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 (fatty acid 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 Linoleic acid 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 Arachidonic acid 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 Eicosatetraenoic acid 4.6 1.0 15.0 25 120 EPA Eicosapentaenoic acid 21 25 120 40 100 DHA Docosahexaenoic acid 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-vaccenic acid 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 Oleic Acid 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 Nervonic acid (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 Behenic acid 34 20 60 80 220 Lignoceric acid 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 Elaidic acid (trans ) 22.5 ≤25.0 15.4 Linolelaidic acid 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 oily fish or fish oil 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 esters 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. Stearidonic acid-enriched soybean oil increased the omega-3 index, an emerging cardiovascular risk marker. Lipids 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 phospholipids. 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 essential fatty acid 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 dermatitis, impaired wound healing and fatty infiltration of the liver with raised hepatic enzyme activities in the serum. Excess dietary fatty acids, particularly trans fatty acids, may also be associated with the development of cardiovascular disease. To assist in the interpretation of results, a short schema of -6 and -3 fatty acid metabolism 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) 9 Weymouth Street, London, W1W 6DB. UK Tel: (44) 020 7636‐5959/5905 Fax: (44) 020 7580‐3910 E‐mail: [email protected] 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 oils. octadecadienoic acid) A major precursor for eicosanoid biosynthesis. From the seed of evening GLA Gamma-linolenic acid (18:3 n-6) primrose (Oenothera biennis), also in blackcurrant, borage and hemp (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 eicosanoids. 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 docosatetraenoic acid) 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, walnut, flax, 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 algae; found in human breast milk. Anti- (cis-5,8,11,14,17-eicosapentaenoic acid) inflammatory, precursor for prostglandin-3 (inhibits platelet aggregation), thromboxane-3 and leukotriene-5. Highest concentration omega-3 fatty acid in lipid 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 triglycerides. Omega‐5 fatty acids Myristoleic acid (14:1 n-5) (9- Metabolically produced from myristic acid 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 palmitic acid by the action of D-6 Palmitoleic acid (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 cholesterol. May have a role in the control of body weight by affecting enzymes of fat oxidation pathways.