Formula for a bright baby?

Abstract

Breast-fed infants perform better on tests that assess neurodevelopmental outcomes than do formula-fed infants (JAMA 2002;287:2365). What's different about formulas? Docosahexaenoic acid (DHA), an omega-3 fatty acid is highly concentrated in brain and retina. Breast milk contains DHA and arachidonic acid (AA), whereas infant formulas marketed in North America traditionally do not. The major questions are should we supplement and if so how? Recent studies have shown a beneficial effect on visual function following weaning supplementation with DHA. For example, Hoffman et al provided evidence for a continued need for DHA beyond 4 months of age to optimize visual development (J Pediatr 2003;142:669). This study, of course, supports the AAP recommendation that “breast-feeding continue for at least 12 months” (Pediatrics 1997;100:1035). The jury is deadlocked regarding neurodevelopmental outcomes. Therefore, the answer to the first question seems to be that supplementation is safe and will increase plasma DHA levels. Whether there are truly any important long-term benefits remains unanswered, but seems likely. Are any potential beneficial effects due solely to DHA and/or AA? What is the role of confounding factors (such as the source and amount of the fatty acids)? In a randomized, controlled trial reported in this issue, Fewtrell et al supplied AA as its precursor gamma-linolenic acid (GLA). GLA was added as borage (starflower) oil in children up to 9 months of age; tuna fish oil provided DHA. The authors state that “this strategy was moderately effective and safe”—however, the degree of AA enrichment was less than expected and only the LCPUFA-supplemented boys had a documented neurodevelopmental outcome. I will have to think about these results a bit more, perhaps after ingesting some DHA or AA! Page 471