The importance of good nutrition for infant growth and development

• The 20th Journées Interactives de Réalités Pédiatriques (JIRP) pediatric conference took place in Versailles, France last month and Talking Nutrition attended to hear the latest developments in infant nutrition.
  
• The first 1,000 days, 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.
  
• The Commission Delegated Regulation (EU) 2016/127 of 25 September 2015 regarding infant nutrition products is due to become mandatory from February 2020. As a result, Talking Nutrition is interested in science related to the importance of nutritional lipids, DHA and ARA, for healthy growth and development.
  
• Not only achieving adequate amounts, but also the right balance between DHA and ARA levels is key, at a time when both are needed for infant health and development, particularly for the brain.

A focus on infant nutrition

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 composition and the significance of DHA and ARA

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

New EU regulation impacts infant products

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.

DHA and ARA should both be supplemented in formulas intended for infants

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.