The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas
Both linoleic acid (LA) and α-linolenic acid (ALA) are essential dietary fatty acids, and a balanced dietary supply of these is of the utmost importance for health. In many countries across the globe, the LA level and LA/ALA ratio in breast milk (BM) are high. For infant formula (IF), the maximum LA...
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MDPI AG
2023-05-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/9/2187 |
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| author | Alexandra W. C. Einerhand Wiola Mi Alfred Haandrikman Xiao-Yang Sheng Philip C. Calder |
| author_facet | Alexandra W. C. Einerhand Wiola Mi Alfred Haandrikman Xiao-Yang Sheng Philip C. Calder |
| author_sort | Alexandra W. C. Einerhand |
| collection | DOAJ |
| description | Both linoleic acid (LA) and α-linolenic acid (ALA) are essential dietary fatty acids, and a balanced dietary supply of these is of the utmost importance for health. In many countries across the globe, the LA level and LA/ALA ratio in breast milk (BM) are high. For infant formula (IF), the maximum LA level set by authorities (e.g., Codex or China) is 1400 mg LA/100 kcal ≈ 28% of total fatty acid (FA) ≈ 12.6% of energy. The aims of this study are: (1) to provide an overview of polyunsaturated fatty acid (PUFA) levels in BM across the world, and (2) to determine the health impact of different LA levels and LA/ALA ratios in IF by reviewing the published literature in the context of the current regulatory framework. The lipid composition of BM from mothers living in 31 different countries was determined based on a literature review. This review also includes data from infant studies (intervention/cohort) on nutritional needs regarding LA and ALA, safety, and biological effects. The impact of various LA/ALA ratios in IF on DHA status was assessed within the context of the current worldwide regulatory framework including China and the EU. Country averages of LA and ALA in BM range from 8.5–26.9% FA and 0.3–2.65% FA, respectively. The average BM LA level across the world, including mainland China, is below the maximum 28% FA, and no toxicological or long-term safety data are available on LA levels > 28% FA. Although recommended IF LA/ALA ratios range from 5:1 to 15:1, ratios closer to 5:1 seem to promote a higher endogenous synthesis of DHA. However, even those infants fed IF with more optimal LA/ALA ratios do not reach the DHA levels observed in breastfed infants, and the levels of DHA present are not sufficient to have positive effects on vision. Current evidence suggests that there is no benefit to going beyond the maximum LA level of 28% FA in IF. To achieve the DHA levels found in BM, the addition of DHA to IF is necessary, which is in line with regulations in China and the EU. Virtually all intervention studies investigating LA levels and safety were conducted in Western countries in the absence of added DHA. Therefore, well-designed intervention trials in infants across the globe are required to obtain clarity about optimal and safe levels of LA and LA/ALA ratios in IF. |
| first_indexed | 2024-03-11T04:10:03Z |
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| id | doaj.art-621b549cdae149a1951e42712fd24ecb |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-11T04:10:03Z |
| publishDate | 2023-05-01 |
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| spelling | doaj.art-621b549cdae149a1951e42712fd24ecb2023-11-17T23:30:19ZengMDPI AGNutrients2072-66432023-05-01159218710.3390/nu15092187The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant FormulasAlexandra W. C. Einerhand0Wiola Mi1Alfred Haandrikman2Xiao-Yang Sheng3Philip C. Calder4Einerhand Science & Innovation, Nutrition Consultancy, 1815 JN Alkmaar, The NetherlandsBunge Loders Croklaan Nutrition, Shanghai 200051, ChinaIndependent Consultant, 3823 HH Amersfoort, The NetherlandsDepartment of Developmental Behavioral Pediatric & Children Healthcare, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200051, ChinaSchool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UKBoth linoleic acid (LA) and α-linolenic acid (ALA) are essential dietary fatty acids, and a balanced dietary supply of these is of the utmost importance for health. In many countries across the globe, the LA level and LA/ALA ratio in breast milk (BM) are high. For infant formula (IF), the maximum LA level set by authorities (e.g., Codex or China) is 1400 mg LA/100 kcal ≈ 28% of total fatty acid (FA) ≈ 12.6% of energy. The aims of this study are: (1) to provide an overview of polyunsaturated fatty acid (PUFA) levels in BM across the world, and (2) to determine the health impact of different LA levels and LA/ALA ratios in IF by reviewing the published literature in the context of the current regulatory framework. The lipid composition of BM from mothers living in 31 different countries was determined based on a literature review. This review also includes data from infant studies (intervention/cohort) on nutritional needs regarding LA and ALA, safety, and biological effects. The impact of various LA/ALA ratios in IF on DHA status was assessed within the context of the current worldwide regulatory framework including China and the EU. Country averages of LA and ALA in BM range from 8.5–26.9% FA and 0.3–2.65% FA, respectively. The average BM LA level across the world, including mainland China, is below the maximum 28% FA, and no toxicological or long-term safety data are available on LA levels > 28% FA. Although recommended IF LA/ALA ratios range from 5:1 to 15:1, ratios closer to 5:1 seem to promote a higher endogenous synthesis of DHA. However, even those infants fed IF with more optimal LA/ALA ratios do not reach the DHA levels observed in breastfed infants, and the levels of DHA present are not sufficient to have positive effects on vision. Current evidence suggests that there is no benefit to going beyond the maximum LA level of 28% FA in IF. To achieve the DHA levels found in BM, the addition of DHA to IF is necessary, which is in line with regulations in China and the EU. Virtually all intervention studies investigating LA levels and safety were conducted in Western countries in the absence of added DHA. Therefore, well-designed intervention trials in infants across the globe are required to obtain clarity about optimal and safe levels of LA and LA/ALA ratios in IF.https://www.mdpi.com/2072-6643/15/9/2187linoleic acid (LA)α-linolenic acid (ALA)polyunsaturated fatty acids (PUFAs)breast milk compositioninfant developmentinfant formula (IF) |
| spellingShingle | Alexandra W. C. Einerhand Wiola Mi Alfred Haandrikman Xiao-Yang Sheng Philip C. Calder The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas Nutrients linoleic acid (LA) α-linolenic acid (ALA) polyunsaturated fatty acids (PUFAs) breast milk composition infant development infant formula (IF) |
| title | The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas |
| title_full | The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas |
| title_fullStr | The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas |
| title_full_unstemmed | The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas |
| title_short | The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas |
| title_sort | impact of linoleic acid on infant health in the absence or presence of dha in infant formulas |
| topic | linoleic acid (LA) α-linolenic acid (ALA) polyunsaturated fatty acids (PUFAs) breast milk composition infant development infant formula (IF) |
| url | https://www.mdpi.com/2072-6643/15/9/2187 |
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