Mead Johnson Asia - Brunei

Some fats - and components of fats (fatty acids) - offer a number of health benefits. For example, there is growing evidence that the fatty acids DHA and ARA are important for mental and visual development in growing infants and young children. (i) (ii)

During pregnancy, a growing baby will receive DHA and ARA from the mother - this is especially important during the last trimester when there is significant brain growth. Breast-fed babies also receive these nutrients; however, the levels they receive depend on the mother's diet. Breastfeeding mothers can increase the amount of DHA in their breast milk by eating foods like salmon, tuna and sardines.

Scientists have known that infants could synthesize DHA and ARA from precursors in infant formula (other fatty acids called alpha-linolenic acid and linoleic acid). However, some recent research (ii) has convinced some experts that not all babies can make enough of these nutrients from these precursors to support optimal development.

"Since rapid infant brain development occurs in the early months of life, a number of researchers believe that a direct dietary source of DHA and ARA at that time can be beneficial for brain and retinal development," said James W. Hansen, MD, PhD, neo-natologist and former Medical Director for Mead Johnson Nutritionals.

DHA- and ARA-enriched formulas have been fed to babies around the world for more than five years. Currently, formulas containing these nutrients are available in more than 60 countries, including the United Kingdom and Hong Kong. Several international organizations - including expert panels sponsored by the Food and Agriculture Organization/ World Health Organization and by the Child Health Foundation - recommend the addition of these nutrients to infant formula. (iii)

A study funded by the National Institute of Child Health and Human Development, U.S.A., published in 2000, found that infants given formula with DHA and ARA performed better on a mental development test compared to infants who consumed the control formula without DHA and ARA.(i) Infants who were fed the new formula with these nutrients scored an average of about seven points higher on the 100-point scale on the mental development test at 18 months of age. The study was led by Eileen Birch, PhD, of the Retina Foundation of the Southwest in Dallas, who has studied DHA and ARA for 15 years.

A 1998 study published by the Lancet and led by Peter Willatts, PhD from the Department of Psychology, University of Dundee, U.K., further supports the benefits provided by DHA and ARA.(iv) That study showed that at 10 months of age, infants who had been fed formula supplemented with these nutrients scored better on a test assessing complex problem-solving skills when compared with infants fed formula that was not supplemented.

DHA is a major structural component of the retina of the eye. It makes up as much as 60 percent of the fatty acids in certain phospholipids of the outer segments of the rods in the retina.

Several studies of infants fed DHA- and ARA-enriched formula have shown more rapid rates of visual development compared to infants fed unsupplemented formula. The advantage is equivalent to about one line on a standard eye chart during the first year of life, according to the Birch study.

In support of this, a further study (v) led by Dr. Hoffman, looked at formula supplemented with 0.72% ARA and 0.36% DHA, from the start of weaning until one year old. The study demonstrated that a dietary supply of DHA+ARA can optimise visual development in weaning babies, not just in the first few months of infancy, but at least up to one year of life.

This strongly hints at a similar benefit to mental development, because "... assessment of visual development in early childhood directly reflects development progression of the brain." (vi)

More than 20 studies have been conducted over the last 10 years with infants fed DHA+ARA-fortified formula. Some of these clinical studies have not shown incremental developmental benefits. Experts disagree as to why some of these studies found different results. Possible explanations, among others, may relate to variations in study design — for example, the sensitivity of the testing methods and the ages of the infants being studied — or the levels of DHA and ARA provided.

We know that the infant's brain development does not stop at the first 6 months of age, even though it grows fastest during that time.

Because the growth in brain size over the first two years of life is so dramatic, many people concentrate on this, and wrongly think that very little growth and development occurs after the first few months of life.

Continued development after 6 months requires building blocks that include DHA and ARA.

Although the infant is born with almost the same number of neurons in its brain that it will ever have, many experts now think that the brain keeps making new neurons, even if at a much reduced rate, over the entire life-span. These new neurons have a limited life-span of about a few weeks, unless they make connections to others directly as a result of learning. Both the formation of new neurons and the formation of new connections between existing neurons, require a good supply of building-blocks.

Neural building-blocks include large amounts of DHA and ARA which must either be made from the precursor essential fatty acids in the liver, or derived from the diet. Clearly the availability of DHA and ARA in the diet may be advantageous for many years into life - perhaps all the way through childhood into adult life.

Seen in the Scientific American, May 2000:

"Formula for intelligence?"

"Researchers may have found a food that makes you smarter - if you're a baby."

"... infants fed (this) formula performed better on tests of mental development than did a control group who received plain formula."

"... The mean result... on enriched formula was 105; babies fed plain formula scored 98."

"... 26% on the fortified diet scored over 115 (ie. mean + ISD), compared with only 5% of those on plain formula."

(Source: "Formula for Intelligence?" Sasha Nemecek, Scientific American, May 2000)

1. Birch EE, Garfield S, Hoffman DR, Uauy R, and Birch DG: A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Developmental Medicine & Child Neurology, 2000; 42:174-181.
2. Birch EE, Hoffman DR, Uauy R, Birch DG and Prestidge C: Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Pediatric Research 1998; 44:201-209.
3. FAO/WHO Joint Expert Consultation. Fats and oils in human nutrition. Report of a joint expert consultation. Rome:FAO/WHO, 1994:49-55.
4. Willatts P, Forsyth JS, DiModugno MK, Varma S, and Colvin M: Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet 1998; 352:688-691.
5. Hoffman DR, Birch EE, Castaneda YS et al. Dietary DHA and visual maturation in the post-weaning term infant. Invest. Opthalmol. Vis Sci 2001; 42:S122.
6. Hoffman DR, Birch EE, Birch DG et al. Impact of early dietary intake and blood lipid composition of long-chain polyunsaturated fatty acids on later visual development. J Pediatr Gastroenterl Nutr. 2000; 31:540-553.