Email id: info@ijclinmedcasereports.com

Review Article

DHA, LCPUFAs, ARA Nutrition Musketeers for Early Infancy and the Role in The Eye & Brain Growth and Development

Said Eldeib1,*, Abdulrahman Zeyada2, Marwa sayed3, Samah Alakhdar4, Dalal Amer5, Mohamed Ghonai6 and Mohammad Rizk Mohammad7

1Department of pediatrics, ADSCC/Yas clinic Hospital, UAE
2Department of pediatrics, NMC royal hospital, AD, UAE
3Department of pediatrics, Mediclinic Aljawhara AlAin UAE
4Department of pediatrics, Mediclinic Aljawhara AlAin UAE
5Department of pediatrics, The medical heart centre AlAin, UAE
6Specialized Rehabilitation Hospital, capital Health group, Abu dhabi, UAE
7Department of pediatrics, Mediclinic Al Ain Hospital,UAE

Received Date: 06/06/2023; Published Date: 12/10/2023

*Corresponding author: Dr. Said Eldeib, Department of pediatrics ADSCC/ Yas clinic Hospital, Abu Dhabi, UAE

DOI: 10.46998/IJCMCR.2023.30.000746

Abstract

DHA – and other long-chain polyunsaturated fatty acids (LCPUFAs) like arachidonic acid (ARA) – have received well-deserved recognition in the world of nutrition for the role they play in early development [1], and, for their role in brain and eye development. In this mini review, let’s dig into the science behind DHA and find out why this omega-3 fatty acid is such a critical part of nutrition early in life.

DHA is an omega-3 fatty acid involved in several aspects of our physiology and metabolism. It is a key component of certain tissues and membranes in the body – which means adequate amounts of it can play a crucial role in development. Specifically, during infancy, DHA plays a central role in the development of the brain, eyes, and immune system.

The long-chain polyunsaturated fatty acids (LCPUFAs) arachidonic acid (AA) and docosahexaenoic acid (DHA) are important components of breast milk.

Immune markers in preterm and term infants fed formula with AA and DHA were like those in infants fed human milk, whereas those in infants fed formula without LCPUFAs were not. Infants who received formula plus LCPUFAs (both AA and DHA) showed a reduced risk of allergic disease and respiratory illness than infants who received standard formula.

Studies in which infants received n-3 LCPUFAs report immune differences from controls that suggest better immune maturation and they show lower risk of allergic disease and respiratory illness over the first years of life. Taken together, these findings suggest that LCPUFAs play a role in immune development that is of clinical significance, particularly regarding allergic sensitisation and allergic manifestations including wheeze and asthma.

Keywords: DHA; AA; LCPUFAs; Brain growth; Infant formula; IQ; Immune development

Introduction

DHA and brain health
The brain accumulates large amounts of DHA before birth [32] – primarily in the third trimester – as well as after birth. DHA uptake by the brain is highest during the first two years of life, a period when the brain is rapidly growing. In fact, the brain growth that occurs before your little one’s second birthday will be faster than any other time in their life! This early stage represents a critical window of time when optimal nutrition is so important for supporting development [33].

DHA and eye health
DHA is also the predominant fatty acid in the retina of the eye. The retina [34] is responsible for visual recognition by receiving and organizing visual information; it then sends signals from the eye to the brain, allowing us to see. In addition to supporting healthy development of the retina, DHA may also offer a protective role to this fundamental tissue in our eyes.

DHA and the immune system
There is some evidence that DHA and ARA might play a role in supporting the immune system, especially during early infancy when the immune system is rapidly developing [35]. In fact, researchers found that infants fed a formula supplemented with DHA and ARA in the new born period had markers of immune function(36) that were similar to those of breastfed infants.

What are the health benefits of DHA?
DHA has been extensively researched over the last few decades, and, to help scientists understand how this fatty acid impacts infant growth and development. The findings from preclinical and clinical trials on DHA – alongside another LCPUFA, ARA – led to the addition of DHA and ARA in infant formulas, a critical innovation in infant feeding.

Some of the most important discoveries around why DHA is so important are highlighted here:

1- DHA and ARA supplementation in infants has been shown to positively impact cognitive development, even beyond the period when the formula was consumed. In one study, infants who received infant formula supplemented with DHA and ARA through four months of age were faster at processing information at six years of age compared to the group who didn’t receive DHA and ARA in infancy [37].

2- Also suggesting that DHA and ARA impact brain development, in a study assessing mental adaptability and flexibility in three-year-olds, children who received the recommended dose of DHA and ARA supplementation had improved scores compared to those who received less than optimal doses [38].

3- Clinical studies have demonstrated that DHA and ARA supplementation in infants improved visual acuity [39] during the first year of life, compared to those who did not receive supplementation. Of note, the findings were based on a specific amount of DHA, 0.32% of total fat, an amount that reflects amounts of DHA found in breast milk. This illustrates that the amount of DHA in baby formula matters!

4- Long-term follow-up of infants who received supplemental DHA and ARA in infancy found that, at four years of age, their visual acuity was similar to what was observed in breastfed infants, which represents the gold standard in infant feeding [40].

The benefits of DHA are seen beyond infancy – research has uncovered positive benefits of DHA and other omega-3 fatty acids in older children and adults as well. Heart health benefits have been observed when DHA is supplemented alongside another omega-3, Eicosapentaenoic Acid (EPA). DHA may also help reduce inflammation, support eye health in adults, and regulate behaviour and attention in people with Attention Deficit Hyperactivity Disorder (ADHD).

Conclusion

As nutrition research continues LCPUFAs, scientists are learning that the presence of both DHA and ARA in infant formula are critical. In addition, the ratio of DHA:ARA also matters. Studies have found positive outcomes when ARA is at least at equal concentration to – and up to twice the amount of – DHA. Higher or lower ratios of ARA to DHA may not yield benefits. Experts agree on the importance of providing both DHA and ARA in infant formula [41].

Recommended intakes of DHA in the US and Europe
There are definite differences between the US and Europe when it comes to recommended intakes of DHA in infancy, as well as the regulations around the addition of DHA to US infant formula [42].

the US NIH recommends 0- to 12-month-olds consume 500 mg per day of omega-3 fatty acids but does not provide guidance for DHA intake specifically.

Alpha-linoleic acid (ALA) is the “parent” fatty acid to DHA. Our bodies, through a series of complex steps, can convert ALA into DHA. However, in general, we don’t do this very efficiently. Further, some people – depending on genetics – have very low rates of converting ALA to DHA at all. For this reason, it’s important that DHA is consumed directly in the diet. Therefore, infants rely on breast milk or infant formula for their DHA [43].

There is some evidence that DHA and ARA might play a role in supporting the immune system, especially during early infancy when the immune system is rapidly developing. In fact, researchers found that infants fed a formula supplemented with DHA and ARA in the new born period had markers of immune function that were similar to those of breastfed infants.

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.

Data Availability Statement: Not applicable.

Acknowledgments: The authors would like to acknowledge the use of Bio render for the conception of the figures.

Conflicts of Interest: No conflict of interest

References

  1. InnisSM.Essential fatty acid transfer and fetal development. Placenta, 2005; 26: S70–S75.
  2. Van HouwelingenAC, SorensenJD, Hornstra G, et al. Essential fatty acid status in neonates after fish-oil supplementation during late pregnancy. Br J Nutr, 1995; 74: 723–731.
  3. EliasSL, InnisSM. Infant plasma trans, n-6, and n-3 fatty acids and conjugated linoleic acids are related to maternal plasma fatty acids, length of gestation, and birth weight and length. Am J Clin Nutr, 2001; 73: 807–814.
  4. DecsiT, CampoyC, Koletzko B. Effect of N-3 polyunsaturated fatty acid supplementation in pregnancy: the Nuheal trial. Adv Exp Med Biol, 2005; 569: 109–113.
  5. Krauss-EtschmannS, ShadidR, Campoy C, et al. Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial. Am J Clin Nutr, 2007; 85: 1392–1400.
  6. KoletzkoB, LarqueE, Demmelmair H. Placental transfer of long-chain polyunsaturated fatty acids (LCPUFA). J Perinat Med, 2007; 35(Suppl 1): S5–11.
  7. LarqueE, Krauss-EtschmannS, Campoy C, et al. Docosahexaenoic acid supply in pregnancy affects placental expression of fatty acid transport proteins. Am J Clin Nutr, 2006; 84: 853–861.
  8. OlsenSF, HansenHS, Sorensen TI, et al. Intake of marine fat, rich in (n-3) polyunsaturated fatty acids, may increase birthweight by prolonging gestation, 1986; 2: 367–369.
  9. OlsenSF.Is supplementation with marine omega-3 fatty acids during pregnancy a useful tool in the prevention of preterm birth? Clin Obstet Gynecol, 2004; 47: 768–774.
  10. HeirdWC,Lapillonne A. The role of essential fatty acids in development. Annu Rev Nutr, 2005; 25: 549–571.
  11. Hadders-AlgraM, BouwstraH, van Goor SA, et al. Prenatal and early postnatal fatty acid status and neurodevelopmental outcome. J Perinat Med, 2007; 35(Suppl 1): S28–S34.
  12. McCannJC,Ames BN. Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals. Am J Clin Nutr, 2005; 82: 281–295.
  13. UauyR,Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. Nutr Rev, 2006; 64: S24–S33.
  14. HibbelnJR, FergusonTA, Blasbalg TL. Omega-3 fatty acid deficiencies in neurodevelopment, aggression and autonomic dysregulation: opportunities for intervention. Int Rev Psychiatry, 2006; 18: 107–118.
  15. InnisSM.Dietary (n-3) fatty acids and brain development. J Nutr, 2007; 137: 855–859.
  16. SchuchardtJP, HussM, Stauss-Grabo M, et al. Significance of long-chain polyunsaturated fatty acids (PUFAs) for the development and behaviour of children. Eur J Pediatr, 2010; 169: 149–164.
  17. ClandininMT, ChappellJE, Leong S, et al. Extrauterine fatty acid accretion in infant brain: implications for fatty acid requirements. Early Hum Dev, 1980; 4: 131–138.
  18. MartinezM.Tissue levels of polyunsaturated fatty acids during early human development. J Pediatr, 1992; 120: S129–S138.
  19. InnisSM.Omega-3 Fatty acids and neural development to 2 years of age: do we know enough for dietary recommendations? JPGN, 2009; 48(Suppl 1): S16–S24.
  20. WilliamsC, BirchEE, Emmett PM, et al. Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study. Am J Clin Nutr, 2001; 73: 316–322.
  21. InnisSM, GilleyJ, Werker J. Are human milk long-chain polyunsaturated fatty acids related to visual and neural development in breast-fed term infants? 2001; 139: 532–538.
  22. HibbelnJR, DavisJM, Steer C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study, 2007; 369: 578–585.
  23. KoletzkoB, LienE, Agostoni C, et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med, 2008; 36: 5–14.
  24. GibsonRA, MuhlhauslerB, Makrides M. Conversion of linoleic acid and alpha-linolenic acid to long-chain polyunsaturated fatty acids (LCPUFAs), with a focus on pregnancy, lactation and the first 2 years of life. Maternal & Child Nutrition, 2011; 7: 17–26.
  25. Delgado-NogueraMF, CalvacheJA, Bonfill C. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev, 2010; CD007901.
  26. DziechciarzP, HorvathA, Szajewska H. Effects of n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and/or lactation on neurodevelopment and visual function in children: a systematic review of randomized controlled trials. J Am Coll Nutr, 2010; 29: 443–454.
  27. MakridesM, CollinsCT, Gibson RA. Impact of fatty acid status on growth and neurobehavioural development in humans. Matern Child Nutr, 2011; 7(Suppl 2): 80–88.
  28. UauyRD, BirchDG, Birch EE, et al. Effect of dietary n-3 fatty acids on retinal function of very low birthweight neonates. Pediatr Research, 1990; 28: 485–492.
  29. BirchDG, BirchEE, Hoffman DR, et al. Retinal development in very-low-birth-weight infants fed diets differing in omega-3 fatty acids. Invest Ophthalmol Vis Sci, 1992; 33: 2365–2376.
  30. CarlsonSE, WerkmanSH, Rhodes PG, et al. Visual-acuity development in healthy preterm infants: effect of marine-oil supplementation. Am J Clin Nutr, 1993; 58: 35–42.
  31. MakridesM, SimmerK, Goggin M, et al. Erythrocyte docosahexaenoic acid correlates with the visual response of the healthy, term infant. Pediatr Res, 1993; 33; 3242–3253.
  32. Docosahexaenoic Acid and Arachidonic Acid Nutrition in Early Development.
  33. Evidence for the essentiality of arachidonic and docosahexaenoic acid in the postnatal maternal and infant diet for the development of the infant’s immune system early in life.
  34. Role of n-3 long-chain polyunsaturated fatty acids in human nutrition and health: review of recent studies and recommendations.
  35. Building Brains – 1,000 Days.
  36. Retina Function, Anatomy & Anatomy | Body Maps.
  37. Evidence for the essentiality of arachidonic and docosahexaenoic acid in the postnatal maternal and infant diet for the development of the infant’s immune system early in life.
  38. Effect of providing a formula supplemented with long-chain polyunsaturated fatty acids on immunity in full-term neonates.
  39. Effects of long-chain PUFA supplementation in infant formula on cognitive function in later childhood.
  40. Docosahexaenoic acid (DHA) and arachidonic acid (ARA) balance in developmental outcomes.
  41. The DIAMOND (DHA Intake and Measurement of Neural Development) Study: a double-masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid.
  42. Visual acuity and cognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chain polyunsaturated fatty acid-supplemented infant formula.
  43. The Importance of the Right Fatty Acids in Infant Nutrition.
logo

Subscribe to newsletter

© 2020. All rights reserved.

TOP