Essential fatty acids in the first 1000 days of life

The first 1000 days of a baby’s life are between conception and 2nd birthday. This is an unique lapse of time mainly because during this period the development and health of the child is determined. Regarding this, the prevention and a healthy lifestyle are the pillars at the basis of the recommendations enfolded in the document “Investing early in health: actions and strategies in the first thousand days of life”, developed in 2019 by the specific Technical Table of the Ministry of Health [1]

During this lapse of time, environmental factors and nutrition have a huge short-and long-term impact on the health and well-being of unborn babies, infants and young children, as well as pregnant and lactating women. Actually, since pregnancy that we witness the growth of the organism, the development of the brain and nervous system, of all systems, of the immune system and metabolism. For this reason, a balanced diet with essential nutrients during gestation and early childhood plays a crucial role in planning for future health.

In this article, we will focus our attention on a category of essential nutrients in the first 1000 days of life: essential, polyunsaturated omega-6 and omega-3 fatty acids.

Pre-conception period

Before becoming pregnant, a woman should pay attention to her lifestyle and nutrition, making changes if necessary. It is, in fact, that with the usual pre-conception maternal diet the reserves of fatty acids are formed which will then be available for the development of the fetus at every stage of gestation: growth, formation and development of organs and tissues.

The availability of adequate reserves of fatty acids is important as it determines the correct formation of the placenta responsible for the exchange of mother-fetus nutrients.

During this period, according to the EFSA recommendations for an adult [2], the woman must intake 250 mg/day of EPA + DHA (omega-3). Linoleic acid (omega-6) and alpha-linolenic acid (omega-3) must represent respectively 4% and 0.5% of the daily energy requirement. It is also important to underline that, for various causes such as lifestyle, stress, accidental situations such as infections or episodes of vomiting, diarrhea, deficiencies of essential fatty acids can be created which can remain “silent”.

During the pregnancy

The energy requirement during gestation has long been overestimated with the false belief that a woman should “eat for two” when, in reality, it increases to a maximum of 15-20% in the last trimester. However, the need of micronutrients increases much more than energy and that is why it is necessary to pay attention to a balanced diet to provide essential nutrients such as:

• Iron, iodine, calcium, zinc, magnesium
• vitamins (folic acid / folate, vitamins A, B6, B12, C, D, E)
• essential fatty acids, such as Omega-3, e.g. docosahexaenoic acid (DHA)

This reduces the risk of complications, such as maternal anemia, preterm birth, low birth weight, miscarriage or preeclampsia.

DHA during pregnancy

A special mention should be made of DHA which concentrates in the membranes of gray matter cells in the brain, where it is involved in the transmission of neuronal signals, and in the rod cells of the retina, where it is responsible for visual quality.

The mobilization of DHA from mother to fetus changes according to the stage of gestation, reaching maximum levels in the last trimester when the demand for growth and organ formation is highest. It is estimated that the total amount of DHA in the fetus up to birth is 10 g, of which 60-70% is mainly accumulated during the last 10 weeks of pregnancy. To this must be added the daily requirement for the mother’s organism which is estimated to be satisfied with 250 mg/day of EPA + DHA. For all these reasons, during pregnancy and breastfeeding, EFSA recommends increasing the intake of DHA by 100 mg/day.

It is therefore important that the woman reaches the last trimester by being able to count on already built up reserves of DHA and continuing to consume sources of DHA during pregnancy. Insufficient quantities of DHA, in fact, are associated with an altered formation of cognitive and visual functions in the child.

In the event that it is not possible to guarantee an adequate supply of DHA, through foods that contain it directly (algae, fish), it will be necessary to supplement with high quality supplements, balanced and aimed at the incorporation of this fatty acid into the cell membranes of mother and fetus. We emphasize that in vegetarian or vegan diets, due to a lack of fish intake, the deficiency of DHA is more easily verifiable. Once again we underline that the deficiency must not remain “silent”, but can be highlighted by specific analyzes of the membrane content of the mature red blood cell.

Breastfeeding: the first 6 months of life

The composition of breast milk is optimally adapted to the needs of the growing baby and helps to:

• support immunity and protect against gastrointestinal and respiratory infections
• support neurodevelopment
• reduce the risk of developing obesity and other non-communicable diseases such as diabetes.

As long as the mother has a balanced diet, her milk provides adequate amounts of the nutrients necessary for the baby’s growth and development.

However, breastfeeding women have an increased need for several micronutrients. Therefore, the recommendations regarding lifestyle and diet during pregnancy generally also apply in the case of breastfeeding.

The concentration in breast milk of omega-6 and omega-3 fatty acids (arachidonic acid and DHA in particular) is connected with the maternal diet, therefore breastfeeding women should continue to pay particular attention to the intake of polyunsaturated fatty acids in a way to ensure, through milk, an adequate supply to the baby.

Since the Western diet is strongly unbalanced to the detriment of omega-3 and that during the first year of life the baby’s neuronal and visual tissues develop rapidly, even during breastfeeding a specific increase of 100mg / day is recommended. intake of DHA, in addition to 250 mg/day of EPA + DHA.

The first two years of life

Appropriate complementary foods (i.e. solid and liquid foods other than milk) should not be started before the start of the 5th month (17 weeks) and not after the start of the 7th month (26 weeks) – continuing breastfeeding until when mother and child desire.

Complementary feeding should include a wide variety of flavors and foods, especially vegetables, fruits, whole grains, proteins and animal origin aliments to ensure the nutritional needs of the growing child.

From the age of two, the dietary recommendations for children are equivalent to those of adults as regards essential fatty acids: the diet must provide the child with up to 4% of the energy needs from linoleic acid and at least 0.5% from alpha-linolenic acid. Given the imbalances of the Western diet and the now established link between excess omega-6, inflammation and oxidative stress, it is recommended that the total of omega-6 fats does not exceed 10% of the daily energy requirement.

On the contrary, given that the intake of EPA and DHA with the diet in children of many Western countries may be lower than desirable, starting from the age of two, as for adults, an intake of 250mg / day of EPA+ DHA (omega-3) is considered balanced. [3].

What we have said about the certainty of an adequate intake of essential fatty acids must lead to highlighting that it is necessary to obtain certainty that there is no deficiency in the body of the mother and infant/child. We remind you that the lack of essential fatty acids leads to various manifestations both local (including those affecting skin with phenomena of sensitivity and dermatitis) and systemic (including problems in terms of mood, behavior, cognitive capacity).

Bibliography:

[1] “Investing in health early: actions and strategies in the first thousand days of life”
Address document for parents, health professionals and policy makers, for the protection and promotion of the health of children and future generations. Link to the portal of the Ministry of Health.
[2] European Food Safety Authority (EFSA) Dietary Reference Values ​​for nutrients. Summary Report (2017)
[3] Uauy R, Dangour AD (2009) Ann Nutr Metab 55: 76–96
[4] Shrestha N, Sleep SL, Cuffe JSM, Holland OJ, Perkins AV, Yau SY, McAinch AJ, Hryciw DH (2020) Clin Exp Pharmacol Physiol 47 (5): 907-915.

Learn more about it on LIPIMAGAZINE:

• Role of DHA in pregnancy
  
• Pregnancy and breastfeeding

Article by the editorial team of Lipinutragen

The information provided must in no way replace the direct relationship between health professional and patient.
The food recommendations in the article are not intended as a substitute for a personalized meal plan and are to be adapted to specific cases.

Photo: 123RF Archivio Fotografico: 27874911 : ©panomacc | 55967795 : ©issaystudio

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The diet of modern society

Modern society, largely urbanized, is characterized by a strong sedentary lifestyle and by an ubiquitous presence of poor quality food, low in nutrients, inexpensive, but highly caloric. These characteristics make the western world highly obesogenic with all the health problems and chronic-degenerative diseases related to excess body fat.

Contrary, it is known that man has evolved in an environment with limited food resources and subject to cyclical periods of famine. Environmental pressure of this type made it possible to select the so-called saver genotype (thrifty gene hypothesis) which, in conditions of alternating presence of nutritional resources, is able to accumulate fats more easily. The stored depository fats, thanks to a greater insulin resistance, will then be used sparingly in times of famine. This phenotypic characteristic, successful over the centuries characterized by the non-constant presence of food resources, becomes instead a negative aspect for the modern society man. Food has become always available 24/7 all year round, without seasonal alternation exposing us to all dysmetabolic diseases such as obesity, hypertension and diabetes.

The negative effect of this, is current observed in populations that until a few decades ago lived in a traditional way and only recently have been “civilized” with Western food and the “cozy” and therefore sedentary lifestyle. This is the case of the Pima tribe, Native Americans of Arizona, who represent a living example of this transition of lifestyles with the consequent achievement of a very high levels of diabetes and obesity (up to over 75%) (2).

The energy balance model

With the aim of curbing the obesity, at the beginning of the 1900s the model based on the hypothesis of energy balance made its way, which sees the increase in body weight as an imbalance between incoming energy (the intake food) and consumed energy (basal metabolic rate + activity).

Figura 1: energy balance model.
(https://www.dgphysique.com/post/eating-clean-vs-being-in-a-calorie-deficit)

Calories introduced = calories consumed → weight maintenance
Calories introduced <calories consumed → weight loss
Calories introduced> calories consumed → weight gain[/vc_column_text][/vc_column_inner][/vc_row_inner]The model made its way in an era in which endocrinology had not yet developed and, in a very simplistic way, it equated the organism with an oven. Recall that in those times calorimeters were available and knowledge of the physiology of nutrition in its complexity as well as the metabolic axes that regulate energy expenditure were lacking. Not intending to refute the physics’ laws, it must in fact be considered that biological systems have homeostatic mechanisms that can alter the energy quotas dedicated to accumulation, rather than thermogenesis, or even the different degree of absorption or assimilation of nutrients, etc.

This calorie-centered model therefore appears limited and does not consider that the human body has an energy requirement below which it should not go down in order not to trigger defense mechanisms and energy savings typical of the saver phenotype.

Energy expenditure and consequences for the body

The total energy expenditure in the 24 hours (EE) is given by the Basal Metabolism (RMR) (sum of the expenditure of all organs and systems) + Thermal Effect of Food (TEF) (energy expenditure for the digestion of food and absorption) + Motor Activity, divided into Spontaneous (NEAT) and Voluntary (Exercise).

The following figure shows that the largest share of energy expenditure in 24 hours is given by the basal metabolism (Resting Metabolic Rate) which represents the cost, in terms of energy, of being alive and functioning. Digestion and assimilation of food depends very much on the type of food (consistency, presence of fibers, etc.) and on the metabolic conditions of the subject. Voluntary physical activity is on average a lower percentage than involuntary daily activities.

Figure 2:
percentages of energy expenditure by categories: Resting Metabolic Rate represents between 60-80% of the total, Thermic Effect of Meals / Food 10%, Physical activity (voluntary and otherwise) a very variable percentage between 20-50%.[/vc_column_text][/vc_column_inner][/vc_row_inner]Quite simply, if an individual with excess weight and body fat, introduces too many calories compared to his needs, it is obvious that eating less (and doing more exercises) represents an appropriate solution.

Contrary, for a person with excess body fat who eats less than his basal needs, perhaps with a past of drastic low-calorie diets, a reduction in energy intake can hardly be an effective strategy. An excessive calorie reduction, compared to individual needs, is interpreted by our neuroendocrine system as a stressor and will push the body to express the so-called saver phenotype, thus adapting to the calorie restriction without losing weight.

Lipids, from enemies to allies

Since fat is the highest energy macronutrient (about 9 kcal/g), the response to obesity based on the energy balance model has generated low-calorie diets with low fat content. In the 70s, the main nutritional guidelines established that the correct diet was the one with low fat and with the highest presence of carbohydrates. Based on this facts a whole industry of light and low fat products has developed, but with the presence of lots of sugars. It is clear to everyone that this model has been a failure and that diabetes and obesity (diabesity) has doubled several times in the past 40 years.

For this reason, dietary fats have been so reviled and only recently are they returning to the fore and acquiring a role of primary macronutrient and moving to a higher percentage (up to 35% of total calories) recommended by the guidelines for healthy nutrition (LARN IV edition, 2014).

Obviously not all fats are the same and must be intaken choosing between saturated (SFA), monounsaturated (MUFA) and polyunsaturated (PUFA) omega 6 (ω-6) and omega 3 (ω-3), so it is a matter of balancing them by choosing the food sources properly.

Even at the molecular level we can observe that the cell is looking for a lipid balance in its plasma membrane. This is because fats have specific functions depending on the tissue or organ they are composing. In addition to the structural properties, lipids are among other things also signal molecules, fundamental in inflammatory and anti-inflammatory processes. Membrane fat imbalances can be correlated with different metabolic conditions, including obesity.

Bibliography:

1. Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”? 1962. Am J Hum Genet.
2. Schulz LO. Effects of Traditional and Western Environments on Prevalence of Type 2 Diabetes in Pima Indians in Mexico and the U.S. 2006. Diabetes Care.
3. Manini TM. Energy expenditure and aging. 2010. Ageing Research Review

Article by:

Francesco Bonucci – Nutrizionista

The diet advise, written in the article, are not intended to be a substitute for a personal nutrition plan and should be adapted to specific cases

Photo: 123RF Archivio Fotografico: 27291006 ©Natalia Klenova /123rf.com

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The importance of fats in our body

In these first twenty years of the 21st century, fats have finally taken a revenge on all the other molecules that represent our body and diet, because their indispensability for the body health has been recognized. We cannot life and well function without fats and this culture concept must be spread as much as possible to avoid important errors which can therefore cause damage, even serious ones. (C. Ferreri. Dalla Parte dei grassi, Mind Editions, 2019)

DHA: indispensable fatty acid

https://www.pathway27.eu/topstory/docosahexaenoic-acid/

At the top of the list of essential fats is certainly DHA or, as it is correctly defined, DOCOSAHEXAENOIC acid, the molecule shown in the figure and made up of 22 carbon atoms with six double bonds. Since 2010, the European food safety agency EFSA has established the quantity to be taken every day for each individual, which is 200-250 mg, underlining its importance in pregnancy, breastfeeding and in some stages of life, such as during growth (EFSA Journal 2010 8 (3): 1461). In 2014 (EFSA Journal 2014; 12 (10): 3840) the effect of DHA on “normal brain development” was verified, especially for infants and children under 2 years with dosages of 100 mg / day and with dosages 250 mg / day for growth from 2 to 18 years.

Together with the other omega-3 EPA, in dosages of at least 250 mg, DHA contributes to maintaining correct heart function (EU regulation 432/2012).

These quantities can certainly be obtained from a diet that includes sources of DHA, such as algae, or fish that eat algae. In 100 grams of fish 500 mg of omega-3 (EPA and DHA) can be found, therefore it is really necessary to frequently consume this type of food, to maintain the levels of fats essential to health.

The formation of DHA in the body and food sources

Can DHA also be prepared by the body? The answer is YES but, being an omega-3 family fatty acid, its precursor – alpha-linolenic acid ALA – must be assumed which our body cannot prepare (ESSENTIAL FATTY ACID) and therefore must be introduced with food. In short, if you do not eat food with DHA you will have to eat food with ALA!

But which foods? ALA is present in good quantities in linseed oil and flax seeds (which must be shredded), in some vegetables (spinach), but very little in meat, beef or chicken, and in derivatives of these animals (milk, eggs, etc.). The reason for the scarcity of omega-3 sources is also found in the feeding followed in “intensive” farms for the placing on the market of terrestrial and marine animals. Fortunately, we are witnessing a greater awareness of livestock breeders for animal nutrition in more recent times, and consumers can play a very important role in changing the market for the better, if they mainly choose to buy products deriving from farms with food and natural treatments.

How to know the level of DHA in the body

If DHA is not taken directly from fish or algae, its preparation – as mentioned above – can take place by the body starting from ALA and involves 6 enzymatic steps (see figure).

The enzymes involved in the transformation of ALA to DHA must be efficient, but this is not always the case: in cases of higher consumption of omega-6 fats, or in the absence of certain vitamins or minerals, these enzymes are not able to complete the 6 steps. Thus DHA decreases gradually in the body, and the tissues in which it is indispensable begin to not receive sufficient DHA for their functioning.

This can happen in the case of absence of fish intake, and therefore if we rely only on ALA to reach the necessary quantities of DHA. This is the case for vegan diets – especially those in which algae are not used.

In this case, it becomes necessary to know the level of DHA reached in your body.

How? In active prevention, you can go to specialized pharmacies and ask to perform the lipidomic analysis of erythrocyte membrane fatpharmacy®, which Lipinutragen has developed with a robotic equipment unique in the world, ensuring precision and reliability.

Given the tissues where DHA plays a fundamental role (brain, heart), DHA levels cannot drop. The optimal percentage present in the membrane of the mature red blood cell (5-7%) is known and, if through the fatpharmacy® analysis, the DHA level is close to or even below 5%, it is necessary to intervene with the feeding, primarily , or with DHA supplementation of at least 200-250 mg per day.

DHA supplements: how to choose them?

Precisely for the integration of DHA and the choice of quality of the supplements on the market, the following points for the consumer are underlined:

1- DHA is a molecule very sensitive to oxidation, therefore the DHA supplement must also contain a well-designed “shield” for the protection of this precious molecule. For example: vitamin E, vitamin C and astaxanthin are an ideal triad for protection in all body areas (aqueous and lipidic).

2- DHA administered as triglyceride from fish oil must be transformed into phospholipid in the body, because in this form it enters the cell membrane, as a constituent of the tissues. DHA-based triglycerides must therefore also be accompanied by “facilitators” of their metabolism, such as the alpha-glyceryl phosphorylcholine molecule, which is the indispensable “brick” for the preparation of phospholipids;

3- Finally, the DHA supplement must not contain other unwanted fats, such as saturated fats and trans fats, because the beneficial effect of DHA refers to a pure source of this fatty acid, and not mixed with other fats that interfere in the its metabolism, distribution and effect.

While DHA in the diet is digested together with all the other active components of the food, DHA in the integration must be in the right formulation to be able to reach the cell membrane from where it exerts its indispensable action. Therefore the formulation must ensure that the dose administered orally is absorbed, protected during biodistribution and incorporated into the phospholipids of biological membranes, as occurs with soft-gel capsules. If you need to check the levels reached by the administrations, you can perform the fatpharmacy® analysis, after a few months of intaking.

Integrating DHA in childhood

We want to conclude with the observation that DHA deficiencies (below 5%) have been found in children suffering from behavioral disorders (our works published on PlosONE 2013 PLoS ONE 8 (6): e66418 and Scientific Reports of Nature 2017, 7, art.no 9854). Although this deficiency cannot be indicated as the sole cause of these disorders, the decrease in DHA must alert the doctor to the possibility of an “essential fatty acid deficiency” disease (EFA deficiency). At this point, having ascertained the deficit, fragile children must take action to ensure the intake of this element so necessary for neuronal development. For this purpose, a nutritional plan is created with the frequent use of the above foods. However, if you cannot ensure the indispensable levels of DHA (250 mg per day), you can resort to integration by ensuring the quality of the chosen supplement, as explained above.

The best supplement for children is that in liquid form and in particular a microemulsion formulation, specifically designed with the above characteristics, is about to enter the market, for the safety of reaching the active site of DHA, the cell membrane.

Dott.ssa Carla Ferreri – Senior Researcher at ISOF-CNR and Lipinutragen co-founder

Photo: 123RF Archivio Fotografico: 28422874 @pichetw /123rf.com | www.pathway27.eu/topstory/docosahexaenoic-acid/

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