Impact of early dietary intake and blood lipid composition of long-chain polyunsaturated fatty acids on later visual development.
BACKGROUND
In contrast to human milk, current infant formulas in the United States do not contain omega3 and omega6 long-chain polyunsaturated fatty acids. This may lead to suboptimal blood lipid fatty acid profiles and to a measurable diminution of visual function in developing term infants. The need for docosahexaenoic acid and arachidonic acid supplementation in the infant diet was evaluated in a double-blind, randomized clinical trial.


METHODS
Healthy term infants were randomized to diets of (1) commercial formula, (2) docosahexaenoic acid-enriched formula (0.35% of total fatty acids), or (3) docosahexaenoic acid- (0.36%) and arachidonic acid- (0.72%) enriched formula. Eighty-seven infants completed the 17-week nutritional trial, and 58 were observed until 52 weeks of life. A reference group was exclusively breast fed for at least 17 weeks (n = 29). Outcome measures included electroretinographic responses, visual evoked potentials, and blood fatty acid analysis in infants at birth and at 6, 17, and 52 weeks of age.


RESULTS
Commercial formula-fed infants had 30% to 50% lower content of docosahexaenoic acid in total red blood cell lipids during the 17-week feeding trial compared with breastfed infants. Significant differences persisted at the 1-year follow-up. Arachidonic acid content was consistently reduced in the commercial formula group by 15% to 20%. Infants fed long-chain polyunsaturated fatty acid-enriched formulas had docosahexaenoic acid and arachidonic acid blood lipid profiles resembling those of human milk-fed infants. Infants receiving this enriched formula had more mature electroretinographic responses than commercial formula-fed infants at 6 weeks of age. Human milk-fed and docosahexaenoic acid-enriched formula-fed infants had better visual acuity than commercial formula-fed infants at both 17 and 52 weeks of age. Early (17-week) fatty acid profiles in blood lipids were correlated with later (52-week) visual function development in study infants.


CONCLUSIONS
Results from this clinical trial demonstrate that long-chain polyunsaturated fatty acid supplementation of formula in term infants produces blood lipid fatty acid profiles that are similar to those observed in breast-fed infants. This supplementation leads to better visual function later in life (i.e., 1 year of age) than that shown by infants fed commercial formula.
Hoffman
D R
DR
Retina Foundation of the Southwest, and Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75231, USA. dhoffman@retinafoundation.org
Birch
E E
EE
Birch
D G
DG
Uauy
R
R
Castañeda
Y S
YS
Lapus
M G
MG
Wheaton
D H
DH
D016718:Arachidonic Acid / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D001903:Bottle Feeding; D001942:Breast Feeding; D015331:Cohort Studies; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D004311:Double-Blind Method; D004596:Electroretinography; D004912:Erythrocytes / Q000737:chemistry; D005074:Evoked Potentials, Visual / Q000187:drug effects* / Q000502:physiology; D005227:Fatty Acids / Q000032:analysis / Q000097:blood*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000032:analysis; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage / Q000032:analysis; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000032:analysis; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008055:Lipids / Q000097:blood / Q000737:chemistry; D012160:Retina / Q000187:drug effects / Q000502:physiology; D014792:Visual Acuity / Q000187:drug effects* / Q000502:physiology
D005227:Fatty Acids; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated; D008055:Lipids; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid