Current Information and Asian Perspectives on Long-Chain Polyunsaturated Fatty Acids in Pregnancy, Lactation, and Infancy

Thursday, Feb 01, 2018

Systematic Review and Practice Recommendations from an Early Nutrition Academy Workshop


Koletzko B, Boey CC, Campoy C, Carlson SE, Chang N, Guillermo-Tuazon MA, Joshi S, Prell C, Quak SH, Sjarif DR, Su Y, Supapannachart S, Yamashiro Y, Osendarp SJ. Current Information and Asian Perspectives on Long-Chain Polyunsaturated Fatty Acids in Pregnancy, Lactation, and Infancy: Systematic Review and Practice Recommendations from an Early Nutrition Academy Workshop. Ann Nutr Metab. 2014 Sep 16;65(1):49-80.

Link to PubMed


  • The Early Nutrition Academy (ENA) reviews recent information on the roles of long-chain polyunsaturated fatty acids (LCPUFAs) during pregnancy, lactation and infancy, with particular consideration on Asian populations.
  • The ENA summarizes the impact of LCPUFAs from different randomized controlled trials. Recommendations for practice are presented at the end of the paper.

Summary of the Recommendations

Subject Amount of intake
Pregnant women
  • An additional supply of at least 200 mg DHA/day, usually a total DHA intake of at least 300 mg/day
  • Higher intakes (600-800 mg DHA/day) may provide greater protection against early preterm birth
Lactating women
  • A minimum average daily supply of 200 mg DHA to achieve a human milk DHA content of ~0.3% fatty acids
Very-low-birth weight infants
(birth weight < 1,500 g)
  • Intakes per kg per day of DHA: 18-60 mg (preferably 55-60mg)
  • Intakes per kg per day of AA: 18-45 mg (preferably 35-45 mg)
  • EPA intake per kg per day should not exceed 20 mg
Term infants
  • Breastfeeding is recommended as the preferred choice for infant feeding
  • During the first months of life, 100 mg DHA/day and 140 mg AA/day should be provided
  • Infant formula should provide at least 0.3% of fatty acids as DHA along with AA
Older Infants
  • A supply of 100 mg DHA/day should continue during the second half of infancy
  • No quantitative advice on AA intake with follow-on formula fed during weaning


Summary of the Reviewed Literatures

  • The mean concentration of DHA in human milk in Asian countries is variable.
  • Populations which consume fish and seafood regularly have higher intake of preformed EPA and DHA.
  • LCPUFA supplementation and its influences on various populations:

Subject Intervention Outcomes with additional LCPUFA supplementation
Pregnant and lactating women
  • (I) Daily 400 mg algae DHA
    (C) Placebo
  • Lower risk of early preterm delivery
  • (I) Daily 2.7 g n-3 LCPUFA
    (C) Daily 2.8 g soybean oil
  • Increase in infant size at birth
  • (I) Daily 1.6 g EPA + 1.1 g DHA
    (C) Placebo
  • Better neonatal and maternal immune response
  • No impact on gestational diabetes and preeclampsia
  • No firm conclusion due to limited research on maternal depression, child,growth, childhood obesity or early markers of cardiovascular diseases
Preterm infants
  • (I) High DHA milk (1% of
         total fatty acids) + 0.5% AA
    (C) Formula with standard
          DHA (0.2%-0.3%) + 0.5% AA
  • Positive effect on chronic lung disease and immune responses
  • Inconsistent results on growth, visual and cognitive outcomes
Full term infants
  • (I) Formula with canola oil
    (C) Formula without canola oil
  • Better gastrointestinal comfort
  • (I) Formula with 0.64% AA
         + 0.96%DHA
    (C) Formula without DHA
  • Better immune responses
  • Inconclusive research on growth or cognitive development
Older infants
  • Inconclusive research on beneficial effects in any aspects

Remarks  (I) = Intervention; (C) = Control



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