Why infant nutrition solutions should include ARA: An expert perspective

• A new EU regulation, which came into play in February 2020, has made it mandatory to add docosahexaenoic acid (DHA) to infant formula and follow-on formula, whereas arachidonic acid (ARA) remains an optional ingredient.
• An expert group led by the University of Granada (Spain) recently assessed the new guidelines. After reviewing all the evidence, the group concluded that ARA should be added to infant formula and follow-on formula in similar or higher concentrations than those of DHA, or at least equal to the levels found in human milk.
• During the 26th congress of the Spanish Society of Gastroenterology, Hepatology and Pediatric Nutrition (SEGHNP), Peter van Dael and Marco Turini from dsm-firmenich’s Nutrition and Science Advocacy (NSA) team interviewed three of the specialists from the expert-led group, including lead author, Prof. Christina Campoy, Prof. José Manuel Moreno Villares and Prof. Ángel Gil. Read on to gain exclusive insights from the interviews, including key reasons for including both ARA and DHA in infant nutrition solutions.

Watch the interview for exclusive expert insights on why formulators should add ARA and DHA to infant nutrition products.

Long-chain polyunsaturated fatty acids (LC-PUFAs) are critical for infant growth and development, particularly (arachidonic acid) ARA and (docosahexaenoic acid) DHA. Both nutrients are key components of cell membrane phospholipids and therefore play an important role in cell division, differentiation and signaling, especially important for brain development.^1,2,3,4,5 In addition, LC-PUFAs are precursors of eicosanoids and metabolites, which help to modulate the immune response.

Exclusive breastfeeding is recommended by WHO during the first months of life to support healthy infant growth and development. Breast milk naturally contains both ARA and DHA, and as such provides these important nutrients to infants as long as they are breastfed. If breastfeeding is not possible, or if a mother chooses not to breastfeed, infants will need to receive the important LC-PUFAs from other reliable sources, like infant nutrition solutions.  

The new Commission Delegated Regulation EU (2016/127) recommends that infant formulas and follow-on formula must contain 20-50 mg DHA/100 kcal (0.5-1% total fatty acids), which is higher than in human milk and most other infant nutrition products on the market. In addition, the regulations specify that ARA remains an optional ingredient. This has caused controversy throughout the infant nutrition market, largely due to the lack of scientific evidence demonstrating the safety of supplying DHA alone and uncertainty regarding the possibility of risks.

Prof. Christina Campoy explains: “Optimal neurodevelopment is dependent on both ARA and DHA – there is data demonstrating the important benefits of both nutrients on brain structure and functionality specifically. For this reason, it is important to supply both ingredients to infants, to ensure they have the nutrients needed for optimal development.”

Prof. José Manuel Moreno Villares adds: “There is a significant gap between our scientific knowledge and the reasoning behind these new regulations. We know the benefits that breast milk brings. We’re also aware of the safety and positive effects of adding ARA and DHA together to infant nutrition solutions, especially for visual and cognitive development. Because there is no data currently available related to the use of DHA without ARA, we strongly recommend that infant nutrition formulators follow existing scientific knowledge – that is to base infant nutrition formulations on the composition of human milk.”

During the first months of life, LC-PUFA synthesis from precursors linoleic acid (LA) and α-linoleic acid (ALA) is not sufficient to support ARA and DHA synthesis due to low enzymatic activity, especially in infants carrying variations of the FADS genes, which are involved in LC-PUFA production. As a result, these infants are unable to supply their own ARA and DHA needs, which can negatively affect their growth and development. It is therefore vital that these infants receive enough ARA and DHA, plus LC-PUFA precursors, LA and ALA, to cover their nutritional needs during this critical window of development.

The interview with Prof. Campoy revealed that approximately 25-50% of populations in Europe, Asia and Oceania carry a variation in the FADS gene, affecting ARA and DHA synthesis and availability. This is as high as 97% in the Latin American population.⁶ Prof. Ángel Gil explained that the new regulation based on an EFSA opinion has not taken the genetic polymorphisms related to FADS into consideration. Because these infants are not able to produce enough ARA, there is even more reason to add it to infant formula to support health outcomes. He concluded that both nutrients should be provided at comparable ratios present in human milk, at least until more research is conducted to thoroughly evaluate the effects of DHA alone.

WHO recommends exclusive breastfeeding for six months. dsm-firmenich fully supports this and continued breastfeeding, along with the introduction of complementary foods as advised by a doctor or health authority. When breast feeding is not possible, dsm-firmenich supports the use of both ARA and DHA in formulas intended for infants during the critical early life stage. dsm-firmenich works as a partner with manufacturers of infant nutrition products to develop solutions that support healthy infant growth and development.