Serum ω-3 PUFAs are associated with favorable scholastic outcomes in Ugandan adolescents regardless of perinatal HIV status.

BACKGROUND: Associations between fatty acids (FAs) and scholastic outcomes in adolescents are understudied. These relationships may be especially important in adolescents with perinatal HIV exposure or infection who are more vulnerable to FA insufficiency and educational disruption. OBJECTIVE: To evaluate associations between baseline FAs, including essential FA deficiency (EFAD), and scholastic outcomes over 18 months, and to assess heterogeneity by perinatal HIV status among Ugandan adolescents METHODS: Adolescents (n=373) were followed for 18 months. Baseline serum FAs, including the triene:tetraene (T:T) ratio, were categorized into tertiles ("low", "moderate", and "high"). Scholastic outcomes were assessed every six months via questionnaires. Self-report scholastic disadvantage, school aversion, and teacher challenge were age- and sex-standardized to z-scores; grade repetition, non-enrollment, and morbidity-related educational loss were dichotomous. Time-averaged mean differences (MDs) or odds ratios (ORs) and 95% confidence intervals (CIs) were measured using adjusted linear mixed-effects models or generalized estimating equations. FA*HIV interactions assessed heterogeneity by perinatal HIV status. RESULTS: Moderate v. low total ω-3 polyunsaturated FAs (PUFAs) were associated with lower teacher challenge (MD [95% CI]: -0.27 [-0.47, -0.07]), whereas a higher ω-6:ω-3 ratio was associated with greater teacher challenge (0.30 [0.07, 0.52]). Contrary to hypotheses, a high v. low T:T ratio was associated with lower school aversion (-0.36 [-0.73, 0.00]) and non-enrollment odds (OR [95% CI]: 0.57 [0.35, 0.94]). High Mead acid levels, however, correlated with higher odds of morbidity-related educational loss (2.48 [1.01, 6.15]). Associations were more consistent for standardized z-score outcomes than dichotomous outcomes. When heterogeneity was present, associations differed by HIV status, with patterns varying across outcomes. CONCLUSIONS: ω-3 PUFAs and the ω-6:ω-3 ratio were more consistently associated with scholastic outcomes than EFAD markers, highlighting the importance of ω-3 PUFA status among adolescents affected by perinatal HIV. Future studies may consider these findings to develop tailored nutritional interventions.