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Home , Behenic acid, Docosatetraenoic acid, Elaidic acid, Essential fatty acid, Linolelaidic acid, Margaric acid

Biolab reference: XXXX/XXXX/G19 Patient: SAMPLE REPORT Referred by: SAMPLE REPORT Date of birth: 01/09/1984

Your reference: Sex: Female Date: 17/07/2019 Sample date: 15/07/2019 Erythrocyte Fatty Acids

( composition of erythrocytes reported as mmol/L of red blood cells)

Result Reference interval w-6 Fatty Acids µmol/L Low High Low Normal High 500 1250 LA 950 500 1250

9.0 42.0 GLA Gamma-linolenic acid 22.0 9.0 42.0

70 150 DGLA Dihomo-gamma-linolenic acid 102 70 150

600 1270 AA 879 600 1270

40.0 100.0 Adrenic Acid 68.4 40.0 100.0

15.0 40.0 Eicosadienoic acid 29.6 15.0 40.0

3.0 28.0 Docosadienoic acid 7.5 3.0 28.0

w-3 Fatty Acids Low Normal High 2.5 17.5 ALA Alpha-linolenic acid 7.6 2.5 17.5

1.0 15.0 ETA 4.6 1.0 15.0

25 120 EPA 21 25 120

40 100 DHA 33 40 100

w-5 Fatty Acids Normal 1.25 Raised

Myristoleic acid 0.13 ≤1.25

w-7 Fatty Acids Normal 60.0 Raised

Palmitoleic acid 15.3 ≤60.0

Low 22.0 Normal 62.0 High

Cis- 53.1 22.0 62.0

Stephen Davies MA BM BCh FACNPage 1 of 3 Mark Adams MSc MACB 9 Weymouth Street, London, W1W 6DB. UK Tel: (44) 020 7636-5959/5905 Fax: (44) 020 7580-3910 E-mail: [email protected] Biolab reference: XXXX/XXXX/G19 Patient: SAMPLE REPORT Referred by: SAMPLE REPORT Date of birth: 01/09/1984

Your reference: Sex: Female Date: 17/07/2019 Sample date: 15/07/2019

Erythrocyte Essential Fatty Acids (continued) (fatty acid composition of erythrocytes reported as mmol/L of red blood cells) Result Reference interval w-9 Fatty Acids µmol/L Low High Low Normal High 550 1300 1153 550 1300

9.0 35.0 Cis-11-eicosanoic acid 15.3 9.0 35.0

Normal Raised 15.0 Mead acid (20:3 n-9)1.8 ≤15.0

Low 12.0 Normal175.0 High

Erucic acid 24.2 12.0 175.0

170.0 650.0 (24:1 n-9) 374.0 170.0 650.0

Saturated Fatty Acids Normal 2.0 Raised

Lauric acid0.5 ≤2.0

Low 10.0 Normal 100.0 High

Myristic acid 11.5 10.0 100.0

Normal 16.0 Raised

Pentadecanoic acid 4.5 ≤16.0

Low 800 Normal 1900 High

Palmitic acid 1051 800 1900

Normal 26.0 Raised

Margaric acid 11.7 ≤26.0

Low 620 Normal1100 High

Stearic acid 697 620 1100

Normal 16.0 Raised

Arachidic acid 5.6 ≤16.0

Low Normal High 3.0 20.0 Heneicosanoic acid 9.4 3.0 20.0

20 60 34 20 60

80 220 175 80 220

Stephen Davies MA BM BCh FACNPage 2 of 3 Mark Adams MSc MACB 9 Weymouth Street, London, W1W 6DB. UK Tel: (44) 020 7636-5959/5905 Fax: (44) 020 7580-3910 E-mail: [email protected] Biolab reference: XXXX/XXXX/G19 Patient: SAMPLE REPORT Referred by: SAMPLE REPORT Date of birth: 01/09/1984

Your reference: Sex: Female Date: 17/07/2019 Sample date: 15/07/2019

Erythrocyte Essential Fatty Acids (continued)

(fatty acid composition of erythrocytes reported as mmol/L of red blood cells)

trans -Fatty Acids Normal Raised 15.0 Trans -vaccenic acid 6.9 ≤15.0

25.0 (trans ) 22.5 ≤25.0

15.4 16.3 ≤15.4

Ratios Value Reference Interval Comment

AA/LA 0.93 <1.90

<10.00 suggests enhanced fish or fish oil AA/EPA 40.92 intake Raised >30.00 suggests poor dietary intake of or fish

AA/DHA 26.64 12.50 - 30.0

Omega 6 / Omega 3 30.89 10.00 - 32.00

Polyunsaturated / Saturated 1.06 0.50 - 1.10

Omega 3 index (total omega 3 fatty acids >4.00% suggests a high cardioprotective 1.1% Low as a percentage of total) effect

References 1. David F, Sandra P, Wylie PL. Improving the analysis of fatty acid methyl using retention time locked methods and retention time databases. Agilent application note 5988-5871EN, Agilent Technologies Inc, 2003.

2. Harris WS, Lemke SL, Hansen SN et al. -enriched increased the omega-3 index, an emerging cardiovascular risk marker. 2008;43:805-811.

3. Cao J, Schwichtenberg KA, Hanson NQ, Tsai MY. Incorporation and clearance of omega-3 fatty acids in erythrocyte membranes and plasma . Clin Chem 2006;52:2265-2271. Stephen Davies MA BM BCh FACN Page 3 of 3 Mark Adams MSc MACB 9 Weymouth Street, London, W1W 6DB. UK Tel: (44) 020 7636-5959/5905 Fax: (44) 020 7580-3910 E-mail: [email protected]

General Comments

Concentrations of red cell essential fatty acids below the indicated reference intervals are consistent with deficiencies of these substances. This can be caused by inadequate dietary intake, intestinal malabsorption or by impaired molecular transformations among the fatty acids (e.g. impaired conversion of linoleic to - linolenic acid secondary to a -6 desaturase deficiency). Treatment of deficiencies depends on the underlying cause and may include supplementation with appropriate -6 or -3 EFAs. Biochemical abnormalities may usually be detected before the onset of clinical manifestations, which include , impaired wound healing and fatty infiltration of the liver with raised hepatic activities in the serum. Excess dietary fatty acids, particularly trans fatty acids, may also be associated with the development of .

To assist in the interpretation of results, a short schema of -6 and -3 fatty acid is shown below.

-6 fatty acids Enzyme -3 fatty acids

Linoleic (LA) 18:2  -Linolenic (ALA) 18:3 ↓ -6 ↓ desaturase -Linolenic (GLA) 18:3 Octadecatetraenoic 18:4 ↓ elongase ↓ Dihomogamma 20:3 Eicosatetraenoic 20:4 linolenic (DGLA) (Eicosatrienoic) ↓ -5 ↓ desaturase Arachidonic (AA) 20:4 Eicosapentaenoic 20:5 (Eicosatetraenoic) (EPA) ↓ elongase ↓ Adrenic 22:4 Decosapentaenoic 22:5 (Docosatetraenoic) ↓ elongase ↓ Tetracosatetraenoic 24:4 Tetracosapentaenoic 24:5 ↓ -6 ↓ desaturase Tetracosapentaenoic 24:5 Tetrahexaneoic 24:6 ↓ - ↓ oxidation Docosapentaenoic 22:5 Docosahexaenoic 22:6 (DPA) (DHA)

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FATTY ACID INFORMATION common and systematic name Omega‐6 essential fatty acids LA and AA are the main essential omega-6 fatty acids, abundant in many LA Linoleic acid (18:2 n-6) (cis-9,12- vegetable . octadecadienoic acid)

A major precursor for . From the seed of evening GLA Gamma-linolenic acid (18:3 n-6) primrose (Oenothera biennis), also in blackcurrant, borage and (cis-6,9,12-octadecatrienoic acid) seed oils. Used in the treatment of inflammatory and autoimmune diseases. DGLA Dihomo-gamma-linolenic acid The elongation product of GLA, found only in trace amounts in animal (20:3 n-6) (cis-8,11,14-eicosatrienoic acid) products. Metabolised to anti-imflammatory . Precursor for the production of pro-inflammatory eicosanoids; some AA Arachidonic acid (20:4 n-6) (cis- metabolic conversion from DGLA, but the main source of AA is the diet.; 5,8,11,14-eicosatetraenoic acid) found in meat, fish and animal products. Adrenic acid (22:4 n-6) (cis-7,10,13,16- Formed metabolically from elongation of arachidonic acid, one of the ) most abundant fatty acids in the early human brain Eicosadienoic acid (20:2 n-6) (cis-11,14- A minor omega-6 fatty acid, found in animal tissues. eicosadienoic acid) Docosadienoic acid (22:2 n-6) (cis-13,16- A minor omega-6 fatty acid, found in animal tissues. docosadienoic acid) Omega‐3 essential fatty acids Essential fatty acid to which many health-beneficial effects are ascribed; ALA Alpha-linolenic acid (18:3 n-3) dietary sources include seed oils (rapeseed, , , hemp) and (cis-9,12,15-octadecatrienoic acid) green leaves of some plants e.g. pursulane (Portulaca oleracea). A minor omega-3 EFA, identified in New Zealand green-lipped mussel ETA Eicosatetraenoic acid (20:4 n-3) (Perna canaliculus), reported to act as an inhibitor of arachidonic acid (cis-8,11,14,17-eicosatetraenoic acid) oxygenation. Essential omega-3 fatty acid obtained in the human diet from oily fish that EPA Eicosapentaenoic acid (20:5 n-3) have consumed certain ; found in human breast . Anti- (cis-5,8,11,14,17-eicosapentaenoic acid) inflammatory, precursor for prostglandin-3 (inhibits platelet aggregation), -3 and -5. Highest concentration omega-3 fatty acid in membranes, primary DHA Docosahexaenoic acid (22:6 n-3) structural component of the human brain and retina. Dietary source is (cis-4,7,10,13,16,19-docosahexaenoic oceanic fish, can be synthesised from EPA. Cardio-protective, lowers acid) serum .

Omega‐5 fatty acids (14:1 n-5) (9- Metabolically produced from by the action of -6 desaturase. tetradecenoic acid) In nature found in oil of nutmeg (Myristica fragrans). Omega‐7 fatty acids Present in all tissues, found in highest concentrations in the liver and adipose tissue. Synthesized from by the action of D-6 (16:1 n-7) (9- desaturase. Dietary sources include animal oils, vegetable oils and hexadecenoic acid) marine oils. Behaves like a saturated fatty acid in its effect of raising LDL . May have a role in the control of body weight by affecting of oxidation pathways. Cis-11-vaccenic acid (18:1 n-7) (11- Vaccenic acid was discovered in 1928 in and animal (vacca = octadecenoic acid) cow). Omega‐9 fatty acids "Oleic" suggests derived from olives, but also produced metabolically. Oleic acid (18:1 n-9) (9-octadecenoic acid) Has been used for the treatment of adrenoleukodystrophy, may have a

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hypotensive effect. Cis-11-eicosanoic acid (20:1 n-9) A mono-unstaurated omega-9 fatty acid, found in various plant oils In severe omega-6 EFA deficiency, mammals will elongate and Mead acid (20:3 n-9) (cis-5,8,11- desaturate oleic acid to Mead acid. Normally present in significant eicosatrienoic acid) amounts in cartilage. Has been identified as a requirement in the biosynthesis of nerve cell Nervonic acid (24:1 n-9) (cis-15- myelin and hence used in the treatment of disorders involving tetracosenoic acid) (selacholeic acid) demyelination (e.g. multiple sclerosis).

Saturated fatty acids Short chain saturated fatty acid, found in human , main dietary 12:0 (dodecanoic acid) source is usually . Can increase production of HDL and hence have an anti-atherogenic effect. Myristic acid is named after nutmeg (Myristica fragrans). Also found in 14:0 Myristic acid (tetradecanoic acid) , cocnut oil and butter fat; a minor component of many other animal fats. 15:0 Pentadecanoic acid (pentadesylic Major source is cows’ milk butter fat; a marker for consumption. acid) One of the most common saturated fatty acids in animals and plants. A major component of the oil from palm trees (palm oil and coconut oil). 16:0 Palmitic acid (hexadecanoic acid) Excess consumption of palmitic acid may increase serum cholesterol levels. Trace component of fat and milk fat of ; not present in high 17:0 (heptadecanoic acid) concentration in any natural animal or vegetable fat. The most common saturated fatty acid (with palmitic acid), more 18:0 (octadecanoic acid) abundant in in than vegetable fat, except for ; consumption is said to lower serum cholesterol. Minor constituent of peanut and corn oil. 20:0 (eicosanoic acid)

21:0 Heneicosanoic acid (heneicosylic Found in human milk fat, HEA is also a part of the phospholipids of the acid) articular cartilage boundary lubricant A major component of ben, or behen, oil from the tree Moringa oleifera. 22:0 Behenic acid (docosanoic acid) Also found in rapeseed and . A cholesterol-raising saturated fatty acid in humans. Found in small amounts in most natural fats. 24:0 Lignoceric acid (tetracosanoic acid)

Trans‐fatty acids Trans-11-vaccenic acid (18:1 n-7t) (trans- A naturally occurring trans-fatty acid found in the fat of ruminants and in 11-octadecaenoic) dairy products. The major trans-fatty acid in hydrogenated vegetable oils. Atherogenic Elaidic acid (18:1 n-9t) (trans-9- effect, increasing cholesteryl transfer (CETP), which in turn octadecaenoic acid) raises VLDL and lowers HDL. Trans- derivative of linoleic acid; its presence in the red is associated with a high intake of omega-6 linoleic acid and/or of cooking practices likely to convert linoleic acid to its trans- derivative (e.g. ready Linolelaidic acid (trans-9,12- meals or cooking at high temperature at home).Like trans-vaccenic acid octadecadienoic acid) (from milk) and elaidic acid (the trans- acid of oleic acid), the presence of significant amounts of linoleladic acid in the membrane can be regarded as a health-negative factor.

(31st August 2012)

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