Abstract
Vegetarian diets have been associated with health benefits, but paradoxically are low in EPA and DHA which are important for development, particularly of the central nervous system, and for health. Humans have limited capacity for synthesis of EPA and DHA from α-linolenic acid, although this is greater in women than men. Oily fish and, to a lesser extent, dairy foods and meat are the primary sources of EPA and DHA in the diet. Exclusion of these foods from the diet by vegetarians is associated consistently with lower EPA and DHA status in vegetarian women compared with omnivores. The purpose of the present review was to assess the impact of low EPA and DHA status in vegetarian pregnancies on the development and health of children. EPA and DHA status was lower in breast milk and in infants of vegetarian mothers than those born to omnivore mothers, which suggests that in the absence of pre-formed dietary EPA and DHA, synthesis from α-linolenic acid is an important process in determining maternal EPA and DHA status in pregnancy. However, there have been no studies that have investigated the effect of low maternal DHA status in vegetarians on cognitive function in children. It is important to address this gap in knowledge in order to be confident that vegetarian and vegan diets during pregnancy are safe in the context of child development.
Highlights
Vegetarianism is a widely practised dietary choice that may be adopted for cultural or religious reasons, or out of personal preference, possibly because of perceived health benefits or concerns about animal welfare[1]
Reddy et al[59] have shown that the proportions of EPA and DHA in erythrocyte phospholipids of 14-week-old infants breast-fed by vegan mothers (n 3) were lower than in infants breast-fed by omnivore mothers (EPA 71 %; DHA 40 %) or born to omnivore mothers and fed cows’ milk formula (EPA 83 %; DHA 49 %). These findings were confirmed by Sanders et al[55] who showed that the proportions of EPA and DHA in erythrocytes of infants of at least 3 months of age breast-fed by vegan mothers (n 3) were lower (EPA 71 %; DHA 69 %) than those of infants breast-fed by omnivore mothers (n 6). Together these data suggest that adaptions to maternal PUFA metabolism that increase DHA status during pregnancy[43], the capacity of women to convert acid α-linolenic acid (ALNA) to longer-chain n-3 PUFA[36] and biomagnification of DHA by the placenta[44,47] were not able to compensate for the absence of pre-formed EPA and DHA either before birth and during breast-feeding
Synthesis of EPA and DHA may be an important source of these fatty acids in vegetarians and, in particular, vegan women and there is no evidence of metabolic compensation for low intakes of EPA and DHA
Summary
Vegetarianism is a widely practised dietary choice that may be adopted for cultural or religious reasons, or out of personal preference, possibly because of perceived health benefits or concerns about animal welfare[1]. The evidence is limited, these findings suggest that, perhaps counter-intuitively, dietary intake of plant-derived essential fatty acids was not greater in vegetarians This has implications for the influence of vegetarian diets on the capacity of vegetarian women to convert ALNA to longer-chain n-3 PUFA compared with omnivores. Since their intake of ALNA substrate and the relative intakes of essential fatty acids which compete for Δ6 desaturase were similar between the dietary groups, the capacity for synthesis of longer-chain n-3 PUFA may be expected to be comparable, except omnivores would be expected to have lower capacity for conversion of ALNA due to product inhibition by pre-formed dietary EPA and DHA. Fish eaters Meat eaters Vegetarians Vegans Difference between groups (ANOVA P) Germany
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