Dietary Docosahexaenoic Acid and Arachidonic Acid in Early Life: What Is the Best Evidence for Policymakers?

Abstract

Background: A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries. It is proposed that this selective evidence base may not fully represent the biological importance of DHA and ARA during early and later life and the aim of this paper is to consider a more inclusive and pragmatic approach to evidence assessment of DHA and ARA requirements in infants and young children, which will allow policymaking to reflect the marked diversity of need worldwide. Summary: Data from clinical RCTs is considered in the context of the extensive evidence from experimental, animal and human observational studies. Although the RCT data shows evidence of beneficial effects on visual function and in specific cognitive domains, early methodological approaches do not reflect current thinking and this undermines the strength of evidence. An outline of a framework for an inclusive and pragmatic approach to policy development on dietary DHA and ARA in early life is described. Conclusion: High-quality RCTs that will determine long-term health outcomes in appropriate real-world settings need to be undertaken. In the meantime, a collective pragmatic approach to evidence assessment, may allow public health policymakers to make comprehensive reasoned judgements on the merits, costs, and expediency of dietary DHA and ARA interventions.

Nutrient Intake Adequacy from Food and Beverage Intake of US Children Aged 1–6 Years from NHANES 2001–2016

“…Consistent with their finding was the low intake of fish, which are a high source of DHA, possibly due to concerns about mercury contamination and food allergies [ 34 ]. Data collected by the FAO has indicated that low DHA intake among infants and young children is a global phenomenon [ 35 ]. Although there has been increased recognition of the importance of DHA for normal brain function and particularly the increased need of DHA during infancy and spurts of development in early childhood [ 9 ], many policy makers have not yet formally developed recommended dietary intakes for DHA [ 35 ].…”

Maternal Supply of Both Arachidonic and Docosahexaenoic Acids is Required for Optimal Neurodevelopment<em> </em>

“…The supplementation of DHA: ARA in infant formulas, ranges from 1:1 to 1:2. The present recommendations with DHA and ARA levels are 0.2% to 0.4% and 0.35% to 0.7% of total fatty acids are appropriate [281]. The formula should reflect human milk composition for optimal neurocognitive benefits.…”

Maternal Supply of Both Arachidonic and Docosahexaenoic Acids Is Required for Optimal Neurodevelopment

“…The supplementation of DHA:ARA in infant formulas ranges from 1:1 to 1:2. The present recommendations with DHA and ARA levels are that 0.2% to 0.4% and 0.35% to 0.7% of total fatty acids are appropriate [ 278 ]. The formula should reflect human milk composition for optimal neurocognitive benefits.…”