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N-3 Fatty Acids
Fatty Acids and Brain DevelopmentCertain fatty acids, present in high amounts in fish, but till recently, absent from infant formula (still not added in the US as of this writing.) may be absolutely necessary for normal brain development, especially in premature infants. This unmet fatty acid requirement especially seems to apply to preterm or low-birth-weight infants who were fed formula or other food. (as opposed to *human* breast-milk) And it is serious. It's effect. Marked differences in brain development. For mothers, eating large amount of fish during pregnancy (and nursing naturally) can help increase the proportion of these fatty acids in an infants diet. Lack of these fatty acids can cause up to a 10% difference in later IQ scores in children and adults fed formula as infants. (For preterm infants fed other foods, it can be even more serious.) It may also permanently effect the brains membrane permeability - and neurotransmission causing a predisposition to / or aggravating genetic factors of diseases like depression, schizophrenia and ADD/ADHD. In fact, this has been clearly proven. Infant formula is required by law to have certain levels of *lineolic acid* which until recently was thought to supply adequate levels of the *precursors* of these n-3 fatty acids. It does for term infants, However, low birth weight or preterm infants *cannot assimilate and convert this nutrient properly*, causing the problem. Diets very high in [omega]-3 fatty acids (fish oils) may help alleviate some of the behavioral symptoms of this brain damage, but the changes in brain structure and lipid permeability seem to be permanent, as are the changes in memory. . So, in short, we encourage nursing mothers to nurse their children naturally and eat plenty of fish. And if they smoke tobacco, to stop smoking until after their baby is finished nursing. Stopping smoking during pregnancy is very important, since smoking *doubles* the risk of premature births and lowers average birth weights substantially. (17% of all women do not stop smoking during pregnancy!) Some references. More on the way. Breastfeeding and cognitive development in the first 2 years of life, from Social Science and Medicine Marry Morrow-Tlucak1,2, Richard H. Haude1 and Claire B. Ernhart2,3 1Department of Psychology, University of Akron, Akron, Ohio, 2Department of Psychiatry, Cleveland Metropolitan General Hospital, Cleveland, Ohio and 3Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, U.S.A ABSTRACT " - The relationship between breastfeeding and cognitive development in the first 2 years of life was examined in a cohort of children being followed in a study of risk factors in development. A significant difference between bottlefed children, children breastfed =< 4 months and those breastfed > 4 months was found on the Mental Development Index of the Bayley Scales at ages 1 and 2 years, favoring the breastfed children. At age 6 months, the direction of the relationship was the same but did not reach significance. Supplementary regression analyses examining the strength of the relationship between duration of breastfeeding and cognitive development similarly showed a small but significant relationship between duration of breastfeeding and scores on the Bayley at 1 and 2 years. Alternative explanations for the results are discussed. " Key Words ---- breastfeeding, cognitive development, early childhood " A number of investigators have reported a relationship between breastfeeding and cognitive development [1-3]. In light of a recent increase in the practice of breastfeeding, promoted by various medical and allied health associations, and the United States Public Health Services [4], the possibility of such a relationship warrants further attention. While there is little direct evidence for a causative mechanism whereby breastfeeding might enhance or, conversely, bottle-feeding might impair cognitive growth, several authors have made suggestions as to a possible link. Menkes [2] proposed that tyrosinemia due to increased protein levels in formula milk might produce and increased incidence of learning disabilities in bottlefed children. Rodgers [3] suggested possible mediating factors might be differences between breast milk and bottle milk in osmotic load or protein and lipid concentrations or differences in the feeding situation such as infection risk and psychological effects. Fergusson et al. [1] included differences in mother/infant interaction as a potential mediator. It is also possible (as is acknowledged by the above mentioned authors) that uncontrolled self-selection factors (maternal differences or differences in the home environment) may produce the observable differences in cognitive development. Previous studies have differed in control of potential confounding variables. Menkes [2], in a retrospective study, found a significantly greater incidence of bottle-feeding among learning disabled children than among controls being followed for other neurological symptoms. However, no control of confounding factors was incorporated. Rodgers [3] described a large, stratified sample of British children. Covariates included social class, parental interest in education, material home conditions, parental education, family size and birth rank. with control of confounding, a small but significant advantage to breastfed children was found on a picture vocabulary test at 8 years of age and on nonverbal ability, mathematics and sentence completion at 15 years. Fergusson et al. [1] examined breastfeeding in a large cohort of New Zealand children. Control variables included maternal intelligence, maternal education, maternal training in child rearing, child's life experiences, socioeconomic status, birth weight and gestational age at birth. With covariate control, a small but significant difference was found with breastfed children performing better on measures of intelligence and comprehension at 3 years of age. It seems likely that differences observed at age 3 and older may be heavily dependent on differential home environments. The purpose of this study was to compare cognitive development in breastfed and bottlefed infants, incorporating rigorous covariate control, in order to determine if the previously found advantage to breastfed children is evident earlier in development (ages 6 months, 1 year and 2 years). " New research concludes lack of breast milk may be risk factor in neurodevelopmental form of schizophrenia Lack of Important Fatty Acids Such As DHA May Increase Risk " Infants deprived of breast milk may be at higher risk for developing schizophrenia later in life, according to a recent study published in the British Journal of Psychiatry. The study suggests that a lack of DHA (docosahexaenoic acid), a key fatty acid found in breast milk, may contribute to this risk. This hypothesis is consistent with the results of an earlier study that documented the correlation between low levels of DHA and schizophrenia in adults. In his study Robin G. McCreadie, M.D., of the Crichton Royal Hospital in Scotland notes that "schizophrenic patients are less likely to have been breast-fed, and those who have not been breast-fed are more likely to have the neurodevelopmental form of the illness." The results show that during childhood, schizophrenics who were not breast- fed "had more schizoid and schizotypal traits, and were more poorly adjusted" than their siblings (who are more likely to have been breast-fed). In addition, the results show that patients who were not breast-fed had a lower mean IQ than breast-fed patients. "A lack of important fatty acids, such as DHA, in bottle-feeds increases the risk of the neurodevelopmental form of schizophrenia in the individual predisposed to the illness by genetic factors or previous environmental insult," hypothesizes Dr. McCreadie. He suggests that key fatty acids found in breast milk, such as DHA, may help reduce the risk of developing this form of schizophrenia. The United Nations Food and Agriculture Organization and World Health Organization joint expert committee on fats and oils in human nutrition has recommended adding DHA to infant formulas at levels historically found in breast milk. Formulas incorporating DHA have recently been introduced in parts of Europe and Asia. In the United States, the only way babies can get DHA is through breast milk because the fatty acid has not yet been incorporated into infant formulas. DHA, an [omega]-3 long-chain polyunsaturated fatty acid, is the building block of human brain tissue and the primary structural fatty acid in the gray matter of the brain. DHA ensures the fluidity of brain cell membranes, essential for the transmission of nerve signals in the brain. Last month at a conference held at The New York Hospital-Cornell Medical Center, leading researchers identified DHA as critical for mental well-being and revealed low DHA levels to be a significant risk factor for Alzheimer's and dementia. They also discussed the correlation between low blood levels of DHA and a number of other behavioral and neurological conditions including ADHD (Attention Deficit Hyperactivity Disorder), hostility and depression. More funding for Mental Health Services in Australia" Breast-Feeding and Optimal Visual Development from Journal of Pediatrics Eileen Birch, PhD, David Birch, PhD, Dennis Hoffman, PhD, Linda Hale, Mary Everett, CO, and Ricardo Uauy, MD, PhD ABSTRACT " The goal of the present study was to determine whether dietary supply of w-3 essential fatty acid (EFA) influences visual development in healthy pre-term and full-term infants. Visual status was examined in human milk-fed infants (ample dietary -3 EFA supply) and corn oil-based formula-fed infants ( no dietary w-3 EFA; standard formula prior to 1987). at 57 weeks postconception (4 months adjusted age), both pre-term and full-term human milk-fed infants had significantly better visual evoked potential (VEP) and forced-choice preferential (FPL) acuity than formula-fed infants. Acuity was correlated with a dietary w-3 sufficiency index from red blood cell membranes obtained at 57 weeks postconception. At 36 months, full-term human milk-fed children had significantly better random dot stereo acuity and letter matching ability than formula-fed children. Stereo acuity and performance on the letter matching test were correlated with a dietary w-3 sufficiency index from red blood cell membranes obtained at 4 months. These results suggest that dietary w-3 fatty acids play an important role in visual development." Title Is docosahexaenoic acid necessary in infant formula? Evaluation of high linolenate diets in the neonatal rat. Author Woods J; Ward G; Salem N Jr Address Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Maryland 20814, USA. Source Pediatr Res, 1996 Nov, 40:5, 687-94 ABSTRACT " Neural accretion of docosahexaenoic acid (DHA) is thought to play an important role in the neural development of human infants. The lack of DHA in infant formulas contributes to the lowered neural accretion of DHA observed in formula-fed infants relative to those breast-fed. We hypothesized that lowering the dietary linoleic acid (LA) to alpha-linolenic acid (LNA) ratio may lead to increases in the level of DHA in the developing brain and retina. Lowering the LA to LNA ratio from 10:1 to 1:1 and to 1:12 in the artificially reared (AR) neonatal rat pup resulted in a significant increase in the percentage of brain DHA between AR dietary groups. The brain level of DHA in the AR group fed a 1:12 ratio was similar to that of a dam-reared reference group. However, levels of DHA in the retina of all AR groups were significantly lower than that of the (chow fed) dam-reared group. It appears that LNA may serve as an adequate substrate for the accretion of DHA in the brain, but not the retina of the developing rat. In both the brain and the retina, levels of arachidonic acid in the AR pups fed the 1:1 ratio were similar to that of the dam-reared group. However, levels in the 1:12 group were significantly reduced. The addition of long chain n-3 polyunsaturates such as DHA to infant formula may therefore be necessary for adequate neural DHA accretion and optimal neural development. " Language of Publication English Unique Identifier 97067537 Title Is dietary docosahexaenoic acid essential for term infants? Author Makrides M; Neumann MA; Gibson RA Address Department of Paediatrics and Child Health, Flinders Medical Centre, Adelaide, Australia. Source Lipids, 1996 Jan, 31:1, 115-9 ABSTRACT " There is a need to determine whether there is a dietary requirement for docosahexaenoic acid (DHA, 22:6 [omega] 3) by term infants to achieve their full developmental potential. Studies of brain fatty acid composition have demonstrated that infants who were breast fed have greater levels of cerebral cortex DHA than infants who were formula fed, suggesting that DHA in the cerebrum is dependent on a supply in the diet. Some physiological studies report that electrophysiological and behavioral assessments of visual function are improved in breast-fed infants relative to those fed formula, and that this is related to the level of DHA in their erythrocytes, whereas other studies demonstrate equivalent visual function between breast- and formula-fed infants. However, randomized studies of DHA supplementation of infant formula demonstrate that the visual function of formula-fed infants can be improved to breast-fed levels by adding DHA to formula. Further work is necessary to establish if there are long-term benefits of dietary DHA to the term infant. " Language of Publication English Unique Identifier 96257961 Title Maternal dietary fish oil enriches docosahexaenoate levels in brain subcellular fractions of offspring. Author Yeh YY; Gehman MF; Yeh SM Address Nutrition Department, Pennsylvania State University, University Park 16802. Source J Neurosci Res, 1993 Jun 1, 35:2, 218-26 ABSTRACT " Prompted by the speculated essentiality of docosahexaenoic acid (DHA) for neural development, this study was undertaken to investigate the incorporation of (n-3) fatty acids in the maternal diet into various phospholipids of infant rat brain subcellular fractions: microsomes (Ms), synaptosomes (Sy), myelin (My), and mitochondria (Mt). Two groups of infant rats were nourished by dams fed diets containing 20% of either corn oil (CO) or menhaden oil (MO) from 2 until 12 days of age. DHA but not eicosapentaenoic acid (EPA) was distributed to all subcellular fractions of infant rats in the CO group. The levels of DHA were higher in Ms and Mt than Sy and My, and higher in phosphatidylethanolamine (PE) and phosphatidylserine (PS) than phosphatidylcholine (PC) and phosphatidylinositol (PI). The MO feeding enriched DHA in PE of all subcellular fractions, PS of all subcellular fractions, except My, PC of Sy, My and Mt, and PI of My. EPA was enriched in phospholipids in all subcellular fractions, except mitochondrial PS of the MO group. In the MO group, the ratios of EPA/DHA, ranging from 0.01 to 0.85, in all subcellular phospholipids were markedly lower than that found in the mother's milk (i.e., 1.5), suggesting an ability to elongate and desaturate EPA to DHA and/or disproportional uptake of the fatty acids by the brain. In PE of all subcellular fractions, the increased levels of DHA and EPA, with a concomitant reduction of arachidonic and/or linoleic acid, yielded higher ratios of total (n-3)/(n-6) fatty acids in the MO than the CO group. The inclusion of preformed DHA and EPA in the maternal diet provides an effective means to enrich these fatty acids in developing brains. " Language of Publication English Unique Identifier 93308764 Title The role of essential fatty acids in neural development: implications for perinatal nutrition. Author Crawford MA Address Institute of Brain Chemistry and Human Nutrition, Hackney Hospital, London, UK. Source Am J Clin Nutr, 1993 May, 57:5 Suppl, 703S-709S; discussion 709S-710S ABSTRACT " The brain is 60% structural lipid, which universally uses arachidonic acid (AA; 20:4n6) and docosahexaenoic acid (DHA; 22:6n-3) for growth, function, and integrity. Both acids are consistent components of human milk. Experimental evidence in animals has demonstrated that the effect of essential fatty acid deficiency during early brain development is deleterious and permanent. The risk of neurodevelopmental disorder is highest in the very-low-birth-weight babies. Babies born of low birth weight or prematurely are most likely to have been born to mothers who were inadequately nourished, and the babies tend to be born with AA and DHA deficits. Because disorders of brain development can be permanent, proper provision should be made to protect the AA and DHA status of both term and preterm infants to ensure optimum conditions for the development of membrane-rich systems such as the brain, nervous, and vascular systems. " Language of Publication English Unique Identifier 93235809 Title Are n-3 fatty acids essential nutrients for fetal and infant development? Author Nettleton JA Address Office of Scientific Public Affairs, Institute of Food Technologists, Chicago, IL 60601. Source J Am Diet Assoc, 1993 Jan, 93:1, 58-64 ABSTRACT " Recent research indicates that n-3 fatty acids (FAs) are essential nutrients in early human development. In human infants, nonhuman primates, and animal models, the n-3 FA, docosahexaenoic acid (DHA, 22:6n-3) is highly concentrated in brain and retinal tissues and accumulates during late fetal and early neonatal life. Diets deficient in n-3 FAs are associated with reduced levels of DHA in erythrocytes and brain and retinal tissues and with abnormalities in retinal function that may be irreversible. The precursor of DHA, alpha-linolenic acid (LNA, 18:3n-3), may be an inadequate substitute for DHA because LNA may not be converted to DHA in sufficient amounts to meet an infant's needs. Premature infants lose DHA from their tissues unless they are fed human milk or formula supplemented with DHA. Fish and shellfish are the main food sources of DHA. Women who consume fish have more DHA in their breast milk than do those who do not eat seafood. Infant formulas contain only LNA as a source of n-3 FAs. Pregnant and nursing women should be encouraged to consume seafood on a regular basis during pregnancy and lactation to furnish DHA for their infants. " Language of Publication English Unique Identifier 93107545 Title Dietary effects on brain fatty acid composition: the reversibility of n-3 fatty acid deficiency and turnover of docosahexaenoic acid in the brain, erythrocytes, and plasma of rhesus monkeys. Author Connor WE; Neuringer M; Lin DS Address Department of Medicine, Oregon Health Sciences University, Portland 97201. Source J Lipid Res, 1990 Feb, 31:2, 237-47 ABSTRACT " Rhesus monkeys given pre- and postnatal diets deficient in n-3 essential fatty acids develop low levels of docosahexaenoic acid (22:6 n-3, DHA) in the cerebral cortex and retina and impaired visual function. This highly polyunsaturated fatty acid is an important component of retinal photoreceptors and brain synaptic membranes. To study the turnover of polyunsaturated fatty acids in the brain and the reversibility of n-3 fatty acid deficiency, we fed five deficient juvenile rhesus monkeys a fish oil diet rich in DHA and other n-3 fatty acids for up to 129 weeks. The results of serial biopsy samples of the cerebral cortex indicated that the changes of brain fatty acid composition began as early as 1 week after fish oil feeding and stabilized at 12 weeks. The DHA content of the phosphatidylethanolamine of the frontal cortex increased progressively from 3.9 +/- 1.2 to 28.4 +/- 1.7 percent of total fatty acids. The n-6 fatty acid, 22:5, abnormally high in the cerebral cortex of n-3 deficient monkeys, decreased reciprocally from 16.2 +/- 3.1 to 1.6 +/- 0.4%. The half-life (t 1/2) of DHA in brain phosphatidylethanolamine was estimated to be 21 days. The fatty acids of other phospholipids in the brain (phosphatidylcholine, -serine, and -inositol) showed similar changes. The DHA content of plasma and erythrocyte phospholipids also increased greatly, with estimated half-lives of 29 and 21 days, respectively. We conclude that monkey cerebral cortex with an abnormal fatty acid composition produced by dietary n-3 fatty acid deficiency has a remarkable capacity to change its fatty acid content after dietary fish oil, both to increase 22:6 n-3 and to decrease 22:5 n-6 fatty acids. The biochemical evidence of n-3 fatty acid deficiency was completely corrected. These data imply a greater lability of the fatty acids of the phospholipids of the cerebral cortex than has been hitherto appreciated. " Language of Publication English Unique Identifier 90217877 " The relationship of breast-milk fatty acids and intelligence has been in the news recently, including in a New York Times article by Jane Brody that has attracted national attention. The essence of the news is this: children breast fed as infants score significantly higher on various tests of cognitive development than do children that were bottle fed [1, 2, 3, 4]. This difference--which has thus far been shown to persist through school age--is not due to the act of breastfeeding, but to components in the breast milk, particulaly certain fatty acids [2, 3, 5]. The addition of certain breast-milk fatty acids to infant formula of itself makes a difference in intelligence. This was explicitly tested using supplemented and unsupplemented infant formulas in comparison to breast milk in a recent prospective study. Infants fed the fatty acid-supplemented formula scored significantly higher on tests of psychomotor development than did infants fed unsupplemented formula [5]. These findings support a large body of work that demonstrates that a dietary factor--the availability of docosahexaenoic acid (DHA) and arachidonic acid (AA) in late fetal development and in early infancy--has a significant and long-term effect on cognitive ability, and markedly changes the composition of the brain [6, 7, 8]. A reasonable assessment of the situation is as follows: "The brain is 60% structural lipid, which universally uses arachidonic acid (AA; 20:4n6) and docosahexaenoic acid (DHA; 22:6n-3) for growth, function, and integrity. [Of this 60%, about 25% is DHA and 15% is AA.] Both acids are consistent components of human milk. Experimental evidence in animals has demonstrated that the effect of essential fatty acid deficiency during early brain development is deleterious and permanent. The risk of neurodevelopmental disorder is highest in the very-low-birth-weight babies. Babies born of low birth weight or prematurely are most likely to have been born to mothers who were inadequately nourished, and the babies tend to be born with AA and DHA deficits. Because disorders of brain development can be permanent, proper provision should be made to protect the AA and DHA status of both term and preterm infants to ensure optimum conditions for the development of membrane-rich systems such as the brain, nervous, and vascular systems" [9]. This raises an important question: Why is DHA-supplemented infant formula not available in the United States? While it is undoubtedly true that the best choice is breastfeeding, it is also true that some babies will not or cannot be breastfed. As noted by Crawford, this is especially important for preterm infants, who are at greatest risk because they are denied the DHA-rich environment of the uterus. Infants born prematurely (who lose their rich supply of DHA and AA at an early stage of brain development) are at a greater risk for neurological deficits, such as learning disabilities, social/behavioral problems, and lower scores on IQ tests. Both term and pre-term infants fed DHA-supplemented formula have exhibited faster mental and visual acuity development rates than infants fed conventional formula. In several other countries, including the United Kingdom, DHA-supplemented formula is now recommended for preterm infants fed formula. Inclusion of DHA in infant formula is not only safe but consistent with the recommendations of the FAO/WHO. It would appear that inclusion of these naturally-occurring compounds should actually be mandated by the Infant Formula Act of 1980 (which is administered by the Food and Drug Administration): the intent of that Act is to that breast milk should serve as the standard for judging infant formula.The FDA convened a panel last May to study this issue; the report is due back this March. It will be surprising if the panel does not find, in agreement with the public health officials of many other countries, that DHA should be added to infant formula--but action will probably take at least a year and a half. In fact, this could be done now. There is no law or rule preventing the addition of these important nutrients to the food required by preterm infants who cannot be breastfed. The technology is in place. The additives are considered Foods Generally Recognized As Safe in other countries, and an independent panel has termed them so in this country. It's very clear that addition of DHA and AA to infant formula would be beneficial to the many preterm and newborn infants that are fed formula in the United States. References: 1. Florey CD; Leech AM; Blackhall A. Infant feeding and mental and motor development at 18 months of age in first born singletons. International Journal of Epidemiology, 1995, 24 Suppl 1:S21-6. 2. Lucas A; Morley R; Cole TJ; Lister G; Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet, 1992 Feb 1, 339(8788):261-4. 3. Lucas A; Morley R; Cole TJ; Gore SM. A randomised multicentre study of human milk versus formula and later development in preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 1994 Mar, 70(2):F141-6. 4. Morrow-Tlucak M; Haude RH; Ernhart CB. Breastfeeding and cognitive development in the first 2 years of life. Social Science and Medicine, 1988, 26(6):635-9. 5. Agostoni C; Trojan S; Bellu R; Riva E; Giovannini M. Neurodevelopmental quotient of healthy term infants at 4 months and feeding practice: the role of long-chain polyunsaturated fatty acids. Pediatric Research, 1995 Aug, 38(2):262-6. 6. Farquharson J; Cockburn F; Patrick WA; Jamieson EC; Logan RW. Infant cerebral cortex phospholipid fatty-acid composition and diet. Lancet, 1992 Oct 3, 340(8823):810-3. 7. Makrides M; Neumann MA; Byard RW; Simmer K; Gibson RA. Fatty acid composition of brain, retina, and erythrocytes in breast- and formula-fed infants. American Journal of Clinical Nutrition, 1994 Aug, 60(2):189-94. 8. Neuringer M. Cerebral cortex docosahexaenoic acid is lower in formula-fed than in breast-fed infants. Nutrition Reviews, 1993 Aug, 51(8):238-41. 9. Crawford MA. The role of essential fatty acids in neural development: implications for perinatal nutrition. American Journal of Clinical Nutrition, 1993 May, 57(5 Suppl):703S-709S. " Effects of Diet on Visual Development " Rapid accretion of the -6 (n-6) and the -3 (n-3) long-chain polyunsaturated fatty acids (LCPUFA) into the structural membranes of the central nervous system and retina occurs during the last trimester of pregnancy and the first year past term. The two LCPUFAs that have received considerable attention in recent years are docosahexaenoic acid (22:6n-3; DHA) and arachidonic acid (20:4n-6; AA).The phospholipid membranes of neural tissue are enriched with both DHA and AA, and DHA is present in large amount in the retina. Infants born prior to term have their intrauterine supply of these fatty acids interrupted. Unlike human milk, formulas for preterm infants, as well as those for term infants, have not contained sources of preformed AA and DHA. Recent research has demonstrated that visual acuity differs in preterm infants based on diet. That is, preterm infants who are fed human breast milk show higher visual acuities than preterm infants fed standard infant formulas. The currently marketed infant formulas do not have the same composition of fatty lipids that are present in human breast milk. They contain only the precursors to these lipids. Techniques have been developed to add these LCPUFAs to infant formulas. Preterm infants who are fed a formula enhanced with DHA and AA) demonstrate improved grating acuity at 3 to 4 months of age when compared with preterm infants whose diet consists of standard formulas. We have been studying the impact of such variations in diet on normal, full-term infants (Auestad, Montalto, Hall, Fitzgerald, Wheeler, Connor, Neuringer, Connor, Taylor, & Hartmann, 1997). Studies with Full-term Infants The studies on the development of visual acuity in full-term human infants fed different dietary fatty acids have yielded discrepant findings. Specifically, Auestad et al (1997) found no differences in either behavioral or VEP acuity estimates in their population of infants who were fed human milk or formulas with or without LCPUFAs. On the other hand, another study reported higher VEP acuity estimates in infants fed human milk compared with those fed a standard formula. In this particular study no difference in VEP acuity estimates between infants fed human milk and those fed a supplemented formula (supplemented with fish oil, DHA) were observed. One possible explanation for these opposing findings is the manner in which VEP acuities were estimated. Stimulus parameters between the two studies differed in terms of temporal frequency, pattern and type of presentation. Dr. Hartmann is currently collaborating with Drs. Vance Zemon (Yeshiva University), Kathleen Fitzgerald (Children's Mercy Hospital, Kansas City, MO) and Ross Laboratories (Columbus OH) to address this discrepancy on a methodological basis. They have implemented two VEP protocols for estimating visual acuity in the same healthy, full-term infants. One protocol is the sweep VEP protocol as presented above. This technique has several advantages over earlier procedures that improve the overall quality of the recordings and hence the accuracy and precision of the acuity estimate (Zemon, Hartmann, Gordon & Prdnte-Glowazki, in press). The second protocol introduced a new technique that characterized the brain's response to patterns that were flashing relatively slowly and were changing in size every two seconds. Their findings indicate that this technique can be used to generate waveforms in 10 seconds that previously required at least 60 seconds of recording. The relatively brief duration needed for testing makes this technique extremely useful for applications with infants and young children (Zemon, Buckley, Fitzgerald, Gordon, Hartmann, Meyer & Montalto, 1997). Studies with Preterm Infants The rapid accretion of AA and DHA during the brain growth spurt, the low adipose stores in preterm infants, the presence of AA and DHA in human milk, and possible benefits to visual and general development have led to recommendations to supplement formula for preterm infants with sources of AA and DHA. Currently, however, there is considerable scientific debate about the suitability and efficacy of adding sources of AA and DHA to preterm infants formulas. In human milk, AA and DHA are found principally as triaclyglycerols and in smaller amounts as phospholipids. Sources of AA and DHA that may be used to add one or both fatty acids to formula include fish oils, egg-derived oils (phospholipids), and oils derived from the fermentation of single cell species, such as algae or fungi. Higher scores on tests of infant development and reports of more rapid visual development to 2 or 4 months corrected age in preterm infants fed formulas containing fish oil have supported the view that DHA should be provided to preterm infants On the other hand, there are reports of slower growth and lower scores on tests of infant development in studies with preterm and term infants fed formulas with DHA from fish oil. Comprehensive studies with preterm infants fed formula containing both AA and DHA are not available. In addition to assessing visual and developmental indicators in these infants, evaluation of clinical and metabolic indicators during the weeks following birth is necessary to adequately evaluate the suitability of including sources of AA and DHA in formula for hospitalized preterm infants. Dr. Hartmann is currently involved with a multi-center, prospective study to assess the suitability, and possible benefits of supplementing formulas for preterm infants with oils containing AA and DHA. The study is sponsored by Ross Products Division of Abbott Laboratories and is being conducted at six national and two international sites. Her collaborator in New York City is Dr. Mirjana Nesin at The New York Hospital, Cornell Medical Center. In-hospital preterm infants will be fed Similac Special CareŽ (SSC) with or without oils containing AA and DHA and/or human milk at the start of enteral feedings and, after hospital discharge , will be fed NeoCareŽ with or without the same oils containing AA and DHA and/or human milk to 12 months corrected age. Infant growth, tolerance to formulas, blood biochemistries including fatty acid composition, and measures of visual (behavioral and VEP acuities, VEP contrast sensitivity and latency of the VEP) and infant development will be assessed from the initiation of enteral feeding through 14 months corrected age. Further Reading Auestad, N., Montalto, M.B., Fitzgerald, K., Hall, R., Wheeler, R.E., Connor, S.L., Connor, W.E., Neuringer, M., Hartmann, E.E., Taylor, J. (1997) Visual acuity, erythrocyte fatty acid composition, and growth in term infants fed formula with long chain polyunsaturated fatty acids (LCP) for one year. Pediatric Research, 41, 1-10. Zemon, V. Buckley, S.W., Fitzgerald, K.M., Gordon, J., Hartmann, E.E., Meyer, A., Montalto, M.B. (1997). A swept-parameter transient visual evoked potential (VEP) technique for the study of visual development. Investigative Ophthalmology and Visual Science (Suppl.), 38(4), S992. " FDA ponders baby formula that's a step closer to mom " By Elizabeth Green / Gannett News Service WASHINGTON -- For the first time in more than a decade, the Food and Drug Administration is considering a change in the nutrients allowed in infant formula -- one that could make it nutritionally more similar to breast milk. A Maryland company has found a way to synthesize DHA, the fatty acid considered a major component of breast milk, and Mead Johnson Nutritionals, the leading infant formula maker and producer of Enfamil and ProSobee, is thinking about adding it to its products. Breast vs. bottle always is a controversial topic in parenting circles, and the debate was fueled by a 1992 study claiming that 8-year-old children breast-fed as babies were an average 8.3 IQ points smarter than bottle-fed peers. Officials at Martek Biosciences Corp., the Columbia, Md., company that found a way to synthesize DHA from a form of algae, believe their additive will close that gap. "DHA is a building block of brain tissue," said David Kyle, a Martek vice-president. If the FDA permits adding DHA to formula, "what this will allow (a formula maker) to do is continue to argue that, 'Ours is closer to breast milk than the others.'" The FDA regulates infant formula as a special diet food, with a 15-page regulation covering everything from a list of required nutrients to drawings of symbols that stand in for written instructions on the formula can. Today's required nutrients would be familiar to anyone who has read a nutrition label: protein, fat, a variety of vitamins, niacin, folic acid, etc. Three nutrients also are required specifically for soy-based formulas that replace nutrients found naturally in milk-based products. But the list, first proposed in 1980 and put into effect in 1985, "is old and out of date," said Elizabeth Yetley, director of the FDA's Office of Special Nutritionals. At a hearing Friday, FDA officials will hear testimony from Martek and formula makers on whether DHA should be added. "It has the potential for benefit, but the manufacturers need to show that it's safe," Yetley said. DHA -- short for docosahexaenoic acid -- is a fatty acid found in seafood. The algae from which Martek synthesizes the substance is the primary source of the fatty acid in fish. Mothers produce the fatty acid and pass it to their infants during their last trimester, and later in breast milk. " So, the long and the short of it is that women who are pregnant or lactating should try to eat as much seafood as possible, and try to breast-feed their children if at all possible. Infant formulas containing DHA and AA will soon be available, probably. (But who knows if there are other essential micronutrients we are missing?) Also, IMHO, current political attempts to limit state money spent on prenatal nutrition is a BAD IDEA.
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