Infant nutrition experts strongly recommend ARA paired with DHA in infant and follow-on formula
Talking Nutrition Editors
Experts weigh in
- New mandates from European regulation are changing the makeup of infant and follow-on formulas in the EU beginning in February 2020.
- Twenty-six international nutrition experts met to evaluate the latest DHA and ARA science and explore questions raised by the new regulation.
- Renowned nutrition experts published a new paper stating that infant and follow-on formula should provide both DHA and ARA.
European regulation for DHA and ARA
European regulation (EU 2016/127) mandates that from February 2020 onward, all infant formula (IF) and follow-on formulas (FOF) marketed in the European Union must contain 20-50mg DHA/100kcal (the equivalent of 0.5-1% of total fatty acids), however arachidonic acid (ARA) remains an optional ingredient and is not required to be added to the finished product. This level of DHA is higher than typically reported in breast milk and what is found in current infant formula products. The new regulation has prompted considerable concerns within the infant nutrition industry and among nutrition experts, who consider this a novel approach to the composition of IF and FOF, and in the absence of credible data available to document the safety and suitability for use in healthy infants.
What nutrition experts are saying
A position paper from the European Academy of Paediatrics and the Child Health Foundation titled “Should formula for infants provide arachidonic acid along with DHA?” was recently published in the American Journal of Clinical Nutrition1. The position paper describes the key findings and conclusions from a meeting of 26 international nutrition experts who met to evaluate the most current DHA and ARA science and explore questions raised by the composition of IF and FOF permitted in the EU as a result of the new regulation (EU 2016/127).
DSM’s Nutritional Science and Advocacy (NSA) team of experts reviewed the position paper and developed the following summary of expert opinions.
All infant and follow-on formula should provide both DHA and ARA
DHA should equal at least 0.3% of the total fatty acids (the mean content in breast milk globally), but preferably reach 0.5% of total fatty acids (the equivalent to the mean + one standard deviation). Providing DHA at 0.5% of total fatty acids was preferred as this would cover the higher needs of some infants who carry variants in genes that reduce the activity of enzymes critical for the synthesis of DHA and ARA. These genetic variants impact ARA more than DHA, resulting in particularly low levels of ARA without the provision of a dietary source of ARA2,3. According to expert opinion, it is likely that the ARA present in breast milk is important in reducing the risk of asthma and the improved cognitive development reported in studies of breast fed infants who were genetically predisposed to a low synthesis of ARA.
Supplementation with ARA is strongly recommended when DHA is added
The experts note that it is yet to be determined what the minimal and optimal intake levels of ARA will be. However, with levels of DHA up to 0.64% of total fatty acids, they recommend adding ARA in at least equal amounts to that of DHA, which is in line with the recommendation of the Codex Alimentarius. With regard to the ratio of DHA to ARA, clinical studies that examined the ratio of DHA to ARA in formula indicate that high DHA intakes without balanced levels of ARA may induce undesirable effects in infants, such as a reduced ARA concentration in brain tissue, suboptimal neurodevelopment and potentially adverse effects on growth and immune development.
More research is needed
The experts reference the precautionary principle which is usually applied when scientific evidence cannot resolve all the uncertainty regarding the possibility of risks. The experts from the European Academy of Paediatrics and the Child Health Foundation recommend that infants should not be fed formula with high DHA contents without the addition of ARA unless there is a thorough evaluation of this novel approach that is performed and evaluated by independent scientific experts.
DSM also supports the use of both DHA and ARA in formulas intended for infants at the ratios found in breast milk during the critical early life stage. DSM works as a partner with manufacturers of infant nutrition products to develop solutions that support healthy infant growth and development.
Read the full position paper published in The American Journal of Clinical Nutrition, “Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation.”
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- Koletzko B, Bergman K, Brenna TJ, Calder PC, Campoy C, Clandinin MT, Colombo J. Daly M, Decsi T, Demmelmair H, Domellöf M, Mis NF, Gonzales-Casanova I, Van Goudoever JB, Hadjipanayis A, Hernell O, Lapillone A, Mader S, Martin CR, Matthäus V, Ramakrishan U, Smuts CM, Strain SJJ, Tanjung C, Tounian P & Carlson SE 2019, “Should Formula for Infants provide arachidonic acid along with docosahexaenoic acid? A position paper of the European Academy of Pediatrics and the Child Health Foundation”. AJCN 2019 (in Press).
- Salas Lorenzo I, Chisaguano Tonato AM, de la Garza Puenbtes A et al.; “The Effect of Infant Formula Supplemented with AA and DHA on Fatty Acid Levels of infants with Different FADS genotypes: the COGNIS study”; Nutrients 2019; 11(3):602.
- Tanjung C, Rzehak P, Sudoyo H et al.; “The effect of fatty acid desaturase gene polymorphisms on long chain polyunsaturated fatty acid composition in Indonesian infants”; Am J Clin Nutr 2018: 1135-44.
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