Preterm infant formula supplementation with alpha-linolenic acid and docosahexaenoic acid.
Preterm infant formula supplementation with alpha-linolenic acid and docosahexaenoic acid.
Year: 2003
Authors: A Rodriguez, D Raederstorff, P Sarda, C Lauret, F Mendy, B Descomps.
Publication Name: Eur. J. Clin. Nutr.
Publication Details: Volume 57; Number 6; 727-734.
Abstract:
A significant supply of n-3 and n-6 PUFA is required for growth and development, particularly during the fetal and perinatal period. Previous studies have demonstrated that preterm infants fed formulas supplemented with long-chain n-3 fatty acids, primarily docosahexaenoic acid (DHA), display better retinal function and processing speed in comparison to infants fed formulas deficient in n-3 fatty acids. Beneficial effects of DHA intake is also significant in term infants. The majority of studies have used DHA as the source of long-chain n-3 PUFA, as the synthesis of sufficient amounts of DHA during ‘regular metabolism’ from the parent n-3 fatty acid alpha-linolenic acid (ALA) remains questionable. Previous research by Rodriguez et al. indicated that formula supplemented with ALA (LA:ALA ratio of 6:1) significantly improved the n-3 series PUFA status in plasma phospholipids and erythrocyte membranes in comparison regular formula in pre-term infants. Although ALA supplemented formula resulted in improved n-3 LCPUFA status, DHA levels did not reach those observed in infants fed human milk. In this study, the effects of a formula supplemented with both ALA and DHA, on the DHA and arachidonic acid (AA) status in pre-term infants was evaluated. Thirty-eight newborns were enrolled when gestational age was less than 34 weeks, birth weight was above the 10th percentile, and clinical conditions permitted early oral feeding. Infants were assigned to two groups: 1) DHA group (n=13) received an experimental formula that contained ALA (0.6% total energy) from low erucic acid rapeseed oil (LEAR), supplemented with DHA (65mg DHA/100g dry milk). The DHA/EPA ratio of this formula was 5:1; or 2) Breast milk (BM; n=25). Infants were studies at the second day (D2), the 15th day (D15), and at approximately 5 weeks (W37) following formula or BM feeding. The study ended 1 month later (W37+ 30) in the formula fed group, however, sampling in the BM group at this time was not possible as it was not designed at the beginning of the study. At D2, D15, W37 and W37 + 30 anthropometric measurements of crown-heal length, head circumference and body weight were recorded, and blood samples collected for analysis of fatty acid parameters such as plasma phospholipids (PL), cholesterol esters (CE), triglycerides (TG) and red blood cell phosphatidylethanolamine (RBC-PE). At W37, weights, heights, and head circumferences were similar in all infants in both the DHA and BM groups. In addition, PL DHA was maintained in the DHA group at the same level as in the BM group, and the same for DHA in PE at W37. At W37, the AA status in RBC-PE was the same in both groups, and AA levels in PL remained very stable throughout the study. However, in the DHA group, AA levels in PL remained in the range observed with standard, nom supplemented, formulas. The results of this study suggest that supplementation of infant formula with both DHA and ALA and an DHA:EPA ratio of 5:1, supports normal growth and n-3 fatty acid metabolism in premature newborns. Importantly, DHA values obtained through the dietary combination of DHA and ALA in this present study were closer to that of the BM group in comparison to DHA values that have been reported using ALA supplementation alone. As such, based on these results the researchers state that supplementing preterm infant formula with DHA in addition to ALA is justified.
