Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation

Berthold Koletzko, Karin Bergmann, Thomas Brenna, Philip Calder, Cristina Campoy, Tom Clandinin, John Colombo, Mandy Daly, Tamas Decsi, Hans Demmelmair, Magnus Domellof, Natasa FildlerMis, Ines Gonzalez-Casanova, Johannes B van Goudoever, Adamos Hadjipanayis, Olle Hernell, Alexandre Lapillonne, Silke Mader, Camilia Martin, Valerie MatthausUsha Ramakrishan, Cornelius Smuts, Sean J J Strain, Conny Tanjung, Patrick Tounian, Susan Carlson

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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.
Original languageEnglish
Pages (from-to)10-16
Number of pages7
JournalAmerican Journal of Clinical Nutrition
Issue number1
Early online date26 Oct 2019
Publication statusPublished (in print/issue) - 1 Jan 2020

Bibliographical note

Funding Information:
Author disclosures: PCC has acted as an advisor or consultant to DSM, Danone/Nutricia, and Cargill. SEC has been a consultant for industry related to long-chain PUFAs. OH is a member of the Scientific Advisory Boards of Hero and Semper and has received honoraria from Arla Foods Ingredients. JC has consulted for Mead Johnson Nutrition, Wyeth/Nestlé, Fonterra Brands, and Ingenuity Foods. BK tends to be biased toward breastfeeding as a member of the German National Breastfeeding Committee and the national program Becoming Breastfeeding Friendly; chair of the Nutrition Committee, German Paediatric Society; and President Elect, the International Society for Research in Human Milk and Lactation. Ludwig-Maximilians-Universität Munich and its employee BK benefit from support for scientific and educational activities from the European Commission, European Research Council, German Ministry of Education and Research, US NIH, Government of Norway, and different health care and nutrition companies, predominantly as part of publicly funded research projects supported by the European Commission or German government. MD received a consultancy fee from Nutricia and speaker fees from Baxter, Nestlé, Semper, Fresenius, and Abbvie. CRM is a member of the Scientific Advisory Boards of Prolacta Biosciences Inc., Alcresta Therapeutics, and Fresenius Kabi, and consultant for Mead Johnson Nutrition. SJJS received support for consultancy from DSM. AL received payment or honoraria for lectures from Mead Johnson and Nestlé. PT received payment from Carrefour, Blédina, Mead Johnson, Nestlé, Novalac, Nutricia, PediAct, and Sodilac. UR participated in the Nestlé Nutrition Workshop Series. CMS received traveling support from Unilever, DSM, and Sight and Life. All other authors report no conflicts of interest. Address correspondence to BK (e-mail: [email protected]).

Publisher Copyright:
Copyright © 2019 The Author(s).

Copyright 2020 Elsevier B.V., All rights reserved.


  • European Commission Formula Delegated Act 2016/127
  • breast milk substitutes
  • food safety
  • infant nutrition
  • long-chain PUFAs


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