Fatty Acids
Mohammed H Moghadasian, Canadian Centre for Agri-Food Research in Health and Medicine, University of Manitoba, Winnipeg,
MB, Canada
Fereidoon Shahidi, Memorial University of Newfoundland, St. John’s, NL, Canada
Ó 2017 Elsevier Inc. All rights reserved.
This article is an updated version of the previous edition article by Fereidoon Shahidi and S.P.J. Namal Senanayake, volume 2, pp. 594–603, Ó 2008,
Elsevier Inc.
Lipids are a class of nutrients primarily composed of carbon,
hydrogen, and oxygen atoms; these energy-yielding nutrients
are hydrophobic in nature. Nutritionally, they are a major
source of energy (9 kcal g
1 or 37 kJ g
1) and carry fat-
soluble vitamins (A, D, E, and K) throughout the body. They
are equally important sources of essential fatty acids that
cannot be made by the body. Essential fatty acids include lino-
leic acid (C18:2 n-6) and alpha-linolenic acid (C18:3 n-3) and
are required for normal growth and development plus physio-
logic function of body systems. In addition, lipids enhance the
foods we eat by providing texture and consistency, imparting
flavor, and contributing to the feeling of satiety after eating.
Lipids are also important functionally in the preparation of
many food products. They may act as tenderizing agents, assist
in aeration, transmit flavors and colors, and supply a heating
medium for food preparation. Fats and oils are present natu-
rally in many foods, such as dairy products, meats, poultry,
fish, and nuts, as well as baked goods, margarines, dressings,
and sauces.
The current Dietary Guidelines from developed countries
advocate the consumption of a wide variety of foods in
moderation combined with a physical exercise regimen. The
2015 Dietary Guidelines for Americans (see Relevant
Website) recommend a total fat intake between 20% and
35% of calories for adults to meet daily energy and nutritional
needs. Intake of fat outside this range is not recommended for
most individuals because of potential adverse effects on
achieving recommended nutrient intake and on risk factors
for chronic diseases. The Institute of Medicine confirms this
advice by recommending that Americans should receive
45–65% of their calories from carbohydrates, 20–35% from
fat, and 10–35% from protein, while including at least 1 h
of moderate exercise per day. Such dietary advice emphasizes
moderation and variety regarding the intake of all nutrients in
the total diet. This concept allows considerable flexibility in
the selection of foods as long as an appropriate balance is
maintained between total calorie intake and calories
expended. The U.S. Department of Agriculture (2005) food
guidance system recommends fats and oils from foods such
as vegetable oils, nuts, and some fish because of their health-
ful qualities.
To understand the nutritional and functional significance of
fats and oils, it is important to understand their chemical
composition. Fatty acids form the basic chemical structure of
lipids. One hundred milligrams of fat or oil will yield approx-
imately 95 mg of fatty acids. Both the physical and chemical
characteristics of fats and oils are influenced greatly by the types
and proportions of the component fatty acids and the way in
which these are positioned on the glycerol molecule. Fatty acids
are saturated and unsaturated carbon chains usually with an
even number of carbon atoms and a single carboxyl group.
114 International Encyclopedia of Public Health, 2nd edition, Volume 3
Fatty acids are classified as saturated and unsaturated fatty
acids, the latter being further subdivided into monounsatu-
rated (MUFA) and polyunsaturated fatty acids (PUFAs)
(Figure 1).
Saturated Fatty Acids and Health
Chemically speaking, saturated fatty acids contain only single
carbon–carbon bonds in the aliphatic chain and all other
available bonds are taken up by hydrogen atoms (Figure 2).
They are the least reactive chemically. The melting point of
saturated fatty acids increases with chain length. For instance,
capric acid and longer chain saturated fatty acids are solid at
room temperature. The most common saturated fatty acids
in animal and plant tissues are straight-chain compounds
with 12, 14, 16, and 18 carbon atoms. Saturated fatty acids
are predominantly found in butter, margarine, shortening,
and coconut and palm oils, as well as foods of animal origin.
Fatty acids containing 4 to 14 carbon atoms occur in milk fat
and in some vegetable oils. For example, cow’s milk fat
contains butyric acid at a level of approximately 4%. In addi-
tion, fatty acids containing 6 to 12 carbon atoms are also
present in small quantities. The short-chain fatty acids are
usually retained in butter and in other milk fat–based prod-
ucts. Tropical fruit oils, such as those from coconut and
palm kernel, contain very high amounts (approximately
50%) of a saturated fatty acid called lauric acid. These oils
also contain significant amounts of caprylic, capric, and myr-
istic acids. Palmitic acid is the most widely occurring saturated
fatty acid. It is found in almost all vegetable oils, as well as in
fish oils and body fat of land animals. The common sources of
palmitic acid include palm oil, cottonseed oil, lard, and
tallow. Stearic acid is less common compared to palmitic
acid. However, it is a major component of cocoa butter.
This fatty acid may be produced by hydrogenation of 18-
carbon-atom chain fatty acids such as oleic, linoleic, and lino-
leic acids.
Saturated fatty acids are important as sources of energy and
as components that make up cell membranes. They are not
‘essential’ because the human body can synthesize its own
saturated fatty acids. Saturated fats, when consumed in excess,
are reported to raise total serum cholesterol levels. This
includes both low-density lipoprotein (LDL) cholesterol
(so-called bad cholesterol) and high-density lipoprotein
(HDL) cholesterol (so-called good cholesterol). Elevated
serum levels of LDL cholesterol may increase the risk for
cardiovascular disease (CVD). Some food choices in this
group are high in saturated fat. These include fatty beef,
lamb, pork, regular ground beef, and majority of processed
foods including regular sausages, hot dogs, bacon, regular
http://dx.doi.org/10.1016/B978-0-12-803678-5.00157-0
 Fatty Acids 115

Lipids

Saturated fats
Unsaturated fats
animal fats (butter, lard)

Monounsaturated fats Polyunsaturated fats

Omega-9 fatty acids Omega-3 fatty acids Omega-6 fatty acids

Olive oil Fish Sunflower oil
Almonds Algae Corn oil
Peanuts Shellfish Safflower oil
Avocados Soybean Borage oil
Flaxseed Evening primrose oil
Walnut Fungal oil
Canola

Figure 1 Classification of lipids and fatty acids.

n-6 PUFAs n-3 PUFAs

18:2n-6 18:3n-3

∆ 6-desaturase

18:3n-6 18:4n-3

Elongase

PGE1 20:3n-6 20:4n-3

∆ 5-desaturase

PGE2 20:4n-6 20:5n-3 PGE3, PGI3, TXA3, LT5

PGI2
TXA2
LT4 Elongase

Elongase
22:4n-6 22:5n-3 24:5n-3

∆6-desaturase
∆4- desaturase
β -oxidation
22:5n-6 22:6n-3 24:6n-3

Figure 2 Classical omega-3 and omega-6 fatty acid synthesis pathways. PUFA, polyunsaturated fatty acid. Source: Senanayake, S.P.J.N., 2000.
Enzyme-Assisted Synthesis of Structured Lipids Containing Long-Chain Omega-3 and Omega-6 Polyunsaturated Fatty Acids (Ph.D. thesis). Memorial
University of Newfoundland, Canada.

bologna, and salami, among others. To help keep blood are metabolized differently than other fats. The American
cholesterol levels healthy, it is important to limit the amount Heart Association’s Nutrition Committee recommends the
of these foods we consume. However, rarely is any consider- amount of saturated fat intake to be less than 7% of total
ation given to the fact that short-chain saturated fatty acids calorie intake.
116 Fatty Acids
Monounsaturated Fatty Acids and Health
Fatty acids containing one or more carbon–carbon double
bonds are termed ‘unsaturated.’ When the fatty acids contain
one carbon–carbon double bond in the aliphatic chain, they
are called monounsaturated. In general, these fats are liquid
at room temperature, but start to solidify at refrigerator
temperature. MUFAs are synthesized within the human
body. A major nutritionally important MUFA is oleic acid.
Examples of dietary sources of MUFAs include olive and
canola oil, avocados, peanuts, nuts, and seeds. Olive oil is
rich in MUFAs and is a major ingredient of the Greek,
southern Italian, and Spanish culinary traditions. Because
MUFAs are present in relatively high amounts in the tradi-
tional Mediterranean diet, mainly due to high intake of olives
and olive oil, and because regions consuming this diet gener-
ally have lower rates of CVD, it has been speculated that
MUFAs are cardioprotective. Furthermore, recent studies
have reported a significant negative association between
regular consumption of Mediterranean diet and cancer and
other chronic disease risk factors. When consumed as a substi-
tute for butter or lard, olive oil appears to lower ‘bad’ choles-
terol (LDL cholesterol) levels in blood, raise ‘good’
cholesterol (HDL cholesterol), and reduce the risk of heart
attack. This may also help explain why CVD death rates
have been reported to be lower among habitants of the Medi-
terranean region. Their diets are higher in vegetables, fruits,
and whole grain products than the typical U.S. diet. Further-
more, antioxidants in olive oil, fruits, and vegetables may
protect body cells and tissues from damage by oxidation –
a process that could set the stage for heart disease. MUFAs
may also have other health benefits. In a study of 3442 Italian
women’s dietary habits, those who ate large amounts of olive
oil (about 1.5 tablespoons) daily reduced their risk for
ovarian cancer by 30%. A survey of 5632 elderly participants,
called the Italian Longitudinal Study on Aging (ILSA) showed
that the higher an individual’s MUFA consumption is, the
lower the likelihood for developing age-related cognitive
decline – a mild deterioration in memory. However, these
findings are still preliminary. The rate of cancer among Medi-
terranean populations seems to be also significantly lower
than among the rest of the world. There is some preliminary
evidence to suggest that these lower rates of cancer, particu-
larly breast cancer, may also be at least in part due to olive
oil consumption, as oleic acid (a component of olive oil)
has shown the potential to prevent breast cancer in laboratory
studies. However, this evidence is still preliminary. In the
United States, it is currently recommended that MUFA and
PUFA sources should be consumed more frequently than
foods rich in saturated fat, trans fat, – but within the restric-
tion of 20–35% of total calories from fat.
What Are Omega-3 Fatty Acids?
Omega-3 fatty acids are a type of PUFAs containing more
than two double bonds. They differ from other fatty acids
because of the location of the first double bond in the
aliphatic chain. The omega-3 fatty acids that are most
important nutritionally are alpha-linolenic acid (ALA),
eicosapentaenoic acid (EPA), and docosahexaenoic acid
(DHA). In particular, ALA is known as an essential fatty
acid, meaning that our body cannot synthesize it. However,
humans may synthesize EPA and DHA in very small amounts
from ALA. The main dietary sources of ALA are flaxseed oil,
canola oil, soybean oil, and walnuts, while sea foods, partic-
ularly fatty fish such as salmon and some species of fish from
Northern lakes, are good sources of EPA and DHA. The body
can use all three of these omega-3 fatty acids to help perform
different functions. Research indicates that EPA is important
in promoting the development of prenatal and infant cardiac
and circulatory systems. DHA, however, seems to receive
more attention and great compliments from the scientific
community with regard to health during pregnancy and
infant nutrition.
It is suggested that 500–1800 mg (0.5–1.8 g) per day of EPA
and/or DHA may reduce the risk of death from heart disease.
However, insufficient information is available to set a safe
upper limit for omega-3 fatty acids. The Food and Drug Admin-
istration (FDA) suggests that up to 3000 mg per day of
EPA þ DHA is generally recognized as safe. Excessive consump-
tion of omega-3 fatty acids may have negative effects on the
immune system and may inhibit blood clotting, so supplemen-
tation should only be considered with caution. The U.S. Insti-
tute of Medicine has established adequate intakes for ALA
and linoleic acid (1.1–1.6 g day
1 and 11–17 g day
1, respec-
tively, for adults) but not for EPA and DHA. The recommended
intake of omega-3 fatty acids in diets for adults by the American
Heart Association is provided in Table 1.
Most American diets provide at least 10 times more omega-
6 (another type of PUFA) than omega-3 fatty acids. Omega-6
essential fatty acid linoleic acid is found in many vegetable
oils (sunflower, corn, safflower, etc.), cereals, snack foods,
and baked goods. There is now general scientific agreement
that individuals should consume more omega-3 and less
omega-6 fatty acids for good health. It is not definitely known,
however, whether a desirable ratio of omega-6 to omega-3
fatty acids exists for the diet or to what extent high intakes of
Table 1 Recommend intakes of omega-3 fatty acids in diets for
adults by the American Heart Association
Population Recommendation
Individuals with no documented Eat a variety of (preferably fatty) fish
coronary heart disease at least twice a week. Include oils
and foods rich in alpha-linolenic
acid (flaxseed, canola, and
soybean oils; flaxseed and
walnuts)
Patients with documented Consume about 1 g of EPA þ DHA
coronary heart disease per day, preferably from fatty fish.
EPA þ DHA supplements could
be considered in consultation with
a physician
Patients who need to lower 2–4 g of EPA þ DHA per day
triacylglycerols provided as capsules under
a physician’s care
Modified from Kris-Etherton, P.M., Harris, W.S., Appel, L.J., 2002. Fish consump-
tion, fish oil, omega-3 fatty acids, and cardiovas-cular disease. Circulation 106,
2747–2757.

omega-6 fatty acids interferes with any benefits of omega-3
fatty acid consumption. The Third National Health and Nutri-
tion Examination Survey examined the intakes of omega-3
fatty acids in the United States and found that men consumed
significantly less ALA than women, adults consumed more
than children, and those with a history of CVD consumed
less than those without CVD (when energy intake was taken
into account in the analysis). On any given day, only 25% of
the population reported consuming any EPA or DHA. Average
daily intakes were 14 g linoleic acid, 1.33 g ALA, 0.04 g EPA,
and 0.07 g DHA.
Omega-3 Fatty Acids and Public Health
Early epidemiological studies published in the late 1970s
noted relatively low cardiovascular mortality in populations
such as the Inuit with high fish and other seafood consump-
tion. The apparent health benefits of fish are explained, at least
in part, by the EPA and DHA they contain. Since these early
studies, hundreds of clinical trials have been conducted to eval-
uate the effects of EPA and DHA from marine sources on
cardiovascular health and disease. The possible health benefits
of omega-3 fatty acids are listed in Table 2.
Several epidemiological studies have examined the relation-
ship between fish intake and stroke incidence. The association
between fish consumption and stroke incidence was assessed
by so-called Cox proportional hazards models. In one study,
the unadjusted hazard ratio of men who consumed an average
of 20 g day
1 of fish was 0.49 compared with those who
consumed less. Likewise, in a follow-up study, white females
who consumed fish more than once per week had an age-
adjusted stroke incidence that was only half that of women
who reported not consuming fish. These studies suggest that
consumption of at least one portion of fish per week may be
associated with a reduced stroke incidence. Research has also
examined the role of omega-3 fatty acids in relation to
omega-6 fatty acids. Some researchers believe one of the
reasons why Americans suffer from high rates of CVD may be
due to an imbalance in the ratio of omega-3 to omega-6 fatty
acids. The optimal ratio of dietary omega-6 to omega-3 fatty
acids is suggested to be 2–4:1. However, in many developed
countries this ratio is up to 15:1. Therefore, many health
promoting organizations recommend an increase in omega-3
fat intake for promoting quality of life in general population.
High ratio of omega-6 to omega-3 fat may be associated with
Table 2 Health benefits of omega-3 fatty acids
Decrease triacylglycerol levels
Help prevent blood from clotting and sticking to artery walls
Lower blood pressure
Reduce inflammation
Decrease the risk of sudden death and abnormal heart rates
Prevent hardening of the arteries
Help to lower the risk for blocked blood vessels and heart attacks
Improve overall heart health
Adapted from Kris-Etherton, P.M., Harris, W.S., Appel, L.J., 2002. Fish consump-
tion, fish oil, omega-3 fatty acids, and cardiovas-cular disease. Circulation 106,
2747–2757.
Fatty Acids 117
the incidence of several disorders. These include CVD, cancer,
and mental disorders.
For example, depression is a common form of mental afflic-
tion and affects about 7% of the American adult population or
some 15 million American adults in any given year. The U.S.
National Institute of Mental Health estimates that about 4%
of adolescents also get seriously depressed. Depression affects
a person’s ability to work, sleep, eat, and experience pleasure,
and it can be disabling. It is more common in women than
men, particularly after childbirth. Depression is least common
in countries where people eat the most fish, such as Japan, Ice-
land, and Korea, while countries with low fish consumption
have the highest rates. They include the United States, Canada,
and West Germany. People with depression often have low
levels of EPA and DHA in their tissues compared with healthy
individuals, but it is not clear what this means. Several studies
have reported positive outcomes in depressed patients who
took EPA along with their usual medication. Low doses of
EPA (1–2 g day
1) were more effective than high-dose levels,
and EPA appears to be more effective than DHA. However,
these encouraging findings must consider that some studies
found no benefits with EPA. Moreover, almost all studies
have been carried out with small numbers of patients. That
means we still need firmer results from larger studies under
strictly controlled conditions.
Fatty Acids for Infant Nutrition
Fatty acids supply the energy consumed in cellular growth at
certain stages of life, particularly during infancy.
DHA and arachidonic acid (ARA) have been identified as
important structural components of the highly specialized
membrane lipids of the human central nervous system, with
phospholipids of brain gray matter containing high propor-
tions of DHA. DHA is also the major long-chain polyunsatu-
rated fatty acid (LC PUFA) in the outer segments of the
retina’s rods and cones in the eyes. In addition, DHA and
ARA are found in breast milk. Given their role as essential fatty
acids and their importance in central nervous system (espe-
cially brain and eye) development, both have been added to
infant formula in the United States since 2002. The levels of
ARA found in breast milk are fairly consistent worldwide;
however, DHA levels show considerable variability and appear
to be linked to maternal dietary intake. DHA- and ARA-
supplemented infant formula are now available in most
countries, including North America, South America, Europe,
Australia, New Zealand, and Asia. The rationale is that
formulas enhanced with DHA and ARA may improve visual
and mental development outcomes in formula-fed babies,
more similar to that of their breastfed counterparts. The U.S.
FDA has stated that it has no objections to the addition of
DHA and ARA to formula for term infants. The British
Nutrition Foundation, the Food and Agriculture Organization
of the United Nations/World Health Organization (FAO/
WHO), and the International Society for the Study of Fatty
Acids and Lipids (ISSFAL) all recommend supplementation
of premature infant formulas with both DHA and ARA. FAO/
WHO reviewed all the available scientific literature on DHA
and ARA supplementation and recommended that all
118 Fatty Acids
full-term infant formulas may provide 20 mg DHA per
kg day
1 and 40 mg ARA per kg day
1 (0.3% DHA and 0.6%
ARA, assuming consumption of 6.5 g fat per kg day
1).
The optimal fatty acid profile of infant formula has not been
determined. Experts agree that infant formulas should be
designed to approximate the fatty acid composition of breast
milk and include omega-3 fatty acids such as DHA. Infants
may have a unique need for certain fatty acids, particularly
DHA and ARA, in addition to essential fatty acids. Worldwide,
DHA concentrations in breast milk range from 0.07% to greater
than 1.0% of the total fatty acids, with a mean of about 0.34%.
ARA concentrations are greater in magnitude and lower in vari-
ability, averaging 0.53%. Given the importance of all omega-3
fatty acids in the diets of infants, the Institute of Medicine set an
adequate intake of 0.5 g of omega-3 fatty acids per day during
the first 12 months of life. The omega-6 to omega-3 ratio of
infant formula may especially be important.
DHA is the most abundant omega-3 fatty acid in the brain
and the retina of the eye, representing about 97% and 93% of
all omega-3 fatty acids in the brain and eyes, respectively. DHA
is key to the developing brain, accumulating in vast amounts
during infant development and during the first few years of
life. DHA is a central component of the nervous system and
promotes neurological development, particularly with regard
to the eyes and to fundamental cognitive function. The brain
grows rapidly during the last months of gestation and
throughout the first years of life. This growth spurt is a time
of rapid DHA accumulation in the brain. An infant’s ability
to produce DHA may be inconsistent and inefficient. Infant
blood DHA levels decrease significantly following birth unless
the infant receives DHA either through breast milk or DHA-
supplemented infant formula.
Studies have examined the impact of dietary DHA and ARA
on visual function of infants. A 1-year study measured the red
blood cell fatty acid composition and visual function of 108
infants over 52 weeks’ time. Twenty-nine of the infants were
breast-fed and the rest were fed either plain infant formula or
formula supplemented with DHA and/or ARA. It was found
that the fatty acid makeup and visual function were similar
between the breastfed- and fatty acid–supplemented groups,
but were inferior in the nonsupplemented formula group
(Birch et al., 1998). Studies suggest that a baby born to a mother
with high levels of DHA in her system will more likely have
advanced cognitive abilities and an increased attention span
(a fundamental nonverbal indicator of intelligence in very early
childhood). These effects have been measured up to age 4, sug-
gesting that there are long-term benefits of DHA consumption
during pregnancy and nursing. Another study tested over 70
mothers and their babies between 4 and 8 months of age.
The study tested for visual acuity and visual-cognitive learning
ability by showing infants pictures and measuring reactions.
Results indicated that babies born to mothers with elevated
DHA levels had increased visual ‘skills’ and abilities.
Infants who were breast-fed and then weaned to formula
supplemented with DHA and ARA demonstrated more mature
visual acuity than those breastfed infants weaned to
nonsupplemented formula. Infants fed DHA-supplemented
formula exhibited better visual acuity than that of the
nonsupplemented infants (equivalent to 1.5 lines on the eye
chart), and similar to that of breastfed infants. One study
showed that infants fed formula supplemented with
DHA (0.36%) and ARA (0.72%) had fewer episodes of
bronchiolitis and bronchitis at age 5, 7, and 9 months
compared to infants fed nonsupplemented formula. Infants
fed formula supplemented with DHA and ARA had
significantly lower blood pressure compared to infants fed
nonsupplemented formula, similar to that of breastfed
infants. Because blood pressure tends to track from
childhood into adult life, it has been suggested that early
intake of DHA may reduce the risk of CVD later in life.
Compared to conventional formula feeding, breastfeeding
has been found to produce long-lasting improvements in
cognitive ability and educational achievement. The analysis
of the data has determined that DHA and ARA contents of
breast milk are at least partially responsible for this difference.
One study found an IQ advantage of preterm infants fed breast
milk by tube compared to a nonsupplemented formula-fed
group, indicating an effect beyond the actual act of breastfeed-
ing. There have also been several studies that have compared
regular infant formula to formula supplemented with DHA
and ARA as to effect on mental development. These studies
have found infants receiving DHA- and ARA-enriched
formula to have greater cognitive ability than infants fed
nonsupplemented formula. Term infants fed formula
supplemented with DHA (0.36%) and ARA (0.72%) scored 7
points higher on the Bayley Mental Development Index at
18 months than those fed nonsupplemented formula. In
a follow-up study of those same children at age 4, visual
acuity and verbal IQ scores were higher in those children
who had received supplemented formula compared with
those who received formula lacking DHA and ARA. The effect
of DHA and ARA in infant formula on problem solving at
10 months of age was evaluated. Forty-four healthy, full-term
newborns were included in this study. Starting shortly after
birth, half the babies received a standard infant formula,
while the others received the same formula supplemented
with DHA and ARA. The fat supplement was derived from
milk fat, vegetable oils, and egg lipids. When tested at
10 months, both groups had normal physical development
and were equally able to solve simple mental problems.
However, faced with a more complex mental challenge, those
taking DHA-supplemented formula did better, and their
advantage was statistically significant.
The accretion of DHA and ARA by the fetal brain during
the last trimester of gestation is essential; therefore, infants
born prematurely are at an increased risk of having a decreased
level of these two fatty acids. Autopsy studies of term infants
who died during the first year of life have also shown such
PUFA differences in the brains and retinas of infants fed
formulas not supplemented with DHA. Studies of fatty acids
in autopsied sudden-infant-death syndrome (SIDS) infants
showed reductions in DHA of around 10% in those fed
conventional formula compared to those fed breast milk.
All of the above studies support the importance of DHA and
ARA for normal neural development. In the United States,
approximately 3600 deaths each year were attributed to
SIDS from 1992 to 1999. However, there have been no reports
of an increase in SIDS-related deaths in countries where
formulas supplemented with a source of DHA and ARA had
been used for several years.

Breast milk is the optimal infant food. Breast milk contains
the long-chain PUFAs DHA and ARA. Recommendations have
been made by several expert groups for infant formulas con-
taining DHA and ARA. Many studies, as discussed previously,
have demonstrated improved mental development for infants
fed DHA- and ARA-supplemented formula compared to
those receiving nonsupplemented formula. These benefits
extend well beyond the period of supplementation and
continue into childhood. Infants rapidly accumulate DHA
from their mother during the last months (third trimester) of
gestation. Infants born prematurely do not have time to
accumulate DHA to the same level as their full-term
counterparts. When fed formula supplemented with DHA
and ARA, preterm infants achieved normal growth in terms
of weight, length, and head circumference and showed
improved visual and mental development compared to the
infants fed formula not supplemented with DHA and ARA.
No concerns have been reported by physicians worldwide
who have monitored the administration of formulas
supplemented with DHA and ARA to low-birth weight
infants. Studies with stable isotopes indicated that preterm
and term infants can convert linoleic acid to ARA and ALA to
DHA. However, sufficient synthesis to enable tissue accretion
is limited at birth because of immature enzyme systems.
Omega-3 Fatty Acids and Maternal Health
Scientific research continues to expand our knowledge of nutri-
tion in pregnancy, and perhaps the most important recent
development in this field is the role played by omega-3 fatty
acids in the development of a healthy baby. Omega-3 fatty
acids are stored by the body and brain of the mother, and
the nutritional benefits of dietary omega-3 fatty acids will be
passed from mother to fetus during pregnancy through the
placenta. During pregnancy, however, if the diet does not
contain sufficient omega-3 fatty acids, the fetus may begin to
utilize omega-3 fatty acids from the mother’s internal stores
in the brain. This can cause a long-term deficit of omega-3 fatty
acids if omega-3 fatty acids are not regularly consumed from
food and/or supplement sources. This deficiency in omega-3
fatty acids intake is compounded by the fact that after a wom-
an’s first pregnancy, her maternal stores become depleted.
Women need to favor their own health and healthy preg-
nancies by having healthy eating habits. For that reason, foods
rich in omega-3 fatty acids, particularly DHA and EPA, should
be included. Before pregnancy, consuming seafood or other
foods with these fatty acids will ensure their availability from
the earliest stages of pregnancy through term. After giving birth,
maintaining good nutrition meets the demands of breastfeed-
ing and helps replenish nutrients reduced during pregnancy.
Women who have had one or more children have less EPA
and DHA available for another pregnancy. It has been shown
that women who have had several children have less DHA in
their tissues than women having their first baby. Unless these
losses are replaced by consuming fish and shellfish or other
sources of EPA and DHA, less DHA will be available for other
pregnancies.
The health benefits of omega-3 fatty acids are, of course, not
restricted to fetal and early-childhood development. One of the
Fatty Acids 119
serious medical complications of pregnancy is preeclampsia/
eclampsia, also known as toxemia. This complication compli-
cates approximately 5–10% of all pregnancies and is a common
cause of maternal mortality, premature delivery (preterm labor),
fetal growth retardation, and perinatal mortality. Women with
lower dietary intake of omega-3 fatty acids have much more
risk of developing preeclampsia. Equally important, higher
levels of omega-3 fatty acids may reduce the odds of postpartum
depression and regulate a newborn’s sleep patterns. An even
more important benefit is the role of omega-3 fatty acids in pre-
venting preterm labor and delivery. Women with lower amounts
of omega-3 fatty acids have a higher risk of preterm labor, and
supplementation with this nutrient has been shown to decrease
the risk of this often catastrophic pregnancy complication.
Fortunately, there are now easy ways to supplement a preg-
nant woman’s diet with these nutrients. One might think that
eating more fish would be a simple, natural way to obtain
more omega-3 fatty acids. However, due to increased mercury
pollution, the levels of mercury in fish may occasionally be
too high. The FDA has issued advisories that limit the amount
of fish that is safe for pregnant woman, nursing mothers, and
young children to consume. Specifically, shark, swordfish,
king mackerel, and tilefish are not considered safe for pregnant
women. However, consumption of salmon, pollock, shrimp,
and catfish as well as small-size fish are recommended by the
FDA. Also, canned ‘light’ tuna can be taken in moderation.
Mercury is a potent neural toxin and may be responsible for
cognitive delays and other types of brain damage. Developing
babies are the most vulnerable to this type of toxin.
Many authorities recommend that pregnant and nursing
women consume fatty fish two to three times weekly and/or
add a minimal amount of flaxseed oil to their diets to insure
adequate intake of omega-3 fatty acids, as the usual diet often
contains sufficient amount of omega-6 fatty acids. Health Can-
ada recommends that women eat adequate amounts of essential
fatty acids while they are pregnant to meet the needs of the fetus.
Different groups have given various recommendations for total
omega-3 fatty acids during pregnancy, ranging from 0.5% to
1.3% of daily calories. One group specifically recommends
that women who are pregnant or breastfeeding should get at
least 300 mg day
1 of DHA. A safer option may be supplements
containing omega-3 fatty acids. In addition to the algal oil and
fish oil capsules sold in health food stores, there are other
brands of prenatal supplements contain DHA. Omega-3 fatty
acids are also available in supplemented infant formula. For
breastfeeding mothers, supplementation would be recommen-
ded so the nutrients can pass to the baby in the breast milk.
Research into the role of omega-3 fatty acids is continuing,
and all of the benefits may not be known for years, especially
given the long time required to study the effects of brain devel-
opment. However, the data so far seem to be encouraging, indi-
cating a benefit for both mother and baby at this critical time
of life.
Public Health Risks of Trans-Fatty Acids
Chemically, unsaturated fatty acids could be found in either cis
or trans isomer forms. In trans-fatty acid molecules, the
hydrogen atoms bonded to double-bonded carbon atoms
120 Fatty Acids
(characteristic of all unsaturated fats) are in the trans (opposite
sides, E configuration) rather than the cis (the same side; Z
configuration) arrangement. This results in a less kinked shape
for the carbon chain, more like the straight chain of a fully satu-
rated fatty acid. Trans-fatty acids are primarily formed when
vegetable oils are processed to make them more solid or more
stable oils. This process is referred to as partial hydrogenation.
The unsaturated fatty acids of vegetable oils are typically in
the cis form. When an oil is partially hydrogenated, some
trans-fatty acids are formed. Additionally, some double bonds
move along the fatty acid chain, so that a group of cis and trans
isomers are formed. Trans-fatty acids may also be formed during
heating and frying of oils at high temperatures. Hydrogenation
is used to convert liquid oils into solid fats, providing the attri-
butes of texture, mouth feel, and eating quality desired by
consumers in baked, fried, or processed foods. Hydrogenation
is also performed to enhance the keeping quality of many foods.
Partially hydrogenated oils protect against oxidative rancidity,
thus preserving freshness and extending the shelf life of foods
containing them. It is important to note that hydrogenation
results in a number of changes in the acyl chain of the fatty
acid moiety, all of which can impact physiological parameters:
conversion of cis to trans double bonds, saturation of double
bonds, and migration of double bonds along the acyl chain
resulting in multiple positional isomers. Another method of
formation of trans-fatty acids is through microorganisms in
the rumen of ruminant animals; such trans fats are also known
as ‘naturally occurring’ trans fats that seem to have beneficial
health effects. The main source of trans-fatty acids in the diet
comes from partially hydrogenated vegetable oils; however,
up to 20% of the trans fats in the U.S. diet is consumed as prod-
ucts of ruminant animals (i.e., beef, dairy, and lamb products).
Several countries have now strict regulations for either produc-
tion of foods without trans fat or labeling the amount of trans
fat which generally is not recommended to be more than 1%
of total calorie intake.
Trans-fatty acids are rare in nature. They are only created in
the rumen of animals such as cows and sheep and are only
found in small amounts in milk, cheese, beef, and lamb.
Some of the unsaturated fatty acids ingested by ruminants are
partially hydrogenated by microorganism in the rumen. Thus,
as a consequence, milk fat, dairy products, beef fat, and mutton
fat also contain cis and trans fatty acid isomers, although the
proportions are somewhat different. The levels found are about
2–9%, and such conjugated trans-fatty acids are found to have
certain benefits, contrary to those created industrially in fats
and oils due to processing and exposure to high temperatures.
In ruminants the main component of the trans-fatty acid is
trans-vaccenic acid, while in processed fats it is elaidic acid.
Partially hydrogenated vegetable oils have been an increas-
ingly significant part of the human diet for about 100 years,
and some deleterious effects of trans fat consumption are scien-
tifically accepted, forming the basis of the health guidelines dis-
cussed above. Unlike other dietary fats, trans fats are neither
required nor generally beneficial for health and, in fact, the
consumption of most trans fats increases one’s risk of coronary
heart disease by raising levels of LDL cholesterol and lowering
levels of HDL cholesterol. Health authorities worldwide recom-
mend that consumption of trans fat be reduced to trace
amounts. Trans fats from partially hydrogenated oils are
generally considered to be more of a health risk than those
from naturally occurring oils.
The exact biochemical methods by which trans fats produce
specific health problems are a topic of continuing research. The
most prevalent theory is that the human lipase enzyme is
specific to the cis configuration. This enzyme can hydrolyze
the cis double bond, resulting in two lower molecular weight
fatty acids that can be further metabolized. The human lipase
enzyme is ineffective with the trans configuration, so trans fat
remains in the bloodstream for a much longer period of time
and is more prone to arterial deposition and subsequent pla-
que formation. While the mechanisms through which trans
fats contribute to coronary heart disease are fairly well under-
stood, the mechanism for trans fat’s effect on diabetes is still
under investigation. There are suggestions that the negative
consequences of trans fat consumption go beyond the cardio-
vascular risk. In general, there is much less scientific consensus
that eating trans fat specifically increases the risk of other
chronic health problems such as obesity, diabetes, and cancer.
Research indicates that trans fat may increase weight gain and
abdominal fat, despite a similar caloric intake. Although obesity
is frequently linked to trans fat in the popular media, this is
generally in the context of eating too many calories; there is no
scientific consensus connecting trans fat and obesity. There is
a growing concern that the risk of type 2 diabetes increases
with trans fat consumption. However, consensus has not been
reached. For example, one study found that risk is higher for
those in the highest quartile of trans fat consumption. Another
study has found no diabetes risk once other factors such as total
fat intake and body mass index (a number calculated from
a person’s weight and height) were accounted for. There is no
scientific consensus that consumption of trans fats significantly
increases cancer risks across the board. However, some studies
have found connections between trans fat and prostate cancer.
Conjugated Linoleic Acid and Health
Conjugated linoleic acid (CLA) is a collective term given to
a group of positional and geometric isomers of linoleic acid in
which the double bonds are conjugated, instead of being in
the typical methylene-interrupted configuration. The conjugated
double bonds occur at carbon atoms 10 and 12 or 9 and 11, with
all possible cis and trans combinations. Although conjugation of
double bonds occurs as part of free radical-mediated oxidation
of linoleic acid, CLA is a true isomer of linoleic acid, in that it
does not possess an additional oxygen. CLA is found primarily
in the meat and dairy products of ruminants (Table 3). CLA
comes in two isomers: the c9,t11 isomer (rumenic acid), which
appears responsible for improving muscle growth; and the
t10,c12 isomer, which primarily prevents lipogenesis (storage
of fat in adipose tissue). Most supplements sold in stores contain
a 50:50 mix of both isomers. CLA is a trans fat which may
provide some health benefits. Unlike most trans-fatty acids
found in the human diet, CLA occurs naturally, produced by
microorganisms in the forestomach of ruminants. Vaccenic
acid is an isomer of CLA available in ruminants’ fat.
Nutritional studies based on animal models have demon-
strated a variety of beneficial health effects from dietary
ingestion of CLA, including antiobesity, anticarcinogenic,
 Fatty Acids 121

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Further Reading Senanayake, S.P.J.N., Fichtali, J., 2006. Single-cell oils as sources of nutraceutical
and specialty lipids: processing technologies and applications. In: Shahidi, F. (Ed.),
Berrino, F., 2016. Mediterranean diet and its association with reduced invasive breast Nutraceutical and Specialty Lipids and Their Co-products. CRC Press, Boca Raton,
cancer risk, 2016 Published online January 21 JAMA Oncol. E1–E2. FL, pp. 251–280.
Best, K.P., Gold, M., Kennedy, D., Martin, J., Makrides, M., 2016. Omega-3 long- Senanayake, S.P.J.N., Shahidi, F., 2001. Modified oils containing highly unsaturated
chain PUFA intake during pregnancy and allergic disease outcomes in the fatty acids and their stability. In: Shahidi, F., Finley, J.W. (Eds.), Omega-3 Fatty
offspring: a systematic review and meta-analysis of observational studies and Acids: Chemistry, Nutrition and Health Effects. American Chemical Society,
randomized controlled trials. Am. J. Clin. Nutr. 103 (1), 128–143. Washington, DC, pp. 162–173.
122 Fatty Acids
Senanayake, S.P.J.N., Shahidi, F., 2005. Dietary fat substitutes. In: Shahidi, F. (Ed.),
Bailey’s Industrial Oil and Fat Products, sixth ed., vol. 3. John Wiley & Sons,
Indianapolis, IN, pp. 503–534.
Senanayake, S.P.J.N., 2000. Enzyme-Assisted Synthesis of Structured Lipids Con-
taining Long-Chain Omega-3 and Omega-6 Polyunsaturated Fatty Acids. Ph.D.
thesis). Memorial University of Newfoundland, Canada.
Shahidi, F., Senanayake, S.P.J.N., 2006. Nutraceutical and specialty lipids. In:
Shahidi, F. (Ed.), Nutraceutical and Specialty Lipids and Their Co-products. CRC
Press, Boca Raton, FL, pp. 1–25.
Shahidi, F., Senanayake, S.P.J.N., 2007. Fat replacers. In: Kirk-Othmer Encyclopedia of
Chemical Technology. John Wiley & Sons, Indianapolis, IN. http://www.heart.org/
HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-
Fats, October 26, 2015.
Smuts, C.M., Huang, M., Mundy, D., Plasse, T., Major, S., Carlson, S.E., 2003.
A randomized trial of docosahexaenoic acid supplementation during the third
trimester of pregnancy. Obstet. Gynocol. 101 (3), 469–479.
Sofi, F., Cesari, F., Abbate, R., Gensini, G.F., Casini, A., September 11, 2008. Adherence
to Mediterranean diet and health status: meta-analysis. BMJ 337, a1344.
Toledo, E., Salas-Salvadó, J., Donat-Vargas, C., Buil-Cosiales, P., Estruch, R., Ros, E.,
Corella, D., Fitó, M., Hu, F.B., Arós, F., Gómez-Gracia, E., Romaguera, D., Ortega-
Calvo, M., Serra-Majem, L., Pintó, X., Schröder, H., Basora, J., Sorlí, J.V.,
Bulló, M., Serra-Mir, M., Martínez-González, M.A., November 1, 2015. Mediterranean
diet and invasive breast cancer risk among women at high cardiovascular risk in the
PREDIMED trial: a randomized clinical trial. JAMA Intern. Med. 175 (11), 1752–1760.
Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., Corella, D., de la Torre, R., Martínez-
González, M.Á., Martínez-Lapiscina, E.H., Fitó, M., Pérez-Heras, A., Salas-
Salvadó, J., Estruch, R., Ros, E., 2015. Mediterranean diet and age-related
cognitive decline: a randomized clinical trial. JAMA Intern. Med. 175 (7),
1094–1103.
Relevant Website
http://www.health.gov/dietaryguidelines/2015/guidelines – Dietary Guidelines (last
accessed 09.06.16.).