Expanding Awareness of Omega-3 DHA during Pregnancy

Transcription

1 ILSI SEAR A Asia Maternal & Infant Nutrition Australia August 2014 ( Expanding Awareness of Omega-3 DHA during Pregnancy Barbara J Meyer, BSc(Hons), RNutr, PhD Director Lipid Research Centre, Immediate Past President, Nutrition Society of Australia Board of Directors, International Society for the Study of Fatty Acids and Lipids, Associate Professor in School of Medicine, University of Wollongong, Wollongong NSW 2522 Lipid Research Centre

2 Omega-3 polyunsaturated fatty acids (n-3 PUFA) Alpha-linolenic acid (ALA) Eicosapentaenoic acid (EPA) Docosapentaenoic acid (DPA) LC n-3 PUFA Docosahexaenoic acid (DHA)

3 Omega-3 PUFA main food sources Alpha-linolenic acid (ALA) spinach, walnuts Eicosapentaenoic acid (EPA) Fish, meat, eggs Docosapentaenoic acid (DPA) Meat, Eggs, fish Docosahexaenoic acid (DHA) Fish, meat, eggs

4 DHA synthesis from ALA

5 Should children consume pre-formed DHA? Children with amino acid metabolism disorders (extremely low protein diet) * * * Vlaardingerbroek et al. Molecular Genetics and Metabolism. 2006:88;

6 Should children consume pre-formed DHA? Children with amino acid metabolism disorders (extremely low protein diet) * * * * Vlaardingerbroek et al. Molecular Genetics and Metabolism. 2006:88;

7 Should children consume pre-formed DHA? Children with amino acid metabolism disorders (extremely low protein diet) * * * DHA semi-essential? * Vlaardingerbroek et al. Molecular Genetics and Metabolism. 2006:88;

8 PUFA synthetic pathways and Australian women dietary intakes (taken from Howe, Meyer et al 2006) 8.7g 0.87g 0.12g 0.06g 0.05g 0.08g

9 PUFA synthetic pathways and Australian women dietary intakes (taken from Howe, Meyer et al 2006) De Groot et al g 0.87g 0.12g 0.06g LA = 10g ALA = 2.8g ALA mother EPA & DPA fetus But no DHA 0.05g 0.08g

10 DHA - is an omega-3 PUFA with 6 double bonds Drawing by Setyaningrum Rahmawaty. Taken from Parletta, Milte, Meyer. J Nutr Biochem. 2013;24:

11 A phosphatidylcholine (PC) lipid with stearic acid (18:0) in blue and 500 ps dynamics of a stearoyl docosohexaenoyl PC lipid molecule, from Scott Feller s site docosahexaenoic acid (DHA, 22:6n-3) in green. PC head-group in brown QuickTime and a YUV420 codec decompressor are needed to see this picture.

12 DHA - Extremely important during pregnancy and for the baby DHA very important during last trimester of pregnancy and during first 2 years of life Martinez M. J Pediatr 1992;120:S129-S138

13 Brain PUFA fingerprint LA ALNA AA 22:4n6 22:5n3 DHA DHA is essential for infant development & growth

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17 Should pregnant women consume pre-formed LC n-3 PUFA? Hibbeln et al (2007) Maternal seafood consumption (>340g per week) in pregnancy results in increased IQ (verbal) in their 8 yr old children. 340g per week = 2 fish meals per week = mg LC n-3 PUFA per day 340g per week = 48g per day (Aust 23g per day)

18 So are pregnant women consuming the recommended intakes of DHA? Recommended DHA intake for pregnant and lactating women = at least 200mg DHA per day Koletzko et al Br J Nutr 2007; 98:

19 So are pregnant women consuming the recommended intakes of DHA? Recommended DHA intake for pregnant and lactating women = at least 200mg DHA per day Koletzko et al Br J Nutr 2007; 98: mg DHA/day (mean) & 75mg DHA/day (median) Cosatto VF, Else PL, Meyer BJ. Nutrients 2010;2(2):

20 Achieving Recommended Intakes of 200mg DHA Food Source Canned Red Salmon (in water) Canned Pink Salmon (in water) Atlantic Salmon Salmon, smoked Australian Salmon Canned tuna (in water) Tuna, bluefin Mussels, blue Scallops Tuna Yellow Fin Whiting Flake steamed King Prawns Boiled eggs Lamb leg steak Beef rump steak Amount to consume to deliver 200mg DHA 15g 33g 53g 69g 86g 97g 100g 120g 167g 200g 333g 400g 400g 444g or 7-8 eggs 2500g 6667g or steaks

21 What do pregnant women know about DHA? Pregnant women in Australia lack knowledge on the importance of DHA for pregnancy Sinikovic D, Yeatman H, Cameron D, Meyer B. Women s awareness of the importance of long-chain omega-3 polyunsaturated fatty acid consumption during pregnancy: knowledge or risks, benefits and information accessibility. Public Health Nutr. 2008; 12 (4):

22 What do pregnant women want? Information on foods they can/should eat during pregnancy for optimal development of their babies. Yet they feel they only receive information on what foods to avoid Butler K, Yeatman H, Williamson M. Enhancing communication of food and nutrition during pregnancy: pregnant women s perspectives. 2006, Thesis (unpublished), School of Health Sciences, University of Wollongong.

23 NSW Food Authority

24 NSW Food Authority

25 bhcarticles.nsf/pages/pregnancy_and_diet Mercury in fish It is suggested that pregnant women eat two to three serves of fish every week for the good health of themselves and their developing baby. However, pregnant women or women intending to become pregnant within the next six months should be careful about which fish they eat. Some types of fish contain high levels of mercury, which can be harmful to the developing foetus. When choosing fish, pregnant women should: limit to one serve (150 g) per fortnight billfish (swordfish, broadbill and marlin) and shark (flake), with no other fish eaten in that fortnight OR limit to one serve (150 g) per week orange roughy (deep sea perch) or catfish, with no other fish eaten that week OR eat two to three serves per week of any other fish or seafood (for example, salmon or tuna). Note: 150 g is equivalent to approximately two frozen crumbed fish portions. Women should not be worried if they ve had the odd meal of fish with high levels of mercury. It is only a potential problem when that type of fish is eaten regularly, which causes a build-up of mercury in the mother s blood.

26 resource/healthy-eating-during pregnancy Specific nutrient requirements: During pregnancy your nutrient requirements increase to support your health and the needs of your growing baby. Particular attention should be given to the following nutrients: Calcium Folate and folic acid Iron Iodine Zinc Protein Mentions fish under the meat category (source of protein)

27 health/diet-during-pregnancy/ Protein: Fish and some seafood can also be a good nutritional choice for pregnancy, within guidelines. Fish that contain high levels of mercury should be avoided (Read more about Fish and Mercury Levels). You should consume at least 3 servings of protein daily. We know that fish can be very nutritious and are packed with great nutrients such as omega-3 s, the B vitamins and lean protein. But unfortunately, fish can also have some unhealthy contaminants. Mercury levels in fish is probably the greatest question of concern. Mercury is a contaminant found in fish that can affect brain development and the nervous system. The FDA has released guidelines for children, women who are pregnant and women who are trying to become pregnant. These guidelines state that no more than 12 oz of low mercury fish should be consumed weekly. Highest mercury fish should be avoided and high mercury fish should be kept to only three 6-oz servings per month. What does this mean for women who are pregnant but also trying to get some of their much needed nutrients from the critters of the sea? It is all about moderation. Recent information released in the American Journal of Preventive Medicine says that no one should cut fish out of their diet altogether. Fish contains too many healthy nutrients that are essential for growth and development, especially in a pregnant mom and baby. There are 4 types of fish that should be on the list to avoid due to mercury levels. These include: shark, king mackerel, swordfish and tilefish. For information regarding other types of fish, the Natural Resources Defense Council (NRDC) has released a list of fish and their mercury levels so that people can be informed on what they are consuming. If you want to get more detailed information about mercury levels and how much you personally are consuming, you can also use the mercury thermometer to calculate your totals.

28 Try to eat two portions of fish a week, one of which should be oily fish such as salmon, sardines or mackerel. Find out about the health benefits of fish and shellfish. There are some types of fish you should avoid in pregnancy: see Foods to avoid. Fish and shellfish does mention omega-3 and oily fish excellent source Foods to avoid Fish in pregnancy You can eat most types of fish when you're pregnant. Eating fish is good for your health and the development of your baby. But you should avoid some types of fish and limit the amount you eat of some others. Fish to avoid: When you're pregnant or planning to get pregnant, you shouldn't eat shark, swordfish or marlin.

29 Information available focussed on mercury and fish as a source of protein Some websites mention the benefits of omega-3 But DHA was not highlighted

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31 Shopping Card: Versions 1 & 2 Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

32 Test the materials useful? Evaluation Stage: 118 Pregnant women recruited from two public NSW hospitals Self administered survey and provision of pamphlet and card Second survey via phone call 2 weeks after provision of pamphlet and card (n=74, 63% response rate) Representative of the 118 Reasons for not doing the second survey: 30 unanswered phones 5 no longer wanted to participate 4 numbers disconnected, 1 wrong number 4 women did not leave contact numbers Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

33 93% of women found the materials useful Main reason mentioned Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

34 Quotes You mean I can eat fish while I m pregnant! I wasn t aware that DHA was in foods other than fish Breakfast, lunch and dinner suggestions were really useful Card was great for shopping Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

35 Awareness of DHA food sources significantly increased after provision of the materials *p<0.05, **p<0.001 Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

36 Resulted in increased fish and DHA consumption Reported fish consumption increased from 1.25 servings/week to 1.65 servings/week (p<0.05) (=1.6 extra servings fish/month) Nearly 2 serves per week. More women reported actively seeking DHA enriched foods after receiving the materials (8/74 (11%) to 28/74 (38%), p<0.001) 68% of women said they would like to receive information on DHA during pregnancy Tertiary educated women were significantly more likely to consume more fish than secondary educated women (p=0.028)

37 Increased awareness & knowledge affects behaviour Increased awareness and knowledge has been shown to positively impact on behaviour adoption Chivu CM, Tulchinsky TH, Soares-Weiser K, Braunstien R, Brezis M. A Systematic Review of Interventions to Increase Awareness, Knowledge, and Folic Acid Consumption Before and During Pregnancy. Nutrition. 2008; 22 (4): With DHA pamphlet & shopping card we ve raised awareness & knowledge may be linked with the reported increase in fish consumption, actively shopping for DHA enriched products and identification of DHA food sources. Emmett R, Akkersdyk S, Yeatman H, Meyer BJ. Nutrients 2013;5(4):

38 In conclusion DHA is extremely important for neurological development Pregnant women want to know what they CAN eat, not what NOT to eat DHA pamphlet and shopping card increased awareness & knowledge about DHA Increased fish consumption Increased awareness of DHA enriched foods Clear message and well accepted design Useful Desire for the materials

39 Acknowledgements Thank you to Rebecca Emmett & Shann Akkersdyk Mel for the beautiful photos All the study participants

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41 Dietary modelling & costs associated with providing 100mg LC n-3 PUFA Food Fish - oily Fish - lean & other seafood Eggs - enriched Cost per 100mg LC n-3 PUFA cents Approx $ cents Bread - enriched $1.30 Yoghurt - enriched $1.50 Milk - enriched $2.00 Lean red meat $2.00 Fayet, Meyer, Baghurst. manuscript in preparation