Infant Red Blood Cell Arachidonic to Docosahexaenoic Acid Ratio Inversely Associates with Fat-Free Mass Independent of Breastfeeding Exclusivity

Nutrients. 2022 Oct 11;14(20):4238. doi: 10.3390/nu14204238.


The prevalence of childhood obesity has increased nearly ten times over the last 40 years, influenced by early life nutrients that have persistent effects on life-long metabolism. During the first six months, infants undergo accelerated adipose accumulation, but little is known regarding infant fatty acid status and its relationship to infant body composition. We tested the hypothesis that a low arachidonic to docosahexaenoic acid ratio (AA/DHA) in infant red blood cells (RBCs), a long-term indicator of fatty acid intake, would associate with more infant fat-free mass (FFM) and/or less adipose accumulation over the first 4 months of life. The fatty acid and composition of breastmilk and infant RBCs, as well as the phospholipid composition of infant RBCs, were quantified using targeted and unbiased lipid mass spectrometry from infants predominantly breastfed or predominantly formula-fed. Regardless of feeding type, FFM accumulation was inversely associated with the infant’s RBC AA/DHA ratio (p = 0.029, R2 = 0.216). Infants in the lowest AA/DHA ratio tertile had significantly greater FFM when controlling for infant sex, adiposity at 2 weeks, and feeding type (p < 0.0001). Infant RBC phospholipid analyses revealed greater peroxisome-derived ether lipids in the low AA/DHA group, primarily within the phosphatidylethanolamines. Our findings support a role for a low AA/DHA ratio in promoting FFM accrual and identify peroxisomal activity as a target of DHA in the growing infant. Both FFM abundance and peroxisomal activity may be important determinants of infant metabolism during development.

Keywords: AA/DHA ratio; infant RBC membrane composition; infant fat-free mass; lipid mass spectrometry; plasmalogens.

MeSH terms

  • Breast Feeding*
  • Child
  • Docosahexaenoic Acids
  • Erythrocytes
  • Ethers / analysis
  • Fatty Acids
  • Female
  • Humans
  • Infant
  • Milk, Human / chemistry
  • Pediatric Obesity*
  • Phosphatidylethanolamines / analysis
  • Phospholipids


  • Docosahexaenoic Acids
  • Phosphatidylethanolamines
  • Fatty Acids
  • Phospholipids
  • Ethers