Plasma and red blood cell n3 fatty acids correlate positively with the WISC-R verbal and full-scale intelligence quotients and inversely with Conner's parent-rated ADHD index t-scores in children with high functioning autism and Asperger's syndrome.

Findings of the fatty acid status of people with autism spectrum disorders have been incongruent perhaps because of the diversity of the condition. A cross-sectional design study was used to  investigated fatty acid levels and relationships between fatty acids, and cognition and behaviour in a homogenous group of children with autism spectrum disorder. Children with Asperger's syndrome (AS) /high functioning autism (n = 44) and healthy siblings (n = 17) were recruited from the Diagnostic and Therapeutic Centre for Children with Autism, Warsaw, Poland. In the AS group, plasma phosphatidylcholine 22:5n3 correlated positively with verbal (r = 0.357, p = 0.019) and full scale (r = 0.402, p = 0.008) IQs, red blood cell phosphatidylcholine 22:5n3 with verbal (r = 0.308, p = 0.044), performance (r = 0.304, p = 0.047) and full scale (r = 0.388, p = 0.011) IQs and red blood cell phosphatidylethanolamine 22:5n3 with verbal (r = 0.390, p = 0.010) and full scale (r = 0.370, p = 0.016) IQs. Whilst, plasma phosphatidycholine 20:5n3 (r = -0.395, p = 0.009), 22:6n3 (r = -0.402, p = 0.007) and total n3 fatty acids (r = -425, p = 0.005), red blood cell phosphatidlycholine 20:5n3 (r = -0.321, p = 0.036) and red blood cell phosphatidylethanolamine 20:5n3 (r = -0.317, p = 0.038), 22:6n3 (r = -0.297, p = 0.05) and total n3 fatty acids (r = -0.306, p = 0.046) correlated inversly with ADHD index. Similarly, inattention was negatively related with plasma phosphatidylcholine 22:6n3 (r = -0.335, p = 0.028), and total n3 fatty acids (r = -0.340, p = 0.026), oppositional with plasma phosphatidylcholine 18:3n3 (r = -0.333, p = 0.029), 20:5n3 (r = -0.365, p = 0.016), total n3 fatty acids (r = -0.293, p < 0.05), red blood cell phosphatidylcholine 18:3n3 (r = -0.337, p = 0.027) and red blood cell ethanolamine 18:3n3 (r = - 0.333, p = 0.029), 20:5n3 (r = -0.328, p = 0.032), 22:6n3 (r = 0.362, p = 0.017) and total n-3 fatty acids (r = -0.298, p < 0.05) and hyperactivity with plasma phosphatidylcholine 22:6n3 (r = -0.320, p = 0.039). In contrast, there were inverse correlations between red blood cell phosphatidylcholine 18:2n6 and performance (r = -0.358, p = 0.019) and full scale (r = -0.320, p = 0.039) IQs, and direct correlations between red blood cell phosphatidylcholine 22:4n6 (r = 0.339, p = 0.026) and 22:5n6 (r = 0.298, p < 0.05) and ADHD index, between red blood cell phosphatidylcholine 22:4n6 (r = 0.308, p = 0.044) and inattention, between plasma phosphatidylcholine 22:4n6 (r = 0.341, p = 0.025), red blood cell phosphatidylcholine 20:4n6 (r = 0.314, p = 0.041) and total n6 fatty acids (r = 0.336, p = 0.028) and oppositional and plasma phosphatidylcholine 20:3n6 (r = 0.362, p = 0.018) and red blood cell phosphatidylcholine 20:3n6 (r = 0.401, p = 0.009) and hyperactivity. The findings of the ethnically homogenous children with Asperger's syndrome/high functioning autism study revealed positive associations between 22:5n3 and cognition, and negative relationships between 20:5n3 and 22:6n3 and behavioural problem. In contrast, cognitive ability and behavioural problems were negatively and positively associated with n6 fatty acids. Further investigation is required to establish whether there a cause and effect relationship. Regardless, it would be prudent to ensure that children with the conditions have optimum n3 PUFA intake.

Physical fitness characteristics of Omani primary school children according to body mass index.

BACKGROUND: There is evidence that children with high cardiorespiratory fitness and normal body mass index (BMI) have less risk of non-communicable diseases (NCDs), however limited research was undertaken in Omani children. Therefore the aims of the present study were to describe body composition and physical fitness of a large cohort of Omani school children of both genders, and to investigate the effects of weight status on physical fitness. METHODS: Three hundred and fourteen Omani school children aged 9 to 10 years old took part in anthropometric assessments, body composition and fitness tests, including handgrip strength, the basketball chest pass, broad jump, 20-m sprint, four 10-m shuttle agility, 30-s sit-up, and multistage fitness test (MSFT). RESULTS: Obese boys and girls performed worse than normal-weight children in sprint, agility and endurance. In addition, fitness measures in the overweight group and underweight groups were not significantly different from other groups, except a better handgrip strength and poorer MSFT in overweight compared to normal weight girls, and poorer agility performance in underweight girls compared to the three other groups. CONCLUSIONS: Most fitness measures are lower in obese Omani children, which suggests that they will be more at risk of developing NCDs later in life.

Randomized open-label trial of docosahexaenoic acid-enriched fish oil and fish meal on cognitive and behavioral functioning in Omani children.

OBJECTIVE: This study aimed to examine the effect of docosahexaenoic acid (DHA)-enriched fish oil supplement and meal of grilled fish on cognitive and behavioral functioning manifested as attention-deficit/hyperactivity disorder in primary school students 9 to 10 y of age in Muscat, Oman. METHODS: This randomized open-label trial involved two types of interventions: fish oil supplement or one serving (100 g) of grilled fish per day (Sunday through Friday) for 12 weeks. Red cell total lipid DHA levels were assessed. The Verbal Fluency Test, Buschke Selective Reminding Test, and Trail Making Test were used to measure cognitive functioning. Behavioral functioning was assessed using a standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scales. All measurements were carried out before and after intervention. RESULTS: DHA levels increased by 72% and 64% in the fish oil (mean, 3.6%-6.2%) and fish-meal (mean, 3.4%-5.6%) groups, respectively (P = 0.000). The Trail Making Test was the only cognitive test that demonstrated marked differences between groups: Median interquartile range difference between pre- and postintervention in the Trail Making Part B score was 61.5 (SE, 19.3, 103.2) in the fish oil versus fish-meal group, 24.5 (SE, -15.2, 74.7, P = 0.005). The Vanderbilt Assessment Scales also showed significant differences between groups (P < 0.001). CONCLUSION: This study contributed to available evidence on the cognitive and behavioral benefits of DHA in healthy school children. Expanding the food fortification program with DHA-enriched fish oil should be considered as part of broader policy to improve child health.

Phosphorylation of protein kinase B, the key enzyme in insulin-signaling cascade, is enhanced in linoleic and arachidonic acid-treated HT29 and HepG2 cells.

OBJECTIVES: Defects in the insulin-signaling pathway have been implicated in the pathogenesis of impaired glucose uptake, insulin resistance, and type 2 diabetes. However, the specific defects that precipitate these abnormalities are yet to be fully elucidated. After binding to insulin, the plasma membrane-embedded insulin receptor transmembrane protein initiates a cascade of phosphorylation that leads to the activation of protein kinase B (AKT) and subsequently to the initiation of some metabolic actions of insulin. The activities of this receptor, insulin binding, and tyrosine kinase activation is dependent on its plasma lipid environment. Published data on the influence of omega-3 and -6 polyunsaturated fatty acids on insulin response are scarce. Moreover, the findings of the published investigations, most of which used omega-3 and -6, polyunsaturated fatty-acid blends, have been inconclusive. Hence, further, well thought out research is needed. The aim of the current study was to elucidate the effect of treatments with linoleic acid (LNA), arachidonic acid (ARA), alpha-linolenic acid (ALA), docoshexaenoic acid (DHA), and eicosapentaenoic acid (EPA) on cell membrane composition and consequently on the insulin-signaling pathway and specifically AKT phosphorylation. METHODS: Human colon adenocarcinoma (HT29) and liver hepatocellular (HepG2) cells were treated with or without 40 µM of LNA, ARA, ALA, EPA, or DHA for 48 h, the fatty-acid composition of phosphatidylcholine (PtdCho) and phosphatidylethanolamine (PtdEtn) from the treated cells by capillary gas liquid chromatograph. Cells were incubated for 30 min with or without human insulin (50 ng/mL), and the phosphorylation of AKT was assessed with the use of Western blotting. RESULTS: The fatty acids were incorporated in the PtdCho and PtdEtn of both cell lines, but the level of incorporation was higher in HT29. Phosphorylation of AKT increased when HT29 was treated with LNA (P < 0.05) and ARA (P < 0.01) but not with ALA, EPA, or DHA. A similar but non-significant increase in AKT phosphorylation was observed in LNA- and ARA- treated HepG2 cells. CONCLUSIONS: The finding of this investigation demonstrates that plasma membrane lipid bilayer enrichment with LNA or ARA treatment enhances insulin action by AKT activation.

Attention Deficit Hyperactivity Disorder and Parental Factors in School Children Aged Nine to Ten Years in Muscat, Oman.

OBJECTIVES: The objectives of this study were to determine the prevalence of attention deficit hyperactivity disorder (ADHD) and specific parental risk factors that may contribute to the development of ADHD in children. METHODS: The study was conducted in Oman among fourth-grade students (aged nine to 10 years). A standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scale (Teachers questionnaire) was used to determine the presence of ADHD. Parental factors such as socioeconomic status, education, and occupation were documented. RESULTS: The prevalence rate of ADHD was 8.8%. Poor maternal education status, low familial socioeconomic status, and paternal occupation were significantly associated with an increased risk of ADHD. CONCLUSIONS: This was the first study that examined familial and parental characteristics of children with ADHD as potential risk factors for the condition. Such psychosocial factors could be employed to further the development of more proficient preventative measures and remedial services.

Efficacy of docosahexaenoic acid-enriched formula to enhance maternal and fetal blood docosahexaenoic acid levels: Randomized double-blinded placebo-controlled trial of pregnant women with gestational diabetes mellitus.

BACKGROUND & AIMS: Gestational diabetes mellitus (GDM) compromises the level of docosahexaenoic acid (DHA) in phospholipids of maternal and fetal red blood cells and fetal plasma. This is of some concern because of the importance of DHA for fetal neuro-visual development. We have investigated whether this abnormality could be rectified by supplementation with DHA-enriched formula. METHODS: Women with GDM (n = 138) recruited from Newham University Hospital, London received two capsules of DHA-enriched formula (active-group) or high oleic acid sunflower seed oil (placebo-group) from diagnosis until delivery. Maternal (baseline and delivery) and fetal (cord blood) red blood cell and plasma phospholipid fatty acid composition, and neonatal anthropometry were assessed. RESULTS: One hundred and fourteen women (58 active, 56 placebo) completed the trial. The active-group compared with the placebo-group had significantly enhanced level of DHA in plasma phosphatidylcholine (4.5% vs 3.8%, P = 0.011), red blood cell phosphatidylcholine (2.7% vs 2.2%, P = 0.022) and phosphatidylethoanolamine (9.5% vs 7.6%, P = 0.002). There was no difference in cord plasma and red blood cell phospholipid DHA between the two groups. The neonates of the two groups of women had comparable anthropometric measurements at birth. CONCLUSION: Daily supplementation of 600 mg DHA enhances maternal but not fetal DHA status in pregnancy complicated by GDM. The inefficacy of the supplement to improve fetal status suggests that the transfer of DHA across the placenta maybe impaired in women with the condition. Regardless of the mechanisms responsible for the impairment of the transfer, the finding has implications for the management of neonates of women with GDM because they are born with a reduced level of DHA and the condition is thought to be associated with a risk of neuro-developmental deficits. We suggest that babies of women with GDM, particularly those not suckling, similar to the babies born prematurely require formula milk fortified with a higher level of DHA.

Lipid-soluble nutrient status of healthy Omani school children before and after intervention with oily fish meal or re-esterified triacylglycerol fish oil.

OBJECTIVES: Over the past two decades, the Omani diet has changed considerably to resemble a high calorie and a low nutrient density Western diet. We investigated the fat soluble nutrient status of children before and after intervention with fish diet or fish oil. METHODS: Children ages 9 and 10 y (n = 314) were recruited from three randomly selected schools. The schools were assigned to a fish, fish oil, or control group and the children were given a lightly grilled oily fish, a re-esterified triacylglycerol fish oil capsule, or no fish for 12 wk. RESULTS: Plasma vitamin A, beta carotene, vitamin E concentrations, and vitamin E/total lipid ratio at baseline were 2.7 ± 0.85 µmol/L, 0.68 ± 0.48 µmol/L, 21.1 ± 4.8 µmol/L, and 5.0 ± 0.81 µmol/mmol, respectively, and none of the children were deficient. They were severely deficient (<27.5 nmol/L; 10.5% boys and 28.5% girls), deficient (27.5-44.9 nmol/L; 47.6% boys and 49.4% girls) or insufficient (50-74.9 nmol/L; 34.6% boys and 21.5% girls) in vitamin D; only 7.3% boys and 0.6% girls had optimal status (≥75 nmol/L). Parathyroid hormone (5.0 ± 1.7 versus 5.8 ± 2.1 pmol/L; P < 0.0001) and alkaline phosphatase (225.2 ± 66.6 versus 247.8 ± 73.7 U/L; P < 0.01) levels were lower in boys. Postintervention, the fish oil (54.1 ± 17.5 nmol/L; P < 0.001) and fish (49.2 ± 17.4 nmol/L; P < 0.05) groups had elevated levels of vitamin D compared with the controls (42.3 ± 17.5 nmol/L). CONCLUSIONS: Vitamin D deficiency is prevalent in Omani school children, but it can be mitigated with omega-3 fatty acid supplementation. Vitamin D plays a crucial role in skeletal and extraskeletal systems. Hence, there is a need for a child-focused program of food fortification and outdoor activities to alleviate the problem.

Regular consumption of Nile river fish could ameliorate the low milk DHA of Southern Sudanese women living in Khartoum City area.

We have reported that milk of Northern Sudanese women contained very low level of docosahexaenoic acid (DHA). This was puzzling since the mothers were not malnourished and some had claimed to eat fish from time to time. War-displaced Southern Sudanese live in Khartoum City and its vicinity. They are distinct in genetic background and traditional dietary culture from the Northerners. Milk DHA is influenced by diet and ethnicity. Fatty acid content of Southern Sudanese milk, and six of the popular River Nile fish species were evaluated. Mature milk compared with transition milk had lower arachidonic (AA, 0.6±0.19 vs. 0.75±0.3; p<0.001), adrenic (0.14±0.1 vs. 0.33±0.23), osbond (0.07±0.05 vs. 0.14±0.08; p<0.0001), eicosapentaenoic (0.04±0.02 vs.0.08±0.07; p<0.01) and DHA (0.10±0.07 vs. 0.16±0.1; p=0.003) acids. The milk of the Southerners like their counterparts from the North had low DHA and total n-3 and high AA and total n-6 levels. Regular consumption of the local fish could provide adequate DHA to help enrich their milk.

Iodine status and fish intake of Sudanese schoolchildren living in the Red Sea and White Nile regions.

OBJECTIVE: To investigate iodine status and fish consumption of schoolchildren living in the Red Sea and White Nile regions of Sudan. DESIGN: Cross-sectional study to determine urinary iodine concentration, visible goitre rate, iodine content of salt and fish consumption. SETTING: Port Sudan (Red Sea) and Jabal Awliya (White Nile), Sudan. SUBJECTS: Two hundred eighty (n 280) children aged 6-12 years (142 boys, 138 girls). RESULTS: The median urinary iodine concentration in children from Port Sudan and Jabal Awliya was 553 and 160 µg/l, respectively. Goitre was detected in 17.1 % of children from Port Sudan but only in 1.4 % from Jabal Awliya, The salt samples from Port Sudan contained 150-360 mg iodine (KOI3)/kg salt, whereas those from Jabal Awliya had levels below the detection limit. Despite consuming salt devoid of iodine, children from Jabal Awliya had optimal iodine status. It is plausible that consumption of Nile fish from Jabal Awliya Reservoir, which is a good source of iodine and favoured by the locals, might have provided sufficient iodine. In contrast, children from Port Sudan were at higher risk of iodine-induced hyperthyroidism resulting from consumption of excessively iodised salt. CONCLUSIONS: The findings of the study clearly demonstrated that (i) Sudan still has a problem with iodine nutrition and quality control and monitoring of salt iodisation and (ii) including fish in the diet could provide a sufficient amount of iodine for schoolchildren.

Effect of storage temperature and length on fatty acid composition of fingertip blood collected on filter paper.

We have compared the fatty acids of the capillary and venous whole blood samples collected on the commercially developed blood collection paper and standard grade filter paper extracted by either the direct methylation or conventional method (including various blood lipids fractions). Also, reproducibility of fatty acids extracted from dried blood on the filter paper after storing at room temperature up to 2 months and at 4°C up to 6 months was assessed. In conclusion, the direct methylation of fingertip blood collected on both brand of papers produced fatty acids that reflected venous blood fatty acids extracted by the conventional method. Of the eight fatty acids evaluated, capillary DHA showed the strongest correlation with DHA of the venous whole lipids as well as various lipid fractions of the plasma and red cells. However, a prolonged storage of blood samples at 4°C had deleterious effect on the qualitative value of fatty acids, especially DHA.

Effectiveness of and Adherence to Dietary and Lifestyle Counselling: Effect on metabolic control in type 2 diabetic Omani patients.

OBJECTIVES: The Nutritional Advice Protocol, established by the Department of Health to combat diabetes, has been implemented in primary health care throughout Oman since 2003. This study aimed to assess the effectiveness of dietary and lifestyle advice and determine the perception and attitudes of Omani adults with type 2 diabetes to diabetes management. METHODS: A cross-sectional epidemiological survey was conducted on 98 patients diagnosed with type 2 diabetes in Al-Buraimi Governorate, Oman. Metabolic parameters, dietary intake and exercise levels were evaluated in 2005 and re-evaluated in 2008. RESULTS: A total of 43% of the patients (male = 16, female = 27) had received no formal education. A significant reduction in fasting glucose and enhanced high density lipoprotein cholesterol were achieved in both male and female patients. However, in men, no changes were noted, other than in anthropometric and metabolic measurements and macronutrient intake. Conversely, women's macronutrient intakes reduced significantly leading to considerable improvement in body weight, body mass index, blood glucose and total cholesterol levels. Eleven patients (11.6%) admitted that they did not adhere at all to the diet advised by the dietician; 63.2% (n = 62) reported they followed their diet sometimes, and 25.2% (n = 25) stated they strictly followed the diet. CONCLUSION: Counselling largely illiterate diabetic patients about the impact of food, nutrition and exercise on diabetes shifted the patients from "Poor" to "Good" control in terms of metabolic outcome (glycosylated haemoglobin, fasting glucose and total cholesterol). This minor improvement could be further enhanced by more health education.

A distinctive fatty acid profile in circulating lipids of Korean gestational diabetics: a pilot study.

Gestational diabetes mellitus (GDM) is a transient metabolic disorder that is a strong predictor of type 2 diabetes and cardiovascular disease. Previously, GDM was associated with reduced red cell long-chain omega-6 and omega-3 fatty acids in population (British) with high intake of total and saturated fat. The aim of the study was to examine blood fatty acids status of GDM patients (n=12) and normoglycaemic women (control, n=12) from South Korea where typical diet retains high omega-3 fat with low total fat intake. Subjects were matched for BMI and gestation week. Blood obtained at delivery were analyzed for plasma triacylglycerols (TG), phosphatidylcholine (PC), sphingomyelin (SM), and red cell PC, phosphatidylethanolamine (PE) and SM fatty acids. GDM patients had lower total saturated fatty acids (SFA) in the plasma TG (p<0.05) and PC (p<0.0001), and higher omega-6 and omega-3 metabolites in the plasma PC (p<0.05) than the controls. Conversely, the red cell PC and PE of the GDM contained higher proportions of palmitic (p<0.05) and SFA (p<0.05) but lower arachidonic (p<0.05) and docosahexaenoic (p>0.05) acids compared with the controls. Interestingly, red cell PC arachidonic acid level was comparable between Korean and British women whereas docosahexaenoic acid level decreased in the order of Korean control (5.5+/-0.9)>Korean GDM (3.5+/-2.1)=British control (3.9+/-2.9)>British GDM (2.8+/-2.3) (p<0.05). The similarity in the plasma and red cell fatty acids profile between Korean and British cohort suggests that the reduced membrane arachidonic and docosahexaenoic acids in GDM might be attributed to the effect of the disease itself regardless of ethnicity, obesity, or diet.

Unfavorable effect of type 1 and type 2 diabetes on maternal and fetal essential fatty acid status: a potential marker of fetal insulin resistance.

BACKGROUND: Pregestational maternal diabetes increases obesity and diabetes risks in the offspring. Both conditions are characterized by insulin resistance, and diabetes is associated with low membrane arachidonic (AA) and docosahexaenoic (DHA) acids. OBJECTIVE: We investigated whether type 1 and type 2 diabetes in pregnancy compromise maternal and fetal membrane essential fatty acids (FAs). DESIGN: We studied 39 nondiabetic (control subjects), 32 type 1 diabetic, and 17 type 2 diabetic pregnant women and the infants they delivered. Maternal and cord blood samples were obtained at midgestation and at delivery, respectively. Plasma triacylglycerols and choline phosphoglycerides and red blood cell (RBC) choline and ethanolamine phosphoglyceride FAs were assessed. RESULTS: The difference in maternal plasma triacylglycerol FAs between groups was not significant. However, the type 1 diabetes group had lower plasma choline phosphoglyceride DHA (3.7 +/- 0.9%; P < 0.01) than did the control group (5.2 +/- 1.6%). Likewise, RBC DHA was lower in the type 1 [choline: 3.4 +/- 1.5% (P < 0.01); ethanolamine: 5.9 +/- 2.5% (P < 0.05)] and type 2 [choline: 3.5 +/- 1.6% (P < 0.05)] diabetes groups than in the control group (choline: 5.5 +/- 2.2%; ethanolamine: 7.5 +/- 2.5%). Cord AA and DHA were lower in the plasma (type 1: P < 0.01) and RBC (type 2: P < 0.05) choline phosphoglycerides of the diabetics than of the control subjects, and cord RBC ethanolamine phosphoglycerides were lower in DHA (P < 0.05) in both diabetes groups than in the control group. CONCLUSIONS: Diabetes (either type) compromises maternal RBC DHA and cord plasma and RBC AA and DHA. The association of these 2 FAs with insulin sensitivity may mean that the current finding explains the higher incidence of insulin resistance and diabetes in the offspring of diabetic women.

Type 1 diabetes compromises plasma arachidonic and docosahexaenoic acids in newborn babies.

The activity of delta6- and delta5-desaturase, enzymes required for the synthesis of AA and DHA, are impaired in human and experimental diabetes. We have investigated whether neonates of type 1 diabetic women have compromised plasma AA and DHA at birth. Cord blood was obtained from healthy babies born to mothers with (n = 31) and without (n = 59) type 1 diabetes. FA composition of plasma choline phosphoglycerides (CPG), TG, and cholesterol esters (CE) was assayed. The neonates of the diabetics had lower levels of AA (20:4n-6, P< 0.0001), adrenic acid (22:4n-6, P < 0.01), sigman-6 metabolites (P < 0.0001), docosapentaenoic acid (22:5n-3, P < 0.0001), DHA (22:6n-3, P < 0.0001), sigman-3 (P < 0.0001), and sigman-3 metabolites (P< 0.0001) in CPG compared with the corresponding babies of the nondiabetic mothers. Similarly, they had lower levels of AA (P< 0.05), sigman-6 metabolites (P < 0.05), DHA (P< 0.0001), and sigman-3 metabolites (P< 0.01) in plasma CE. There was also a nonsignificant reduction of AA and DHA in TG in the babies of the diabetic group. The current investigation indicates that healthy neonates born to mothers with type 1 diabetes have highly compromised levels of AA and DHA. These nutrients are of critical importance for neurovisual and vascular system development. In poorly controlled maternal diabetes, it is conceivable that the relative "insufficiency" of AA and DHA may exacerbate speech and reading impairments, behavioral disorders, suboptimal performance on developmental tests, and lower IQ, which have been reported in some children born to mothers with type 1 diabetes mellitus. Further studies are needed to understand the underlying mechanism for this biochemical abnormality and its implications for fetal and infant development.