Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial

Hélène Fougère,Isabelle Marc,David Simonyan,Line Berthiaume,Pierre Julien,Bruno Piedboeuf,Mireille Guillot,Jean-François Bilodeau,Ibrahim Mohamed,Iwona Rudkowska,Pascal M Lavoie,Etienne Pronovost

doi:10.1038/s41598-021-01017-8

Abstract

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.

Highlights

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD)
From 461 mothers enrolled in the MOBYDIck trial, breast milk samples were analyzed for 389 mothers (84.4%), with 196 mothers in the S-DHA group and 193 mothers in the placebo group (Fig. 1)
Results for compliance as measured by counting capsules returned by mothers at the time of breast milk sample collection were respectively 82 ± 24% in the S-DHA group and 78 ± 27% in the placebo group

Summary

Introduction

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). Preterm infants have limited anti-inflammatory defenses during the early neonatal period[1], which contributes to the development of morbid diseases including bronchopulmonary dysplasia (BPD)[2,3]. Two recent randomized clinical trials reported that supplementing DHA to preterm infants either directly through fish oil supplementation[16], or via maternal algae oil supplementation[17], increased BPD. To help reconcile these findings, we hypothesize that enteral DHA either administered directly to the preterm infant or through breast milk from their mothers adversely affects the inflammatory response and contributes to BPD development

Results

Discussion

Conclusion