To maintain good health, people need to consume two kinds of polyunsaturated fat — omega-3 fatty acids and omega-6 fatty acids. Both are essential to the structure and function of our cells, and they regulate critical aspects of brain function, metabolism and the immune system.
Our bodies can’t easily make enough omega-3, so to get optimal amounts, we have to rely on foods or supplements. Seafood is particularly rich in healthy omega-3 fatty acids, though they can be found in red meat, eggs and dairy, as well.
As you might imagine, these fatty acids are particularly important for infants and children as they develop. And research shows women should consume ample omega-3s during pregnancy.
In 1994, expert panels from the World Health Organization and the Child Health Foundation recommended adding omega-3 DHA and omega-6 AA to infant formula. The move was based on studies that showed omega-3 DHA, or docosahexaenoic acid, is essential for brain and eye development in children before and after birth, while omega-6 AA, or arachidonic acid, is crucial for brain development. The U.S. FDA approved the use of DHA in baby formula in 2001, and today most popular formulas are DHA-fortified.
In this article we’ll explore why, if you give your infant formula, seeking one that contains DHA is worthwhile.
Babies get DHA from their mothers via their shared bloodstreams before birth and from nursing. But the typical American mother’s diet is deficient in the best dietary sources of DHA: fish and fish oil (or other marine oils) (Yuhas et al., 2008). Meanwhile omega-6 AA abounds in American mothers’ breast milk, because the standard American diet is overloaded with omega-6 fatty acids, which are abundant in cheap oils such as soybean oil.
So before we get into the subject of formula, let us emphasize that it’s vital for nursing mothers to consume foods or supplements that supply ample omega-3 fatty acids. Vital Choice partner William Sears M.D., recommends an intake of at least gram per day.
Research testing the effects of omega-3- and omega-6-fortified infant formulas has given mixed results. Some studies have found no effect from adding omega-3 DHA and omega-6 AA to infant formula (Auestad et al., 2003; Byerlein, 2010; Hadders-Algra et al., 2007; Qawasmi et al., 2012; Smithers et al., 2008).
Meanwhile, others found it helpful for growth and development, especially for premature infants (Fleith & Clandinin, 2005). Like results often found in adults, the benefits of omega-3s included better eye health (Birch et al., 2007) and brain development (Birch et al., 2000; Drover et al., 2011; Werkman & Carlson, 1996).
Why the mixed research, if omega-3 DHA is known to be essential to brain and eye development? It’s possible some studies found no benefits because they stopped testing children’s visual, physical and mental abilities before the toddlers reached two years of age — most end at 18 months.
Also, these studies often used infant formulas that provided substantially less DHA than is found in the milk of mothers who eat fish or take fish oil frequently. In other words, the formula may not have contained enough DHA to make a measurable difference.
That’s why in the early 2000s, researchers from Kansas set out to conduct a better study that would really confirm — or refute — whether omega-3-fortified formulas helped infants develop into kids with healthier brains and healthier eyes. They found that children who received a DHA-enriched formula in infancy showed improved brain performance in childhood.
The University of Kansas team conducted a randomized, double-blind, controlled trial in 81 infants born in the Kansas City area between September of 2003 and October of 2005 (Colombo et al., 2013). The trial was led by researchers John Colombo and Susan Carlson, whose earlier work influenced the FDA approval of omega-3-fortified formulas in 2001, and which prompted formula makers to begin adding DHA in 2002.
The infants were divided into four groups, each fed a different formula from birth to 12 months. A control group got a formula without any added omega-3 DHA or omega-6 AA. Three groups got formulas with omega-6 AA plus one of three levels of omega-3 DHA. The children were then tested every six months from the age of 18 months until six years of age, using nine different cognitive tests.
In the first 12 months, the researchers found improved attention and lower heart rates in all of the omega-3 groups (Colombo et al., 2011). But by 18 months, the omega-3 group children did not perform any better on the standardized tests. If the study had stopped there, it would have just added more mud to the waters.
But by age three, the researchers again began to see significant differences in the performance of children who were fed the enriched formulas. These included superior performance among the omega-3 groups on “finer-grained” measures of several aspects of cognitive function, like pattern recognition, rule learning and inhibition and picture vocabulary tests.
More recently, researchers have gone beyond observational studies (that is: feed infants DHA and see what happens), and have made strides in understanding exactly what dietary DHA and AA are doing in infants’ bodies. This includes how and when the compounds are metabolized, and how much of the DHA and AA from formula (or breast milk) actually shows up in infants’ blood plasma (Lien et al., 2018).
The results of cognitive and eye-health studies continue to be mixed, while hints of new benefits are coming to light, specifically related to immune function and disease incidence (Lien et al., 2018). Infants fed DHA-supplemented formula had a T-cell count and cytokine profile — two key facets of a strong immune system — closer to infants fed breast milk than to infants on unsupplemented formula.
Another study found that infants up to one year old who were fed DHA- and AA-containing formula had a lower prevalence of bronchitis (Pastor et al., 2006) — others have found similar results related to both infectious respiratory infections and allergic diseases (Lien et al., 2018).
And there’s a new explanation for why some infants might benefit from supplementation, while others don’t: genetics. Researchers have identified specific genes that affect the amount of DHA and AA an infant needs for healthy development. In a recent study, they found that formula supplementation increased DHA and AA levels in the infants, but only for those who carried a certain version of a gene called FADS, or fatty acid desaturase, which influences the metabolism of the fatty acids (Salas Lorenzo et al., 2018).
Clinical trial researchers are still figuring out exactly how much DHA and AA is helpful, to which infants, and why. Although many studies over the past few decades have shown benefits or been inconclusive, many researchers have still come out neutral or in favor of supplementation, and none of the infants fared worse after consuming the supplemented formula.
So if you’re looking for a healthy infant formula, take a leaf out of the adult’s book — where we know DHA makes a difference — and make sure to find a formula that includes omega-3s.
Yuhas, R., Pramuk, K., & Lien, E. L. (2006). Human milk fatty acid composition from nine countries varies most in DHA. Lipids, 41(9), 851–858. http://doi.org/10.1007/s11745-006-5040-7
Auestad, N., Scott, D. T., Janowsky, J. S., Jacobsen, C., Carroll, R. E., Montalto, M. B., Halter, R., Qiu, W., Jacobs, J. R., Connor, W. E., Connor, S. L., Taylor, J. A., Neuringer, M., Fitzgerald, K. M., & Hall, R. T. (2003). Visual, cognitive, and language assessments at 39 months: A follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics, 112(3 Pt 1), e177–183. https://doi.org/10.1542/peds.112.3.e177
Beyerlein, A., Hadders-Algra, M., Kennedy, K., Fewtrell, M., Singhal, A., Rosenfeld, E., Lucas, A., Bouwstra, H., Koletzko, B., & VonKries, R. (2010). Infant formula supplementation with long-chain polyunsaturated fatty acids has no effect on Bayley developmental scores at 18 months of age — IPD meta-analysis of four large clinical trials. Journal of Pediatric Gastroenterology and Nutrition, 50, 79–84. https://doi.org/10.1097/MPG.0b013e3181acae7d
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Smithers, L. G., Gibson, R. A., McPhee, A., & Makrides, M. (2008) Effect of long-chain polyunsaturated fatty acid supplementation of preterm infants on disease risk and neurodevelopment: a systematic review of randomized controlled trials. American Journal of Clinical Nutrition, 87(4), 912–920. https://doi.org/10.1093/ajcn/87.4.912
Fleith, M., & Clandinin, M. T. (2005). Dietary PUFA for preterm and term infants: Review of clinical studies. Critical Reviews in Food Science and Nutrition. 45(3), 205–229. https://doi.org/10.1080/10408690590956378
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Drover, J. R., Hoffman, D. R., Castaneda, Y. S., Morale, S. E., Garfield, S., Wheaton, D. H., & Birch, E. E. (2011) Cognitive function in 18-month-old term infants of the DIAMOND study: A randomized, controlled clinical trial with multiple dietary levels of docosahexaenoic acid. Early Human Development, 87(3), 223–230. https://doi.org/10.1016/j.earlhumdev.2010.12.047
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Colombo, J., Carlson, S. E., Cheatham, C. L., Shaddy, D. J., Kerling, E. H., Thodosoff, J. M., Gustafson, K.M., and Brez, C. (2013). Long-term effects of LCPUFA supplementation on childhood cognitive outcomes. American Journal of Clinical Nutrition, 98(2), 403–12. https://doi.org/10.3945/ajcn.112.040766
Colombo, J., Carlson, S. E., Cheatham, C. L., Fitzgerald-Gustafson, K. M., Kepler, A., Doty, T. (2011). Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention. Pediatric Research, 70, 406–410. https://doi.org/10.1203/PDR.0b013e31822a59f5
Lien, E. L., Richard, C., & Hoffman, D. R. (2018). DHA and ARA addition to infant formula: Current status and future research directions. Prostaglandins, Leukotrienes and Essential Fatty Acids, 128, 26–40. https://doi.org/10.1016/j.plefa.2017.09.005
Pastor, N., Soler, B., Mitmesser, S. H., Ferguson, P., & Lifschitz, C. (2006). Infants fed docosahexaenoic acid- and arachidonic acid-supplemented formula have decreased incidence of bronchiolitis/bronchitis the first year of life. Clinical Pediatrics, 45(9), 850–855. https://doi.org/10.1177/1073858406289801
Salas Lorenzo, I., Chisaguano Tonato, A. M., de la Garza Puentes, A., Nieto, A., Herrmann, F., Dieguez, E., Castellote, A. I., López-Sabater, M. C., Rodríguez-Palmero, M., & Campoy, C. (2019). The effect of an infant formula supplemented with AA and DHA on fatty acid levels of infants with different FADS genotypes: The COGNIS Study. Nutrients, 11(3), 602. https://doi.org/10.3390/nu11030602