The development of human body is tightly interlinked with the essential organ system development from the infancy. To accomplish this, the required constituents are needed by the body on time. This is nothing but the supplementation of nutrients to the body, which in general, is taken up from outside food sources and by the human body itself that synthesizes some nutrients.
Especailly, women who feed the new born or infant through the breast milk are self potent. Breast milk has good nutrient constituents like vitamin A, n-3 and n-6 fatty acids as important constituents of diet needed for development of retina and brain (Innis 2004). N-3 fatty acid docosahexaenoic acid (DHA) is mostly deposited in grey matter of brain and the visual components of retina. In the modern clinical research differences in the composition of DHA particularly of n-6 and n-3 fatty acids and infant formulas is a matter of debate. This could be due to the fact that considerable variations in various women population with regard to breast milk’ fatty acid content and its impact on growth an development of infant (Innis 2004).
Large number of commercial manufacturers of infant supplements has sprouted up like mushrooms. The bone of contention is to provide a high quality infant supplement equivalent to or even superior to breast milk. Addition of long-chain polyunsaturated fatty acids including docosahexaenoic acid (DHA) and arachidonic acid (AA), to the supplement formula is making the product a success in the market.
There is a need to carry out a review to determine whether these long-chain polyunsaturated fatty acids are beneficial or harmful to the infant growth.
In detail, the role of long-chain polyunsaturated fatty acids abbreviated as LCPUFAs in human milk is very huge.
The 2 most widely present LCPUFAs are that of docosahexaenoic acid (DHA) and arachidonic acid (ARA) in the region of brain. They possess a very structural and significant role in the development of infant. This is because located in the prefrontal cortex, DHA serves for the short-term memory and association in certain cells of retina. During the first year of life, in human breast milk proportions of PUFAs are very consistent. This contributes to the red blood cell greater proportion of DHA and its greater mean weight percentage in contrast to formula-fed infant supplement. In addition, DHA of cortex in breast fed infants gradually increases with development because of feeding duration. Human breast milk’s LCPUFA composition is largely influenced by smoking, parity, gestational age and diet.
Supplements or formula feeds encompassing DHA and ARA also lead to development of infants equivalent to breast-feeding, and has beneficial effect on childhoods blood pressure in the later stages (Agostoni, 2008). Both DHA and AA are considered as the biomembrane structural lipid components. Their successful role during infant stages is more connected to their inter-placental transport. These agents are transported to the fetus from mother across the placenta during pregnancy.
Once the baby is born, they will have potential to yield AA from linoleic acid and DHA from alpha-linolenic acids as revealed by stable isotope study demonstration (Larque, Demmelmair & Koletzko, 2002). This is common for both preterm and full term babies (Larque, Demmelmair & Koletzko, 2002).
LC-PUFA is previously produced from breast milk and there will be increased tissue and plasma phospholipid levels in breast fed infants when compared to infant formulas of native type (Larque, Demmelmair & Koletzko, 2002).
This has strengthened a report that described the significance of PUFA in preterm and term infants. According to this study, breast-fed infants have increased DHA status compared to formula based infant supplements when they lack LCPUFA in formulas. Infants of preterm age require an outside supply of AA and DHA in order to obtain the equal benefits of breast-fed infants with regard to fatty acid in plasma and RBC (red blood cell) composition.
Enhanced scores were observed in infants fed with DHA and AA with regard to their development skills(Fleith and Clandinin, 2005). Parameters like anthropometrics, body weight, and growth are similar for preterm and term infants fed formulas that had both n-3 and n-6 LCPUFA fatty acids. Infants fed formulas without LCPUFA also had similar effect on preterm and term infants (Fleith and Clandinin 2005). However, in a long-term feeding study of preterm infants, developmental scores and enhanced growth was observed indicating the need for LCPUFA. It was recommended that LCPUFA intake should be facilitated as that of human milk. This is accomplished by the combined AA to DHA ratio of 1. 5 with 0. 4% of DHA content. Compared to term infants, at moderate level, infants of preterm age will be beneficial from increased amount of fatty acids (Fleith and Clandinin, 2005).
This is because, an improvement in the status of fatty acid was observed for several weeks, with feeding levels greater than 0. 2% DHA and 0. 3% AA. When formula lacks the presence of AA forever, it provides the AA and DHA status more equivalent to human milk fed infants. Hence, for term infants, the LCPUFA addition in infant formulas with suitable qualitative and quantitative qualities is reliable and facilitates the development of similar blood LCPUFA status as seen with formula-fed and breast-fed infant (Fleith and Clandinin 2005). Infants fed with infant formulas that contain DHA and ARA of LCPUFA would have good visual and cognitive development. This was revealed in a 39 month follow up study on infants who were randomized based on fed control formula, only DHA, both DHA and ARA intervention groups. Here, important assessments like red blood cell fatty acid levels, morbidity, Growth, were made along with IQ, vocabulary and visual acuity tests (Auestad et al. 2003). Next, DHA and ARA levels maintained in proper ratio in preterm formulas fed for one year contribute to lessened fat mass and increased lean body mass. In infants born with less than 33 week gestation age period, the supplemented feed formulas with DHA and ARA have assisted the routine bone mineralization and growth. Hence, the body composition and growth of premature infants is largely influenced by the LCPUFA (Groh-Wargo et al. 2005). Very often in preterm infants, LCP’s provided in increased concentrations may lead to lipid peroxidation and oxidative stress.
But experiments carried out have demonstrated that DHA and ARA supplemented with high-dose vitamin E have not depleted the tocopherol levels and hypothesized that the stability and solubility of tocopherol could be improved by LCP supplementation. Even, healthy preterm infants, tocopherols deposited in increased levels could be identified. This indicated the influence of LCP on vitamin E functional activity (Rotzoll et al. 2003). Lactating mothers supplemented with low dietary DHA intake for (1200 mg/d) until 36 wk after conception have contributed to high plasma DHA status in very preterm infants. This approach could overcome any DHA deficiency in very preterm infants (Marc et al. 2011).
In spite of health benefits contributed by the presence of LCP in breast milk or supplement formula, certain adverse consequences will also ensue owing to their deficiency. Arachionic acid (AA) is essential for immune functions and preterm neonates are highly vulnerable to infection compared to term neonates. Deficiency of AA may predispose preterm infants to infections (Moodley et al. 2009). Hence, its supplementation is mandatory for preterm and also term infants. Visual anomalies could result in preterm neonates due to deficiency in DHA and AA levels in infant formulas. They may interfere with the sensitive periods of development, amblyopia, or ocular misalignment or visual deprivation mechanism. This could be alleviated by optimized nutrition in infants (Gignac et al. 2011). Experiments have demonstrated that DHA deficiency contribute to decrease in neuron size. This was observed in parietal cortex, hypothalamus, hippocampal regions of brain in rats surviving on diet without DHA (Ahmad, Moriguchi and Salem 2002).
Thus, with this background information, it is essential to recommend the company “Baby Foods ‘R’ Us” with the new formula containing LCP as the main ingredient. More probably, the benefits offered by LCP are huge which made it a preferred formula of choice for infant supplements. In a variety of clinical and non human studies, the findings on LCP have furnished better insights on the role of DHA and AA. DHA is vital for visual and brain functions where as AA is vital for immune system. Both these components when provided in the infant formula would assure good growth and development of infants. It is important to note that even lactating mothers have been fed with LCP which sheds light on the nutritional significance the LCP’s possess.
Regardless of the term of infants, LCPs have become the best exogenous sources by almost mimicking the supplements of breast milk. In terms of all functional outcomes, LCP’s have capability to give rise to a child with a highly intellectual personality. The company should realize the significant information accumulated so far on LCP’s role for infant development and also should perceive the data in an evidence based practice approach. This makes the company’s’ proposed infant product a very authentic and successful piece free from legal and ethical regulations.
Agostoni,C. “Role of long-chain polyunsaturated fatty acids in the first year of life.” J Pediatr Gastroenterol Nutr 47.2 (2008): S41-4.
Ahmad, A, Moriguchi, T and Salem,N. “Decrease in neuron size in docosahexaenoic acid-deficient brain.” Pediatr Neurol 26.3 (2002):210-8.
Auestad, N, Scott, DT, Janowsky, JS, Jacobsen, C, Carroll, RE, Montalto, MB, Halter, R, Qiu, W, Jacobs, JR, Connor, WE, Connor, SL, Taylor, JA, Neuringer, M, Fitzgerald ,KM, Hall, RT. “Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age.” Pediatrics112 (2003):e177-83.
Fleith, M and Clandinin, MT. “Dietary PUFA for preterm and term infants: review of clinical studies.” Crit Rev Food Sci Nutr 45.3 (2005):205-29.
Gignac Brmond,D, Copin, H, Lapillonne, A, Milazzo, S. “Visual development in infants: physiological and pathological mechanisms.” Curr Opin Ophthalmol 22 (2011):S1-8.
Groh-Wargo, S, Jacobs, J, Auestad, N, O’Connor, DL, Moore, JJ, Lerner, E. “Body composition in preterm infants who are fed long-chain polyunsaturated fatty acids: a prospective, randomized, controlled trial.” Pediatr Res 57 (2005): 712-8.
Innis, SM. “Polyunsaturated fatty acids in human milk: an essential role in infant development.” Adv Exp Med Biol 554 (2004):27-43.
Larque, E, Demmelmair, H and Koletzko, B. “Perinatal supply and metabolism of long-chain polyunsaturated fatty acids: importance for the early development of the nervous system.” Ann N Y Acad Sci 967 (2002):299-310.
Marc Isabelle, Lucas Michel, Sterescu Anca, Piedboeuf Bruno, Dufresne, Alexandra, Nuyt Monique Anne, Lvy mile and Dodin Sylvie. “Early Docosahexaenoic Acid Supplementation of Mothers during Lactation Leads to High Plasma Concentrations in Very Preterm Infants.”J. Nutr 141.2 (2004):231-236.
Moodley, T, Vella, C, Djahanbakhch,O, Branford-White, CJ, Crawford, MA. “Arachidonic and docosahexaenoic acid deficits in preterm neonatal mononuclear cell membranes: Implications for the immune response at birth.” Nutr Health 20.2 (2009):167-85.
Rotzoll- Kaempf, DE, Hellstern, G, Linderkamp, O. “Influence of long-chain polyunsaturated fatty acid formula feeds on vitamin E status in preterm infants.” Int J Vitam Nutr Res 73.5 (2003):377-87.