Viktória Jakobik

Methods of assessment of n–3 long-chain polyunsaturated fatty acid status in humans: a systematic review

BACKGROUND The availability of reliable biomarkers of n-3 (omega-3) long-chain polyunsaturated fatty acid (LCPUFA) status is a prerequisite for linking dietary n-3 LCPUFA status to clinical outcomes. OBJECTIVE The objective of this meta-analysis was to assess the usefulness of different biomarkers of n-3 LCPUFA status in healthy humans. DESIGN We searched Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases from inception to September 2007 for human intervention studies in which n-3 LCPUFA status changed after > or =2 wk of n-3 LCPUFA supplementation. We used formal inclusion/exclusion criteria and applied standard procedures for data extraction, validity assessment, and meta-analysis. RESULTS We included 41 studies (34 randomized controlled trials and 7 before-after studies) reporting on 18 different biomarkers. The data allowed specific evaluation of biomarkers of docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA, 20:5n-3) status in response to supplementation. There were sufficient data to determine that plasma DHA, plasma phospholipid DHA, plasma triacylglycerol DHA, plasma cholesteryl ester DHA, plasma nonesterified DHA, erythrocyte DHA, erythrocyte phospholipid DHA, and platelet DHA were all effective biomarkers of DHA status and that plasma phospholipid EPA was an effective marker of EPA status. Plasma phospholipid DHA appears to be a good marker of DHA status in adult men and women irrespective of DHA baseline status or supplementation dose, but its usefulness in other population subgroups is unclear. CONCLUSION There appears to be a range of useful biomarkers of DHA status in humans, but further research is needed to characterize which work best in particular population subgroups.

Genetic variants in the FADS gene cluster are associated with arachidonic acid concentrations of human breast milk at 1.5 and 6 mo postpartum and influence the course of milk dodecanoic, tetracosenoic, and trans-9-octadecenoic acid concentrations over the duration of lactation.

BACKGROUND Breastfeeding is considered an optimal nutritional source of n-6 (omega-6) and n-3 (omega-3) fatty acids (FAs) for the proper visual and cognitive development of newborn children. In addition to maternal nutrition as an important regulator of FA concentrations, first results exist on an association of breast-milk FAs with single nucleotide polymorphisms (SNPs) in the FADS gene cluster, which encodes the rate-limiting enzymes in the elongation-desaturation pathway of long-chain polyunsaturated fatty acids (LC-PUFAs). OBJECTIVE We analyzed the influence of FADS SNPs on breast-milk FA concentrations and their time course during lactation in the Ulm Birth Cohort study, which comprised 772 nursing mothers at 1.5 mo after giving birth, and in a subset of 463 mothers who were still breastfeeding at 6 mo postpartum. DESIGN We conducted linear regression analysis of 8 FADS SNPs with FA concentrations at both time points separately and assessed the genotype effect over time in a longitudinal analysis by using a generalized estimating equation regression model. RESULTS We observed significant associations of FADS genotypes with arachidonic acid (AA) concentrations and the 20:4n-6/20:3n-6 ratio at both time points but no association of FADS SNPs with the time course of AA concentrations. A longitudinal analysis of FAs other than LC-PUFAs by genotype over time showed associations for dodecanoic acid, cis-15-tetracosenoic acid, and trans-9-octadecenoic acid. CONCLUSIONS Maternal FADS genotypes are associated with breast-milk AA concentrations and might therefore influence the supply of this FA for children. Furthermore, our data indicate an interrelation between the LC-PUFA pathway and saturated and monounsaturated FAs.

Fatty acid composition of erythrocyte membrane lipids in healthy subjects from birth to young adulthood

The fatty acid composition of erythrocyte membrane lipids may better reflect the fatty acid status of the organism than the fatty acid composition of plasma lipids. The present study aimed to provide normal values for erythrocyte fatty acid composition in a sizeable group of healthy subjects throughout the paediatric age group. The fatty acid composition of erythrocyte membrane phosphatidylcholine (PC) and phosphatidylethanolamine (PE) lipids was determined by high-resolution capillary gas chromatography in 188 apparently healthy subjects from birth to young adulthood (newborns: n = 17, infants: n = 97, children: n = 38, young adults: n = 36). The values of linoleic acid (C18:2n-6) increased steadily between birth and young adulthood (newborns: 6.49 [2.45], infants: 14.51 [4.32], children: 18.10 [3.25], young adults: 19.87 [2.03], PC lipids, shown as median [interquartile range, IQR], p < 0.001]. In contrast, the values of arachidonic acid (C20:4n-6) were significantly higher in children than in young adults (PC: 9.48 [6.64] versus 8.00 [1.85], PE: 26.38 [3.98] versus 24.46 [2.44], p < 0.05). The values of alpha-linolenic acid (C18:3n-3) decreased significantly between children and young adults (0.14 [0.11] versus 0.08 [0.07], PE lipids, p < 0.05). The values of docosahexaenoic acid (C22:6n-3) increased significantly from infancy through childhood up to young adulthood (PE: 4.20 [2.41] and 4.55 [0.97] and 6.66 [1.81], p < 0.05 and 0.001, respectively). We found significantly higher total trans isomeric fatty acid values in newborns than in infants (PC: 0.60 [0.27] versus 0.43 [0.19], p < 0.05; PE: 0.66 [0.76] versus 0.30 [0.26], p < 0.001). From the results, we conclude that: (1) the data obtained in the present study may serve as reference values in the evaluation of the fatty acid status from birth to young adulthood; (2) the significantly higher values of trans fatty acids at birth than at later stages of life may be of concern, because previous studies suggested that trans fatty acids may interfere with essential fatty acid metabolism during the perinatal period.

Influences on infant feeding decisions of first-time mothers in five European countries

BACKGROUND/OBJECTIVES:Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours.SUBJECTS/METHODS:First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007–2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests.RESULTS:In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts.CONCLUSION:Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries

OBJECTIVE To (i) identify and describe prevailing infant feeding policy documents in five diverse European countries; (ii) analyse types of health outcomes for the infant that are associated with feeding breast milk rather than formula milk in the documents of different countries; and (iii) assess the extent to which documents reflect the WHO global recommendation of exclusive breast-feeding for 6 months. DESIGN Documentary review and analysis. SETTING Five geographically dispersed countries of Europe (England, Finland, Germany, Hungary and Spain). SUBJECTS Policy documents on infant feeding were identified; statements that linked choice between breast- and formula-feeding to a health outcome for the infant were extracted. RESULTS Twenty-six documents (varied authorships, dates, length and character) were identified: four from England; two from Finland; nine from Germany; six from Hungary; and five from Spain. There was no consistency in the way in which health outcomes were cited as factors in the recommendations for breast- rather than formula-feeding. Seven documents contained no reference to the health implications of infant feeding choice. Of 203 statements in remaining documents citing health outcomes, 24.1 % mentioned general health effects, 32.5 % protection against infections, 31.5 % long-term conditions (e.g. diabetes, CVD) and 11.8 % mentioned allergy. Health outcomes were linked to exclusive breast-feeding in only 25 % of statements. CONCLUSIONS Policy documents in the study countries varied in the extent to which they reflect the health outcomes for the baby of breast-feeding, and this may limit effective promotion by health professionals. There is scope to improve the process of bringing evidence and recommendations into policy documents.

Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries

Parents’ decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.

Developmental origins of health and disease: the views of first-time mothers in 5 European countries on the importance of nutritional influences in the first year of life

BACKGROUND The programming concept suggests that poor early nutrition causes an array of medical problems later in life. Public health messages about the implications of programming may not be reaching parents and influencing infant feeding behaviors. OBJECTIVE The views of new mothers were sought about the extent to which lifelong health is influenced by diet as an infant, rather than by genetic predispositions or lifestyles and behaviors. DESIGN A questionnaire survey of first-time mothers was undertaken in 5 European countries. RESULTS A convenience sample of 2071 mothers from England (438), Finland (426), Germany (414), Hungary (389), and Spain (404) self-completed the questionnaire. High proportions of mothers agreed that how an infant is fed affects his or her health over the first year (95.8%) and in subsequent years (88.5%), but the effect of infant feeding decisions on the development of long-term conditions was the least-cited underlying reason. Diet as an infant was rated an extremely/very important influence on adult health by 64% of mothers, equivalent to environmental pollution (63%), but by fewer mothers than were diet and physical activity in childhood/adolescence (79%, 84%) and adulthood (81%, 83%), genetics/inheritance (70%), and exposure to cigarette smoke (81%). Inter- and intracountry differences were observed. CONCLUSIONS Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.

Obesity Related Programming Statements in Materials on Infant Feeding Aimed at Parents in Five European Countries

Early nutrition programming as an origin of obesity is well acknowledged, but to what extent is this concept communicated to parents? In five European countries, UK, Finland (FI), Germany (DE), Hungary (HU) and Spain (ES), a total of 130 stand alone leaflets and 161 articles from parenting magazines providing information on feeding of healthy infants aged 0-12 months were identified and screened for nutrition programming statements. Obesity was mentioned in 8.5% (54/638) of the statements, and was the fourth most frequent outcome after allergy (20.7%), risk of infections (15.5%) and growth and development (11.4%). A temporal prognosis was given in 39% of obesity related statements, 6% referring to short- (< 5 years), 13% to medium- (5-15 years) and 20% to long-term (>15 years) duration of effects. So advice on obesity focuses on the intrinsic long-term perspective of programming in contrary to other surveyed health-outcomes where only 8- considered a lifelong approach. The major programming related behaviour concerned breast-feeding compared to formula and complementary feeding with meaningful differences concerning the recommended duration: for ES and HU the predominant advice was for exclusive breast-feeding for 6 months, for DE exclusive breast-feeding for 4-6 months and for UK and FI breast-feeding without further specification. In summary, statements relating to the programming of later obesity have been partially integrated into feeding information in five European countries. These countries have slightly different breastfeeding recommendations, but consistently refer to the preventive potential of breastfeeding in general. This is important as obesity and its resulting morbidity are of increasing public health concern in developed countries.

Trans Isomeric and LCPUFA Are Inversely Correlated in Erythrocyte Membrane Lipids at Mid-gestation

Fatty acid composition of erythrocyte phosphatidylcholines was determined by high-resolution capillary gas chromatography in Spanish (n = 120), German (n = 78) and Hungarian (n = 43) expectant women at the 20th week of gestation. The sum of trans isomeric fatty acids was significantly (p < 0.05) lower in Hungarian (0.68 [0.43]% wt/wt, median [IQR]) than in Spanish (0.82 [0.53]) expectant women. There were no significant correlations between the sum of trans isomers and linoleic acid or alpha-linolenic acid in either of the three groups. In contrast, there were significant inverse correlations between the sum of trans fatty acids and arachidonic acid and docosahexaenoic acid in all the three groups. These data raise the possibility that maternal trans isomeric fatty acid status may be inversely associated to the essential fatty acid status of the foetus.

Inulin-Type Fructan Supplementation of 3- to 6-Year-Old Children Is Associated with Higher Fecal Bifidobacterium Concentrations and Fewer Febrile Episodes Requiring Medical Attention

Abstract Background Inulin-type fructans used in formula have been shown to promote microbiota composition and stool consistency closer to those of breastfed infants and to have beneficial effects on fever occurrence, diarrhea, and incidence of infections requiring antibiotic treatment in infants. Objectives The primary study aim was to explore whether prophylactic supplementation with prebiotic fructans is able to influence the frequency of infectious diseases in kindergarten children during a winter period. A secondary objective was to ascertain the effect on the intestinal microbiota. Methods 142 boys and 128 girls aged 3–6 y were randomly allocated to consume 6 g/d fructans or maltodextrin for 24 wk. At baseline, stool samples were collected for microbiota analysis and anthropometric measurements were made. During the intervention period diagnoses were recorded by physicians, whereas disease symptoms, kindergarten absenteeism, dietary habits, and stool consistency were recorded by parents. Baseline measurements were repeated at wk 24. Results In total 219 children finished the study. Both the relative abundance of Bifidobacterium (P < 0.001) and that of Lactobacillus (P = 0.014) were 19.9% and 7.8% higher, respectively, post data normalization, in stool samples of children receiving fructans as compared with those of controls at wk 24. This was accompanied by significantly softer stools within the normal range in the prebiotic group from wk 12 onwards. The incidence of febrile episodes requiring medical attention [0.65 ± 1.09 compared with 0.9 ± 1.11 infections/(24 wk × child), P = 0.04] and that of sinusitis (0.01 ± 0.1 compared with 0.06 ± 0.25, P = 0.03) were significantly lower in the prebiotic group. The number of infectious episodes and their duration reported by parents did not differ significantly between the 2 intervention groups. Conclusions Prebiotic supplementation modified the composition of the intestinal microbiota and resulted in softer stools in kindergarten-aged children. The reduction in febrile episodes requiring medical attention supports the concept of further studies on prebiotics in young children. This trial was registered at clinicaltrials.gov as NCT03241355.