Dietary Intakes of Arachidonic Acid and Docosahexaenoic Acid in Early Life - With a Special Focus on Complementary Feeding in Developing Countries.

BACKGROUND: In developing countries, dietary intakes of arachidonic acid (ARA) and docosahexaenoic acid (DHA) in early life are lower than current recommended levels. This review specifically focusses on the contribution that complementary feeding makes to ARA and DHA intakes in medium- to low-income countries. The aims of the review are (1) to determine the availability of ARA and DHA food sources in developing countries, (2) to estimate the contribution of complementary feeding to dietary intakes of ARA and DHA in infants aged 6-36 months, and (3) to relate the dietary ARA and DHA intake data to key socioeconomic and health indicators. SUMMARY: The primary dietary data was collected by the Food and Agriculture Organisation (FAO) using Food Balance Sheets, and fatty acid composition was based on the Australian food composition tables. There is evidence of wide variation in per capita dietary intake for both DHA and ARA food sources, with low intakes of meat and seafood products being highly prevalent in most low-income countries. In children aged 6-36 months, the supply of ARA and DHA from the longer duration of breastfeeding in low-income countries is counterbalanced by the exceptionally low provision of ARA and DHA from complementary foods. The lowest tertile for ARA intake is associated with higher percentages of childhood stunting, birth rate, infant mortality, and longer duration of breast feeding. Key Message: In developing countries, intakes of DHA and ARA from complementary foods are low, and public health organisations need to adopt pragmatic strategies that will ensure that there is a nutritional safety net for the most vulnerable infants.

Global Estimates of Dietary Intake of Docosahexaenoic Acid and Arachidonic Acid in Developing and Developed Countries.

BACKGROUND/AIM: For international recommendations on docosahexaenoic acid (DHA) and arachidonic acid (ARA) dietary intake to be valid, there needs to be a greater understanding of dietary patterns across both the developed and developing world. The aim of this investigation was to provide a global overview of dietary intake of DHA and ARA. METHODS: Food balance sheets from the Food and Agriculture Organisation Statistics Division and fatty acid composition data from Australian food composition tables in Nutrient Tables 2010 were utilised to generate median per capita intake estimates for DHA and ARA in 175 countries worldwide. RESULTS: Estimated dietary intake per capita for DHA and ARA in 47 developed and 128 developing countries demonstrated that 48% of the 175 countries have an ARA intake of <150 mg/day and 64% have a dietary DHA intake of <200 mg/day. There was a direct relationship between dietary ARA and DHA intake and the per capita gross national income of the country. Regional analysis showed the lowest ARA and DHA dietary intake in Sub-Saharan Africa and Central and Southern Asian populations. CONCLUSIONS: This study demonstrates there are many populations worldwide that have ARA and DHA intake that do not reflect current international recommendations, and the public health consequences of this global inadequacy need to be urgently considered.

Estimated Dietary Intakes of Arachidonic Acid and Docosahexaenoic Acid in Infants and Young Children Living in Developing Countries.

BACKGROUND/AIMS: There are only few data on dietary arachidonic acid (ARA) and docosahexaenoic acid (DHA) intake in infants from developing countries, and current global recommendations on intake during early life may not reflect the needs of the world's most vulnerable infants. The aim of the study was to provide estimates of intake of ARA and DHA in infants and young children aged 6-36 months who live in developing countries. METHODS: FAO Food Balance Sheets and fatty acid composition data from Australian food composition tables were utilized to generate mean per capita intake estimates for DHA and ARA in developing countries. The median daily intake of DHA and ARA in children age 6-36 months in each country was determined by combining the fatty acid composition of breast milk and complementary foods with the estimated intakes being weighted according to median duration of any breastfeeding. RESULTS: The median daily dietary intake for ARA and DHA across 76 developing countries was 64.0 and 48.9 mg/day, respectively. The lowest complementary food intake of ARA and DHA was present in countries with the lowest gross national income and highest birth rates. CONCLUSION: Global recommendations on ARA and DHA in early life need to reflect the specific needs of infants and families living in low income countries, and country-specific food policies should address gaps between recommended and achieved intakes.

The importance of dietary DHA and ARA in early life: a public health perspective.

Although the literature on the contribution of DHA and arachidonic acid (ARA) to fundamental metabolic functions in brain, immune and cardiovascular systems is extensive, there is a lack of consensus on the need for explicit recommendations on dietary intake for both DHA and ARA during the early years of life. This review takes a public health perspective with the objective of ensuring that recommendations protect the most vulnerable children worldwide. Most studies on the effects of DHA and ARA in early life have been undertaken in high-income countries and this is reflected in policy recommendations. Although breast milk is considered the gold standard and always contains DHA and ARA, there are proposals that infant formulas, especially follow-on formulas, do not need to be supplemented with these fatty acids. Complementary foods frequently have low concentrations of ARA and DHA and this is most significant in low-income countries where availability is also limited. Recent evidence shows that in developing countries, intakes of DHA and ARA during the age period 6-36 months are low and this relates to low national income. It is concluded that a continuum of DHA and ARA intake needs to be maintained during early life, a critical period of infant growth and development. For both infant and follow-on formulas, DHA and ARA should be mandatory at levels that are equivalent to breast milk. An optional recommendation may be limited to countries that can demonstrate evidence of adequate intakes of DHA and ARA during early life.

The Essentiality of Arachidonic Acid in Infant Development.

Arachidonic acid (ARA, 20:4n-6) is an n-6 polyunsaturated 20-carbon fatty acid formed by the biosynthesis from linoleic acid (LA, 18:2n-6). This review considers the essential role that ARA plays in infant development. ARA is always present in human milk at a relatively fixed level and is accumulated in tissues throughout the body where it serves several important functions. Without the provision of preformed ARA in human milk or infant formula the growing infant cannot maintain ARA levels from synthetic pathways alone that are sufficient to meet metabolic demand. During late infancy and early childhood the amount of dietary ARA provided by solid foods is low. ARA serves as a precursor to leukotrienes, prostaglandins, and thromboxanes, collectively known as eicosanoids which are important for immunity and immune response. There is strong evidence based on animal and human studies that ARA is critical for infant growth, brain development, and health. These studies also demonstrate the importance of balancing the amounts of ARA and DHA as too much DHA may suppress the benefits provided by ARA. Both ARA and DHA have been added to infant formulas and follow-on formulas for more than two decades. The amounts and ratios of ARA and DHA needed in infant formula are discussed based on an in depth review of the available scientific evidence.

Effects of long-chain polyunsaturated fatty acid supplementation on neurodevelopment in childhood: a review of human studies.

Omega-3 and omega-6 long-chain polyunsaturated fatty acids (LCPUFA) are critical for infant and childhood brain development, but levels of the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are often low in the Western diet. Increasing evidence from both epidemiological and intervention studies, reviewed here, indicates that DHA supplementation, during pregnancy, lactation, or childhood plays an important role in childhood neurodevelopment. Arachidonic acid (ARA) is also important for infant growth and development. Several studies have demonstrated positive associations between blood DHA levels and improvements on tests of cognitive and visual function in healthy children. Controlled trials also have shown that supplementation with DHA and EPA may help in the management of childhood psychiatric disorders, and improve visual and motor functions in children with phenylketonuria. In all studies, DHA and EPA supplementation is typically well tolerated. Further research is needed to determine optimal doses for efficacy at different developmental ages. The potential long-term benefits of early LCPUFA supplementation also require consideration.