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Investigating the Latest Science on the Impact of Nutrition on Infant Health and Development

NUTRI-FACTS Editor

April 30, 2019

NUTRI-FACTS recently attended the 20th Journées Interactives de Réalités Pédiatriques (JIRP) in Versailles, France – a leading pediatric conference that reports on the latest research and scientific developments in infant and child health. Good nutrition throughout the first 1,000 days – between the onset of a woman’s pregnancy and her child’s second birthday – was a key focus during the event. The importance of dietary fats, including the long-chain polyunsaturated fatty acids (LCPUFAs), docosahexaenoic acid (DHA) and arachidonic acid (ARA), in particular, was also highlighted.

DHA and ARA are essential for infant development

DHA and ARA are the primary omega-3 and omega-6 LCPUFAs found naturally in breast milk and are passed preferentially across the placenta to the infant during pregnancy. Research presented at JIRP showed that DHA levels can vary in breast milk depending on maternal dietary intake, whereas ARA levels are more constant. (1)  The consistency of ARA level in breast milk suggests that it has an important role in infant health and development. Recent studies show that DHA and ARA, when supplemented together during the first 12 months of life, can have a positive impact on cognitive development of a child, including supporting brain structure and function, through 9 years of age. (2,3)  Furthermore, research spanning 20 years highlights the important roles DHA and ARA play in visual development and function, blood flow, and development and function of the immune system during infancy. (4-6)  As DHA and ARA fatty acids are clearly important for infant growth and development it is therefore recommended that infants receive formulas that are supplemented with both DHA and ARA when breastfeeding is not possible.

New EU regulation for formulas intended for infants

Despite this evidence, recent changes in EU regulation, governing the composition of formulas intended for infants, now mandate that DHA must be added to these formulas, whereas the addition of ARA is at the discretion of manufacturers. (7)  The Commission Delegated Regulation (EU) 2016/127 of 25 September 2015 regarding formulas intended for infants states that a minimum addition of 20 mg of DHA/ 100 kcal is essential to infant health and development, while ARA remains an optional ingredient. (8)  These legal specifications, which become mandatory as of February 2020 onwards, has prompted concerns from several scientific experts who have suggested this may have the potential for unintended consequences. They describe the need for further research to determine if products supplemented with the newly mandated levels of DHA, but without ARA, will support adequate infant growth and development. (9-12)  Given the vulnerability of infants, and expert concerns regarding the lack of research, NUTRI-FACTS concluded that it may be premature to provide infants with nutrition products which diverge from the composition of breast milk. As such, there is a need to consider including ARA in addition to DHA, and not just DHA alone, in stage 1 formula.

Ensuring the balance between DHA and ARA in formulas intended for infants

DHA and ARA status, as well as the balance between the fatty acid levels, should be considered to ensure optimal infant development and health. (13)  The science behind this was explained at JIRP; omega-3 and omega-6 fatty acid families compete for the same enzymes that are responsible for the conversion of dietary precursors to DHA and ARA. Too much omega-6 compared to omega-3 can limit DHA synthesis, whereas too much omega-3 compared to omega-6 fatty acids can limit ARA synthesis. Moreover, genetic polymorphisms in elongase or desaturase enzymes responsible for the synthesis of DHA and ARA, affect normal enzyme activity which may lead to lower levels of the fatty acids in infants. New research has identified groups of infants who may require higher levels of DHA and ARA to compensate for the negative effects of these genetic polymorphisms. (14,15)

In light of this research, national regulations permit supplementation of nutritional formulas intended for infants with DHA and ARA at ratios of 1:1 to 1:2. (16,17)  This not only provides a balance that is reported in breast milk, but it also supports optimal infant growth and development as demonstrated by extensive research. However, vegetarian mothers, who do not eat oily fish such as sardines, salmon or mackerel which are rich in DHA, may be at risk of inadequate intake of the fatty acid and lower levels of DHA in their breast milk. It is therefore recommended that they try to consume 1-2 portions of oily fish per week or increase their intake of DHA via alternative sources, such as algal-based or fish oil supplements, to reach optimal amounts of DHA in breast milk.

The future of infant nutrition solutions

New research continues to identify nutrients and bioactive factors in human milk that are not currently present in infant nutrition products. Based on this evidence, the ingredients used in infant nutrition products will continue to evolve to support growth and development during a critical stage of life.

To stay updated on the latest research and regulation impacting early life nutrition, follow NUTRI-FACTS on Facebook at @Understanding.vitamins

References

  1. Fu Y. et al., ‘An updated review of worldwide levels of docosahexaenoic and arachidonic acid in human breast milk by region’, Public Health Nutrition, vol. 19, no. 15, pg. 2675-2687, 2016.
  2. Lepping RJ. et al., ‘Long‐chain polyunsaturated fatty acid supplementation in the first year of life affects brain function, structure, and metabolism at age nine years’, Developmental Psychobiology, vol. 61, pg. 5-16, 2019.
  3. Colombo J et al., ‘Long-term effects of LCPUFA supplementation on childhood cognitive outcomes’, Am J Clin Nutr., vol.  98, no. 2, pg. 403–412, 2013.
  4. Lien EL. et al.,  ‘DHA and ARA addition to infant formula: Current status and future research directions’, Prostaglandins Leukot Essent Fatty Acids, vol. 128, pg. 26-40, 2018.
  5. Crawford MA. et al.,  ‘The European Food Safety Authority recommendation for polyunsaturated fatty acid composition of infant formula overrules breast milk, puts infant at risk, and should be revised’, Prostaglandins Leukot Essent Fatty Acids, vol. 102 -103, pg. 1-3, 2015.
  6. Richard C., et al., ‘Evidence for the essentiality of arachidonic acid and docosahexaenoic acid in the post natal maternal and infant diet for the development of the infants immune system early in life’, Appl Physiol Nutr Metab, vol. 41, no. 5, pg.461-75, 2016.
  7. China: National Food Safety Standards (GB 10765-2010 Infant Formula) and GB 10767-2010 Formula for Older Infants and Young Children); Australia New Zealand Food Safety Code Standard 2.9.1 (Infant Formula Products), Indonesia: Infant Formula and Infant Formula for Special Medical Purposes (Number HK.00.05.1.52.3920); Vietnam National Technical Regulations for Infant Formula QCVN 11-1:2012/BYT and Vietnam National Technical Regulations for Follow Up Formula for Infants aged 6-36 months QCVN 11-3:2012/BYT; Brazil: Technical Regulations for Infant Formula No. 43, 19 Sept 2011 and Technical Regulations for Follow Up Formula for infants and Young Children No. 44, 19 Sept 2011; US FDA GRAS notifications for DHA in infant formula; NORMA Oficial Mexicana NOM-131-SSA1-2012; Codex Standard for Infant Formula (CODEX STAN 72-1981), revised in 2007.
  8. 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, [website], https://eur-lex.europa.eu/eli/reg_del/2016/127/oj, accessed 26 April 2019.
  9. Koletzko B. et al., ‘Should Infant formula provide both omega- 3 DHA and Omega- 6 ARA?’, Ann Nutr Metab, vol. 66, pg. 137-138, 2015.
  10. Crawford MA. et al., ‘New European Food Safety Authority recommendation for infant formulae contradicts the physiology of human milk and infant development’, Nutrition and Health, vol. 2, no.2, pg. 81-87, 2013.
  11. Op. Cit. (Crawford, 2015)
  12. Brenna JT., ‘Arachidonic acid needed in infant formula when docosahexaenoic acid is present’, Nutrition Reviews, vol. 74, no.5, pg. 329-336, 2016.
  13. Colombo J. et al., ‘Docosahexaenoic acid (DHA) and arachidonic acid (ARA) balance in developmental outcomes’, Prostaglandins Leukot Essent Fatty Acids, vol. 121, pg.52-56, 2017.
  14. M. Lankinen et al., ‘Genes and dietary fatty acids in regulation of fatty acid composition of plasma and erythrocyte membranes’, Nutrients, vol. 10, no. 11, pg. 1785, 2018.
  15. Salas- Lorenzo I. et al., ‘The Effect of an Infant Formula Supplemented with AA and DHA on Fatty Acid Levels of Infants with Different FADS Genotypes: The COGNIS Study’, Nutrients, vol. 12, no. 3, pg. 11, 2019.
  16. Op. Cit. (EU regulations).
  17. Op. Cit. (Fu, 2016).