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Gilbreath D, Hagood D, Larson-Prior L. A Systematic Review over the Effect of Early Infant Diet on Neurodevelopment: Insights from Neuroimaging. Nutrients 2024; 16:1703. [PMID: 38892636 PMCID: PMC11174660 DOI: 10.3390/nu16111703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/29/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
The optimization of infant neuronal development through nutrition is an increasingly studied area. While human milk consumption during infancy is thought to give a slight cognitive advantage throughout early childhood in comparison to commercial formula, the biological underpinnings of this process are less well-known and debated in the literature. This systematic review seeks to quantitatively analyze whether early diet affects infant neurodevelopment as measured by various neuroimaging modalities and techniques. Results presented suggest that human milk does have a slight positive impact on the structural development of the infant brain-and that this impact is larger in preterm infants. Other diets with distinct macronutrient compositions were also considered, although these had more conflicting results.
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Affiliation(s)
- Dylan Gilbreath
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Science, Little Rock, AR 72207, USA;
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
| | - Darcy Hagood
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
| | - Linda Larson-Prior
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Science, Little Rock, AR 72207, USA;
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
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2
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García G, Pérez-Ríos M, Ruano-Ravina A, Candal-Pedreira C. Assessing conflict of interest reporting and quality of clinical trials on infant formula: a systematic review. J Clin Epidemiol 2024; 169:111313. [PMID: 38432526 DOI: 10.1016/j.jclinepi.2024.111313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aims to assess the quality, risk of bias, and conflicts of interest (COIs) of clinical trials conducted on the effects of fortified infant formula. STUDY DESIGN AND SETTTING Systematic review including all randomized clinical trials targeting healthy children and using three arms: fortified infant formula; standard formula; and breastfeeding. We performed a descriptive analysis of the studies reviewed, assessed their quality using the "Risk of Bias 2- RoB 2" tool, and identified COIs. RESULTS A total of 40 studies were included. All showed a high overall risk of bias, with this being especially noteworthy in the "deviations from intention to treat" and "missing outcome data" domains. Of the total included studies, 29 reported conclusions in favor of the fortified formula; 15 studies reported multiple conclusions that were either contradictory or not in line with the results. COIs with industry were identified in 33 studies, and in 17 studies, these conflicts were not declared in the appropriate section. CONCLUSION From a methodological perspective, studies on fortified infant formula display low quality, made evident by the high risk of bias. Additionally, there are frequent COIs. These aspects must be considered by health professionals and the population when drawing up recommendations for the use of this product.
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Affiliation(s)
- Guadalupe García
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), Santiago de Compostela, Galicia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
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3
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Cerdó T, Ruíz A, Acuña I, Nieto-Ruiz A, Diéguez E, Sepúlveda-Valbuena N, Escudero-Marín M, García-Santos JA, García-Ricobaraza M, Herrmann F, Moreno JA, De Castellar R, Jiménez J, Suárez A, Campoy C. A synbiotics, long chain polyunsaturated fatty acids, and milk fat globule membranes supplemented formula modulates microbiota maturation and neurodevelopment closer to breastfed infants. Clin Nutr 2022; 41:1697-1711. [DOI: 10.1016/j.clnu.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
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4
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Nieto-Ruiz A, García-Santos JA, Verdejo-Román J, Diéguez E, Sepúlveda-Valbuena N, Herrmann F, Cerdó T, De-Castellar R, Jiménez J, Bermúdez MG, Pérez-García M, Miranda MT, López-Sabater MC, Catena A, Campoy C. Infant Formula Supplemented With Milk Fat Globule Membrane, Long-Chain Polyunsaturated Fatty Acids, and Synbiotics Is Associated With Neurocognitive Function and Brain Structure of Healthy Children Aged 6 Years: The COGNIS Study. Front Nutr 2022; 9:820224. [PMID: 35356726 PMCID: PMC8959863 DOI: 10.3389/fnut.2022.820224] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/01/2022] [Indexed: 12/25/2022] Open
Abstract
Background Adequate nutrient intake during the first few months of life plays a critical role on brain structure and function development. Objectives To analyze the long-term effects of an experimental infant formula (EF) on neurocognitive function and brain structure in healthy children aged 6 years compared to those fed with a standard infant formula or breastfed. Methods The current study involved 108 healthy children aged 6 years and participating in the COGNIS Study. At 0-2 months, infants were randomized to receive up to 18 months of life a standard infant formula (SF) or EF enriched with milk fat globule membrane (MFGM), long-chain polyunsaturated fatty acids (LC-PUFAs) and synbiotics. Furthermore, a reference group of breastfed (BF) infants were also recruited. Children were assessed using neurocognitive tests and structural Magnetic Resonance Imaging (MRI) at 6 years old. Results Experimental infant formula (EF) children showed greater volumes in the left orbital cortex, higher vocabulary scores and IQ, and better performance in an attention task than BF children. EF children also presented greater volumes in parietal regions than SF kids. Additionally, greater cortical thickness in the insular, parietal, and temporal areas were found in children from the EF group than those fed with SF or BF groups. Further correlation analyses suggest that higher volumes and cortical thickness of different parietal and frontal regions are associated with better cognitive development in terms of language (verbal comprehension) and executive function (working memory). Finally, arachidonic acid (ARA), adrenic acid (AdA), docosahexaenoic acid (DHA) levels in cheek cell glycerophospholipids, ARA/DHA ratio, and protein, fatty acid, and mineral intake during the first 18 months of life seem to be associated with changes in the brain structures at 6 years old. Conclusions Supplemented infant formula with MFGM components, LC-PUFAs, and synbiotics seems to be associated to long-term effects on neurocognitive development and brain structure in children at 6 years old. Clinical Trial Registration https://www.clinicaltrials.gov/, identifier: NCT02094547.
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Affiliation(s)
- Ana Nieto-Ruiz
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Health Sciences Technological Park, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - José A. García-Santos
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Health Sciences Technological Park, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Juan Verdejo-Román
- Department of Personality, Assessment & Psychological Treatment, School of Psychology, University of Granada, Granada, Spain
| | - Estefanía Diéguez
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Health Sciences Technological Park, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Natalia Sepúlveda-Valbuena
- Nutrition and Biochemistry Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Florian Herrmann
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Tomás Cerdó
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
- Carlos III Health Institute, Madrid, Spain
| | | | | | - Mercedes G. Bermúdez
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Health Sciences Technological Park, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Miguel Pérez-García
- Department of Personality, Assessment & Psychological Treatment, School of Psychology, University of Granada, Granada, Spain
- Mind, Brain and Behavior Research Centre—CIMCYC, University of Granada, Granada, Spain
| | - M. Teresa Miranda
- Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain
| | - M. Carmen López-Sabater
- Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Barcelona, Spain
- National Network of Research in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III (Barcelona's Node), Madrid, Spain
| | - Andrés Catena
- Mind, Brain and Behavior Research Centre—CIMCYC, University of Granada, Granada, Spain
- Department of Experimental Psychology, School of Psychology, University of Granada, Granada, Spain
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Health Sciences Technological Park, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
- National Network of Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III (Granada's Node), Madrid, Spain
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5
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Heath RJ, Klevebro S, Wood TR. Maternal and Neonatal Polyunsaturated Fatty Acid Intake and Risk of Neurodevelopmental Impairment in Premature Infants. Int J Mol Sci 2022; 23:ijms23020700. [PMID: 35054885 PMCID: PMC8775484 DOI: 10.3390/ijms23020700] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/15/2022] Open
Abstract
The N3 and N6 long chain polyunsaturated fatty acids (LCPUFA) docosahexaenoic acid (DHA) and arachidonic acid (AA) are essential for proper neurodevelopment in early life. These fatty acids are passed from mother to infant via the placenta, accreting into fetal tissues such as brain and adipose tissue. Placental transfer of LCPUFA is highest in the final trimester, but this transfer is abruptly severed with premature birth. As such, efforts have been made to supplement the post-natal feed of premature infants with LCPUFA to improve neurodevelopmental outcomes. This narrative review analyzes the current body of evidence pertinent to neurodevelopmental outcomes after LCPUFA supplementation in prematurely born infants, which was identified via the reference lists of systematic and narrative reviews and PubMed search engine results. This review finds that, while the evidence is weakened by heterogeneity, it may be seen that feed comprising 0.3% DHA and 0.6% AA is associated with more positive neurodevelopmental outcomes than LCPUFA-deplete feed. While no new RCTs have been performed since the most recent Cochrane meta-analysis in 2016, this narrative review provides a wider commentary; the wider effects of LCPUFA supplementation in prematurely born infants, the physiology of LCPUFA accretion into preterm tissues, and the physiological effects of LCPUFA that affect neurodevelopment. We also discuss the roles of maternal LCPUFA status as a modifiable factor affecting the risk of preterm birth and infant neurodevelopmental outcomes. To better understand the role of LCPUFAs in infant neurodevelopment, future study designs must consider absolute and relative availabilities of all LCPUFA species and incorporate the LCPUFA status of both mother and infant in pre- and postnatal periods.
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Affiliation(s)
- Rory J. Heath
- Emergency Medicine Department, Derriford Hospital, University Hospitals Plymouth NHS Foundation Trust, Plymouth PL68DH, UK;
| | - Susanna Klevebro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden;
| | - Thomas R. Wood
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Center on Human Development and Disability, University of Washington, Seattle, WA 98195, USA
- Institute for Human and Machine Cognition, Pensacola, FL 32502, USA
- Correspondence:
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6
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Kytikova OY, Novgorodtseva TP, Denisenko YK, Antonyuk MV, Gvozdenko TA. Associations Of Delta Fatty Acid Desaturase Gene Polymorphisms With Lipid Metabolism Disorders. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Overweight, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, and non-alcoholic fatty liver disease are common chronic ailments associated with lipid metabolism disorders. One of the mechanisms of these disorders is related to the deficiency and/or change in the balance of essential fatty acids (FAs). At the same time, the provision of ω3 and ω6 polyunsaturated fatty acids (PUFAs) depends, besides sufficient dietary intake, on efficiency of their endogenous biosynthesis by desaturation and elongation processes regulated by FA elongases and FA desaturases. Desaturases are encoded by PUFA desaturase genes (FADSs): FADS1 and FADS2. Alteration of FA desaturase activity and single nucleotide polymorphisms (SNPs) in the FADS1 and FADS2 gene cluster are associated with lipid metabolism dysfunction and may affect the pathogenesis of lipid-related diseases. People of different ages, from different ethnic backgrounds and countries may exhibit varying degrees of response to dietary supplements of ω3 and ω6 PUFAs. The study of the relationship between lipid metabolism disorders and genetic factors controlling FA metabolism is an important research area since the health effects of alimentary ω3 and ω6 PUFAs can depend on genetic variants of the FADS genes. This review summarizes the literature data on the association of FADS gene polymorphisms with lipid metabolism disorders and their role in the development of chronic non-communicable pathologies associated with changes in lipid metabolism.
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Affiliation(s)
- Oksana Yu. Kytikova
- Research Institute of Medical Climatology and Rehabilitative Treatment, Vladivostok, Russia
| | | | - Yulia K. Denisenko
- Research Institute of Medical Climatology and Rehabilitative Treatment, Vladivostok, Russia
| | - Marina V. Antonyuk
- Research Institute of Medical Climatology and Rehabilitative Treatment, Vladivostok, Russia
| | - Tatyana A. Gvozdenko
- Research Institute of Medical Climatology and Rehabilitative Treatment, Vladivostok, Russia
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7
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Hahn K, Hardimon JR, Caskey D, Jost DA, Roady PJ, Brenna JT, Dilger RN. Safety and Efficacy of Sodium and Potassium Arachidonic Acid Salts in the Young Pig. Nutrients 2021; 13:nu13051482. [PMID: 33925724 PMCID: PMC8145490 DOI: 10.3390/nu13051482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
Arachidonic acid (ARA; 20:4n6) and docosahexaenoic acid (DHA; 22:6n3) are polyunsaturated fatty acids (FA) naturally present in breast milk and added to most North American infant formulas (IF). We investigated the safety and efficacy of novel sodium and potassium salts of arachidonic acid as bioequivalent to support tissue levels of ARA comparable to the parent oil; M. alpina oil (Na-ARA and K-ARA) and including a Na-DHA group. Pigs of both sexes were randomized to one of five dietary treatments (n = 16 per treatment; 8 male and 8 female) from postnatal day 2 to 23. ARA and DHA were included as either triglyceride (TG) or salt. Target dietary ARA/DHA concentrations as percent of total FA by weight were as follows: TT (0.47 TG/0.32 TG), NaT (0.47 Na-salt/0.32 TG), KT (0.47 K-salt/0.32 TG), and Na0 (0.47 Na-salt/0.00), NaNa (0.47 Na-salt/0.32 Na-salt). The primary outcome in this study was bioequivalence of ARA brain accretion. Growth performance; blood and tissue fatty acid levels; liver histology; complete blood cell counts; and serum chemistries were all evaluated. Overall, diets containing test sources of ARA and DHA did not affect growth performance; liver histology; or substantially influence hematological outcomes as compared with TT. The results confirm that the use of Na and K salt forms of ARA yield bioequivalent ARA accretion in the cerebral cortex and retinal tissue compared to TG-ARA. These findings confirm that use of Na-ARA and K-ARA salts in the young pig was safe and nutritionally bioequivalent to TG-ARA for critical neural tissues.
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Affiliation(s)
- Kaylee Hahn
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
| | | | - Doug Caskey
- Jost Chemical Co, St., Louis, MO 63114, USA; (J.R.H.); (D.C.); (D.A.J.)
| | - Douglas A. Jost
- Jost Chemical Co, St., Louis, MO 63114, USA; (J.R.H.); (D.C.); (D.A.J.)
| | - Patrick J. Roady
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA;
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA
| | - J. Thomas Brenna
- Dell Pediatric Research Institute, Department of Pediatrics, of Chemistry, and of Nutrition, University of Texas at Austin, Austin, TX 78723, USA;
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Ryan N. Dilger
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
- Correspondence:
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Kilvington A, Barnaba C, Rajasekaran S, Laurens Leimanis ML, Medina-Meza IG. Lipid profiling and dietary assessment of infant formulas reveal high intakes of major cholesterol oxidative product (7-ketocholesterol). Food Chem 2021; 354:129529. [PMID: 33761334 DOI: 10.1016/j.foodchem.2021.129529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
Approximately two-thirds of US infants receive infant formula (IF) as a primary or sole nutritional source during the first six months of life. IF is available in a variety of commercial presentations; from a manufacturing standpoint, they can be categorized as powder- (PIF) or liquid- (LIF) based formulations. Thirty commercial IFs were analyzed in their oxidative and non-oxidative lipid profiles. We identified 7-ketocholesterol - a major end-product of cholesterol oxidation - as a potential biomarker of IF manufacturing. The statistical analysis allowed a re-classification of IF based on their metabolomic fingerprint, resulting in three groups assigned with low-to-high oxidative status. Finally, we modeled the dietary intake of cholesterol, sterols, and 7-ketocholesterol in the first year of life. The database provided in this study will be instrumental for scientists interested in infant nutrition, to establish bases for epidemiological studies aimed to find connections between nutrition and diet-associated diseases, such as sitosterolemia.
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Affiliation(s)
- Alice Kilvington
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI, USA.
| | - Carlo Barnaba
- Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA.
| | - Surender Rajasekaran
- Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI, USA; Department of Pediatric and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Mara L Laurens Leimanis
- Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI, USA; Department of Pediatric and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Ilce G Medina-Meza
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI, USA; Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI, USA.
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9
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Jiménez DG, García CB, Martín JJD. Uses and Applications of Docosahexaenoic Acid (DHA) in Pediatric Gastroenterology: Current Evidence and New Perspective. Curr Pediatr Rev 2021; 17:329-335. [PMID: 33655869 DOI: 10.2174/1573396317666210303151947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022]
Abstract
In this paper, we will review the dietary allowances of these fatty acids in the paediatric population, and also the indications in different pathologies within the field of pediatric gastroenterology. Finally, we will try to explain the reasons that may justify the difficulty in translating good results in experimental studies to the usual clinical practice. This "good results" may be too little to be detected or there may be other causes but misinterpreted as effects of DHA.
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Affiliation(s)
| | - Carlos Bousoño García
- Pediatric Gastroenterology and Nutrition, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo,Spain
| | - Juan Jose Diaz Martín
- Pediatric Gastroenterology and Nutrition, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo,Spain
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The Effects of an Infant Formula Enriched with Milk Fat Globule Membrane, Long-Chain Polyunsaturated Fatty Acids and Synbiotics on Child Behavior up to 2.5 Years Old: The COGNIS Study. Nutrients 2020; 12:nu12123825. [PMID: 33333767 PMCID: PMC7765166 DOI: 10.3390/nu12123825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/10/2023] Open
Abstract
Although early life nutrition influences brain development and mental health, the long-term effects of supplemented infant formula on children´s behavior remain unclear. We analyzed the effects of a bioactive nutrients-enriched-infant formula on children’s behavior up to 2.5 years, compared to a standard infant formula or breastfeeding. Current analysis involved 70 children who were fed a standard infant formula (SF, n = 29) or a bioactive compounds enriched-infant formula (EF, n = 41), during their first 18 months of life, and 33 breastfed (BF) children (reference group) participating in the COGNIS study. Behavioral problems were evaluated using the Child Behavior Checklist at 18 months and 2.5 years. Different statistical analyses were performed using SPSS. EF children aged 2.5 years presented fewer pathological affective problems than SF children. Besides, SF children were classified more frequently as bordering on internalizing problems than BF children. Rates of externalizing problems were increased in SF infants compared to EF and BF infants. Higher maternal IQ was found to have beneficial effects on internalizing and total problem rate in their offspring at 18 months of life; finally, higher maternal educational level was related with fewer ADHD problems in children at 18 months, as well as internalizing, externalizing, total and anxiety problems in children aged 2.5 years. Our analysis suggests that enriched infant formula fed infants seem to show fewer behavioral problems up to 2.5 years compared to a standard infant formula-fed infants. In addition to type of early feeding, maternal IQ and educational level seem to play a key role on children behavioral development.
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11
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Hahn KE, Dahms I, Butt CM, Salem N, Grimshaw V, Bailey E, Fleming SA, Smith BN, Dilger RN. Impact of Arachidonic and Docosahexaenoic Acid Supplementation on Neural and Immune Development in the Young Pig. Front Nutr 2020; 7:592364. [PMID: 33195377 PMCID: PMC7658628 DOI: 10.3389/fnut.2020.592364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/16/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Human milk contains both arachidonic acid (ARA) and docosahexaenoic acid (DHA). Supplementation of infant formula with ARA and DHA results in fatty acid (FA) profiles, neurodevelopmental outcomes, and immune responses in formula-fed infants that are more like those observed in breastfed infants. Consequently, ARA and DHA have been historically added together to infant formula. This study investigated the impact of ARA or DHA supplementation alone or in combination on tissue FA incorporation, immune responses, and neurodevelopment in the young pig. Methods: Male pigs (N = 48 total) received one of four dietary treatments from postnatal day (PND) 2–30. Treatments targeted the following ARA/DHA levels (% of total FA): CON (0.00/0.00), ARA (0.80/0.00), DHA (0.00/0.80), and ARA+DHA (0.80/0.80). Plasma, red blood cells (RBC), and prefrontal cortex (PFC) were collected for FA analysis. Blood was collected for T cell immunophenotyping and to quantify a panel of immune outcomes. Myelin thickness in the corpus callosum was measured by transmission electron microscopy and pig movement was measured by actigraphy. Results: There were no differences in formula intake or growth between dietary groups. DHA supplementation increased brain DHA, but decreased ARA, compared with all other groups. ARA supplementation increased brain ARA compared with all other groups but did not affect brain DHA. Combined supplementation increased brain DHA levels but did not affect brain ARA levels compared with the control. Pigs fed ARA or ARA+DHA exhibited more activity than those fed CON or DHA. Diet-dependent differences in activity suggested pigs fed ARA had the lowest percent time asleep, while those fed DHA had the highest. No differences were observed for immune or myelination outcomes. Conclusion: Supplementation with ARA and DHA did not differentially affect immune responses, but ARA levels in RBC and PFC were reduced when DHA was provided without ARA. Supplementation of either ARA or DHA alone induced differences in time spent asleep, and ARA inclusion increased general activity. Therefore, the current data support the combined supplementation with both ARA and DHA in infant formula and raise questions regarding the safety and nutritional suitability of ARA or DHA supplementation individually.
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Affiliation(s)
- Kaylee E Hahn
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Division of Nutrition Sciences, University of Illinois, Urbana, IL, United States
| | - Irina Dahms
- DSM Nutritional Products, Kaiseraugst, Switzerland
| | | | - Norman Salem
- DSM Nutritional Products, Columbia, MD, United States
| | | | - Eileen Bailey
- DSM Nutritional Products, Columbia, MD, United States
| | - Stephen A Fleming
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Neuroscience Program, University of Illinois, Urbana, IL, United States
| | - Brooke N Smith
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Ryan N Dilger
- Piglet Nutrition & Cognition Laboratory, Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Division of Nutrition Sciences, University of Illinois, Urbana, IL, United States.,Neuroscience Program, University of Illinois, Urbana, IL, United States
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12
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Tounian P, Bellaïche M, Legrand P. ARA or no ARA in infant formulae, that is the question. Arch Pediatr 2020; 28:69-74. [PMID: 33268182 DOI: 10.1016/j.arcped.2020.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/09/2020] [Accepted: 10/02/2020] [Indexed: 01/09/2023]
Abstract
Recently, the European Commission issued a Delegated Regulation updating the compositional and information requirements for infant and follow-on formulae that are to be applied at the latest in February 2021. This new regulation changes the status of docosahexaenoic acid (DHA) from an optional ingredient to a mandatory nutrient in these formulae at levels between 20 and 50mg/100kcal (0.5-1% of fatty acids). By contrast, arachidonic acid (ARA) becomes an optional nutrient. Following publication of the new regulation, global scientific experts have expressed concerns regarding the potential health risks of new infant formulae containing only DHA, especially at levels higher than those in breast milk and infant formulae marketed to date. Both DHA and ARA play a crucial role in infant development. First, breast milk, the gold standard for infant feeding, contains both DHA and ARA. Second, during development, the conversion of linoleic acid into ARA through desaturation steps is not sufficient to meet nutritional needs, especially in carriers of newly identified genetic variants in fatty acid desaturases, which weaken the biosynthetic production of ARA. Third, circulating levels of DHA and ARA in breastfed infants can only be matched with the addition of both fatty acids to formulae. And fourth, most studies performed to date have demonstrated that important physiological and developmental endpoints are sensitive to the ratio of dietary ARA:DHA. The precautionary principle applies when implementing the new EU regulation for infant and follow-on formulae. As a consequence, given the vulnerability of developing infants as well as the absence of conclusive evidence that formulae with at least 20mg DHA/100kcal, but no ARA, are safe and suitable to support the growth and development of infants similar to their breastfed peers, it remains necessary to still market formulas containing both ARA and DHA until proved otherwise.
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Affiliation(s)
- P Tounian
- Pediatric Nutrition and Gastroenterology department, Trousseau Hospital, AP-HP, Sorbonne University, 75012 Paris, France.
| | - M Bellaïche
- Pediatric Gastroenterology and Nutrition department, Robert Debré Hospital, AP-HP, 75019 Paris, France
| | - P Legrand
- Biochemistry/Human Nutrition, Agrocampus-Ouest, Rennes, 35042 Rennes, France
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13
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Arachidonic Acid in Human Milk. Nutrients 2020; 12:nu12030626. [PMID: 32121018 PMCID: PMC7146261 DOI: 10.3390/nu12030626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
Breastfeeding is universally recommended as the optimal choice of infant feeding and consequently human milk has been extensively investigated to unravel its unique nutrient profile. The human milk lipid composition is unique and supplies specifically long-chain polyunsaturated fatty acids (LC-PUFAs), in particular, arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3). Arachidonic acid (ARA) is the most predominant long-chain polyunsaturated fatty acid in human milk, albeit at low concentrations as compared to other fatty acids. It occurs predominantly in the triglyceride form and to a lesser extent as milk fat globule membrane phospholipids. Human milk ARA levels are modulated by dietary intake as demonstrated by animal and human studies and consequently vary dependent on dietary habits among mothers and regions across the globe. ARA serves as a precursor to eicosanoids and endocannabinoids that also occur in human milk. A review of scientific and clinical studies reveals that ARA plays an important role in physiological development and its related functions during early life nutrition. Therefore, ARA is an important nutrient during infancy and childhood and, as such, appropriate attention is required regarding its nutritional status and presence in the infant diet. Data are emerging indicating considerable genetic variation in encoding for desaturases and other essential fatty acid metabolic enzymes that may influence the ARA level as well as other LC-PUFAs. Human milk from well-nourished mothers has adequate levels of both ARA and DHA to support nutritional and developmental needs of infants. In case breastfeeding is not possible and infant formula is being fed, experts recommend that both ARA and DHA are added at levels present in human milk.
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14
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Nieto-Ruiz A, Diéguez E, Sepúlveda-Valbuena N, Catena E, Jiménez J, Rodríguez-Palmero M, Catena A, Miranda MT, García-Santos JA, G. Bermúdez M, Campoy C. Influence of a Functional Nutrients-Enriched Infant Formula on Language Development in Healthy Children at Four Years Old. Nutrients 2020; 12:nu12020535. [PMID: 32092927 PMCID: PMC7071497 DOI: 10.3390/nu12020535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 12/17/2022] Open
Abstract
Nutrition during early life is essential for brain development and establishes the basis for cognitive and language skills development. It is well established that breastfeeding, compared to formula feeding, has been traditionally associated with increased neurodevelopmental scores up to early adulthood. We analyzed the long-term effects of a new infant formula enriched with bioactive compounds on healthy children's language development at four years old. In a randomized double-blind COGNIS study, 122 children attended the follow-up call at four years. From them, 89 children were fed a standard infant formula (SF, n = 46) or an experimental infant formula enriched with functional nutrients (EF, n = 43) during their first 18 months of life. As a reference group, 33 exclusively breastfed (BF) were included. Language development was assessed using the Oral Language Task of Navarra-Revised (PLON-R). ANCOVA, chi-square test, and logistic regression models were performed. EF children seemed to show higher scores in use of language and oral spontaneous expression than SF children, and both SF and EF groups did not differ from the BF group. Moreover, it seems that SF children were more frequently categorized into "need to improve and delayed" in the use of language than EF children, and might more frequently present "need to improve and delayed" in the PLON-R total score than BF children. Finally, the results suggest that SF children presented a higher risk of suffering language development than BF children. Secondary analysis also showed a slight trend between low socioeconomic status and poorer language skills. The functional compound-enriched infant formula seems to be associated with beneficial long-term effects in the development of child's language at four years old in a similar way to breastfed infants.
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Affiliation(s)
- Ana Nieto-Ruiz
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs. GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
- Mind, Brain and Behaviour Research Centre-CIMCYC, University of Granada, 18011 Granada, Spain;
| | - Estefanía Diéguez
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs. GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Natalia Sepúlveda-Valbuena
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Nutrition and Biochemistry Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Elvira Catena
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- Mind, Brain and Behaviour Research Centre-CIMCYC, University of Granada, 18011 Granada, Spain;
| | - Jesús Jiménez
- Ordesa Laboratories, S.L., 08820 Barcelona, Spain; (J.J.); (M.R.-P.)
| | | | - Andrés Catena
- Mind, Brain and Behaviour Research Centre-CIMCYC, University of Granada, 18011 Granada, Spain;
| | - M. Teresa Miranda
- Department of Biostatistics, School of Medicine, University of Granada, 18016 Granada, Spain;
| | - José Antonio García-Santos
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs. GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Mercedes G. Bermúdez
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs. GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (A.N.-R.); (E.D.); (E.C.); (J.A.G.-S.); (M.G.B.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs. GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada’s node, Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-629-308-695
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15
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Coltell O, Sorlí JV, Asensio EM, Barragán R, González JI, Giménez-Alba IM, Zanón-Moreno V, Estruch R, Ramírez-Sabio JB, Pascual EC, Ortega-Azorín C, Ordovas JM, Corella D. Genome-Wide Association Study for Serum Omega-3 and Omega-6 Polyunsaturated Fatty Acids: Exploratory Analysis of the Sex-Specific Effects and Dietary Modulation in Mediterranean Subjects with Metabolic Syndrome. Nutrients 2020; 12:E310. [PMID: 31991592 PMCID: PMC7071282 DOI: 10.3390/nu12020310] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Many early studies presented beneficial effects of polyunsaturated fatty acids (PUFA) on cardiovascular risk factors and disease. However, results from recent meta-analyses indicate that this effect would be very low or nil. One of the factors that may contribute to the inconsistency of the results is that, in most studies, genetic factors have not been taken into consideration. It is known that fatty acid desaturase (FADS) gene cluster in chromosome 11 is a very important determinant of plasma PUFA, and that the prevalence of the single nucleotide polymorphisms (SNPs) varies greatly between populations and may constitute a bias in meta-analyses. Previous genome-wide association studies (GWAS) have been carried out in other populations and none of them have investigated sex and Mediterranean dietary pattern interactions at the genome-wide level. Our aims were to undertake a GWAS to discover the genes most associated with serum PUFA concentrations (omega-3, omega-6, and some fatty acids) in a scarcely studied Mediterranean population with metabolic syndrome, and to explore sex and adherence to Mediterranean diet (MedDiet) interactions at the genome-wide level. Serum PUFA were determined by NMR spectroscopy. We found strong robust associations between various SNPs in the FADS cluster and omega-3 concentrations (top-ranked in the adjusted model: FADS1-rs174547, p = 3.34 × 10-14; FADS1-rs174550, p = 5.35 × 10-14; FADS2-rs1535, p = 5.85 × 10-14; FADS1-rs174546, p = 6.72 × 10-14; FADS2-rs174546, p = 9.75 × 10-14; FADS2- rs174576, p = 1.17 × 10-13; FADS2-rs174577, p = 1.12 × 10-12, among others). We also detected a genome-wide significant association with other genes in chromosome 11: MYRF (myelin regulatory factor)-rs174535, p = 1.49 × 10-12; TMEM258 (transmembrane protein 258)-rs102275, p = 2.43 × 10-12; FEN1 (flap structure-specific endonuclease 1)-rs174538, p = 1.96 × 10-11). Similar genome-wide statistically significant results were found for docosahexaenoic fatty acid (DHA). However, no such associations were detected for omega-6 PUFAs or linoleic acid (LA). For total PUFA, we observed a consistent gene*sex interaction with the DNTTIP2 (deoxynucleotidyl transferase terminal interacting protein 2)-rs3747965 p = 1.36 × 10-8. For adherence to MedDiet, we obtained a relevant interaction with the ME1 (malic enzyme 1) gene (a gene strongly regulated by fat) in determining serum omega-3. The top-ranked SNP for this interaction was ME1-rs3798890 (p = 2.15 × 10-7). In the regional-wide association study, specifically focused on the FADS1/FASD2/FADS3 and ELOVL (fatty acid elongase) 2/ELOVL 5 regions, we detected several statistically significant associations at p < 0.05. In conclusion, our results confirm a robust role of the FADS cluster on serum PUFA in this population, but the associations vary depending on the PUFA. Moreover, the detection of some sex and diet interactions underlines the need for these associations/interactions to be studied in all specific populations so as to better understand the complex metabolism of PUFA.
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Affiliation(s)
- Oscar Coltell
- Department of Computer Languages and Systems, Universitat Jaume I, 12071 Castellón, Spain;
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
| | - Jose V. Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Eva M. Asensio
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Rocío Barragán
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - José I. González
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Ignacio M. Giménez-Alba
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Vicente Zanón-Moreno
- Area of Health Sciences, Valencian International University, 46002 Valencia, Spain;
- Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Ophthalmology Research Unit “Santiago Grisolia”, Dr. Peset University Hospital, 46017 Valencia, Spain
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | | | - Eva C. Pascual
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
- Assisted Reproduction Unit of the University Hospital of Valencia, 46010 Valencia, Spain
| | - Carolina Ortega-Azorín
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Jose M. Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111 USA;
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- IMDEA Alimentación, 28049 Madrid, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.S.); (E.M.A.); (R.B.); (J.I.G.); (I.M.G.-A.); (R.E.); (C.O.-A.)
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain;
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16
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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. Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation. Am J Clin Nutr 2020; 111:10-16. [PMID: 31665201 DOI: 10.1093/ajcn/nqz252] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Berthold Koletzko
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany.,Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Karin Bergmann
- Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - J Thomas Brenna
- Dell Pediatric Research Institute, Departments of Pediatrics, Chemistry, and Nutrition, University of Texas at Austin, Austin, TX, USA.,Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Philip C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Cristina Campoy
- Department of Pediatrics, University of Granada, Granada, Spain
| | - M Tom Clandinin
- Departments of Agriculture, Food and Nutritional Science and of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John Colombo
- Department of Psychology and Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Mandy Daly
- Irish Neonatal Health Alliance, Bray, Ireland
| | - Tamás Decsi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Hans Demmelmair
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Magnus Domellöf
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Nataša FidlerMis
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Johannes B van Goudoever
- Amsterdam Academic Medical Center, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | - Adamos Hadjipanayis
- Pediatric Department, Larnaca General Hospital, Larnaca, Cyprus.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Olle Hernell
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France.,Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Valerie Matthäus
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Usha Ramakrishan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sean J J Strain
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | | | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
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17
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Nieto-Ruiz A, García-Santos JA, Bermúdez MG, Herrmann F, Diéguez E, Sepúlveda-Valbuena N, García S, Miranda MT, De-Castellar R, Rodríguez-Palmero M, Catena A, Campoy C. Cortical Visual Evoked Potentials and Growth in Infants Fed with Bioactive Compounds-Enriched Infant Formula: Results from COGNIS Randomized Clinical Trial. Nutrients 2019; 11:nu11102456. [PMID: 31615134 PMCID: PMC6835488 DOI: 10.3390/nu11102456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/09/2019] [Accepted: 10/12/2019] [Indexed: 12/18/2022] Open
Abstract
Postnatal nutrition is essential for growth and neurodevelopment. We analyzed the influence of a new enriched-infant formula with bioactive compounds on growth, neurodevelopment, and visual function (VF) in healthy infants during their first 18 months of life. A total of 170 infants were randomized in the COGNIS randomized clinical trial (RCT) to receive a standard infant formula (SF = 85) or a new experimental infant formula supplemented with functional nutrients (EF = 85). As a control, 50 breastfed infants (BF) were enrolled. Growth patterns were evaluated up to 18 months of life; neurodevelopment was assessed by general movements at 2, 3, and 4 months; VF was measured by cortical visual evoked potentials at 3 and 12 months. No differences in growth and neurodevelopment were found between groups. Regarding VF, SF and EF infants presented prolonged latencies and lower amplitudes in the P100 wave than BF infants. In the EF group, a higher percentage of infants presented response at 7½′ of arc at 12 months compared to 3 months of age; a similar proportion of BF and EF infants presented responses at 7½′ of arc at 12 months of age. Early nutritional intervention with bioactive compounds could narrow the gap in growth and neurodevelopment between breastfed and formula-fed infants.
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Affiliation(s)
- Ana Nieto-Ruiz
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
- Mind, Brain and Behaviour Research Centre-CIMCYC, University of Granada, 18011 Granada, Spain.
| | - José Antonio García-Santos
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
| | - Mercedes G Bermúdez
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
| | - Florian Herrmann
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
| | - Estefanía Diéguez
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
| | - Natalia Sepúlveda-Valbuena
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Nutrition and Biochemistry Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá 110231, Colombia.
| | - Salomé García
- Clinical Service of Neurophysiology, Clinical University Hospital San Cecilio, 18016 Granada, Spain.
| | - M Teresa Miranda
- Department of Biostatistics, School of Medicine, University of Granada,18016 Granada, Spain.
| | | | | | - Andrés Catena
- Mind, Brain and Behaviour Research Centre-CIMCYC, University of Granada, 18011 Granada, Spain.
| | - Cristina Campoy
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada´s Node, Institute of Health Carlos III, 28029 Madrid, Spain.
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