{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:33:48Z","timestamp":1787567628619,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"4U Pharma GmbH, Herisau, Switzerland","award":["23-01\/2025"],"award-info":[{"award-number":["23-01\/2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Docosahexaenoic acid (DHA) is an essential component of breast milk for infant neurocognitive and visual development. Because DHA depends largely on dietary intake, women with low seafood consumption are at increased risk of inadequate DHA contents in breast milk. This study aims to quantify the DHA content in breast milk and assess how recommended dietary supplementation during lactation affects these contents among lactating women in three Balkan countries. Methods: This cross-sectional multicenter study included 128 lactating women (18\u201335 years). Dietary intake of DHA was assessed using a modified Food Frequency Questionnaire. DHA in breast milk was measured by gas chromatography following standard protocols. Both the FFQ and breast milk samples were collected at two time points: 20\u201340 (visit 1\u2014V1) and 80\u2013100 days (visit2\u2014V2) postpartum. Results: In lactating women, seafood intake was low (Visit 1: 37.5 (0.0\u201393.8) g\/week), meeting about 28% of the recommended amount, with some variation between countries. Consequently, the mean dietary n-3 PUFA and DHA intake for the total sample was less than 50% and 5% of the recommended daily allowance, respectively. Correlation analysis indicates that DHA content in breast milk is related to dietary DHA intake (Visit 1: r = 0.258, p = 0.001; Visit 2: r = 0.238, p = 0.012). DHA contents failed to reach the 0.3% clinical threshold for optimal neurodevelopment, with average levels ranging from 0.149 to 0.165%. Furthermore, no significant differences were observed between supplemented and unsupplemented women at either time point, highlighting a persistent regional deficit regardless of supplementation status. Conclusions: Lactating women in the Balkan region have a low dietary intake of n-3 PUFA and DHA, which is reflected in the breast milk lipid profile, regardless of standard supplementation. These findings highlight the need for a targeted nutritional strategy both via nutrition and supplementation to improve DHA intake in lactating women, but more importantly in infants.<\/jats:p>","DOI":"10.3390\/nu18172761","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"2761","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Docosahexaenoic Acid (DHA) Deficiency in Breast Milk: A Cross-Sectional Study of Lactating Women in Serbia, Montenegro, and North Macedonia"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0170-7705","authenticated-orcid":false,"given":"Tena","family":"Niseteo","sequence":"first","affiliation":[{"name":"Referral Center for Pediatric Gastroenterology and Nutrition, Children\u2019s Hospital Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Nutrition, Food Quality and Safety, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7121-7333","authenticated-orcid":false,"given":"Ana","family":"Ili\u0107","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Food Quality and Safety, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevena","family":"Cupara","sequence":"additional","affiliation":[{"name":"Faculty od Technology, University of Montenegro, 2 Cetinjski Put, 81000 Podgorica, Montenegro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dijana","family":"\u0110urovi\u0107","sequence":"additional","affiliation":[{"name":"Center for Ecotoxicological Research, Sarla de Gola 2, 81000 Podgorica, Montenegro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Dimitrovska","sequence":"additional","affiliation":[{"name":"Department of Food Quality and Safety, Institute for Public Health of the Republic of N. Macedonia, 50th Division No. 6, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidija","family":"Po\u010dek","sequence":"additional","affiliation":[{"name":"Institute for Children\u2019s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Pop Lazarova","sequence":"additional","affiliation":[{"name":"PHI General Hospital \u201cRe-Medika\u201d, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8585-9807","authenticated-orcid":false,"given":"Jelena","family":"Marti\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Mother and Child Health Care Institute of Serbia \u201cDr Vukan Cupic\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.pcl.2012.10.002","article-title":"Human Milk Composition. Nutrients and Bioactive Fators","volume":"60","author":"Ballard","year":"2013","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4113","DOI":"10.1021\/acs.jproteome.7b00486","article-title":"Absolute Quantification of Human Milk Caseins and the Whey\/Casein Ratio during the First Year of Lactation","volume":"16","author":"Liao","year":"2017","journal-title":"J. Proteome Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ijdevneu.2019.10.004","article-title":"Docosahexaenoic Acid, 22:6n-3: Its Roles in the Structure and Function of the Brain","volume":"79","author":"Mallick","year":"2019","journal-title":"Int. J. Dev. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S129","DOI":"10.1016\/S0022-3476(05)81247-8","article-title":"Tissue Levels of Polyunsaturated Fatty Acids during Early Human Development","volume":"120","author":"Martinez","year":"1992","journal-title":"J. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.biochi.2010.05.005","article-title":"Docosahexaenoic Acid (DHA) and the Developing Central Nervous System (CNS)\u2014Implications for Dietary Recommendations","volume":"93","author":"Guesnet","year":"2011","journal-title":"Biochimie"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1097\/MPG.0b013e31819773cf","article-title":"Omega-3 Fatty Acids and Neural Development to 2 Years of Age: Do We Know Enough for Dietary Recommendations?","volume":"48","author":"Innis","year":"2009","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102010","DOI":"10.1016\/j.cdnut.2023.102010","article-title":"Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Erythrocyte Membrane Docosahexaenoic Acid Concentrations and Alters Infant n\u20136:N\u20133 Fatty Acid Ratio","volume":"7","author":"Khandelwal","year":"2023","journal-title":"Curr. Dev. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1080\/09637486.2020.1746958","article-title":"Is Fatty Acid Composition of Breast Milk Different in Various Populations? A Systematic Review and Meta-Analysis","volume":"71","author":"Bahreynian","year":"2020","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Basak, S., Mallick, R., Banerjee, A., Pathak, S., and Duttaroy, A.K. (2021). Maternal Supply of Both Arachidonic and Docosahexaenoic Acids Is Required for Optimal Neurodevelopment. Nutrients, 13.","DOI":"10.20944\/preprints202104.0665.v3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100161","DOI":"10.1016\/j.advnut.2023.100161","article-title":"Docosahexaenoic Acid","volume":"15","author":"Richard","year":"2024","journal-title":"Adv. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1093\/advances\/nmac097","article-title":"Human Milk Lipid Profiles around the World: A Systematic Review and Meta-Analysis","volume":"13","author":"Zhang","year":"2022","journal-title":"Adv. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2675","DOI":"10.1017\/S1368980016000707","article-title":"An Updated Review of Worldwide Levels of Docosahexaenoic and Arachidonic Acid in Human Breast Milk by Region","volume":"19","author":"Fu","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s13594-013-0125-6","article-title":"Relationship between Mediterranean Diet and Breast Milk Fatty Acid Profile: A Study in Breastfeeding Women in Croatia","volume":"93","year":"2013","journal-title":"Dairy Sci. Technol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102248","DOI":"10.1016\/j.plefa.2021.102248","article-title":"Baseline Red Blood Cell and Breast Milk DHA Levels Affect Responses to Standard Dose of DHA in Lactating Women on a Controlled Feeding Diet","volume":"166","author":"Jackson","year":"2021","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_15","unstructured":"World Health Organization (2024, September 17). The Global Health Observatory\u2014Body Mass Index. Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/topic-details\/GHO\/body-mass-index."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jada.2010.10.007","article-title":"Validation of a Food Frequency Questionnaire to Assess Intake of N-3 Polyunsaturated Fatty Acids in Subjects with and without Major Depressive Disorder","volume":"111","author":"Sublette","year":"2011","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_17","unstructured":"(2026, August 01). U.S. Department of Agriculture FoodData Central: Foundation Foods 2023, Available online: https:\/\/fdc.nal.usda.gov\/."},{"key":"ref_18","unstructured":"(2026, August 01). National Food Institute Technical University of Denmark Food Data 2019. Available online: https:\/\/fcdb.fooddata.dk\/search."},{"key":"ref_19","unstructured":"(2021, February 12). European Food Safety Authority Nutrient Recommendations. Available online: https:\/\/efsa.gitlab.io\/multimedia\/drvs\/index.htm."},{"key":"ref_20","unstructured":"(2014). Animal and Vegetable Fats and Oils\u2014Gas Chromatography of Fatty Acid Methyl Esters\u2014Part 1: Guidelines on Modern Gas Chromatography of Fatty Acid Methyl Esters (Standard No. ISO 12966-1:2014)."},{"key":"ref_21","unstructured":"(2017). Animal and Vegetable Fats and Oils\u2014Gas Chromatography of Fatty Acid Methyl Esters\u2014Part 2: Preparation of Methyl Esters of Fatty Acids (Standard No. ISO 12966-2:2017)."},{"key":"ref_22","unstructured":"(2015). Animal and Vegetable Fats and Oils\u2014Gas Chromatography of Fatty Acid Methyl Esters\u2014Part 4: Determination by Capillary Gas Chromatography (Standard No. ISO 12966-4:2015)."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"European Food Safety Authority (2014). Scientific Opinion on Health Benefits of Seafood (Fish and Shellfish) Consumption in Relation to Health Risks Associated with Exposure to Methylmercury. EFSA J., 12, 3761.","DOI":"10.2903\/j.efsa.2014.3761"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mile\u0161evi\u0107, J., Zekovi\u0107, M., \u0160arac, I., Knez, M., Krga, I., Taki\u0107, M., Marta\u010di\u0107, J.D., Stevanovi\u0107, V., Vidovi\u0107, N., and Rankovi\u0107, S. (2025). Energy and Macronutrient Dietary Intakes of Serbian Adults 18\u201364 Years Old: EFSA EU Menu Food Consumption Survey in Serbia (2017\u20132022). Foods, 14.","DOI":"10.3390\/foods14071228"},{"key":"ref_25","unstructured":"European Food Safety Authority (2021, October 26). The EFSA Comprenhensive European Food Consumption Database. Available online: https:\/\/www.efsa.europa.eu\/en\/data-report\/food-consumption-data#the-efsa-comprehensive-european-food-consumption-database."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00431-014-2411-6","article-title":"Contribution of N-3 Long-Chain Polyunsaturated Fatty Acids to Human Milk Is Still Low in Hungarian Mothers","volume":"174","author":"Lohner","year":"2015","journal-title":"Eur. J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.foodchem.2004.09.026","article-title":"Fatty Acid Composition of Mature Breast Milk in Brazilian Women","volume":"93","author":"Silva","year":"2005","journal-title":"Food Chem."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"De Bernardo, G., Leone, G., Izzo, F., Giovengo, M., Basilicata, M.G., Centanni, F., Morlino, F., Salviati, E., Giordano, M., and Perrone, S. (2025). Fatty Acid Profiling of Breast Milk at Different Gestational Ages. Nutrients, 17.","DOI":"10.3390\/nu17162672"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Vizzari, G., Morniroli, D., Alessandretti, F., Galli, V., Colombo, L., Turolo, S., Syren, M.-L., Pesenti, N., Agostoni, C., and Mosca, F. (2022). Comparative Analysis of Docosahexaenoic Acid (DHA) Content in Mother\u2019s Milk of Term and Preterm Mothers. Nutrients, 14.","DOI":"10.3390\/nu14214595"},{"key":"ref_30","first-page":"e6483","article-title":"Perinatal Benefits and Recommendations of Docosahexaenoic Acid and Arachidonic Acid","volume":"63","year":"2025","journal-title":"Rev. Med. Inst. Mex. Seguro Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1093\/ajcn\/85.6.1457","article-title":"Docosahexaenoic and Arachidonic Acid Concentrations in Human Breast Milk Worldwide","volume":"85","author":"Brenna","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.plefa.2015.01.005","article-title":"Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Plasma Docosahexaenoic Acid Concentrations and Alters Infant Omega 6:3 Fatty Acid Ratio","volume":"95","author":"Sherry","year":"2015","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.clnesp.2024.09.029","article-title":"Maternal High-Dose Docosahexaenoic Acid Supplementation and Neurodevelopment at 5 Years of Preterm Children","volume":"64","author":"Paquet","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_34","first-page":"e9865","article-title":"Frequency of Consumption of Different Fish, Crustacean and Mollusc Species Contributing to Methylmercury Exposure and Consumer Awareness of National Advice on Their Consumption","volume":"24","author":"Bearth","year":"2026","journal-title":"EFSA J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.earlhumdev.2010.01.003","article-title":"Docosahexaenoic Acid (DHA): From the Maternal\u2014Foetal Dyad to the Complementary Feeding Period","volume":"86","author":"Agostoni","year":"2010","journal-title":"Early Hum. Dev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.plefa.2017.09.005","article-title":"DHA and ARA Addition to Infant Formula: Current Status and Future Research Directions","volume":"128","author":"Lien","year":"2018","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/MPG.0000000000003642","article-title":"Enteral Nutrition in Preterm Infants (2022): A Position Paper from the ESPGHAN Committee on Nutrition and Invited Experts","volume":"76","author":"Embleton","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_38","unstructured":"European Comission (2016). Commission Delegated Regulation (EU) 2016\/127 of 25 September 2015 Supplementing Regulation (EU) No 609\/2013 of the European Parliament and of the Council as Regards the Specific Compositional and Information Requirements for Infant Formula and Follow-on Formula and as Regards Requirements on Information Relating to Infant and Young Child Feeding. Off. J. Eur. Union, 25, 1\u201329."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1515\/JPM.2008.001","article-title":"The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: Review of current knowledge and consensus recommendations","volume":"36","author":"Koletzko","year":"2008","journal-title":"J. Perinat. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.jpeds.2012.11.052","article-title":"Lipid needs of preterm infants: Updated recommendations","volume":"162","author":"Lapillonne","year":"2013","journal-title":"J. Pediatr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2761\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:29:31Z","timestamp":1787563771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":40,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18172761"],"URL":"https:\/\/doi.org\/10.3390\/nu18172761","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}