Perinatal Supply and Metabolism of Long‐Chain Polyunsaturated Fatty Acids

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Abstract
Abstract: The long‐chain polyunsaturated fatty acids, arachidonic (AA) and docosahexaenoic acid (DHA), are essential structural lipid components of biomembranes. During pregnancy, long‐chain polyunsaturated fatty acids (LC‐PUFA) are preferentially transferred from mother to fetus across the placenta. This placental transfer is mediated by specific fatty acid binding and transfer proteins. After birth, preterm and full‐term babies are capable of converting linoleic and α‐linolenic acids into AA and DHA, respectively, as demonstrated by studies using stable isotopes, but the activity of this endogenous LC‐PUFA synthesis is very low. Breast milk provides preformed LC‐PUFA, and breast‐fed infants have higher LC‐PUFA levels in plasma and tissue phospholipids than infants fed conventional formulas. Supplementation of formulas with different sources of LC‐PUFA can normalize LC‐PUFA status in the recipient infants relative to reference groups fed human milk. Some, but not all, randomized, double‐masked placebo‐controlled clinical trials in preterm and healthy full‐term infants demonstrated benefits of formula supplementation with DHA and AA for development of visual acuity up to 1 year of age and of complex neural and cognitive functions. From the available data, we conclude that LC‐PUFA are conditionally essential substrates during early life that are related to the quality of growth and development. Therefore, a dietary supply during pregnancy, lactation, and early childhood that avoids the occurrence of LC‐PUFA depletion is desirable, as was recently recommended by an expert consensus workshop of the Child Health Foundation.