I investigated whether metabolism of
essential fatty acids and the concentrations of their long-chain metabolites (long-chain
polyunsaturated fatty acids [LCPUFAs]) are altered in fetal or perinatal growth retardation, maternal
hypercholesterolemia, low-grade systemic
inflammation,
insulin resistance, and
atherosclerosis, conditions that predispose to the development of
coronary heart disease (CHD).I critically reviewed the literature pertaining to the metabolism of
essential fatty acids in CHD and conditions that predispose to it.LCPUFAs enhance endothelial
nitric oxide synthesis, suppress the production of the proinflammatory
cytokines tumor necrosis factor and
interleukin-6, attenuate
insulin resistance, and have antiatherosclerotic properties. Low-
birthweight infants have decreased concentrations of LCPUFAs, especially
arachidonic acid. Neonatal
arachidonic acid status is related to intrauterine growth, and LCPUFAs improve fetal and postnatal growth. LCPUFAs are useful in the management of
hyperlipidemia, inhibit 3-hydroxy-3-methylglutaryl
coenzyme A reductase activity, and may mediate the beneficial actions of
statins. Plasma concentrations of various LCPUFAs are low in
diabetes mellitus,
hypertension, and CHD and in populations at high risk of CHD. Breast milk is rich in LCPUFAs, and this may explain why and how adequate (6 mo to 1 y) breast feeding protects against the development of
obesity,
hypertension,
insulin resistance, and CHD.LCPUFAs are essential for the growth and development of the fetus and infant. LCPUFAs can prevent various conditions that predispose to the development of CHD. The low incidence of CHD seen in adequately breast-fed infants can be linked to the LCPUFA content of breast milk. Based on this evidence, I suggest that provision of LCPUFAs during critical periods of growth, especially from the second trimester of pregnancy to age 5 y, prevents CHD in adult life.