TY - JOUR
T1 - Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation
AU - Koletzko, Berthold
AU - Bergmann, Karin
AU - Brenna, Thomas
AU - Calder, Philip
AU - Campoy, Cristina
AU - Clandinin, Tom
AU - Colombo, John
AU - Daly, Mandy
AU - Decsi, Tamas
AU - Demmelmair, Hans
AU - Domellof, Magnus
AU - FildlerMis, Natasa
AU - Gonzalez-Casanova, Ines
AU - van Goudoever, Johannes B
AU - Hadjipanayis, Adamos
AU - Hernell, Olle
AU - Lapillonne, Alexandre
AU - Mader, Silke
AU - Martin, Camilia
AU - Matthaus, Valerie
AU - Ramakrishan, Usha
AU - Smuts, Cornelius
AU - Strain, Sean J J
AU - Tanjung, Conny
AU - Tounian, Patrick
AU - Carlson, Susan
N1 - 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: office.koletzko@med.lmu.de).
Publisher Copyright:
Copyright © 2019 The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/10
Y1 - 2020/1/10
N2 - 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.
AB - 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.
KW - European Commission Formula Delegated Act 2016/127
KW - breast milk substitutes
KW - food safety
KW - infant nutrition
KW - long-chain PUFAs
UR - https://pure.ulster.ac.uk/en/publications/should-formula-for-infants-provide-arachidonic-acid-along-with-dh
UR - http://www.scopus.com/inward/record.url?scp=85077624608&partnerID=8YFLogxK
U2 - 10.1093/ajcn/nqz252
DO - 10.1093/ajcn/nqz252
M3 - Article
C2 - 31665201
VL - 111
SP - 10
EP - 16
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
SN - 0002-9165
IS - 1
ER -