·31, 95 % CI: 0·03, 0·60), low Mead acid (SMD = 0·38, 95 % CI: 0·02, 0·74), low total n-9 (SMD = 0·44, 95 % CI: 0·08, 0·80) and low triene-to-tetraene ratio (SMD = 0·42, 95 % CI: 0·07, 0·77) predicted superior growth over 12 months. Conversely, low LA (SMD = -0·47, 95 % CI: −0·82, −0·12) and low total PUFA (sum of total n-3, total n-6 and Mead acid) (SMD = -0·33 to −0·39, 95 % CI: −0·71, −0·01) predicted growth deficit over 12 months follow-up, regardless of HIV status. Conclusion: Low n-3 FA (ALA, EPA and n-3 index) predicted growth deficits among community controls. EFA sufficiency may improve stature in school-aged children regardless of HIV status. Evaluating efficacy of diets low in total SFA, sufficient in EFA and enriched in n-3 FA for improving child growth is warranted.

New Perspectives on the Associations between Blood Fatty Acids, Growth Parameters, and Cognitive Development in Global Child Populations

“…Studies that reported FA levels in child populations 16 years of age and under demonstrate that FA levels, specifically EFA levels, vary greatly (Table 1). When comparing EFA levels, child whole-blood LA levels range from a low of 8.83% total FA in Pakistan [31] to a high of 36.8% in Uganda [32,33], and child whole-blood ALA levels range from 0.17% in Pakistan [31] and 0.54% in the United Kingdom [34]. HUFA levels also demonstrated variability.…”

“…Moreover, EPA levels varied from 0.1% in Cambodia [36] to 0.84% in Inuit children living in Canada [37], and DHA levels varied from 0.8% in Cambodian children [36] to 8.3% in South Korean children [35]. Child populations had amounts of DGLA as low as 0.56% in Uganda [32,33] and as high as 19.1 ng/uL in Gambia [38], and DTA levels as high as 3.05% in Pakistan [31] and as low as 0.018% in Uganda [32,33]. DPAn-6 levels ranged from 0.01% (in Uganda) [32,33] to 3.32 ng/uL (in Gambia) [38], while DPAn-3 levels ranged from 0.067% (in Uganda) [32,33] to 11.9 ng/uL (in Gambia) [38].…”

“…Child populations had amounts of DGLA as low as 0.56% in Uganda [32,33] and as high as 19.1 ng/uL in Gambia [38], and DTA levels as high as 3.05% in Pakistan [31] and as low as 0.018% in Uganda [32,33]. DPAn-6 levels ranged from 0.01% (in Uganda) [32,33] to 3.32 ng/uL (in Gambia) [38], while DPAn-3 levels ranged from 0.067% (in Uganda) [32,33] to 11.9 ng/uL (in Gambia) [38]. Mead acid, which was the most understudied fatty acid, ranged from 0.07% in Burkina Faso [39] to 0.37% in Pakistan [31].…”

“…Consequently, LMIC child populations had the highest level of a number of fatty acids. LA levels were the highest among Ugandan children aged 6-10 years (mean (SD): 36.8 (0.35)% total FA) [32,33], DGLA and DPAn-6 levels were highest among 3-9-month-old Gambian children (DGLA: 19.1 (6.49) ng/uL; DPAn-6: 3.32 (1.24) ng/uL)) [53], and DTA levels were highest among 0-5-year-old Pakistani children (median (IQR): 3.05 (2.13-3.85)% total FA) [31]. Lastly, DPAn-3 levels were highest among Gambian children aged 3-9 months (mean (SD): 11.9 (3.82) ng/uL) [38].…”

“…FA levels among child populations differ greatly within country income categories (Table 1). For instance, Ugandan children aged 6-10 years have higher LA levels (mean (SD): 36.8 (0.35)% total FA) but lower DGLA (0.56 (0.20)%), DPAn-6 (0.014 (0.001)%, ALA (0.26 (0.10)%), and DPAn-3 levels (0.067 (0.003)%) [32,33] compared to other LMIC child populations within sub-Saharan Africa and Asia. Colombian children 5-12 years old, however, had LA levels (30.3 (3.10)%) [45] comparable to those of the Ugandan children.…”