Early life nutrition and the critical roles of DHA, ARA and HMOs: key takeaways from ESPGHAN 2022

Summary

• The first 1,000 days of life – the time between conception and a child’s second birthday – is a unique period of opportunity for establishing the foundations of optimum health. Providing sufficient quantities of key nutrients during this period supports infant growth and development.
• During the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Congress 2022 in Copenhagen, Denmark, expert speakers at the dsm-firmenich Symposium discussed frontiers in early life nutrition and emerging science for both long-chain polyunsaturated fatty acids and human milk oligosaccharides in infant development.
  
• Read on to discover the key takeaways from the symposium that shed light on current and future possibilities for innovative infant nutrition solutions. 

Early life experience influences health through adulthood, exerting permanent programming effects on long-term physiology and function. While genetic and environmental factors are potential mechanisms of early life programming, nutrition is a predominant influencer.

At the ESPGHAN Congress 2022, leading industry specialists, academics and professionals came together to share the latest scientific knowledge and best practices for promoting better nutritional health in infants. As a Gold sponsor at the four-day congress, dsm-firmenich hosted a symposium featuring three expert speakers who discussed the role of long-chain polyunsaturated fatty acids (LCPUFAs) and new insights and research on human milk oligosaccharides (HMOs) in supporting early life development. Read on for our key takeaways from the symposium. Interested in catching up on-demand? Click here to watch the session. 

Setting the stage for optimal early life development

The first 1,000 days of life – from conception until the third birthday – is a critical window of time where nutrition can impact the risk of developing non-communicable diseases such as heart disease and diabetes later in life. Professor José Manuel Moreno-Villares, co-director of the Department of Pediatrics and medical director of the Clínica Universidad de Navarra in Madrid, Spain, kicked off the symposium with an introduction to the significance of optimizing nutrition during the first 1,000 days of life to mitigate metabolic risk factors for chronic diseases.

While metabolic risk factors for non-communicable diseases such as hypertension, hyperglycemia and obesity have traditionally been addressed in adulthood, it is now recognized that early life nutrition is linked to epigenetic changes that could modify metabolic risk factors in later life and even future generations. The establishment of the microbiome begins in early life, directly influencing metabolic programming and immune system development, with ramifications for neurodevelopment and the risk of developing anxiety, depression and learning impairments. 

Human milk is the gold standard for infant nutrition as it contains essential nutrients and bioactive components that influence metabolic programming, thereby reducing metabolic risk factors. But what makes human milk so special?

DHA and ARA: Working in tandem to promote healthy infant development

Human milk contains the LCPUFAs omega-6 arachidonic acid (ARA) and omega-3 docosahexaenoic acid (DHA) in the average ratio of 1.8:1. However, there is a range of factors influencing optimal DHA and ARA supplementation in formulas intended for infants as explored by Berthold V. Koletzko, Professor of Paediatrics at Ludwig Maximilians University of Munich, in his presentation.

ARA and DHA – which accumulate rapidly in the infant’s growing brain throughout pregnancy and the first two years of life – are also precursors for resolvins and other eicosanoids that play a role in inflammation and immune system function. Although humans can synthesize ARA and DHA from precursor fatty acids, infants have a limited capacity for LCPUFA conversion and conversion rates for DHA are slower. Genetically, some people carry a Fatty Acid Desaturase (FADS) polymorphism that limits their ability to convert precursor fatty acids to ARA. When formula-fed infants with FADS polymorphisms are fed infant formula without preformed ARA and DHA, they score lower on IQ tests compared to those without FADS polymorphisms. However, this difference is not observed among breastfed infants with and without FADS polymorphisms because human milk provides preformed ARA and DHA.  

In a randomized trial, infants received either a formula with no ARA and DHA or one of three formulas with different ratios of ARA and DHA. Infants that received formulas with ARA and DHA at ratios of 1:1 or 2:1 scored better on neurodevelopment and language development tests compared to those who received formulas without ARA and DHA or with a higher DHA to ARA ratio.¹ Experts therefore strongly recommend that infant formula should provide both DHA and ARA, with ARA levels at least equal to DHA.²

Uncovering the benefits and potential of HMOs

HMOs also play a significant role in infant health. As the third most predominant solid component of human milk, HMOs have bioactive properties with specific compositions varying from mother to mother and throughout lactation. During the symposium, Sharon Donovan, Professor of Food Science and Human Nutrition at the University of Illinois, Urbana-Champaign, shared her insights on how HMOs function as modulators of infant development.

HMOs are resistant to digestive enzymes and remain intact within the intestine. There, they serve as prebiotics for specific strains of bifidobacteria and beneficial bacteroides and can also help support gut barrier function, inhibit binding of pathogens and promote systemic benefits for immune and neurocognitive development.³ Randomized controlled trials have shown that adding HMOs to infant formulas could potentially improve gastrointestinal tolerance, reduce levels of inflammatory cytokines, lower rates of parent-reported incidence of lower respiratory tract infections and reduce use of antipyretic and antibiotic medications when compared to control infant formulas not containing HMOs.^4,5,6,7,8 Prof. Donovan highlighted that further research may reveal additional insights on the role of HMOs in improving growth and reducing the risk of necrotizing enterocolitis in preterm infants.

Co-creating the future of infant nutrition

Along with the demand for more effective infant nutrition solutions, knowledge of the complex composition of human milk is steadily increasing. A better understanding of the benefits of known human milk components, such as LCPUFAs and HMOs, and the identification of new functional components could pave the way forward in closing the nutritional gap between breastfed and formula-fed infants to support growth and development.

At dsm-firmenich, we are your end-to-end partner in purpose-led infant nutrition solutions that support the first 1,000 days of life. We offer a complete portfolio of nutritional ingredients that meet the highest safety and quality requirements, including HMOs, DHA and ARA as well as fully customizable premix solutions. As research continues to evolve, we monitor the latest nutrition science and regulatory changes and help our customers with dedicated services from application, technical and regulatory expertise, to scientific and marketing support.