Nutr Res Pract.  2019 Aug;13(4):344-351. 10.4162/nrp.2019.13.4.344.

Dietary intake of n-3 and n-6 polyunsaturated fatty acids in Korean toddlers 12–24 months of age with comparison to the dietary recommendations

• Kim Y
• Kim H
• Kwon O

• KMID: 2453113
• DOI: http://doi.org/10.4162/nrp.2019.13.4.344

Abstract

BACKGROUND/OBJECTIVES
Adequate dietary fatty acid intake is important for toddlers between 12-24 months of age, as this is a period of dietary transition in conjunction with rapid growth and development; however, actual fatty acid intake during this period seldom has been explored. This study was conducted to assess the intake status of n-3 and n-6 polyunsaturated fatty acids by toddlers during the 12-24-month period using 2010-2015 Korea National Health and Nutrition Examination Survey data.
SUBJECTS/METHODS
Twenty-four-hour dietary recall data of 12-24-month-old toddlers (n = 544) was used to estimate the intakes of α-linolenic acid (ALA; 18:3n-3), eicosapentaenoic acid (EPA; 20:5n-3), docosahexaenoic acid (DHA; 22:6n-3), linoleic acid (LA; 18:2n-6), and arachidonic acid (AA; 20:4n-6), as well as the major dietary sources of each. The results were compared with the expected intake for exclusively breastfed infants in the first 6 months of life and available dietary recommendations.
RESULTS
Mean daily intakes of ALA, EPA, DHA, LA, and AA were 529.9, 22.4, 37.0, 3907.6, and 20.0 mg/day, respectively. Dietary intakes of these fatty acids fell below the expected intake for 0-5-month-old exclusively breastfed infants. In particular, DHA and AA intakes were 4 to 5 times lower. The dietary assessment indicated that the mean intake of essential fatty acids ALA and LA was below the European and the FAO/WHO dietary recommendations, particularly for DHA, which was approximately 30% and 14-16% lower, respectively. The key sources of the essential fatty acids, DHA, and AA were soy (28.2%), fish (97.3%), and animals (53.7%), respectively.
CONCLUSIONS
Considering the prevailing view of DHA and AA requirements on early brain development, there remains considerable room for improvement in their intakes in the diets of Korean toddlers. Further studies are warranted to explore how increasing dietary intakes of DHA and AA could benefit brain development during infancy and early childhood.

Keyword

Dietary intake assessment; essential fatty acids; docosahexaenoic acid; arachidonic acid; Infant and child nutrition

MeSH Terms

Animals
Arachidonic Acid
Brain
Diet
Eicosapentaenoic Acid
Fatty Acids
Fatty Acids, Essential
Fatty Acids, Unsaturated*
Growth and Development
Humans
Infant
Korea
Linoleic Acid
Nutrition Surveys
Arachidonic Acid
Eicosapentaenoic Acid
Fatty Acids
Fatty Acids, Essential
Fatty Acids, Unsaturated
Linoleic Acid

Figure

• 

  Fig. 1 Top contributing food sources of n-3 and n-6 polyunsaturated fatty acids among toddlers aged 12–24 months in the KNHANES 2010–2015. (A) ALA, α-linolenic acid 18:3n-3; (B) EPA, eicosapentaenoic acid 20:5n-3; (C) DHA, docosahexaenoic acid 22:6n-3; (D) LA, linoleic acid 18:2n-6; and (E) AA, arachidonic acid 20:4n-6. KNHANES, Korean National Health and Nutrition Examination Survey. Foods contributing less than 2.0% to the overall intake of each fatty acid are not shown. All estimates were weighted and calculated for consideration of the complex survey design.

Reference

1. Wachs TD, Georgieff M, Cusick S, McEwen BS. Issues in the timing of integrated early interventions: contributions from nutrition, neuroscience, and psychological research. Ann N Y Acad Sci. 2014; 1308:89–106.

2. Georgieff MK. Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr. 2007; 85:614S–620S.

3. Bazinet RP, Layé S. Polyunsaturated fatty acids and their metabolites in brain function and disease. Nat Rev Neurosci. 2014; 15:771–785.

4. Keim SA, Branum AM. Dietary intake of polyunsaturated fatty acids and fish among US children 12–60 months of age. Matern Child Nutr. 2015; 11:987–998.

5. Dobbing J, Sands J. Quantitative growth and development of human brain. Arch Dis Child. 1973; 48:757–767.

6. Martinez M. Abnormal profiles of polyunsaturated fatty acids in the brain, liver, kidney and retina of patients with peroxisomal disorders. Brain Res. 1992; 583:171–182.

7. Birch EE, Garfield S, Castañeda Y, Hughbanks-Wheaton D, Uauy R, Hoffman D. Visual acuity and cognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chain polyunsaturated fatty acid-supplemented infant formula. Early Hum Dev. 2007; 83:279–284.

8. Lien EL, Richard C, Hoffman DR. DHA and ARA addition to infant formula: current status and future research directions. Prostaglandins Leukot Essent Fatty Acids. 2018; 128:26–40.

9. Dutta-Roy AK. Transport mechanisms for long-chain polyunsaturated fatty acids in the human placenta. Am J Clin Nutr. 2000; 71:315S–322S.

10. Kim H, Kang S, Jung BM, Yi H, Jung JA, Chang N. Breast milk fatty acid composition and fatty acid intake of lactating mothers in South Korea. Br J Nutr. 2017; 117:556–561.

11. Gibson S, Sidnell A. Nutrient adequacy and imbalance among young children aged 1–3 years in the UK. Nutr Bull. 2014; 39:172–180.

12. Baek Y, Hwang JY, Kim K, Moon HK, Kweon S, Yang J, Oh K, Shim JE. Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013. Nutr Res Pract. 2015; 9:650–657.

13. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77.

14. Kim Y. The Korea National Health and Nutrition Examination Survey (KNHANES): current status and challenges. Epidemiol Health. 2014; 36:e2014002.

15. Yoon MO, Kim K, Hwang JY, Lee HS, Son TY, Moon HK, Shim JE. Development of a fatty acids database using the Korea National Health and Nutrition Examination Survey data. J Nutr Health. 2014; 47:435–442.

16. Ministry of Health & Welfare. The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2015. Seoul: The Korean Nutrition Society;2015.

17. Butte NF, Lopez-Alarcon MG, Garza C. Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant during the First Six Months of Life. Geneva: World Health Organization;2002.

18. Tsuboyama-Kasaoka N, Takizawa A, Tsubota-Utsugi M, Nakade M, Imai E, Kondo A, Yoshida K, Okuda N, Nishi N, Takimoto H. Dietary intake of nutrients with adequate intake values in the dietary reference intakes for Japanese. J Nutr Sci Vitaminol (Tokyo). 2013; 59:584–595.

19. Institute of Medicine. 8. Dietary fats: total fat and fatty acids. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: National Academy Press;2005. p. 422–541.

20. Clark KJ, Makrides M, Neumann MA, Gibson RA. Determination of the optimal ratio of linoleic acid to alpha-linolenic acid in infant formulas. J Pediatr. 1992; 120:S151–S158.

21. Aggett PJ, Haschke F, Heine W, Hernell O, Koletzko B, Launiala K, Rey J, Rubino A, Schöch G, Senterre J, Tormo R. ESPGAN Committee on Nutrition. Comment on the content and composition of lipids in infant formulas. Acta Paediatr Scand. 1991; 80:887–896.

22. International Society for the Study of Fatty Acids and Lipids. ISSFAL Board Statement: recommendations for the essential fatty acid requirement for infant formulas. J Am Coll Nutr. 1995; 14:213–214.

23. Raiten DJ, Talbot JM, Waters JH. Assessment of nutrient requirements for infant formulas. J Nutr. 1998; 128:i–iv. 2059S–2293S.

24. Barbarich BN, Willows ND, Wang L, Clandinin MT. Polyunsaturated fatty acids and anthropometric indices of children in rural China. Eur J Clin Nutr. 2006; 60:1100–1107.

25. Sioen I, Huybrechts I, Verbeke W, Camp JV, De Henauw S. n-6 and n-3 PUFA intakes of pre-school children in Flanders, Belgium. Br J Nutr. 2007; 98:819–825.

26. Nordgren TM, 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:E197.

27. Carlson SE, Colombo J. Docosahexaenoic acid and arachidonic acid nutrition in early development. Adv Pediatr. 2016; 63:453–471.

28. Michaelsen KF, Dewey KG, Perez-Exposito AB, Nurhasan M, Lauritzen L, Roos N. Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6–24 months), and pregnant and lactating women. Matern Child Nutr. 2011; 7:Suppl 2. 124–140.

29. Liu MJ, Li HT, Yu LX, Xu GS, Ge H, Wang LL, Zhang YL, Zhou YB, Li Y, Bai MX, Liu JM. A correlation study of DHA dietary intake and plasma, erythrocyte and breast milk DHA concentrations in lactating women from coastland, lakeland, and inland areas of China. Nutrients. 2016; 8:E312.

30. Choi E, Park Y. The association between the consumption of fish/whellfish and the risk of osteoporosis in men and postmenopausal women aged 50 years or older. Nutrients. 2016; 8:113.

31. Forsyth S, Gautier S, Salem N Jr. Estimated dietary intakes of arachidonic acid and docosahexaenoic acid in infants and young children living in developing countries. Ann Nutr Metab. 2016; 69:64–74.

32. European Food Safety Authority. DHA and ARA and brain development-Scientific substantiation of a health claim related to docosahexaenoic acid (DHA) and arachidonic acid (ARA) and brain development pursuant to Article14 of Regulation (EC) No 1924/2006. EFSA J. 2009; 7:1000.

33. Hadley KB, Ryan AS, Forsyth S, Gautier S, Salem N Jr. The essentiality of arachidonic acid in infant development. Nutrients. 2016; 8:216.

34. Brenna JT. Arachidonic acid needed in infant formula when docosahexaenoic acid is present. Nutr Rev. 2016; 74:329–336.

35. Crawford MA, Wang Y, Forsyth S, Brenna JT. The European Food Safety Authority recommendation for polyunsaturated fatty acid composition of infant formula overrules breast milk, puts infants at risk, and should be revised. Prostaglandins Leukot Essent Fatty Acids. 2015; 102-103:1–3.

36. Koletzko B, Carlson SE, van Goudoever JB. Should infant formula provide both omega-3 DHA and omega-6 arachidonic acid? Ann Nutr Metab. 2015; 66:137–138.

37. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Control and Prevention, National Center for Health Statistics. NHANES Dietary Data Tutorial: Module 14. Task 1: Key concepts about estimating mean food intakes [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2012. cited 2019 Apr 30. Available from: https://www.cdc.gov/nchs/tutorials/Dietary/Basic/PopulationMeanIntakes/Info1.htm.

38. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention;2010.

39. Food and Agriculture Organization of the United Nations. World Health Organization. Fats and Fatty Acids in Human Nutrition: Report of an Expert Consultation. FAO Food and Nutrition Paper No. 91. Geneva: Food and Agriculture Organization of the United Nations;2010.

40. Ministry of Health, Labour and Welfare of Japan. Dietary Reference Intakes for Japanese (2015) [Internet]. Tokyo: Ministry of Health, Labour and Welfare of Japan;2015. cited 2019 Apr 30. Available from: http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/overview.pdf.

41. Chinese Nutrition Association. Chinese Dietary Reference Intakes. Beijing: China Light Industry Publishing House;2012.

42. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012: Integrating Nutrition and Physical Activity. 5th ed. Copenhagen: Nordic Council of Ministers;2014.

43. Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J. 2010; 8:1461.

44. National Health and Medical Research Council. Australian Government Department of Health and Ageing. New Zealand Ministry of Health. Macronutrients and water. Nutrient Reference Values for Australia and New Zealand: Including Recommended Dietary Intakes. Canberra: National Health and Medical Research Council;2006. p. 35–42.