Erythrocyte membrane fatty acid content in infants consuming formulas supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA): an observational study

Dietary intake of different ratios of ARA/DHA in early stages and its impact on infant development

Long-chain polyunsaturated fatty acids (LC-PUFAs), arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3) are essential in the development of infants. ARA and DHA from breast milk or infant formula are the main sources of access for infants to meet their physiological and metabolic needs. The ratio of ARA to DHA in breast milk varies among regions and different lactation stages. Different ratios of ARA and DHA mainly from algal oil, animal fat, fish oil, and microbial oil, are added to infant formula in different regions and infant age ranges. Supplementing with appropriate ratios of ARA and DHA during infancy promotes brain, neural, visual, and other development aspects. In this review, we first introduced the current intake status of ARA and DHA in different locations, lactation stages, and age ranges in breast milk and infant formula. Finally, we discussed the effect of different ratios of ARA and DHA on infant development. This review provided a comprehensive research basis for the nutritional research of infants who consume different ratios of ARA and DHA.

Impact of Maternal Fish Consumption on Serum Docosahexaenoic Acid (DHA) Levels in Breastfed Infants: A Cross-Sectional Study of a Randomized Clinical Trial in Japan

Docosahexaenoic acid (DHA), an essential n-3 long-chain polyunsaturated fatty acid (LCPUFA) abundant in fish, is crucial for infant brain development. We investigated the associations between maternal dietary habits, infant feeding patterns, and serum levels of DHA and other LCPUFAs in infants aged 5-6 months in Japan, where fish consumption is high. This cross-sectional study used serum samples from 268 infants enrolled in a randomized clinical trial. The frequency of mothers' consumption of 38 food items and infant feeding patterns were prospectively surveyed. Cow's milk formula (CMF) supplemented with 15.9% linolenic acid, 1.6% α-linolenic acid, 0.40% DHA, and 0.27% arachidonic acid was used. Significant positive associations with infants' serum DHA levels were found for "Blue-back fish" (rho = 0.24; p = 0.0001) and "White fish" (rho = 0.25, p = 0.0001). The combined variable "Blue-White fish" was found to be significantly associated with higher serum DHA levels in infants (rho = 0.29, p < 0.0001). Predominantly breastfed infants had significantly higher serum DHA levels than those fed more CMF (rho = 0.32, p < 0.0001). After multivariate analysis, "Blue-White fish" and "Feeding patterns" remained significantly and independently associated with serum DHA levels. These findings suggest that frequent consumption of "Blue-back fish" and/or "White fish" by lactating mothers, along with prioritizing breastfeeding over DHA-supplemented CMF, might effectively increase infants' serum DHA levels.

Effect of Milk-Based Infant Formula Fortified with PUFAs on Lipid Profile, Growth and Micronutrient Status of Young Children: A Randomized Double-Blind Clinical Trial

BACKGROUND

Polyunsaturated fatty acids (PUFAs) are essential to child growth and development.

OBJECTIVE

To assess the effect of PUFAs-fortified infant formula on lipid profile, growth and micronutrient status in children 12 to 30 months old.

METHODS

This study is a double-blind randomized controlled clinical trial. Two study groups were assessed: (a) milk-based infant formula with micronutrients and PUFAs (PUFAs) and (b) milk-based infant formula with micronutrients, no PUFAs added (Non-PUFAs). Children received prepared formula (240 mL) twice a day, according to the color-code assigned to each infant. Anthropometric measurements and venous blood samples were taken at each day-care center at baseline, and again after four months. Total serum lipid extraction was 0.5 mL. Samples were treated and modified by the Folch method and analyzed with gas chromatography.

RESULTS

Changes in serum lipid profile (expressed as % FA) between baseline and four months showed a statistically significant increase in docosahexaenoic acid (DHA) (0.22 vs. -0.07, p < 0.05) and Alpha-Linoleic acid (0.08 vs. 0.02, p < 0.05) in infants who consumed PUFAs-fortified formula compared to Non-PUFAs-fortified formula. Infants increased their length/height-for-age Z-score: median change for the PUFAs group was 0.16 (95% CI = 0.08, 0.28) and 0.23 (95% CI = 0.14, 0.33) for Non-PUFAs, with no differences between groups. Median folate level was significantly higher among the PUFAs group compared to Non-PUFAs: -0.87 (95% CI = -1.38, -0.44) and -3.83 (95% CI = -4.65, -3.03) respectively. Consumption of both supplements was adequate and stable during the intervention.

CONCLUSION

A significant improvement was observed in the lipid profile of children who received the PUFAs-fortified milk-based formula.

An infant formula containing dairy lipids increased red blood cell membrane Omega 3 fatty acids in 4 month-old healthy newborns: a randomized controlled trial

Background

When breastfeeding is not possible, infants are fed formulas (IF) in which lipids are usually of plant origin. However, the use of dairy fat in combination with plant oils enables a lipid profile closer to breast milk in terms of fatty acid (FA) composition, triglyceride structure, polar lipids and cholesterol contents. The objective of this study was to determine the effect of an IF containing a mix of dairy fat and plant oils on Omega-3 FA content in red blood cells (RBC).

Methods

This study was a monocentric, double-blind, controlled, randomized trial. Healthy term infants were fed formulas containing a mix of dairy fat and plant oils (D), plant oils (P) or plant oils supplemented with ARA and DHA (PDHA). Breastfed infants were enrolled as a reference group (BF). FA in RBC phosphatidylethanolamine was evaluated after 4 months and FA in whole blood were evaluated at enrollment and after 4 months by gas chromatography. Differences between groups were assessed using an analysis of covariance with sex and gestational age as covariates.

Results

Seventy IF-fed and nineteen BF infants completed the protocol. At 4 months, RBC total Omega-3 FA levels in infants fed formula D were significantly higher than in group P and similar to those in groups PDHA and BF. RBC DHA levels in group D were also higher than in group P but lower than in groups PDHA and BF. RBC n-3 DPA levels in group D were higher than in groups P, PDHA and BF. A decrease in proportions of Omega-3 FA in whole blood was observed in all groups.

Conclusions

A formula containing a mix of dairy lipids and plant oils increased the endogenous conversion of Omega-3 long-chain FA from precursor, leading to higher total Omega-3, DPA and DHA status in RBC than a plant oil-based formula. Modifying lipid quality in IF by adding dairy lipids should be considered as an interesting method to improve Omega-3 FA status.

Trial registration

Identifier NCT01611649, retrospectively registered on May 25, 2012.

Red blood cell membrane fatty acid composition in infants fed formulas with different lipid profiles

BACKGROUND

There is growing interest in the fatty acid composition of breast milk and substitute formulas used to replace or complement infant breastfeeding.

AIM

The aims of this study were to assess the impact of two follow-up infant formulas based on cow milk fat, vegetable oils and different docosahexaenoic (DHA) and arachidonic (ARA) acid content on red blood cell membrane fatty acid composition, and determine the percent saturated fatty acid (SFA) incorporation into the membrane.

STUDY DESIGN

This was a double-blind, randomized, controlled, parallel-group clinical trial. Infants received treatment or control product for at least four months before the age of six months. The control group (n=25) received standard infant formula (FA) and the treatment group (n=24) received the same formula supplemented with higher DHA and ARA content (FB). The reference group (n=47) consisted of normal healthy exclusively breastfed infants.

OUTCOME MEASURE

Red blood cell membrane fatty acid composition was determined by capillary gas chromatography.

RESULTS

Ninety-six infants completed the study (FA, 25; FB, 24; reference, 47). Higher DHA content reflected higher DHA percentage in the red blood cell membrane. Breast milk and FB did not show any significant differences in DHA content. ARA percentage was higher in breastfed infants and palmitic acid percentage was higher in FB- compared with FA-fed infants.

CONCLUSION

DHA and palmitic acid percent distributions were higher in the red blood cell membrane of infants receiving FB. DHA percent distribution was not significantly different in FB-fed and breastfed infants. SFA percent distribution was not significantly different when comparing both formulas with breast milk.

Therapeutic potential of umbilical cord blood cells for type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) is a chronic disorder that results from autoimmune-mediated destruction of pancreatic islet β-cells. However, to date, no conventional intervention has successfully treated the disease. The optimal therapeutic method for T1DM should effectively control the autoimmunity, restore immune homeostasis, preserve residual β-cells, reverse β-cell destruction, and protect the regenerated insulin-producing cells against re-attack. Umbilical cord blood is rich in regulatory T (T(reg)) cells and multiple types of stem cells that exhibit immunomodulating potential and hold promise in their ability to restore peripheral tolerance towards pancreatic islet β-cells through remodeling of immune responses and suppression of autoreactive T cells. Recently, reinfusion of autologous umbilical cord blood or immune cells from cord blood has been proposed as a novel therapy for T1DM, with the advantages of no risk to the donors, minimal ethical concerns, a low incidence of graft-versus-host disease and easy accessibility. In this review, we revisit the role of autologous umbilical cord blood or immune cells from cord blood-based applications for the treatment of T1DM.

Comprehensive profiling of plasma fatty acid concentrations in young healthy Canadian adults

Circulating fatty acids (FA) are associated with a multitude of chronic diseases. However, a major gap in establishing such relationships is the lack of accepted fatty acid reference ranges representing healthy individuals. Data on validated FA reference ranges would provide a better understanding of study baseline measures and aid in the evaluation and interpretation of pharmaceutical or dietary interventions. Reference ranges for plasma FA levels have been reported in a few small studies and on a limited number of FA. Therefore, we determined the average and percentiles of a broad set of 61 FA (C14 - C24:1) from plasma total lipids from an ethnically diverse population of healthy young Canadian males and females (Total n = 826). Plasma concentrations of some of the major FA ranged from 0.3 to 4.1 mmol/L for palmitic acid, 0.1 to 1.0 mmol/L for stearic acid, 0.03 to 3.2 mmol/L for oleic acid, 0.2 to 5.0 mmol/L for linoleic acid (LA), 12.0 to 186.9 μmol/L for α-linolenic acid, and 7.2 to 237.5 μmol/L for docosahexaenoic acid (DHA). Males had significantly higher plasma concentrations of γ-linolenic acid (GLA) and n-3 docosapentaenoic acid and lower concentrations of palmitoleic acid, LA and DHA than females. Comparison of FA concentrations between Caucasians, East Asians and South Asians revealed that South Asians had significantly lower levels of palmitoleic acid (p < 0.01) and oleic acid (p = 0.01) while East Asians had lower levels of GLA (p = 0.02) and dihomo-γ-linolenic acid (p = 0.03). Overall, these data provide a comprehensive set of quantitative values that profiles a small cohort of Canadians which highlights the utility of establishing validated FA reference ranges that may be used to understand how deficient, suboptimal, or excess amounts of a given FA may be associated with chronic disease.

Autologous umbilical cord blood infusion followed by oral docosahexaenoic acid and vitamin D supplementation for C-peptide preservation in children with Type 1 diabetes

We sought to determine if autologous umbilical cord blood (UCB) infusion followed by 1 year of supplementation with vitamin D and docosahexaenoic acid (DHA) can preserve C-peptide in children with type 1 diabetes. We conducted an open-label, 2:1 randomized study in which 15 type 1 diabetes subjects with stimulated C-peptide > .2 pmol/mL received either (1) autologous UCB infusion, 1 year of daily oral vitamin D (2000 IU), and DHA (38 mg/kg) and intensive diabetes management or (2) intensive diabetes management alone. Primary analyses were performed 1 year after UCB infusion. Treated (N = 10) and control (N = 5) subjects had median ages of 7.2 and 6.6 years, respectively. No severe adverse events were observed. Although the absolute rate of C-peptide decline was slower in treated versus control subjects, intergroup comparisons failed to reach significance (P = .29). Area under the curve C-peptide declined and insulin use increased in both groups (P < .01). Vitamin D levels remained stable in treated subjects but declined in control subjects (P = .01). DHA levels rose in treated subjects versus control subjects (P = .003). CD4/CD8 ratio remained stable in treated subjects but declined in control subjects (P = .03). No changes were seen in regulatory T cell frequency, total CD4 counts, or autoantibody titers. Autologous UCB infusion followed by daily supplementation with vitamin D and DHA was safe but failed to preserve C-peptide. Lack of significance may reflect small sample size. Future efforts will require expansion of specific immunoregulatory cell subsets, optimization of combined immunoregulatory and anti-inflammatory agents, and larger study cohorts.

Progress in immune-based therapies for type 1 diabetes

Immune-based therapies that prevent type 1 diabetes or preserve metabolic function remaining at diagnosis have become a major objective for funding agencies and international trial consortia, and receive backing from notable patient advocate groups. The development of immune-based therapeutic strategies in this arena requires a careful balancing of the risks of the therapy against the potential benefits, because many individuals are diagnosed or identified as being at increased risk of disease in early childhood, a period when manipulation of the developing immune system should be undertaken with caution. In addition, a therapy exists (daily insulin injection) that is life-saving in the acute stages of disease and can be used effectively over a lifetime as maintenance. Conversely, the disease is increasing in incidence; is peaking in ever-younger age groups; carries significant risk of increased morbidity and early mortality; and remains difficult to manage effectively in many settings. With these issues in mind, in this article we review progress towards immune-based strategies for this chronic autoimmune disease.

The influence of a formula supplemented with dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in healthy full-term infants: a double-blind randomized controlled trial

BACKGROUND

Human milk is the optimal nutrition for infants. When breastfeeding is not possible, supplementation of infant formula with long chain polyunsaturated fatty acids appears to promote neurodevelopmental outcome and visual function. Plant oils, that are the only source of fat in most of infant formulas, do not contain specific fatty acids that are present in human and cow milk and do not encounter milk fat triglyceride structure. Experimental data suggest that a mix of dairy lipids and plant oils can potentiate endogenous synthesis of n-3 long chain polyunsaturated fatty acids. This trial aims to determine the effect of an infant formula supplemented with a mixture of dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in full-term infants (primary outcome). Erythrocyte membrane long chain polyunsaturated fatty acids and fatty acids content, the plasma lipid profile and the insulin-growth factor 1 level, the gastrointestinal tolerance, the changes throughout the study in blood fatty acids content, in growth and body composition are evaluated as secondary outcomes.

METHODS/DESIGN

In a double-blind controlled randomized trial, 75 healthy full-term infants are randomly allocated to receive for four months a formula supplemented with a mixture of dairy lipids and plant oils or a formula containing only plant oils or a formula containing plant oils supplemented with arachidonic acid and docosahexaenoic acid. Twenty-five breast-fed infants constitute the reference group. Erythrocyte membrane omega-3 fatty acid profile, long chain polyunsaturated fatty acids and the other fatty acids content, the plasma lipid profile and the insulin-growth factor 1 level are measured after four months of intervention. Gastrointestinal tolerance, the changes in blood fatty acids content, in growth and body composition, assessed by means of an air displacement plethysmography system, are also evaluated throughout the study.

DISCUSSION

The achievement of an appropriate long chain polyunsaturated fatty acids status represents an important goal in neonatal nutrition. Gaining further insight in the effects of the supplementation of a formula with dairy lipids and plant oils in healthy full-term infants could help to produce a formula whose fat content, composition and structure is more similar to human milk.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT01611649.

Evaluation of bioequivalency and toxicological effects of three sources of arachidonic acid (ARA) in domestic piglets

Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are routinely added to infant formula to support growth and development. We evaluated the bioequivalence and safety of three ARA-rich oils for potential use in infant formula using the neonatal pig model. The primary outcome for bioequivalence was brain accretion of ARA and DHA. Days 3-22 of age, domestic pigs were fed one of three formulas, each containing ARA at ∼0.64% and DHA at ∼0.34% total fatty acids (FA). Control diet ARA was provided by ARASCO and all diets had DHA from DHASCO (Martek Biosciences Corp., Columbia, MD). The experimental diets a1 and a2 provided ARA from Refined Arachidonic acid-rich Oil (RAO; Cargill, Inc., Wuhan, China) and SUNTGA40S (Nissui, Nippon Suisan Kaisha, Ltd., Tokyo, Japan), respectively. Formula intake and growth were similar across all diets, and ARA was bioequivalent across treatments in the brain, retina, heart, liver and day 21 RBC. DHA levels in the brain, retina and heart were unaffected by diet. Liver sections, clinical chemistry, and hematological parameters were normal. We conclude that RAO and SUNTGA40S, when added to formula to supply ∼0.64% ARA are safe and nutritionally bioequivalent to ARASCO in domestic piglets.