HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Makrides, M. Articles by Gibson, R. A Search for Related Content PubMed Articles by Makrides, M. Articles by Gibson, R. A Agricola Articles by Makrides, M. Articles by Gibson, R. A

Reply to C Kuratko et al and to P Grandjean

Child Health Research Institute
Women's Youth and Children's Health Service
Department of Pediatrics
University of Adelaide
72 King William Road
North Adelaide SA 5006
Australia
E-mail: makridesm{at}mail.wch.sa.gov.au

Dear Sir:

The purpose of our systematic review was to evaluate the effect of supplementing infant formula with long-chain polyunsaturated fatty acids (LCPUFAs) on the growth of term infants (1). Growth was the primary focus because it is often used by health workers and public health authorities to assess the nutritional health and well-being in preverbal children. Our review included data from 14 randomized controlled trials of formula feeding with 1846 infants and showed no significant effect of LCPUFA supplementation on infant weight, length, or head circumference at any assessment age, regardless of the type [only n–3 LCPUFA or n–3 LCPUFA plus arachidonic acid (AA)] or the source (phospholipid or triacylglycerol) of supplementation (1). The original impetus to add AA to infant formulas was based on the results of early small-scale trials that used formulas containing only n–3 LCPUFAs, which suggested that preterm infants fed formulas supplemented with n–3 LCPUFAs alone had lower plasma AA concentrations and weighed less and were shorter than preterm infants fed standard unsupplemented formulas (2–4). Although term infants fed n–3 LCPUFAs alone also had a lower AA status, our data clearly show that their growth is not compromised (1).

Kuratko et al from Martek Biosciences, who market AA and docosahexaenoic acid (DHA) supplements for infant formula, do not dispute our findings, but they are concerned that readers may interpret these findings to indicate that AA supplementation of infant formulas is unnecessary and suggest that AA may be required for neurologic and immune development. This issue was not an objective of our review and, therefore, was not extensively discussed. However, few trials have been specifically designed to assess the health effects of AA supplementation. Only 3 trials involving term infants compared DHA plus AA supplementation with n–3 LCPUFA supplementation alone and a control (5–7). Two of the 3 trials involving >200 infants found no differences in either visual or neurologic outcomes through 2 y of age (5, 7). Only one study involving 68 infants reported a benefit of DHA plus AA supplementation at a single assessment age (6). We are aware of no published trials that assessed the addition of only AA to infant formula. Definitive statements regarding the specific health effects of AA can only be made after a sufficient body of evidence is aggregated from appropriately designed randomized controlled trials with sufficient power to detect effects if they are there.

The issue of environmental contaminants in LCPUFA supplements for infant formulas and their influence on growth was not specifically addressed in our review. No published data regarding concentrations of lipophilic pollutants or heavy metals in infant formulas are available. However, our discussions with the infant formula manufacturers that provided data for our systematic review indicated that, although highly purified oils are used in the manufacture of infant products, levels of pesticides and heavy metals in infant formulas are at a minimum. It is therefore unlikely that infant formulas are contaminated with concentrations of pollutants, such as polychlorinated biphenyls, that are likely to cause adverse consequences.

In conclusion, the data from any systematic review and meta-analysis is only as robust as the data from the trials reviewed. We were fortunate to have completed a collaborative review with data from high-quality trials conducted both by industry and by academia. We found no evidence that LCPUFA supplementation of infant formula influences the growth of term infants in either a positive or a negative way (1). The challenge now is to assemble new and existing data in robust systematic reviews of other health effects of LCPUFA supplementation in formula-fed infants.

ACKNOWLEDGMENTS

The authors had no conflict of interest.

REFERENCES

1. Makrides M, Gibson RA, Udell T, Ried K, International LCPUFA Investigators. Supplementation of infant formula with long-chain polyunsaturated fatty acids does not influence the growth of term infants. Am J Clin Nutr 2005;81:1094–101.[Abstract/Free Full Text]
2. Carlson SE, Cooke RJ, Werkman SH, Tolley EA. First year growth of preterm infants fed standard compared to marine oil n–3 supplemented formula. Lipids 1992;27:901–7.[Medline]
3. Carlson SE, Werkman SH, Tolley EA. Effect of long-chain n–3 fatty acid supplementation on visual acuity and growth of preterm infants with and without bronchopulmonary dysplasia. Am J Clin Nutr 1996;63:687–97.[Abstract/Free Full Text]
4. Ryan AS, Montalto MB, Groh-Wargo S, et al. Effect of DHA-containing formula on growth of preterm infants to 59 weeks postmenstrual age. Am J Hum Biol 1999;11:457–67.[Medline]
5. Auestad N, Montalto MB, Hall RT, et al. Visual acuity, erythrocyte fatty acid composition, and growth in term infants fed formulas with long chain polyunsaturated fatty acids for one year. Pediatr Res 1997;41:1–10.[Medline]
6. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol 2000;42:174–81.[Medline]
7. Makrides M, Neumann MA, Simmer K, Gibson RA. A critical appraisal of the role of dietary long chain polyunsaturated fatty acids on neural indices of term infants: a randomized, controlled trial. Pediatrics 2000;105:32–8.[Abstract/Free Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Makrides, M. Articles by Gibson, R. A Search for Related Content PubMed Articles by Makrides, M. Articles by Gibson, R. A Agricola Articles by Makrides, M. Articles by Gibson, R. A