title: An updated review of worldwide levels of docosahexaenoic and arachidonic acid in human breast milk by region.
abstract: We aimed to evaluate the DHA and arachidonic acid (AA) levels in human breast milk worldwide by country, region and socio-economic status.
  
  
  
  Descriptive review conducted on English publications reporting breast-milk DHA and AA levels.
  
  
  
  We systematically searched and identified eligible literature in PubMed from January 1980 to July 2015. Data on breast-milk DHA and AA levels from women who had given birth to term infants were included.
  
  
  
  Seventy-eight studies from forty-one countries were included with 4163 breast-milk samples of 3746 individuals.
  
  
  
  Worldwide mean levels of DHA and AA in breast milk were 0·37 (sd 0·11) % and 0·55 (sd 0·14) % of total fatty acids, respectively. The breast-milk DHA levels from women with accessibility to marine foods were significantly higher than those from women without accessibility (0·35 (sd 0·20) % v. 0·25 (sd 0·14) %, P<0·05). Data from the Asian region showed the highest DHA concentration but much lower AA concentration in breast milk compared with all other regions, independent of accessibility to marine foods. Comparison was made among Canada, Poland and Japan - three typical countries (each with sample size of more than 100 women) from different regions but all with high income and similar accessibility to fish/marine foods.
  
  
  
  The current review provides an update on worldwide variation in breast-milk DHA and AA levels and underlines the need for future population- or region-specific investigations.
authors.affiliation: 1Maternal and Infant Nutrition Research Department,Beingmate Baby and Child Food Co., Ltd,512 Shunfeng Road,Hangzhou 311106,People's Republic of China.
authors.forename: Yuanqing
authors.initials: Y
authors.lastname: Fu
authors.affiliation: 2Department of Epidemiology and Health Statistics,Xi'an Jiaotong University Health Science Center,Xi'an,People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: 1Maternal and Infant Nutrition Research Department,Beingmate Baby and Child Food Co., Ltd,512 Shunfeng Road,Hangzhou 311106,People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhou
authors.affiliation: 3Department of Internal Medicine,Rush University Medical Center,Chicago,IL,USA.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Jiang
authors.affiliation: 1Maternal and Infant Nutrition Research Department,Beingmate Baby and Child Food Co., Ltd,512 Shunfeng Road,Hangzhou 311106,People's Republic of China.
authors.forename: Lingying
authors.initials: L
authors.lastname: Chai
mesh_terms: D016718:Arachidonic Acid / Q000032:analysis*; D002170:Canada; D004032:Diet; D004281:Docosahexaenoic Acids / Q000032:analysis*; D005260:Female; D006801:Humans; D007564:Japan; D008895:Milk, Human / Q000737:chemistry*; D011044:Poland; D017747:Seafood
chemical_list: D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid
keywords: Arachidonic acid; DHA; Human breast milk; Infant nutrition