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While the review is extremely thoughtful and reflects the deep insights of the author into the field, the two assumptions cited above need be challenged. We fully agree with Hadders-Algra that AA has its own potent and biologically important functions, which makes it unwise to support interventions markedly reducing tissue levels of AA, but we do not have evidence for any such risk with a DHA supply in the currently recommended dosage near 200 mg/day w13, 15x. Both AA and DHA are formed by endogenous conversion of the precursor essential fatty acids, linoleic acid and alpha-linolenic acid, respectively w17x. However, AA is synthesised via a rather short enzyme catalised pathway of only two desaturation and one elongation steps, whereas the synthesis of DHA from alpha-linolenic acid is very long, complex and indirect w17x. Accordingly, numerous studies using assessment of blood levels or stable isotope turnover methodology indicate that the endogenous synthesis of AA is far more effective than DHA, resulting in a much greater metabolic control and stability of AA than of DHA levels in human blood and

Prenatal supply of docosahexaenoic acid (DHA): should we be worried?