Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation
Koletzko B, Bergmann K, Brenna JT, Calder PC, Campoy C, Clandinin MT, Colombo J, Daly M, Decsi T, Demmelmair H, Domellöf M, FidlerMis N, Gonzalez-Casanova I, van Goudoever JB, Hadjipanayis A, Hernell O, Lapillonne A, Mader S, Martin CR, Matthäus V, Ramakrishan U, Smuts CM, Strain SJJ, Tanjung C, Tounian P, Carlson SE (2019) Am J Clin Nutr. 111(1) 10-16. doi: 10.1093/ajcn/nqz252. Epub 12/11/2019
Abstract:
Recently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from February 2020 onwards, all such products marketed in the European Union must contain 20-50 mg omega-3 DHA (22:6n-3) per 100 kcal, which is equivalent to about 0.5-1% of fatty acids (FAs) and thus higher than typically found in human milk and current infant formula products, without the need to also include ω-6 arachidonic acid (AA; 20:4n-6).This novel concept of infant formula composition has given rise to concern and controversy because there is no accountable evidence on its suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and AA, and to discuss the questions arising from the new European regulatory standards.
Based on the available information, we recommend that infant and follow-on formula should provide both DHA and AA. The DHA should equal at least the mean content in human milk globally (0.3% of FAs) but preferably reach 0.5% of FAs. Although optimal AA intake amounts remain to be defined, we strongly recommend that AA should be provided along with DHA. At amounts of DHA in infant formula up to ∼0.64%, AA contents should at least equal the DHA contents.
Further well-designed clinical studies should evaluate the optimal intakes of DHA and AA in infants at different ages based on relevant outcomes.
FAB RESEARCH COMMENT:
See the associated news article:Once again, leading international scientists have expressed their concerns over the EFSA judgement (due to come into effect in 2020) that the important long-chain omega-6 fatty acid arachidonic acid (AA) does not need to be added to infant formula, but that its omega-3 DHA content should be raised.
AA and DHA are both found in human breastmilk; and the expert consensus is that adding both of these LC-PUFA to infant formula is beneficial owing to the critical and complementary roles that these nutrients play in normal brain, cardiovascular and immune development.
In this review, they once again explain why they believe this EFSA judgement to be misguided, and summarise the scientific evidence indicating that adding DHA without AA to infant formula could actually cause harm.
For more information on this subject, see also:
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