Download PDF
Aktuelle Ernährungsmedizin 2009; 34(5): 240-245
DOI: 10.1055/s-0029-1220446
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Langkettige Omega-3-Fettsäuren in der Perinatalzeit: Empfehlungen zur Zufuhr

Long-Chain Omega-3 Fatty Acids in the Perinatal Period: Recommendations for IntakeC.  Glaser1 , B.  Koletzko1
  • 1Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München
Further Information

Publication History

Publication Date:
07 September 2009 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Die frühe Kindheit ist eine kritische Zeit des Wachstums und der Organentwicklung, welche von einer angemessenen Nährstoffversorgung abhängen. Langkettige mehrfach ungesättigte Fettsäuren (long-chain polyunsaturated fatty acids, LC-PUFA) sind essenzielle Komponenten der Strukturlipide in Hirn und Retina und beeinflussen die frühkindliche Entwicklung. Gefördert von der Europäischen Kommission entwickelten die Perinatal Lipid Nutrition Group (PeriLip) und das Early Nutrition Programming Project (EARNEST) auf der Basis systematischer Literaturanalysen und eines formellen Konsensusverfahrens evidenzbasierte Konsensempfehlungen zur Nahrungsfettzufuhr für schwangere und stillende Frauen mit Unterstützung zahlreicher internationaler wissenschaftlicher Fachgesellschaften. Es wird gefolgert, dass es keine Evidenz für den Nutzen einer im Vergleich zur Empfehlung für die Allgemeinbevölkerung veränderten Zufuhr an Fett (% der Energie) und des Anteils an gesättigten, einfach und mehrfach ungesättigten Fettsäuren in der Nahrung in Schwangerschaft und Stillzeit gibt. Empfohlen wird jedoch eine regelmäßige Zufuhr langkettiger Omega-3-Fettsäuren vor dem Hintergrund einer deutlichen Risikoreduktion für frühe Frühgeburten und zur Förderung einer optimalen visuellen und kognitiven Entwicklung des Fötus und des Neugeborenen. Eine mittlere Aufnahme von mindestens 200 mg pro Tag Docosahexaensäure (DHA) während der Schwangerschaft und in der Stillzeit sollte erreicht werden. Diese Zufuhrmenge kann durch den Verzehr von 1–2 Portionen fettreichem Meeresfisch pro Woche erreicht werden. Für gesunde Säuglinge ist Stillen die bevorzugte Ernährung. Ist ausschließliches Stillen nicht möglich, wird eine Flaschennahrung empfohlen mit einem DHA-Gehalt von 0,2–0,5 % des Fettgehalts und einem Gehalt von Arachidonsäure (AA) der mindestens dem DHA-Gehalt entspricht. Bei Schwangeren sollte nach inadäquaten Ernährungsgewohnheiten gefahndet und bei Bedarf eine individuelle Beratung angeboten werden.

Abstract

Fetal and infant growth and tissue development depend on a balanced nutrient supply. Long-chain polyunsaturated fatty acids (LC-PUFA) are essential compounds of structural lipids in brain and retina and are important for pregnancy and infant outcomes. Supported by the European Commission, the Perinatal Lipid Nutrition Project (PeriLip) and The Early Nutrition Programming Project (EARNEST) developed evidence consensus recommendations on dietary fat intake in pregnancy and lactation based on a systematic review of available evidence and a formal consensus process, which were also supported by several international scientific organizations. It is concluded there is no evidence to support changes in the dietary intake of fat (% of energy) and of the relative contribution of saturated, monounsaturated and polyunsaturated fatty acids in pregnancy and lactation, as compared to recommended intakes for the general population. However, a regular supply of long-chain omega-fatty acids is recommended in view of a significant risk reduction of early preterm birth as well as support of optimal visual and cognitive development of the fetus and child. An average daily intake of at least 200 mg docosahexaenoic acid (DHA) during pregnancy and lactation should be approached. This recommended intake can be met by consuming one to two portions of oily sea fish per week. For healthy term infants, breastfeeding is the preferred feeding. If exclusive breastfeeding cannot be achieved, an infant formula should be provided with DHA levels between 0.2 and 0.5 weight percent of total fat, and with the minimum amount of arachidonic acid (AA) equivalent to the DHA content. Dietary inadequacies should be screened for during pregnancy, and individual counselling be offered if needed.

Schlüsselwörter

Alpha-Linolensäure - Docosahexaensäure - Eicosapentaensäure - essenzielle Fettsäuren

Keywords

alpha-linolenic acid - docosahexaenoic acid - eicosapentaenoic acid - essential fatty acids

Literatur

  • 1 Burdge G C, Calder P C. Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults.  Reprod Nutr Dev. 2005;  45 581-597
    CrossrefSearch in Google Scholar
  • 2 Innis S M. Essential fatty acid transfer and fetal development.  Placenta. 2005;  26 (Suppl. A) S70-S75
    CrossrefSearch in Google Scholar
  • 3 Sprecher H, Luthria D L, Mohammed B S. et al . Reevaluation of the pathways for the biosynthesis of polyunsaturated fatty acids.  J Lipid Res. 1995;  36 2471-2477
    Search in Google Scholar
  • 4 Schaeffer L, Gohlke H, Muller M. et al . Common genetic variants of the FADS1 FADS2 gene cluster and their reconstructed haplotypes are associated with the fatty acid composition in phospholipids.  Hum Mol Genet. 2006;  15 1745-1756
    CrossrefSearch in Google Scholar
  • 5 Malerba G, Schaeffer L, Xumerle L. et al . SNPs of the FADS gene cluster are associated with polyunsaturated fatty acids in a cohort of patients with cardiovascular disease.  Lipids. 2008;  43 289-299
    CrossrefSearch in Google Scholar
  • 6 Rzehak P, Heinrich J, Klopp N. et al . Evidence for an association between genetic variants of the fatty acid desaturase 1 fatty acid desaturase 2 (FADS1 FADS2) gene cluster and the fatty acid composition of erythrocyte membranes.  Br J Nutr. 2009;  101 20-26
    CrossrefSearch in Google Scholar
  • 7 Burdge G. Alpha-linolenic acid metabolism in men and women: nutritional and biological implications.  Curr Opin Clin Nutr Metab Care. 2004;  7 137-144
    CrossrefSearch in Google Scholar
  • 8 Olsen S F, Hansen H S, Sorensen T I. et al . Intake of marine fat, rich in (n-3)-polyunsaturated fatty acids, may increase birthweight by prolonging gestation.  Lancet. 1986;  2 367-369
    Search in Google Scholar
  • 9 Oken E, Osterdal M L, Gillman M W. et al . Associations of maternal fish intake during pregnancy and breastfeeding duration with attainment of developmental milestones in early childhood: a study from the Danish National Birth Cohort.  American Journal of Clinical Nutrition. 2008;  88 789-796
    Search in Google Scholar
  • 10 Olsen S F, Secher N J. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study.  BMJ. 2002;  324 447
    CrossrefSearch in Google Scholar
  • 11 Szajewska H, Horvath A, Koletzko B. Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials.  Am J Clin Nutr. 2006;  83 1337-1344
    Search in Google Scholar
  • 12 Makrides M, Duley L, Olsen S F. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction.  Cochrane Database Syst Rev. 2006;  3 , CD003402
    Search in Google Scholar
  • 13 Horvath A, Koletzko B, Szajewska H. Effect of supplementation of women in high-risk pregnancies with long-chain polyunsaturated fatty acids on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials.  Br J Nutr. 2007;  98 253-259
    CrossrefSearch in Google Scholar
  • 14 Martinez M. Polyunsaturated fatty acids in the developing human brain, erythrocytes and plasma in peroxisomal disease: therapeutic implications.  J Inherit Metab Dis. 1995;  18 (Suppl. 1) 61-75
    Search in Google Scholar
  • 15 Ghys A, Bakker E, Hornstra G. et al . Red blood cell and plasma phospholipid arachidonic and docosahexaenoic acid levels at birth and cognitive development at 4 years of age.  Early Hum Dev. 2002;  69 83-90
    CrossrefSearch in Google Scholar
  • 16 Helland I B, Saugstad O D, Smith L. et al . Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women.  Pediatrics. 2001;  108 E82
    CrossrefSearch in Google Scholar
  • 17 Innis S M. Essential fatty acids in growth and development.  Prog Lipid Res. 1991;  30 39-103
    CrossrefSearch in Google Scholar
  • 18 Koletzko B, Larque E, Demmelmair H. Placental transfer of long-chain polyunsaturated fatty acids (LC-PUFA).  J Perinat Med. 2007;  35 (Suppl. 1) S5-11
    CrossrefSearch in Google Scholar
  • 19 Larque E, Demmelmair H, Berger B. et al . In vivo investigation of the placental transfer of C-13-labeled fatty acids in humans.  Journal of Lipid Research. 2003;  44 49-55
    CrossrefSearch in Google Scholar
  • 20 Larque E, Krauss-Etschmann S, Campoy C. et al . Docosahexaenoic acid supply in pregnancy affects placental expression of fatty acid transport proteins.  Am J Clin Nutr. 2006;  84 853-861
    Search in Google Scholar
  • 21 Larque E, Demmelmair H, Klingler M. et al . Expression pattern of fatty acid transport protein-1 (FATP-1), FATP-4 and heart-fatty acid binding protein (H-FABP) genes in human term placenta.  Early Hum Dev. 2006;  82 697-701
    CrossrefSearch in Google Scholar
  • 22 Krauss-Etschmann S, Shadid R, Campoy C. et al . Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial.  Am J Clin Nutr. 2007;  85 1392-1400
    Search in Google Scholar
  • 23 Hibbeln J R, Davis J M, Steer C. et al . Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study.  Lancet. 2007;  369 578-585
    CrossrefSearch in Google Scholar
  • 24 Helland I B, Smith L, Saarem K. et al . Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age.  Pediatrics. 2003;  111 e39-e44
    CrossrefSearch in Google Scholar
  • 25 Jensen C L. Effects of n-3 fatty acids during pregnancy and lactation.  Am J Clin Nutr. 2006;  83 1452S-1457S
    Search in Google Scholar
  • 26 Koletzko B, Cetin I, Brenna J T. Dietary fat intakes for pregnant and lactating women.  Br J Nutr. 2007;  98 873-877
    Search in Google Scholar
  • 27 European Food Safety Authority . Opinion of the scientific Panel on Contaminants in the Food Chain on a request from the Comission related to mercury and methylmercury in food (Request No EFSA-Q-2003-030, adopted on 24 February 2004).  The EFSA Journal. 2007;  34 1-14
    Search in Google Scholar
  • 28 European Food Safety Authority . Opinion of the scientific Panel on Contaminants in the Food Chain on a request from the European Parliament related to the safety of assessment of wild and farmed fish (Question No EFSA-Q-2004-022, adopted on 22 June 2005).  The EFSA Journal. 2005;  236 1-118
    Search in Google Scholar
  • 29 Koletzko B, Lien E, Agostoni C. et al . The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.  J Perinat Med. 2008;  36 5-14
    CrossrefSearch in Google Scholar
  • 30 European Food Safety Authority . Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from Mead Johnson & Company on DHA and ARA and brain development (Question No EFSA-Q-2008-212, adopted on 13 March 2009).  The EFSA Journal. 2009;  1000 1-13
    Search in Google Scholar
  • 31 European Food Safety Authority . Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from Mead Johnson Nutritionals on DHA and ARA and visual development (Question No EFSA-Q-2008-211, adopted on 22 January 2009).  The EFSA Journal. 2009;  941 1-14
    Search in Google Scholar
  • 32 Hibbeln J R, Davis J M, Steer C. et al . Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study.  Lancet. 2007;  369 578-585
    CrossrefSearch in Google Scholar

Univ.-Prof. Dr. med. habil. Berthold Koletzko

Abt. Stoffwechselkrankheiten und Ernährungsmedizin, Dr. von Haunersches Kinderspital, Klinikum der Universität München

Lindwurmstr. 4

80337 München

Fax: 089/5160-7742

Email: office.koletzko@med.uni-muenchen.de