Is Docosahexaenoic Acid (DHA) Essential? Lessons from DHA Status Regulation, Our Ancient Diet, Epidemiology and Randomized Controlled Trials

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Abstract
The human diet has changed considerably during the last 100 y. One of the striking changes is the tremendous increase in dietary fat. In terms of quality we have increased our intakes of saturated fatty acids (SFA),1 linoleic acid (LA) and trans-fatty acids, concomitant with reduced intakes of (n-3) fatty acids. The latter comprises reduced intake of α-linolenic acid (ALA) rich foods, and less consumption of long-chain PUFA of the (n-3) series [LC(n-3)P], i.e., eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids notably from fish (1). These dietary and other environmental changes are considered to be among the major causes of the rapid expansion of diet-related chronic disease (2), including cardiovascular disease (CVD) in the past century. Our genetic constitution is unlikely to have kept pace with the changing diet. Today's nutritional habits are consequently not the same as those on which our genes are based (2). The return to basics may be indicated, but we unfortunately have no reliable knowledge of the ancient diet on which our genes evolved. In this literature study we seek to find whether LC(n-3)P, and notably DHA, are essential.