Why are DHA and ARA so Important for Infant Nutrition?

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are long-chain polyunsaturated fatty acids (LC-PUFAs), that play a crucial role in infant growth and development.1,2,10,11,12,13,14,16 DHA is the most abundant omega-3 fatty acid in the brain and the retina of the eye, representing about 97% and 93% of all the omega-3 fatty acids found in the brain and eyes.1,2  ARA is the primary omega-6 fatty acid in the brain, representing about 48% of the omega-6 fats found there.2  Recent findings suggest DHA and ARA have positive effects on a child’s development when provided together and in efficacious levels, during infancy.11,16  DHA supports brain and cognitive development, mental adaptability and problem solving, visual development, attention and information processing10,11,12,13,16 while ARA may play a role in supporting development of a healthy immune system, bone formation, blood flow and blood vessel function.14,15


Breast milk is the gold standard for infant feeding and naturally contains both DHA and ARA, typically with ARA levels higher than those of DHA.3,4 Experts in infant nutrition have endorsed the presence of both DHA and ARA in infant and follow-on formula during this critical window of development..5,6,7,8,9,17

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References

1. Dobbing, J. and J. Sands, Quantitative growth and development of human brain. Arch Dis Child, 48(10): p. 757--‐67, 1973. Lipid Res, 40(1--‐2): p. 1--‐94, 2001.

2. Martinez, M., Tissue levels of polyunsaturated fatty acids during early human development. J Pediatr, 120(4 Pt 2): p. S129--‐38, 1992.

3. Brenna, J. et al., ‘Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide’, Am J Clin Nutr., vol. 85, no. 6, pg. 1457-1464, 2007.

4. Fu, Y. et al., ‘An updated review of worldwide levels of docosahexaenoic and arachidonic acid in human breast milk by region’, Public Health Nutr., vol. 19, no. 15, pg. 2677-2687, 2016.

5. Tounian, P. et al., ‘Why to care about lipid deficiencies in paediatrics?’, Réalitiés Pédiatriques, 2019.

6. Brenna, J. et al., ‘Arachidonic acid needed in infant formula when docosahexaenoic acid is present’, Nutr Rev., vol. 74, no. 5, pg. 329-326, 2016.

7. Crawford, M. et al., ‘The European Food Safety Authority recommendation for polyunsaturated fatty acid composition of infant formula overrules breast milk, puts infants at risk, and should be revised’, Prostaglandins Leukot Essent Fatty Acids, vol. 102-103, pg. 1-3, 2015.

8. Koletzko, B. et al., ‘Should infant formula provide both omega-3 DHA and omega-6 arachidonic acid’, Ann Nutr Metab., vol. 66, no. 2-3, pg. 137-138, 2015.

9. Koletzko, B. et al., “Should Formula for Infants provide arachidonic acid along with docosahexaenoic acid? A position paper of the European Academy of Paediatrics and the Child Health Foundation”. Am J Clin Nutr., 2019 (in Press).

10. 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.

11. Birch, E. et al., 'The DIAMOND (DHA intake and measurement of neural development) study: a double-masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid' Am J Clin Nutr., vol. 91, no.4, pg. 848–859, 2010.

12. Lien, E. L. 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.

13. Willatts, P. et al., ‘Effects of nutrition on the development of higher-order cognition’, Nestle Nutr Inst Workshop Ser., vol. 89, pg. 175-184, 2018.

14. Richard, C. et al., ‘Evidence for the essentiality of arachidonic and docosahexaenoic acid in the postnatal maternal and infant diet for the development of the infant’s immune system early in life’, Appl Physiol Nutr Metab., vol. 41, no. 5, pg. 461-75, 2016.

15. Hadley, B. et al., ‘The essentiality of arachidonic acid in infant development’, Nutrients, vol. 8, no. 4, pg. 216, 2016.

16. Lepping, R. J. et al., ‘Long-chain polyunsaturated fatty acid supplementation in the first year of life affects brain function, structure and metabolism at nine years of age’, Dev Psychobiol., 2018.

17. Forsyth, S. et al., ‘Dietary intakes of arachidonic acid and docosahexaenoic acids in early life – with a special focus on complementary feeding in developing countries’, Ann Nutr Metab., vol. 70, no. 3, pg. 217-227, 2017.

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