Highlights
- •Supplementing with at least 200 mg/d of docosahexaenoic acid (DHA) during lactation has been recommended to ensure a sufficient supply of DHA for the infant.
- •This was an exploratory study of red blood cell and breast milk DHA changes in lactating women on a controlled-feeding diet including 200 mg/d of supplemental DHA.
- •On average, red blood cell DHA levels did not change while breast milk DHA levels increased significantly.
- •Red blood cell and breast milk DHA levels above the median at baseline (5% and 0.19%, respectively) did not change while those below the median significantly increased.
- •These results indicate a need for personalizing DHA dosing based on red blood cell or breast milk DHA status during lactation to ensure sufficient DHA for both mother and baby.
Abstract
Background
The importance of providing the newborn infant with docosahexaenoic acid (DHA) from
breast milk is well established. However, women in the United States, on average,
have breast milk DHA levels of 0.20%, which is below the worldwide average (and proposed
target) of >0.32%. Additionally, the relationship between maternal red blood cell
(RBC) and breast milk DHA levels may provide insight into the sufficiency of DHA recommendations
during lactation. Whether the standard recommendation of at least 200 mg/day of supplemental
DHA during lactation is sufficient for most women to achieve a desirable RBC and breast
milk DHA status is unknown.
Methods
Lactating women (n = 27) at about 5 weeks postpartum were enrolled in a 10–12 week controlled feeding
study that included randomization to 480 or 930 mg choline/d (diet plus supplementation). As part of the intervention, all participants were required to
consume a 200 mg/d of microalgal DHA. RBC and breast milk DHA levels were measured
by capillary gas chromatography in an exploratory analysis.
Results
Median RBC DHA was 5.0% (95% CI: 4.3, 5.5) at baseline and 5.1% (4.6, 5.4) after 10
weeks of supplementation (P = 0.6). DHA as a percent of breast milk fatty acids increased from 0.19% (0.18, 0.33)
to 0.34% (0.27, 0.38) after supplementation (P<0.05). The proportion of women meeting the target RBC DHA level of >5% was unchanged
(52% at baseline and week 10). The proportion of women achieving a breast milk DHA
level of >0.32% approximately doubled from 30% to 56% (p = 0.06). Baseline RBC and breast milk DHA levels affected their responses to supplementation.
Those with baseline RBC and breast milk DHA levels above the median (5% and 0.19%,
respectively) experienced no change or a slight decrease in levels, while those below
the median had a significant increase. Choline supplementation did not significantly
influence final RBC or breast milk DHA levels.
Conclusions
On average, the standard prenatal DHA dose of 200 mg/d did not increase RBC DHA but
did increase breastmilk DHA over 10 weeks in a cohort of lactating women in a controlled-feeding
study. Baseline DHA levels in RBC and breast milk affected the response to DHA supplementation,
with lower levels being associated with a greater increase and higher levels with
no change or a slight decrease. Additional larger, dose-response DHA trials accounting
for usual intakes and baseline DHA status are needed to determine how to best achieve
target breast milk DHA levels and to identify additional modifiers of the variable
breast milk DHA response to maternal DHA supplementation.
Keywords
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Article info
Publication history
Published online: January 11, 2021
Accepted:
January 11,
2021
Received in revised form:
January 9,
2021
Received:
September 14,
2020
Footnotes
Sources of support: The work presented herein was partially supported by the National Institute of Food and Agriculture U.S. Department of Agriculture, HATCH under accession number 1013729 and through a Cornell Institute of Biotechnology's Center for Advanced Technology (CAT) grant, funded through New York State Division of Science, Technology, and Innovation (NYSTAR). The secondary analysis did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2021 Published by Elsevier Ltd.
