Fatty acid profile of buccal cheek cell phospholipids as an index for dietary intake of docosahexaenoic acid in preterm infants

Cheek cells (buccal epithelia) were utilized as a noninvasive index of fatty acid status in a study of the effects of n-3 long chain polyunsaturated fatty acid supplementation on visual function in preterm infants. The fatty acid profile of cheek cell phospholipids was directly correlated with the dietary docosahexenoic acid (DHA) intake of infants receiving: (i) primarily human milk; (ii) n-3 fatty acid-defcient corn oil-based, commercial formula (CO); (iii) alpha-linolenic acid-enriched, soy oil-based, commercial formula; or (iv) experimental formula enriched with soy and marine oils providing a DHA level equivalent to that in human milk. In a subset of infants with complete cheek cell fatty acid profiles and visual function assessments, preterm infants at both 36 wk (n = 63) and 57 wk (n = 45) post conceptional age had significantly (P < 0.0005) reduced cheek cell phospholipid DHA levels in the n-3-deficient, CO-fed group compared to the other diet groups. The DHA content in cheek cell phospholipids was highly correlated (P < 0.0005) with that of both red blood:cell lipids and plasma phospholipids at the 36- and 57-wk time points. The DHA content in cheek cell lipids of infants at 36 wk was significantly correlated with electroretinographic responses (r = -0.29; P < 0.03) and visual acuity (r = -0.31; P < 0.02) as measured by visual-evoked potentials (VEP). Cheek cell DHA was highly correlated (r = -0.57; P < 0.0005) with VEP acuity at the 57-wk time point. These results suggest that the fatty acid profile of cheek cells is a valid index of essential fatty acid status, can be monitored frequently, and is associated with functional parameters in infants.