Associations of whole blood polyunsaturated fatty acids and insulin resistance among European children and adolescents


This study aims to examine the association of whole blood n-3 and n-6 polyunsaturated fatty acids (PUFA) with insulin resistance (IR) in children. Whole blood fatty acids were measured in 705 children aged 2–9 years of the European IDEFICS/I.Family cohort using gas chromatography in units of weight percentage of all detected fatty acids (%wt/wt). IR was determined by the Homeostasis Model Assessment for IR (HOMA). Mixed effect models were used to assess the associations between selected baseline PUFA and HOMA z-scores at baseline and after 2- and 6-year follow-ups using models with basic and additional confounder adjustment as well as stratified by sex and weight status. In the basic model, α-linolenic (β = 1.46 SD/%wt/wt, p = 0.006) and eicosapentaenoic acid (β = 1.17 SD/%wt/wt, p = 0.001) were positively associated with baseline HOMA z-score. In the stratified analyses, α-linolenic acid was positively associated with HOMA z-score in girls only (β = 1.98 SD/%wt/wt, p = 0.006) and arachidonic acid was inversely associated with baseline HOMA in thin/normal-weight children (β = − 0.13 SD/%wt/wt, p = 0.0063). In the fully adjusted model, no statistically significant associations were seen.

Conclusions: Our overall results do not indicate a protective role of higher blood n-3 PUFA or an adverse role of higher blood arachidonic acid proportion on the risk of IR.

What is Known:
•Intervention studies reported a beneficial effect of n-3 PUFA supplementation on insulin resistance compared with placebo while observational studies in cildren are inconclusive.
•Studies have shown a positive association of n-6 arachidonic acid and insulin resistance indicating an adverse role of arachidonic acid.
What is New:
•Cross-sectional and longitudinal analyses based on circulating blood fatty acid concentrations in a large cohort of European children and adolescents.
•Overall results do not support a protective role of n-3 PUFA or an adverse role of arachidonic acid in insulin resistance.

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Fig. 1



α-Linolenic acid


Body mass index


Docosahexaenoic acid


Eicosapentaenoic acid


Fatty acids


Homeostasis Model Assessment for insulin resistance


Identification and prevention of dietary- and lifestyle-induced health effects in children and adolescents


Insulin resistance


Insulin sensitivity


International Standard Classification of Education


Polyunsaturated fatty acids


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This work was done as part of the IDEFICS study ( and the I.Family Study ( The authors wish to thank the IDEFICS/I.Family children and their parents for participating in the extensive examinations. We are grateful for the support of school boards, head teachers and communities. The authors cordially thank Dr. Florence Samkange-Zeeb for the English language editing of the manuscript.


This study was supported by the European Commission within the Sixth RTD Framework Programme (Contract No. 016181 (FOOD)) for the IDEFICS study and within the Seventh RTD Framework Programme (Contract No. 266044) for the I.Family study.

Author information





Conceptualization, MW. Formal Analysis, CB, SM. Acquisition of data, KM, PRu, LAM, SDH, TV, DM, MT, PRi. Writing-original draft, SM. Writing-review & editing, MW, CB, KM, PRu, LAM, SDH, TV, DM, MT, PRi. All authors including SM, CB, KM, PRu, LAM, SDH, TV, DM, MT, PRi, MW have read and approved the final manuscript.

Corresponding author

Correspondence to Maike Wolters.

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Ethical approval was obtained from all participating study centers.

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The authors declare that they have no conflict of interest.

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Sarah Marth and Claudia Börnhorst shared first authorship.

Communicated by Gregorio Paolo Milani

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Marth, S., Börnhorst, C., Mehlig, K. et al. Associations of whole blood polyunsaturated fatty acids and insulin resistance among European children and adolescents. Eur J Pediatr 179, 1647–1651 (2020).

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  • Children
  • HOMA
  • Insulin resistance
  • n-3 fatty acids
  • n-6 fatty acids
  • Polyunsaturated fatty acids