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

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

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.

European Commission Formula Delegated Act 2016/127, breast milk substitutes, food safety, infant nutrition, long-chain PUFAs
0002-9165
10-16
Koletzko, Berthold
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Bergmann, Karin
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Brenna, J. Thomas
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Calder, Philip
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Martin, Camilia R.
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Carlson, Susan E.
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Koletzko, Berthold
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Bergmann, Karin
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Matthäus, Valerie
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Ramakrishan, Usha
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Smuts, Cornelius M.
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Strain, Sean JJ
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Koletzko, Berthold, Bergmann, Karin, Brenna, J. Thomas, Calder, Philip, Campoy, Cristina, Clandinin, M. Tom, Colombo, John, Daly, Mandy, Descsi, Tamás, Demmelmair, Hans, Domellöf, Magnus, Fidler Mi, Nataša, Gonzalez-Casanova, Ines, van Goudoever, Johannes B, Hadjipanayis, Adamos, Hernell, Olle, Lapillonne, Alexandre, Mader, Silke, Martin, Camilia R., Matthäus, Valerie, Ramakrishan, Usha, Smuts, Cornelius M., Strain, Sean JJ, Tanjung, Conny, Tounian, Patrick and Carlson, Susan E. (2020) Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation. American Journal of Clinical Nutrition, 111 (1), 10-16. (doi:10.1093/ajcn/nqz252).

Record type: Article

Abstract

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.

Text
AJCN-D-19-00876 Rev 1_LC-PUFA infant formula-CLEAN - Accepted Manuscript
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Accepted/In Press date: 9 September 2019
e-pub ahead of print date: 26 October 2019
Published date: 1 January 2020
Additional Information: 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).
Keywords: European Commission Formula Delegated Act 2016/127, breast milk substitutes, food safety, infant nutrition, long-chain PUFAs

Identifiers

Local EPrints ID: 434154
URI: http://eprints.soton.ac.uk/id/eprint/434154
ISSN: 0002-9165
PURE UUID: 3028e608-0dd1-4550-b361-7cd788c2c0d2
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 13 Sep 2019 16:30
Last modified: 29 Jul 2022 04:01

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Contributors

Author: Berthold Koletzko
Author: Karin Bergmann
Author: J. Thomas Brenna
Author: Philip Calder ORCID iD
Author: Cristina Campoy
Author: M. Tom Clandinin
Author: John Colombo
Author: Mandy Daly
Author: Tamás Descsi
Author: Hans Demmelmair
Author: Magnus Domellöf
Author: Nataša Fidler Mi
Author: Ines Gonzalez-Casanova
Author: Johannes B van Goudoever
Author: Adamos Hadjipanayis
Author: Olle Hernell
Author: Alexandre Lapillonne
Author: Silke Mader
Author: Camilia R. Martin
Author: Valerie Matthäus
Author: Usha Ramakrishan
Author: Cornelius M. Smuts
Author: Sean JJ Strain
Author: Conny Tanjung
Author: Patrick Tounian
Author: Susan E. Carlson

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