Nutrition during the early life cycle

Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: a randomized controlled trial in rural Ethiopia




For infants and young children in low-income settings, human milk (HM) is the main source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). However, the n-3 LCPs concentrations of HM show wide variability, largely depending on the maternal intake of marine foods. This may put children living far from coastal areas at risk of inadequate intake. We evaluated the efficacy of fish-oil (FO) supplementation of lactating mothers on HM n-3 LCPs concentrations in a rural setting from Ethiopia.


Mothers (n = 360) with children 6–12 months old were randomized to receive either intervention FO capsules (215 mg DHA + 285 mg EPA) or control corn-oil capsules (without n-3 LCPs). In a random subsample of 154 participants, we analyzed LCPs in HM and child capillary blood using gas chromatography.


Compared to the control, FO supplementation increased HM concentrations of DHA by 39.0% (95% CI: 20.6, 57.5%; P < 0.001) and EPA by 36.2% (95% CI: 16.0, 56.4%; P < 0.001), whereas the arachidonic acid (AA)/(DHA + EPA) ratio decreased by 53.5% (95% CI: −70.2, −36.7%; P < 0.001). We also found statistically significant association between the changes in (DHA + EPA)/AA ratio in HM and child capillary blood (P < 0.001). However, HM DHA concentrations remained lower than international norms after FO supplementation.


FO supplementation improves n-3 LCPs content of HM. Future studies should evaluate different doses of n-3 LCPs and consider potential effect modifiers such as genetic polymorphism and diet. This trial was registered at as NCT01817634.

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Fig. 1: Trial flowchart.
Fig. 2: HM LCP concentrations at baseline, midline and endline of intervention in the CO (---; n = 82) and FO (—; n = 72) groups.
Fig. 3: Relationship between the change in HM and child capillary blood (DHA + EPA)/AA ratios following the intervention.


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This study was funded by the Institutional University Collaboration Programme of the Flemish Interuniversity Council with Jimma University, Nutrition Third World, the Nutricia Research Foundation, Michiels Fabrieken NV, and Fortitech Inc. The funders had no role in the design, analyses and interpretation results.

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KPB, LH, PK, and MW conceived the study. AA, KPB, MW, and LH implemented the study. BDM performed the laboratory analysis. AA and KPB analyzed the data and wrote the manuscript with support from all authors. All authors read and approved the final manuscript.

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Correspondence to Alemayehu Argaw.

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Argaw, A., Bouckaert, K.P., Wondafrash, M. et al. Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: a randomized controlled trial in rural Ethiopia. Eur J Clin Nutr (2020).

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