Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial

Abstract

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.

Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis

“…Fatty acids. Twenty-nine publications on fatty acids were included, fifteen experimental studies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) , and fourteen observational studies (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) and are summarised in Table 1.…”

“…Of the experimental studies, three were rated low risk of bias (22,25,29) and twelve were identified having some concerns (19)(20)(21)23,24,(26)(27)(28)(29)(31)(32)(33) . For the observational studies, three were of good quality (41,42,44) , nine were fair quality (34)(35)(36)39,40,43,(45)(46)(47) and two were poor quality (38,39) .…”

Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants

“…By contrast, data suggested a benefit of DHA alone for inflammation in preterm infants and for lung architecture in animals, with observational studies also supporting a reduced risk of chronic lung disease with higher postnatal levels of DHA in very preterm infants . High-dose DHA enteral supplementation should not have substantially modified the AA intake . However, it is plausible that imbalance in the AA to DHA ratio may be associated with the impaired mechanisms involved in the active resolution of inflammation, potentially resulting in increased BPD when DHA is supplemented in the absence of sufficient AA …”

“… 12 High-dose DHA enteral supplementation should not have substantially modified the AA intake. 41 , 42 However, it is plausible that imbalance in the AA to DHA ratio may be associated with the impaired mechanisms involved in the active resolution of inflammation, potentially resulting in increased BPD when DHA is supplemented in the absence of sufficient AA. 43 , 44 , 45 …”

Effect of Maternal Docosahexaenoic Acid Supplementation on Very Preterm Infant Growth: Secondary Outcome of a Randomized Clinical Trial

“…The DHA-rich algae oil supplementation we used significantly increased DHA content in breast milk at day 14 post-delivery compared to mothers receiving a placebo. However, it also significantly altered other fatty acid in breast milk, especially n-6 docosapentaenoic acid although it led to an increase of n-3-to-n-6 and DHA-to-ARA ratios [17]. We cannot exclude that supplementation with DHA alone and the relative availability of ARA and DHA and the timing of these fatty acids may have influenced the expected growth [1, 18-20].…”