Indian Journal of Biochemistry & Biophysics Vol. 39, October 2002, pp. 303-311

Minireview

Essential fatty acids in maternal and infant nutrition

C Gopalan* and Rita Patnaik

Nutrition Foundation of India, C-I3, Qutab lnstitutional Area, New De lhi 11001 6

Received J3 May 2002; accepted 2 July 2002

Introduction In many developing countries of the world and

more especially in the countries of South Asia, the major nutritional problems that are now being encountered on a public-health scale are those related to mothers and infants. Maternal mortality rates in these countries range from 140 to 540; almost a third of infants are of low birth weight «2.5 kg) and over 50% of under-fives are "stunted"l. The latest National Family Health Surveys data shows a maternal mortality rate of 540 in India. Thus, more than 100,000 women in India die each year due to pregnancy related causes .

Low birth weight is multifactorial in its causation. Factors such as low energy intake, low weight gain in pregnancy, low pregnancy weight, short maternal stature, anaemia, infections and smoking have all been identified as poss ible factors. The studies of Barker et al.2 have revealed disturbing long-term implications of intra-uterine growth retardation and low birth weight - namely predi sposition to chronic degenerati ve di seases in adulthood. Retardation of growth and development at the intrauterine stage and in early infancy are perhaps the most urgent public health nutntlon problems confronting many developing countries today.

Household diets of poor communities in these developing countries are deficient in a wide range of nutrients and stand in need of overall improvement. That good maternal nutrition status - at the pre­conceptional and post-conceptional stages, is important for maternal health, and foetal development, is now well recognised. However, preci se information as to the crucial nutrients involved in ensuring optimal nutntlon in pregnancy, lactation and in infant/child development could provide practical leads to public-health agencies as to the specific directions in which dietary improvement

* Author for correspondence.

must be attempted. It is in thi s contex t that the emerging knowledge on the importance of essential fatty acids in maternal and infant nutrition is of great practical relevance.

In this presentation, we briefly review (i), the current knowledge regarding the role of essential fa tty acids in maternal and infant nutrition ; (ii), the current state of maternal and infant nutrition in poor communities; and (iii), address the question of how the emerging knowledge with respect to essential fatty acids could be usefully applied towards the improvement of maternal and infant nutrition.

Essential Fatty Acids Pol yunsaturated fatty acids (PUF A) i ncl ude the

parent essential fatty acids namely linoleic acid LA

(n6) and (X-linolenic acid ALNA (n3) and their long­chain more unsaturated derivatives. The parent essential fatty acids LA and ALNA cannot be synthesized in humans and therefore, need to be consumed as part of the diet. They are converted into their desaturated derivatives as indicated in Fig. I. Both n3 and n6 fatty acids have common enzymes in their metabolic pathway ; n3 fatty acids usuall y have higher affi nity for the enzymes than the n6 fatty acids. The rate limiting enzymes in the desaturation process

is the ~-6 desaturase. Thi s enzyme is under the control of many dietary and hormonal fac tors. The most important PUFA of the n6 series are dihomogammalinoleic acid (DHGLA) and arachidonic acid (A A) and these are the precursors of the eicosanoids of '1' and '2' series respectively. The important PUFA of the n3 series are eicosopentanoic acid (EPA) and docosahexaenoic acid (DHA). EPA (to which DHA can be reconverted) is the precursor of the eicosanoids of '3' series.

Eicosanoids derived from these precursors are highly active compounds. The eicosanoids cascade consists of (a) cyclic products generated by cyc lo­oxygenase - such as prostaglandins, prostacyc lin and

304 IND IAN J. BIOC HEM. BIOPHYS .. VOL. 39. OCTOBER 2002

Essentia l fatty acids n-6 Fa mily n-3 Family

Linole ic 18:2 ()( - Lino lenic 18: 3

~ y -linolen ic

t.6-desaturase 18:3

~ elongase Dihomo -y linolenic 20:3

t.5-desarurase Arachidonic 20:4

elongase Adren ic 22:4

t.4-desaturase Docosapentaenoic 22:5

Octadecatetraenoic 18:4

Eicasatet raeno ic 20:4

~ Eicasopentaenoic 20:5

Docosapen taenoic 22:5

Docosahexaenoic 22:6

Fi g. I--Conversion of PUFA in to the ir desa tu rated de ri va ti ves [The parent essenti al fa tty ae ids LA (linole ic acid , n-6) and ALNA (a- linole ic acid. n-3) have common enzymes in the ir metabo lic pa th way, the rate limi ting enzy mes in the desaturation process being t.-6 desaturase]

thromboxane (b) lipoxygenase products such as Ieukotrienes and (c) products of cytocrane P400

acti vity (Fig. 2). The wide-ranging functions of the eicosanoids are indicated in Table 1. AA (of the n6 series) and EPA (of the n 3 seri es) compete for the same enzymes, cyc la-oxygenase and lipoxygenases for conversion to eicosanoids (prostaglandins th romboxanes and leukotrienes) . Ei cosanoids derived from AA and fro m EPA have opposing metaboli c properties. Therefore, it is important to ensure a balanced dietary intake of n6 and n3 PUFA's.

Pregnancy There are a number of observations pointing to the

ro le of essenti al fa tty acids in pregnancy3.4 . According to some es timates5 the average total accreti on of essent ia l fa tty ac ids during normal pregnancy of a well -nouri shed woman could amount to 600 g. During gestati on the placenta preferenti all y selects arachidonic ac id (of the n6 series) and docosahexaenoic ac id (DH A) (of the n3 series); and thi s is refl ec ted in substanti all y hi gher proporti on of these ac ids in foe tal ci cul ation at mid-term6and term7

.

Such beneficial effects that these nutrients may have on birth weight and neonatal development may be den ied in varying degrees to preterm in fants. Defi cits of arach idon ic ac id and DH A have been reported in the circul ati on of low birth weight new-borns8

.12 and

there is also ev idence of vascul ar pathologies in the pl acenta of low birth weight babies 13. 14. Essential fatty acid defic iency is believed to contribute to poor

Arach idonic acid 20:4 n-6

Epoxy-prostaglandins

Cyclo-oxygcnasc Lipoxygenasc

Cyclic endoperoxidcs

pros laCYC l i l~boxancs Prostaglandsins

Hydropcrox yacids

/~ Leuco tncnes Hydroxy.

Fatty acids

Fig. 2- Eicosanoid cascade [A rachidonic ac id (AA) and di homogammalino le ic ac id (D HG LA) a re PUFA of the n-6 series and important precursors of e icosanoids. The casc ade co nsists of (a). cyclic prod ucts generated by cyclo-oxygenase such as prostag landins, prostacyc1 in and th romboxane and (b), li poxygenase products such as leukotrie nes and (c), prod ucts of cytochrome P4oo ac ti vity]

Table I-Biological effec ts of e icasonoids deri ved from arachidoni c (20:4 n-6) and e icasopen tanoic (20: 5 n-3) acids

Cell type

Plate le ts

Endothe li a l

Leukocy tes

Se vera I ce II s

AA(20:4,n-6)

TXA2

Aggregating Vasoconstri cting

PG I2

Aggregating

LTB4 C hemotax is + + + Aggregating + + + Receptor bind + + + Permeability + + +

PGE 2

Vasod il at ing Permeability Hypera lges ic

+ Denotes bio logical effect

EPA(20:S,n-3)

TXA ) Ant i-aggregat ing

PG I3

Ant i-aggregating

LTBs C hemotax is + Aggrega ting + Receptor b ind + Permeabili ty +

PGE :< I mm utlosuppress i ve

vascul ar growth and consequent rupture and coagulation in blood vessels leading to infa rctions in the pl acenta that are beli eved to result in impaired placental functions and low birth weights 13. 14 .

Arachidonic ac id is essenti al fo r the structural integrity of the vascul ar endothelium. Arachidon ic ac id is the precursor fo r the sy nthesis of pros tacyc lin , whi ch prevents th romboxanes fil tration l5

. Th rough a proper balance between n3 and n6 fatty ac id s in the endothelium, vasoconstri ctors and thrombogeni c

. . . . fI d l6 17 L b' h . h d actIvItIes are In uence '. ow Irt welg t an

..

GOPALAN & PATNA IK: ESSENTI AL FAn' Y AC IDS IN MATER NA L AND INFA NT NUTRITION 305

prematurity are assoc iated with a high incidence of neuro developmental di sorders and disabi I iti es 18-22 .

A positi ve correlati on between arachidonic acid level in circu lation and birth weigh t as al so between duration of gestation and DHA level have been demonstrated 12. Reducecl leve ls of arachidonic acid in maternal and cord blood phosphoglycerides are assoc iated w ith low birth weight , low head circumference and low placenta l weight2} . High fi sh oil intak es have been shown to be associated w ith longer gestati on and higher birth we ight. Interven ti on studi es w ith ri sh o i ls have also indica ted that long­chain n3 ratt y ac ids have an import ant ro le in ensuring normal birth weight2

.\.25 These observati ons point to the need for ensuring adequate nutriti onal statu s w ith respect to essential fatt y acids in pregnancy. Indeed proper atten ti on to adequate intake of essential fa tty ac ids could be as important as attention to iron and foli c acid. W e wi ll revert to th is aspec t later in thi s paper.

Lactat ion

Mature human breas t milk is a good source or essent ial fatt y acids or both the n6 and n3 seri es. A normal we ll -nouri shed woman puts forth adequate amou nts or these acids needed for her inrant in her breast milk as shown in data in Tab le 2. However, the re is need ror Illo re in forma ti on on the adequacy or otherw ise o f ratty acids in human milk of undernouri shed Illothers. In a normal wel l nouri shed woman th e fat-s tores accumulated during pregnancy by themsel ves could prov ide a signifi cant proportion of the essen ti al ratt y acids of milk at least during thc fi rst 3 months of laclati on2

(, . ndernouri shed women may be expected to have accu mulatcd rclati ve ly less fa t-stores during pregnanci 7

.28 Fat output in milk is

variable and depends on materna l nutriti on and prolac tin secretion. It has been es timated th at the Illother' s diet should prov ide 3 to 5 g o f essential fa tty acid dail y to ensure adequate concentration of essential fa tt y acids in milk2

l) In the absence of adequate intake of foods ri ch in e. sential fally ac ids including fi sh, green lea fy vege tab les and pul ses, essen tial fatt y ac ids in breast milk o f undernouri shed mothers could fal l short o f the requirements for normal infant growth and deve lopment. It is es timated th at as many as six to ten thousand synapti c connections between neural cel ls are made in the post-natal peri od and earl y infancy . The basic material s required for thi s major operation are the essential fa tty acids of human mi lk . The child 's

Table 2- Fatty acid co ntent in mJture human mi lk*

(%Wt/Wt ) Europe Afri ca

Saturated 45.2 53.5

Monoulls:llu ratcd :lg.S 2X.2

Linoleic Acid 11 .0 12.0

Total n-o LCP 1.1 1.5

Linoleni c Acid 0.9 o. g

Tota l n-3 LCP 0.6 0.6

n-3 +n-o PUFA 13.6 10.6

"' Soul'ce: Reference 29

eventual state of mental development may we ll depend on the adequacy of supply of the needed fa tty ac ids at thi s crucial stage of deve lopment.

Neura l development A lmost two- thirds of the structural materi al of brain

is lipid composed of choles terol and phophogly­cerides ri ch in arachidoni c acid and DH A. It is, therefore, understandab le that dietary supp ly of EFA is limit ing for bra in growth . In the rods of the retina, DHA accounts fo r 50-60'lc of the phosphog lycerides embedding rhodopsin and the G_Protein.lIUI. DH IS.

therefore, central to receptor and neural tran smi ss ion system on which brai n funct ion depend s.

Studi es on rhesus monkeys.l2-.l5 subjec ted to n3 fa tt y ac ids defici ency revea led th at progress i ve dep letion of docosahexaenoic ac id from neural and reti nal phosphol i pids followed by signi ficant i mpai rmcnt of visual acuity, abnormaliti es in the elec troretin ogram and polydypsia.

Ev idence indicates th at both n3 and n6 fatt y acids arc limiting for brain growth and that neural integrity can be perman entl y c1i . turbecl by deficiency of bOlh

6 d " . I r' . I l(l-1') I . I n an n-, essentla atty aC lc s· . . ntrautenne growt 1

retardation caused by n6 and n3 defic iency in pregnancy may thu s affec t both phys ical and mental deve lopment of the infant.

The above observa ti on poin t to the important role or essential fatty ac ids in ensuring maternal nutrition , good pregnancy outcome and optimal growth and development o f the o ffspring in the intrauterine phase and in the infancy.

Low birth weight and in tra-uterine retardation in poor communities

Probabl y the highes t incidence of low birth weight deli veri es in the world occurs in poor communiti es in South Asia 10 (including Inclia4 1-45, Pakistan.JIl..J2ASA6,

306 INDIAN J. BIOCHEM. BIOPHYS., VOL. 39, OCTOBER 2002

Bangladesh40.42.45.47, NepaI40

.48, Sri Lanka40.42.45 and

Maldives'l(\ There have been several reported studies on birth weights from these countries. The major conclusions that emerge from these studies are:

1) The gestational age of live born infants in poor communities appears to be significantly shortened as compared to those in the developed countries. Infants born prior to 37 weeks of gestation is just 5% in developed countries (US A.J9and Norwaio) as against 12-14% births in India51

.

2) The incidence of low birth weight in full term deliveries in South Asian Countries is significantly mllch higher th an the incidence reported from the developed countries. Thus, in a study involving over 20,000 fu ll-term deliveries, the incidence of low birth weights was as high as 25 % as against 6-7% in developed countries52

. The Nutrition Foundation of India carri ed out a study in 1998, which involved nearly 15,000 births that took place in a major hosp ital in Delhi catering to the poorest segments of the population53

. The results show that the high incidence of low birth weight deliveries even in full­term infants born after the 37 weeks of gestation in poor communities is to a considerable extent, a reOection of relative shortening of the gestational period. Nearly 34% of all deliveries had taken place 37-38 weeks of gestation and 44% after the 39th week of gestation.

3) On the other hand , even in developi ng countries aillong the affluent secti ons of the population the incidence of low birth weight deliveries is apparentl y of the sa me order as observed in the developed coun tries. Thus a studi~ by Nutrition Foundation of India showed th at only 6% of the infants among the affl uent sec ti ons of fndian popul at ion were of low birth weight, indicating clearly that soc io-economic factors, particularly undernutrition play the determining role.

As was pointed out ear li er, low birth weight is probably of multifactorial ori g in. The outstanding common feature in poor communities assoc iated with low birth weight IS, however, maternal malnutri ti on55

-62

.

Essential fatty acids an Indian diets The important question from the point of view of

present di scuss ion is how adequate are the diets of poor pregnant women in India with respect to the essential fatty acids content. Pioneering studies on the essen tial fatly acids content of habitual Indian di ets have been carri ed out by Ghafforunissa63 and

Achaya64 and these studies provide a fa ir picture of the essential fatty acids intakes in Indian diets .

Diets of the poor Indian communi ties are largely cereal and pulse based. Vegetable oil extracted from oil seed used as cooking fat is the major source of (visible) fat in the diet. The intake of such vegetable oil s hardly exceeds 10 g per head per day. While in most poor households a single type of oil is used, in some others different types of vegetable oil may be employed depending on the food to be cooked. Apart from vegetable oils other sources of fat li ke meat and fish do not figure largely in the diets of poor households. Moreover, a considerable proportion of the Indian populati on is vegetarian. Milk intake is also marginal in poor households. All this may suggest that the intake of the essential fatty ac id is highly inadeq uate in poor indian diets.

However, careful analytical studies in recent years have shown that thi s is not the case. The picture with regard to overall essential fatty ac ids intake in poor Indian diets is however, reasonably bright in the li ght of recent studies. The major components of the Indian diet like cereals, pulses, tubers and vegetab les are good source of invisible fat (meaning fat , which is an integral part of grain). Invi sible fat was earlier not recognised because it was poorly analysed and detected for the reason that ti ghtly bound structural lipid is not easily extractabl e by conventi onal methods. AchayaM had computed that \ 0-15 en % (a level of fat that would provide as much as 10-\5 % of the total energy va lu e of the diet) is present in the invisible form. In visible fat is a good source of LA and ALNA. For thi s reason Achaya considered poor Indian diets were reasonably adequate to meet essential fatty acids requirements in a normal subject. Using accurate method of extraction and gas­chromatography analys is Ghafforunissa6

\ found that the cereals contain 3% and pulses 2% of in visible fa t and that on an average cereals provide 1.3% LA and 0.5 % ALNA, pulses 1.2% LA and 0. 25 % ALNA. With an intake of around 500 g of cereals, diets could thus provide 7 en % of invi sible fat 2.2% of LA and 0.16 en % ALNA . Ghafforunissa63

, however, argues that while the present level of essential fatty acids even in poor Indian diets would thus meet normal requirements , they could be inadequate in pregnancy and lactation. She had computed that over and above the invisible fat present in the diet an intake of vegetable oil of the order of 30 g in pregnancy and 45 g in lactation would be necessary to fully meet requirements . On the basis of thi s computation it

, - <4.

•

GOPALAN & PATNAIK: ESSENTIAL FATTY ACIDS IN MATERNAL AND INFANT NUTRITION 307

could be concluded that poor Indian diets are deficient in essential fatty acids despite the substantial contribution of invi sible fat from cereals, pulses, tubers and vegetables In the case of pregnant and nursing women.

Studies on effect of dietary supplementation to mothers on pregnancy outcome

Several studies on the effect of dietary supplementation on pregnancy performance and delivery outcome has been carried out in the developing countries. Some of the results have been briefly reviewed below.

Energy supplement In most of the earlier studies on the effect of dietary

supplementation to mothers during pregnancy on pregnancy outcome, the basic hypothes is had been that maternal energy intake could be a major determinant of intrauterine growth and foetal

. . Th 65 nutrition. us, Iyengar ' had shown that dietary supplements providing 500 additi onal calories per day even in the last 6-8 weeks of gestati on to pregnant women habitually subsisting on low energy intake could bring about signifi cant improvement in the birth weight of their offspring. Following this, several studi es on the effect of dietary energy supplementation, had been carri ed out in India66

, Sri Lanka67, Thaiwan(iS, Guatemala69

, USA7o, Mex ic071 , Canada72

, Indones ia7, and Gambia74. The results of these studi es have been conFusing and contradictory. While some studies have reported increase in birth weight of offspring ranging from 40-320 g, following on energy suppl ementati on, others have reported negative resu lts. Kusin 73 had show n that in malnouri shed mothers with very low energy intake, dietary energy supplementation during pregnancy contributed to increased weight gain in the mother but had 11 0 significant effect on the birth weight of the offspring. In sit uations of extreme under-nutriti on, there could be a competiti on between maternal and feota l ti ss ues for di etary energy supplements. Studies . G b' 74 In am la had shown that heavy physical activity resulting in increased energy expenditure could have a significant impact on maternal and in fant birth weioht

b

and supplements to such women with such marked calori c deficit resulted in greater we ight gai n to the mother with littl e impact on the birth weight of the offspring. The results of studi es on the effect on dietary energy supplemen tati on to the mothers on birth weight of their offspring have been equivocal

and contradictory. That protein supplementation to maternal diets in pregnancy had no beneficial effect on the birth weight of offspring was shown by studies from USA 70 and Guatemala69

.

Most of these studies on macronutrient supplementation had not fully taken into consideration, the multiplicity of factors, which could affect the birth weights of infants such as maternal anaemia, infections and lack of physical rest in the last trimester of pregnancy.

Apart from these considerations in some of these earlier studies where dietary energy supplementation was attempted, the food sources of the so-called energy supplement could have actually provided apart from energy , quite a few micronutrients including essential fatty acids. If for example-the caloric supplement was largely based on cereals, the in visible fat in such cereals supplement could have prov ided essential fatty acids. It is possible that the absence of uniformity in the nature and the food source of supplement could account for the contradictory and equivocal results obtained.

IronlFolic Acid/Zinc and Copper The di ets of poor pregnant women are deficient in a

multiplicity of nutri ents. In predominantl y cerea l based di ets on which poor communities subsist the bioavailability of iron and zinc, for example, are low because of the high phytate content of cereals. [ron deficiency anaem ia is, thereFore, common in pregnant women of the poor communities of South Asia. Anemia is recognized to be a major factor assoc iated with high maternal morbidity and mortality and routine administration of iron/folate in the last months of pregnancy is major public health approach in prevention of anaemia in pregnancy.

[n this context it is important for us to determine to what extent iron/folate deficiency apart from anemi a, also accounts for intra-uterine growth retardation resulting in low birth weight. Lecla Iyengar7.'> had show n that the birth weight of infants born to mothers receiving 200-300 micro gms of foli c acid were signi ficantly higher than those of mothers who did not receive such supplement thus showing a pos itive effect of fo lic acid supplementation on the birth weight of infants. Prema had shown that with iron suppl ementation, there was not only increase in haemoglobin level s of the mothers but al so in the birth weight of the offspring76.77.

The relationship between maternal haemoglobin level s and birth weight of offsprings has also been

308 INDI AN J. 1310CHEM. 1310PHYS., VOL. 39, OCTOBER 2002

demonstrated in the form o f a U curve wi th a progress ive drop in the incidence of low birth weight del iveri es 'vvith increase in haemog lobin levels from 8-I I g and an actual increase in low birth weight de li veri es from th Zl t point with an increase of haemoglob i n beyond 11 g. Th i s latter increase may be due to hemoconcen tration and consequentl y poor placen tal perfu sion.

Striking changes in maternal se rulll zinc and materna l serum copper levels ha ve been demonstrated 7o

-W in pregnancy. There is a slow but

steady increase in the malernal copper leve ls and a eorresponcli ng slow fall in maternal serum I.i nc leve ls >1. Maternal-se rulll zinc leve ls reach lowest poin t at the time of de l iverl~. It is onl y after six weeks of deli very that materna l se rum zinc leve ls ri se to the pre-pregnancy concen tration. The ri se in maternal serUlll copper leve ls is due to es trogen induced sy nthes is of cerulop lasminS.l and fall in zinc

is due to al tered binding affin ity of zi nc protei ns. The fact that cord serum zinc leve ls arc higher than maternal serUlll zinc leve ls is belie ved to indicate act ive transp()rt of zi nc across the placenta during pregnancy. However, the claims that in low birth weight infants cord plasma zinc level s are hi gher ,IS compared to infants with normal birth weight has not heen substant iatedXH5 There is no correlation between matenal copper and I.inc leve ls and cord level s of copper and zinco(, .

It is thus clear that iron, folic aeie!. zinc and copper arc micronutrient s. which arc activel y involved in pregnancy.

T he role of mi crol1utricnts a nd fatty adds - 1\ final comlllon pathway

The claims wi th regard to the positive e!lect of iron ane! folate supplementation on the birth we ights and those regarding the dl'ccl of essent ial fatly ac id supplementation neee! not necessaril y be con tradic tory. There is evidence now that iron, foli c acid, zinc and copper could all playa part in t/' and fj. ')

desaturases system, and in the cyc logenases and lipoxygenases sys tem that conve rt arachidoni c acid to eicasan oids.

StudiesS70n rats fed w ith fat free iron defici ent diets on the one hand and stucli esRx on rats where iron defic iency was induced during pregnancy have indicated that conversion o f 18:2 n-6 to their long chai n cieri vat i ves may be blocked in i ron deficiency and th at th e cyc loxygcnases and lipoxygenases whi ch convert arachidonic acid to eicasanoicls are inhibited

(Fig. 3). Thus, th re is ev idence In literature indicating an interrelati onshi p87.8s between iron statu s

and eieasanoiclmetaboli sm. There is also similar ev idence to suggest that zinc

and copper may playa role in essential fatly acid and eicasanoidmetaboli sm, zinc and copper being integral components of the fj. () desaturase sy~ tem 8') (Fig. 3). Accumulation of 18:2 n-6 fatty acids in tissues of zinc defici ent rats has been demonstratedl)(). Copper has also been shown to play a part in the eicasanoid metaboli sm. It has been reportecl l h~lt folic acid ad mini strati on increases the n-3 PUFA in plasma l ipid fract ions, In plate let. ery th rocy tes ~lIlc.l intestinal phospolipicl s')1 (Fig . 4) .

It woul d seem reasonable to propose that the micronutri ents li ke iron , copper. zinc ancI fo li c acid on Ihe one hand and essential fatty aciels on the ot her, do not act discordantl y or independent ly of each other: but th at . they arc a part o f a we ll c ordin ated and orches trated metabol ic process. So we Illay be deal i ng w ith a we ll -coord inated symphony and not di scordant so los.

Tlt ese cOl/sideratiol/s ul/derscore the fact tltat iI/ ul/dem ourislted populatiol/ livil/g 01/ diets deficieu/ iI/ a lIIultiplicity of I/utriel/ts includillg iroll. folate. ~il/ c, copper al/d esselltial fatty acids, it lIIay be

I.inoleic ac id tl X::2)

I ~()-d eS, 11 lIr.l se

( Iron. i'.inc ck pclllknl ( - \ ,.) T(Coppe r depcndenl ( -n')

y -Linoknil' (I ~:3)

I 1 Elongase

DilHlll10 -'f linoicnic (20:3)

!\raehid,)nic acid (20: 4 )

lc yc!ux ygenase & Lipox ygcnase (Iron dependent)

Eicosanoids 2 se ries

Fig. _ Role or iron. zi nc and cop per in n-o fa ll y ac id mctabol ism IExperiments in ralS ind ical e Ihal convcrsio ll or 18:2 n-6 rall y acids to Iheir long chain de ri va li ves may be blocked in iron defic iency and Ihal cyc lo-oxygcnases and li pllxygenases Ihal co nvert arachidonic Jc id 10 eicmanoids are inhi bitedS8

. There is similar cv idcnce 10 show Ihal zinc and coppcr whic h are integral eomponenl s of the 6.-6 desalurase system 1ll:IY playa role in essenti al falty acid and cicosanoid metaboli smS') 1

GOPALAN & PATNAIK: ESSENTIAL FATTY ACIDS IN MATERNAL AND IN FANT NUTR ITI ON 309

ex -Linolenic (18:3)

I ~6-desaturase

• (iron dependent)

Octadecatetraenoic acid( 18:4)

1 elongase

Eicasatetraenoic acid (20:4)

~ ~5 -desaturasc (fo li c acid dependent)

Eicasopentaenoic ac id (20:5)

Eicosanoids 3 series

Fig. 4--Role of iron and folic ac id in n-3 fa tty acid metaboli sm

unwise to depend on either essential fatty acid supplementation alone or on iron and folate supplementation alone in improving the pregnancy outcome. Indeed, it had been shown in the context of low iron intake, essential fatty acid administration could aggravate anaemia. Our objective must be to ensure adequacy with respect to iron and folate on one side and essential fatty acids on the other. Green leafy vegetables like spinach fortunately are not only rich in iron and folate but also in essential fatty acids. Thus, the major approach towards combating of low birth weight among undernourished population may lie in the promotion of dietary diversification resulting in the increased intake of green leafy vegetables, pulses, milk and probably fish and not 011 isolated synthetic supplements.

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di sease . Cllrr obslel Cyl/ ecol, 3, 200-206 3 Allen KG & Harri s M A (200 I) The role of n-3 fa lly ac ids in

gcstati on and parturition. Exp Biul Met! (Maywood). 226(6), 498-506

4 Homstra G, AI M D, Van Houwelingen A & Foreman van Dronegelen M ( 1995) Essellli al fally acids in pregnancy and early human development. Eli I' .J Obslel Cyl/ ecol Reprod Bioi, 6 1, 57-62

:1 Recommendat ions on energy illl akes for preg nancy. WHO, Ge neva, 1985a

6 Crawford M A, Hassa m A G. Williams G & Whitehouse W (1976) Essential falty acids and feta l bra in growth . Th e Loncel I, 452-453

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