Efficacy and safety of docosahexaenoic acid and arachidonic acid addition to infant formulas: can one buy better vision and intelligence?

Breastfeeding may protect against persistent stuttering

PURPOSE

This study investigated the hypothesis that breastfeeding in infancy might protect against persistent stuttering in children.

METHOD

We collected new data from the mothers of current and past participants in the Illinois Stuttering Research Program on their children's feeding history during infancy. We obtained 47 usable responses, for 17 children with persistent stuttering and 30 children who recovered naturally after a period of stuttering.

RESULTS

A chi-squared test for linear trend revealed a significant relationship between breastfeeding duration and the likelihood of natural recovery for the boys in the sample. Mothers of children in the persistent group were no more likely to report early feeding difficulties which might have suggested an underlying oral motor deficit in children predisposed toward persistent stuttering.

CONCLUSIONS

Our results offer preliminary support for the idea that breastfeeding may confer a measure of protection against persistent stuttering. The fatty acid profile of human milk, with its potential to affect both gene expression and the composition of neural tissue, may explain this association. Further research is called for.

LEARNING OUTCOMES

The reader will be able to discuss at least one reason why human milk may make a difference in neurodevelopment generally and with regard to stuttering outcomes specifically. Additionally, the reader will be able to describe the relationship between breastfeeding duration and stuttering recovery observed in this sample.

Preparation of human milk fat substitutes from palm stearin with arachidonic and docosahexaenoic acid: combination of enzymatic and physical methods

Human milk fat substitutes (HMFSs) were prepared by a two-step process, namely, Lipozyme RM IM-catalyzed acidolysis of interesterified high-melting palm stearin with fatty acids from rapeseed oil and blending of the enzymatic product with the selected oils on the basis of the calculation model. The optimum conditions for the enzymatic reaction were a mole ratio of palm stearin/fatty acids 1:10, 60 °C, 8% enzyme load (wt % of substrates), 4 h, and 3.5% water content (wt % of enzyme); the enzymatic product contained 39.6% palmitic acid (PA), 83.7% of the fatty acids at sn-2 position were PA (sn-2 PA), and the distribution probability of PA at the sn-2 position among total PA (% sn-2 PA) was 70.5%. With the fatty acid profiles of human milk fat (HMF) as a preferable goal, a physical blending model was established for the second step to guarantee the maximum addition of selected oils. Based on the model prediction, a desirable formula constituted enzymatic product/rapeseed oil/sunflower oil/palm kernel oil/algal oil/microbial oil at a mole ratio of 1:0.28:0.40:0.36:0.015:0.017, and the final product had PA content, sn-2 PA, and %sn-2 PA at 23.5, 43.1, and 61.1%, respectively. The contents of arachidonic and docosahexaenoic acids were 0.4 and 0.3%, respectively. Relying on the total and sn-2 fatty acid compositions of HMF and "deducting score" principle, the score for the similarity between the final product and HMF was scaled as 89.2, indicating the potential as a fat substitute in infant formulas.

Visual development in infants: physiological and pathological mechanisms

PURPOSE OF REVIEW

This review summarizes current knowledge on ocular conditions related to abnormal visual development in infants, including prevalence, risk factors, causes, and mechanisms involved. We discuss the role of eyeball growth with pathologic mechanism of visual deprivation and development of amblyopia in infants, particular developmental issues in preterm neonates, methods of visual assessment and screening, diagnosis, treatment, and nutritional issues.

RECENT FINDINGS

Visual development is incomplete at birth, particularly in premature infants; maturation of the visual system--including neurological and ocular components--is influenced by many factors including prenatal and postnatal nutrition and postnatal visual stimulation. In early life, particularly during sensitive periods of development, abnormal visual input, for example caused by visual deprivation mechanism, amblyopia, or ocular misalignment, leads to abnormalities in visual development, including abnormal eyeball growth and neurological changes. Untreated anomalies or abnormal visual development can result in long-term or even permanent visual impairment. Nutrition plays a key role in visual development: infant formulas containing nutrients essential for normal visual development (specifically omega-3 fatty acid docosahexaenoic acid and omega-6 fatty acid arachidonic acid) may protect nonbreast-fed infants against visual development abnormalities.

SUMMARY

Problems related to visual anomalies are common among young children, particularly in preterm neonates. Screening to enable early diagnosis and correction of visual deficiency is important as abnormal visual input can lead to abnormalities in visual development, which can become permanent visual impairment if left untreated. Optimized nutrition can help to reduce the risk of abnormal visual development and prevent long-term or permanent visual deficits.

Maternal dietary omega fatty acid intake and auditory brainstem-evoked potentials in Mexican infants born at term: cluster analysis

OBJECTIVE

To identify biological and socioeconomic factors associated with the neurological development of Mexican infants born at term, as measured by brainstem auditory-evoked potentials (BAEPs).

SUBJECTS AND METHODS

We conducted a cohort study among 76 women with low risk pregnancies recruited in their third trimester of pregnancy and followed their infants until 12 months of age. BAEP tests were conducted on the infants before 3 months of age during physiologic sleep, using 100 msec bipolar clicks. Maternal dietary intake was evaluated by food frequency questionnaire. Two BAEP groups (short latency, long latency) were identified by cluster analysis. The association between BAEP group and maternal PUFAs was estimated using logistic regression models adjusted for socioeconomic and biological factors.

RESULTS

Short latency BAEPs were associated with a maternal diet rich in arachidonic acid (OR=3.63, 95% CI 1.23-10.67) after adjusting for age (in days) sex, head circumference and gestational age but was not significantly associated to a maternal diet rich in docosahexaenoic acid (DHA).

CONCLUSIONS

Our results suggest the importance of arachidonic acid intake during pregnancy for short latency BAEPs and adequate fetal myelination.

The effects of maternal dietary docosahexaenoic acid intake on rat pup myelin and the auditory startle response

We investigated the effects of maternal docosahexanoic acid (DHA) supplementation on pups' auditory startle responses and the composition of brain myelin.

METHODS

Timed-pregnant rats were fed throughout pregnancy and lactation diets that contained 0, 0.3, 0.7 or 3% of total fatty acids as DHA. Milk was collected from culled pups' stomachs on postnatal day (PND) 3, latency of the auditory startle reflex was measured on PND 15, and pups were killed and brains collected on PND 24.

RESULTS

Higher levels of DHA in maternal diet were reflected in milk and in pups' myelin. The latency of the auditory startle response was significantly longer in offspring of dams fed higher levels of DHA. There was a positive correlation between the myelin content of DHA and the latency of the startle response (p = 0.044), and a negative correlation between the myelin content of DHA and the myelin content of cholesterol (p = 0.005).

CONCLUSION

High levels of maternal DHA intake alter the lipid composition of rat pup myelin, and are associated with longer latencies of the auditory startle response--a myelin-dependent electrophysiologic response.

Has an aquatic diet been necessary for hominin brain evolution and functional development?

A number of authors have argued that only an aquatic-based diet can provide the necessary quantity of DHA to support the human brain, and that a switch to such a diet early in hominin evolution was critical to human brain evolution. This paper identifies the premises behind this hypothesis and critiques them on the basis of clinical literature. Both tissue levels and certain functions of the developing infant brain are sensitive to extreme variations in the supply of DHA in artificial feeding, and it can be shown that levels in human milk reflect maternal diet. However, both the maternal and infant bodies have mechanisms to store and buffer the supply of DHA, so that functional deficits are generally resolved without compensatory diets. There is no evidence that human diets based on terrestrial food chains with traditional nursing practices fail to provide adequate levels of DHA or other n-3 fatty acids. Consequently, the hypothesis that DHA has been a limiting resource in human brain evolution must be considered to be unsupported.

Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition

BACKGROUND

Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge, its role in reversing growth deficits after hospital discharge remains poorly defined.

OBJECTIVE

The aim was to determine the effect of different formulas on the growth, bone mass, and body composition of preterm infants after hospital discharge.

DESIGN

This was a randomized, double blind comparison of a nutrient-enriched formula (EF) and a formula for term infants (TF) given for 1 y after hospital discharge. Compared with the TF, the EF had a higher energy density and higher contents of protein, calcium, and phosphorus (by 10%, 21%, 44%, and 11%, respectively) and higher contents of almost all other nutrients (by >or=10%).

RESULTS

Birth weights of the infants were 630-1620 g (median: 1250 g) and gestational ages were 24-34 wk (median: 29 wk). TF resulted in significantly greater weight, length, head circumference measurements, and their respective z scores on the basis of age- and sex-specific norms. At the end of the study, the mean z scores for the corrected age of infants in the TF group were -0.37 for weight, 0.001 for length, and 0.50 for head circumference. The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group (P < 0.05 for all comparisons).

CONCLUSIONS

The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth, bone mineralization, and body composition. More studies are needed to determine the optimal postdischarge nutrition support for preterm infants.

Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey

BACKGROUND

Although Autistic Disorder is associated with several congenital conditions, the cause for most cases is unknown. The present study was undertaken to determine whether breastfeeding or the use of infant formula supplemented with docosahexaenoic acid and arachidonic acid is associated with Autistic Disorder. The hypothesis is that breastfeeding and use of infant formula supplemented with docosahexaenoic acid/arachidonic acid are protective for Autistic Disorder.

METHODS

This is a case-control study using data from the Autism Internet Research Survey, an online parental survey conducted from February to April 2005 with results for 861 children with Autistic Disorder and 123 control children. The analyses were performed using logistic regression.

RESULTS

Absence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.78). Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132).

CONCLUSION

The results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder.

Omega-3 Fatty Acid Supplementation in Perinatal Settings

The purpose of this article is (a) to explain the role of omega-3 fatty acids in human health, specifically in fetal/neonatal development, (b) to summarize the recent research behind the innovations in infant formula manufacturing and advertisement of omega-3 fatty acid supplementation for pregnant and lactating mothers, and (c) to relate the research findings to clinical practice. Omega-3 fatty acid supplementation in perinatal settings is discussed here from three vantage points: (a) supplementation of the third-trimester pregnant woman to enhance fetal development, (b) supplementation of the lactating mother to enhance development of the breastfeeding infant, and (c) supplementation of infant formulas to enhance development of the bottle-feeding infant. Supplementation can occur by increasing one's intake of foods high in omega-3 fatty acids or by ingesting fatty acid nutritional supplements. The challenge of supplementation for vegan and vegetarian women is also addressed.

Serum lipid fatty acids, phonological processing, and reading in children with oral clefts

Reading skill is suggested to be related to phonological processing ability and polyunsaturated fatty acids (PUFAs). Here we investigated whether fatty acids (FAs) are related to phonological processing, whether the relations between PUFAs and reading generalize to other FAs, whether these relations are mediated by phonological processing, and whether relations of FAs are specific for language-related functions. Blood samples of 49 ten-year-old children with oral clefts were collected for FA proportion analysis in serum cholesteryl esters and phospholipids. On the same day, they performed tasks of phonological processing, reading, and both verbal and nonverbal intelligence. Sequential regression analyses (adjusted for age, gender, and cleft type) showed that phonological processing was inversely related to myristic acid in phospholipids and positively related to eicosapentaenoic acid in cholesteryl esters. Reading was inversely related to palmitoleic and gammalinolenic acids in phospholipids. The relations between FAs and reading were not mediated by phonological processing and FAs related only to language-related functions.

Association Between School Performance, Breast Milk Intake and Fatty Acid Profile of Serum Lipids in Ten-Year-Old Cleft Children

The fatty acid profiles of serum lipids were examined in 53 ten-year-old cleft children. The children presented with different cleft types (cleft lip, cleft lip and palate, isolated cleft palate and submucuous cleft palate) and were recruited from the Finnish Cleft Center. We also studied associations between serum lipid fatty acids and early breast milk intake, cognitive development in terms of preschool language learning and school achievement. The fatty acid profiles of serum lipids did not differ between boys and girls. The proportion of myristic acid in serum cholesteryl esters (CE) was higher and proportion of nervonic acid in phospholipids (PL) lower in children with isolated palatal clefts than in those with submucuous clefts. Out of the present children, 30% and 60% received breast milk less than 1 or 3 months, respectively. The proportions of docosahexaenoic acid in CE and in PL were significantly higher in the children whose breast milk intake was longer than 3 months. The number of children requiring special education was higher among those who received breast milk less than 1 month than among those with longer breast milk intake. In conclusion, the fatty acid profiles of serum lipids seem to be comparable among children with different cleft types. Short breast milk intake was associated with poorer school performance.

Tissue accretion and milk content of docosahexaenoic acid in female rats after supplementation with different docosahexaenoic acid sources

BACKGROUND

Docosahexaenoic acid (DHA) is highly concentrated in the mammalian nervous and visual system. The fatty acid, which is required by the fetus and the newborn, is supplied by the mother from their tissue reservoirs. It has been suggested that mother's supplementation with DHA during pregnancy and even before pregnancy. Different sources of DHA are available for supplementation such as: single-cell algae triglycerides (TG), egg's yolk phospholipids (PL), DHA ethyl esther (EE), and sn-2 DHA monoacylglyceride (MG). We evaluated comparatively the effectiveness of these different DHA sources to produce tissue DHA accretion and to increase milk DHA content.

METHODS

Female Wistar rats fed a diet which provided no DHA, were daily supplemented by 40 days before mating (BM) and during the pregnancy with either TG, PL, EE, or MG to an amount which provided 8 mg/kg b.w. of DHA. Samples of blood plasma, erythrocytes, hepatic and adipose tissue were obtained from rats at the BM condition and after the delivery (AD), and milk samples were also obtained from the gastric content of the pups nursed by the rats at day 3, 11 and 20 of suckling. Samples were processed to assess DHA and arachidonic acid (AA) content by gas-chromatography.

RESULTS

TG, PL, EE, and MG supplementation produced a similar intestinal absorption of DHA as estimated from the plasma DHA at the BM condition. However, PL and MG supplementation produced a higher accretion of DHA into erythrocytes, hepatic, and adipose tissue than TG and EE supplementation at the BM condition. AA content was not modified by the different supplementing oils. A reduction of the DHA content of plasma, erythrocytes, hepatic and adipose tissue at the AD condition was observed, and a reduction of AA for the hepatic and adipose tissues was also observed, suggesting the importance of these tissues as DHA and AA reservoirs. Milk secretion from PL and MG supplemented rats showed a higher DHA content than secretion from TG- and EE-supplemented rats.

CONCLUSIONS

We conclude that PL and MG supplementation provides higher tissue DHA accretion and higher milk DHA content than TG and EE supplementation. However, we were not able to visualize the comparative advantages derived from PL vs. MG supplementation.

Delayed spatial alternation impairments in adult rats following dietary n-6 deficiency during development

Dietary n-3 fatty acid (FA) deficiencies during development can cause learning and memory impairments, but the functional effects of dietary n-6 FA deficiencies, reflected in a lowered n-6/n-3 ratio, are less clear. We investigated the effects of maternal diets containing fish oils, resulting in lowered n-6/n-3 ratios, on a spatial working memory task in their offspring. Starting on gestational day 6, Sprague-Dawley timed-pregnant rats were placed on one of three experimental diets: control (unadulterated powdered rat chow), Pacific Ocean (PO) fish (powdered rat chow containing 20% (w/w) lyophilized PO salmon), or PO oil (powdered rat chow containing 6% (w/w) oil extracted from PO salmon). The 6% oil dose was selected because it is equivalent to the amount of oil in the 20% lyophilized fish diet. The experimental diets were fed until weaning on postnatal day (PND) 21, at which time all pups were placed on the rat chow diet. Starting on approximately PND77, one male and one female from each litter began a cognitive test battery using 2-lever operant chambers. PO groups failed to reach the same level of performance as the controls on the delayed spatial alternation (DSA) task and also showed decreased performance on delay trials. FA analyses of the diets found that the n-6/n-3 ratios for the PO fish and oil groups were reduced to 2.5 and 3.2, respectively, vs. 6.9 for controls. Analysis of brain tissue taken from pups on PND21 confirmed that the n-6/n-3 ratios within the brain were significantly reduced from 1.18 for controls to 0.87 and 0.90 for PO fish and oil groups, respectively. Specifically, the PO diets significantly increased long-chain n-3 FAs (20:5 n-3 and 22:6 n-3) and decreased long-chain n-6 FAs (20:4 n-6 and 22:4 n-6) in the brain. Thus, the observed delayed spatial alternation impairments in rats fed PO fish and fish oil are hypothesized to have resulted from the altered n-6/n-3 FA ratios.

Effect of supplementation with docosahexaenoic acid ethyl ester and sn-2 docosahexaenyl monoacylglyceride on plasma and erythrocyte fatty acids in rats

BACKGROUND/AIMS

Docosahexaenoic acid (C22:6, DHA) is an omega-3 fatty acid required for the normal development of the mammalian nervous and visual system. DHA is provided by the mother during pregnancy and lactating period. Mother's DHA supplementation during pregnancy, and even before pregnancy, has been suggested. DHA can be provided by marine oils, egg's yolk phospholipids, single cell algae oils, the pure fatty acid, or by the ethyl ester derivative (DHA-EE). Another way to provide DHA can be by sn-2 docosahexaenyl monoacylglyceride (DHA-MG), obtained by the treatment of fish oil with stereospecific lipases. sn-2 Fatty acid monoacylglycerides can be more easily absorbed at the intestine than other fatty acid derivatives.

METHODS

Female rats fed with a synthetic, which provided essentially no DHA, received a 40-day supplementation of either DHA-EE or DHA-MG. Plasma and erythrocyte fatty acid composition were assessed by gas chromatography at day 0 and 40 of supplementation.

RESULTS

DHA-EE increased plasma and erythrocyte DHA by 15 and 11.9%, respectively, with no modification of arachidonic acid (AA) content. DHA-MG supplementation increased plasma and erythrocyte DHA by 24 and 23.8%, respectively, but reduced AA by 5.5 and 3%, respectively.

CONCLUSIONS

We conclude that in the rat, DHA-MG supplementation allows a higher plasma and erythrocyte DHA content than DHA-EE with minor modification of AA content.