Talking Nutrition Editors
The 20th Journées Interactives de Réalités Pédiatriques (JIRP) is a leading pediatric conference which took place in Versailles, France last month and Talking Nutrition attended to learn more about the latest developments in infant nutrition. The discussions at the conference reinforced the importance of good nutrition throughout the first 1,000 days of a child’s life. This critical stage between the onset of a woman’s pregnancy and her child’s second birthday, is a crucial time in an infant’s growth and development. During this period, adequate nutrient intake is a key factor that supports optimal growth and developmental outcomes and. the role of nutritional lipids in infant nutrition was highlighted at the event.
Breast milk is considered the gold standard for infant feeding and is therefore an important reference in defining the nutritional requirements of infants. The long-chain polyunsaturated fatty acids (LCPUFAs) arachidonic acid (ARA) and docosahexaenoic acid (DHA) are the primary omega-6 and omega-3 (respectively) LCPUFAs found in breast milk and are passed preferentially across the placenta to the infant during pregnancy. While DHA levels can vary depending on individual intake, ARA levels are more constant in breast milk worldwide.1 The consistency of ARA levels in breast milk suggests an important role in infant health and development. Recent studies highlight that DHA and ARA – when provided together – can have a positive effect on brain structure and function through 9 years of age.2 DHA and ARA also support visual development and function, blood flow, and the development and function of the immune system during this critical period.3,4,5
The Commission Delegated Regulation (EU) 2016/127 of 25 September 2015 regarding infant formula and follow-on formula, mandates a minimum of 20 mg DHA/100 kcal, with the addition of ARA being optional. This EU regulation, which becomes mandatory as of February 2020 onwards, has prompted concerns from several scientific experts. These scientists have suggested this may result in a risk of unintended consequences, as this departs from the composition of breast milk and there is a lack of clinical data to determine if infant nutrition products with only DHA added at a minimum of 20 mg/100 kcal will provide the same functional outcomes as those reported in studies supplementing infant nutrition products with DHA and ARA.6,7,8,9 Given the vulnerability of infants, and based on the substantial and growing body of evidence regarding the importance of adequate levels of both DHA and ARA for infant health and development, there is need to consider including ARA in addition to DHA, and not just DHA, in stage 1 infant formula.
Not only the amount but also the balance between DHA and ARA levels is important at a time when both are needed for growth and development, particularly for the brain.10 The omega-3 and omega-6 fatty acid families compete for the same enzymes that are responsible for the synthesis of DHA and ARA respectively. This means that too much omega-6 compared with omega-3 can limit DHA synthesis, whereas too much omega-3 including DHA compared to omega-6 fatty acids can limit ARA synthesis. National regulations permit the addition of DHA and ARA to formulas intended for infants at a ratio of 1:1 to 1:2. These are ratios studied in clinical trials and that mirror levels found in breast milk.11
New research indicates polymorphisms of genes that modulate the activity of enzymes involved in the synthesis DHA and ARA can result in lower levels of DHA and ARA than those found in the breast fed infant.12 This may suggest that some infants could require more DHA and ARA to overcome the effects of genetic polymorphisms that are reported in up to 30% of the EU population.13 Therefore, it is important that the correct amount and type of fatty acids are provided to overcome the effects of genetic polymorphisms.
It is also important to note that mothers with vegetarian diets are at a higher risk of having suboptimal dietary intake of DHA, which is found most commonly in oily fish. To reach adequate amounts of DHA in breast milk, mothers should consume 1-2 portions of oily fish per week or increase their intake of DHA from alternative sources, such as fish oil and algal supplements.
DSM is committed to supporting customers in developing science based infant nutrition products, which contain important nutrients such as ARA and DHA, at levels that are scientifically demonstrated to be safe and effective in supporting the growth and development of the infant.
Sheila Gautier, Nutrition Science and Advocacy at DSM commented, “The composition of breast milk is complex and naturally optimized to support the healthy growth and development of an infant. DSM supports the use of ARA and DHA in formulas intended for infants at the ratios found in breast milk during this important life stage. As highlighted at the JIRP conference, 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 find out more about how DSM supports the development of infant nutrition products for optimal early life nutrition, please contact us.
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.
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.
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.
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.
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.
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.
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.
Op. Cit. (Crawford, 2015)
Brenna JT., ‘Arachidonic acid needed in infant formula when docosahexaenoic acid is present’, Nutrition Reviews, vol. 74, no.5, pg. 329-336, 2016.
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.
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.
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.
Schaeffer L. et al., ‘Common genetic variants of the FADS1 FADS2 gene cluster and their reconstructed haplotypes are associated with the fatty acid composition in phospholipids’, Hum Mol Genet, vol. 15, no. 11, pg. 1745-56, 2006.