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Baseline red blood cell and breast milk DHA levels affect responses to standard dose of DHA in lactating women on a controlled feeding diet

  • Kristina Harris Jackson
    Correspondence
    Corresponding author at: 5009 W. 12th St., Suite 9A, Sioux Falls, SD 57105.
    Affiliations
    OmegaQuant Analytics, LLC. Sioux Falls, SD, 57105, USA

    Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, 57105, USA
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  • Kevin C. Klatt
    Affiliations
    USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, 77030, USA
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  • Marie A. Caudill
    Affiliations
    Division of Nutritional Science, Cornell University, Ithaca, NY, 14853, USA
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  • Author Footnotes
    # MQM passed away during the writing and submission of this manuscript.
    ,
    Author Footnotes
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Melissa Q. McDougall
    Footnotes
    # MQM passed away during the writing and submission of this manuscript.
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Affiliations
    Division of Nutritional Science, Cornell University, Ithaca, NY, 14853, USA
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  • Author Footnotes
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Allyson A. West
    Footnotes
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Affiliations
    Division of Nutritional Science, Cornell University, Ithaca, NY, 14853, USA
    Search for articles by this author
  • Author Footnotes
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Cydne A. Perry
    Footnotes
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
    Affiliations
    Division of Nutritional Science, Cornell University, Ithaca, NY, 14853, USA
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  • Olga V. Malysheva
    Affiliations
    Division of Nutritional Science, Cornell University, Ithaca, NY, 14853, USA
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  • William S. Harris
    Affiliations
    Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, 57105, USA

    Fatty Acid Research Institute, Sioux Falls, SD, 57105, USA
    Search for articles by this author
  • Author Footnotes
    # MQM passed away during the writing and submission of this manuscript.
    1 Current affiliations: Nutrition Sciences Department, Dominican University, River Forest, IL (AAW); Department of Applied Health Science, Indiana University School of Public Health-Bloomington, IN (CAP); Pharmavite, LLC (MQM)
Published:January 11, 2021DOI:https://doi.org/10.1016/j.plefa.2021.102248

      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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      References

        • Brenna J.T.
        • Lapillonne A.
        Background paper on fat and fatty acid requirements during pregnancy and lactation.
        Ann. Nutr. Metab. 2009; 55: 97-122
        • Koletzko B.
        • Cetin I.
        • Brenna J.T.
        Dietary fat intakes for pregnant and lactating women.
        Br. J. Nutr. 2007; 98: 873-877
        • Carlson S.E.
        • Colombo J.
        Docosahexaenoic acid and arachidonic acid nutrition in early development.
        Adv. Pediatr. 2016; 63: 453-471
        • Scholtz S.A.
        • Colombo J.
        • Carlson S.E.
        Clinical overview of effects of dietary long-chain polyunsaturated fatty acids during the perinatal period.
        Nestle Nutr. Inst. Workshop Ser. 2013; 77: 145-154
        • Salem N.
        • Wegher B.
        • Mena P.
        • Uauy R.D.
        Arachidonic acid and docosahexaenoic acids are biosynthesized from their 18-carbon precursors in human infants.
        Proc. Natl. Acad. Sci. 1996; 93: 49-54
        • Haggarty P.
        Meeting the fetal requirement for polyunsaturated fatty acids in pregnancy.
        Curr. Opin. Clin. Nutr. Metab. Care. 2014; 17: 151-155
        • Koletzko B.
        • Boey C.C.
        • Campoy C.
        • et al.
        Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop.
        Ann. Nutr. Metab. 2014; 65: 49-80
        • March of Dimes
        Vitamins and Other Nutrients During Pregnancy.
        March of Dimes, 2018 (Accessed at)
        • Nordgren T.M.
        • Lyden E.
        • Anderson-Berry A.
        • Hanson C
        Omega-3 fatty acid intake of pregnant women and women of childbearing age in the United States: potential for deficiency?.
        Nutrients. 2017; 9
        • Jackson K.H.
        • Harris W.S.
        Should there be a target level of docosahexaenoic acid in breast milk?.
        Curr. Opin. Clin. Nutr. Metab. Care. 2016; 19: 92-96
        • Brenna J.T.
        • Varamini B.
        • Jensen R.G.
        • Diersen-Schade D.A.
        • Boettcher J.A.
        • Arterburn L.M.
        Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide.
        Am. J. Clin. Nutr. 2007; 85: 1457-1464
        • Colombo J.
        • Carlson S.E.
        • Cheatham C.L.
        • et al.
        Long-term effects of LCPUFA supplementation on childhood cognitive outcomes.
        Am. J. Clin. Nutr. 2013; 98: 403-412
        • Drover J.
        • Hoffman D.R.
        • Castaneda Y.S.
        • Morale S.E.
        • Birch E.E.
        Three randomized controlled trials of early long-chain polyunsaturated fatty acid supplementation on means-end problem solving in 9-month-olds.
        Child Dev. 2009; 80: 1376-1384
        • Birch E.E.
        • Garfield S.
        • Hoffman D.R.
        • Uauy R.
        • Birch D.G.
        A randomized controlled trial of early dietary supply of longchain polyunsaturated fatty acids and mental development in term infants.
        Dev. Med. Child Neurol. 2000; 42: 174-181
        • Davenport C.
        • Yan J.
        • Taesuwan S.
        • et al.
        Choline intakes exceeding recommendations during human lactation improve breast milk choline content by increasing PEMT pathway metabolites.
        J. Nutr. Biochem. 2015; 26: 903-911
        • Yan J.
        • Jiang X.
        • West A.A.
        • et al.
        Pregnancy alters choline dynamics: results of a randomized trial using stable isotope methodology in pregnant and nonpregnant women.
        Am. J. Clin. Nutr. 2013; 98: 1459-1467
        • Yan J.
        • Jiang X.
        • West A.A.
        • et al.
        Maternal choline intake modulates maternal and fetal biomarkers of choline metabolism in humans.
        Am. J. Clin. Nutr. 2012; 95: 1060-1071
        • West A.A.
        • Yan J.
        • Jiang X.
        • Perry C.A.
        • Innis S.M.
        • Caudill M.A.
        Choline intake influences phosphatidylcholine DHA enrichment in nonpregnant women but not in pregnant women in the third trimester.
        Am. J. Clin. Nutr. 2013; 97: 718-727
        • Harris W.S.
        • Pottala J.V.
        • Vasan R.S.
        • Larson M.G.
        • Robins S.J.
        Changes in erythrocyte membrane trans and marine fatty acids between 1999 and 2006 in older Americans.
        J. Nutr. 2012; 142: 1297-1303
        • Rudolph M.C.
        • Young B.E.
        • Jackson K.H.
        • Krebs N.F.
        • Harris W.S.
        • MacLean P.S.
        Human milk fatty acid composition: comparison of novel dried milk spot versus standard liquid extraction methods.
        J Mammary Gland Biol. Neoplasia. 2016; 21: 131-138
        • Jackson K.H.
        • Harris W.S.
        A prenatal DHA test to help identify women at increased risk for early preterm birth: a proposal.
        Nutrients. 2018; 10: 1-12
        • Stark K.D.
        • Beblo S.
        • Murthy M.
        • et al.
        Comparison of bloodstream fatty acid composition from African-American women at gestation, delivery, and postpartum.
        J. Lipid Res. 2005; 46: 516-525
        • Gellert S.
        • Schuchardt J.P.
        • Hahn A.
        Higher omega-3 index and DHA status in pregnant women compared to lactating women - Results from a German nation-wide cross-sectional study.
        Prostaglandins Leukot Essent Fatty Acids. 2016; 109: 22-28
        • Jensen C.L.
        • Voigt R.G.
        • Prager T.C.
        • et al.
        Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants.
        Am. J. Clin. Nutr. 2005; 82: 125-132
        • Bergmann R.L.
        • Haschke-Becher E.
        • Klassen-Wigger P.
        • et al.
        Supplementation with 200 mg/day docosahexaenoic acid from mid-pregnancy through lactation improves the docosahexaenoic acid status of mothers with a habitually low fish intake and of their infants.
        Ann. Nutr. Metab. 2008; 52: 157-166
        • Makrides M.
        • Neumann M.A.
        • Gibson R.A.
        Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition.
        Eur. J. Clin. Nutr. 1996; 50: 352-357
        • Huang H.L.
        • Chuang L.T.
        • Li H.H.
        • Lin C.P.
        • Glew R.H.
        Docosahexaenoic acid in maternal and neonatal plasma phospholipids and milk lipids of Taiwanese women in Kinmen: fatty acid composition of maternal blood, neonatal blood and breast milk.
        Lipids Health Dis. 2013; 12: 27
        • Walker R.E.
        • Jackson K.H.
        • Tintle N.L.
        • et al.
        Predicting the effects of supplemental EPA and DHA on the omega-3 index.
        Am. J. Clin. Nutr. 2019; 110: 1034-1040
        • Giltay E.J.
        • Gooren L.J.
        • Toorians A.W.
        • Katan M.B.
        • Zock P.L.
        Docosahexaenoic acid concentrations are higher in women than in men because of estrogenic effects.
        Am. J. Clin. Nutr. 2004; 80: 1167-1174
        • Kuipers R.S.
        • Luxwolda M.F.
        • Sango W.S.
        • Kwesigabo G.
        • Dijck-Brouwer D.A.
        • Muskiet F.A.
        Postdelivery changes in maternal and infant erythrocyte fatty acids in 3 populations differing in fresh water fish intakes.
        Prostaglandins. Leukot. Essent. Fatty Acids. 2011; 85: 387-397
        • Harris W.S.
        • Pottala J.V.
        • Vasan R.S.
        • Larson M.G.
        • Robins S.J.
        Changes in Erythrocyte Membrane Trans and Marine Fatty Acids between 1999 and 2006 in Older Americans.
        J. Nutr. 2012; 142: 1297-1303
        • Katan M.B.
        • Deslypere J.P.
        • van Birgelen A.P.
        • Penders M.
        • Zegwaard M.
        Kinetics of the incorporation of dietary fatty acids into serum cholesteryl esters, erythrocyte membranes, and adipose tissue: an 18-month controlled study.
        J. Lipid Res. 1997; 38: 2012-2022