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.