Title: PUFAs and Infant Formula

Key words: Essential fatty acids, PUFA, infant formula, breast feeding

Date: June 1999

Category: 4. Food Data

Type: Article

Author: Dr van Rhijn


PUFAs and Infant Formula

The Rationale For The Addition Of Long-Chain Polyunsaturated Fatty Acids To Infant Formula


Observational studies suggest that breast feeding may advantage the infant in cognitive and intellectual development in comparison with infants fed on formula milk, even if various confounding variables are controlled for. There is speculation that one of the beneficial components of breast milk in this regard may be long chain polyunsaturated fatty acids (LC-PUFA’s). The evidence for this hypothesis will be discussed.

What are LC-PUFA’s

Two parental essential fatty acids (EFA’s), Linoleic Acid (18:2 n-6) and Linolenic acid (18:3 n-3 LNA) are converted to LC-PUFA’s by a series of desaturation and chain elongation steps into their functional derivatives Arachidonic acid (20:4 n-6 AA) and Docosahexaenoic acid (22:6 n-3 DHA) respectively. Neural, retinal and vascular development in the foetus and neonate is dependent on an adequate supply of LC-PUFA’s, especially AA and DHA1, 2, 3, as 60% of the structural material of the brain is lipid (> 50% PUFA’s).

Biological Mechanisms

Supplementation with DHA enhances maturation of electroretinographic (ERG), improve visual-evoked potentials (VEP) and forced-choice preferential looking (FPL), reflecting a rapid retinal development4. Supplementation with LC-PUFA’s resulted in shorter fixation duration scores (releasing attention), which is inversely related to intelligence5. This increased ability to process information (faster reaction times), reflects developmental maturity of frontal eye fields and cortex (Parietal & Prefrontal), secondary to an accumulation of LC-PUFA’s in cell membranes6. This may be due to dopaminergic and serotonergic neurotransmission promotion. DHA is essential for normal rhodopsin7 function.

Rational for Fortification

Reports on brain lipid composition confirm that breast fed infants have higher DHA levels compared to those fed on formula8,9. DHA levels only increased to similar levels when formulas were supplemented with fish oils rather than with the precursors LA or alpha-linolenic acid. This supports the evidence that preterm infants may be unable to convert EFA’s10, 11, resulting in deficiencies at a critical stage of Central Nervous System development12. No correlation with visual function was associated with the parent LNA. Deficiencies (non-fortified formula milks) may result in impaired neuro-development, poor visual acuity13, 14. Breast-feeding may confer prospective long-term benefits on neurological development15, as well as higher IQ scores at 8 years of age in pre-term infants16. Studies have demonstrated improved visual acuity in those infants receiving supplemented formula17, 18, but conflicting results with regard to cognitive function19, 20.


Many of the above mentioned studies lack proper randomisation and utilise different measuring tools for vision tests. The results are difficult to interpret if different maturation rates and age of individual testing are taken into consideration. Infants with intrauterine growth retardation may receive more benefit from supplementation with LC-PUFA’s with regards to cognitive function, making a case for early supplementation with EFA’s during pregnancy.


More research, controlling for the number of experimental variables, as well as consensus about the optimum quantities, duration, safety and source of LC-PUFA supplementation appropriate for pre-term and term infants are required before major changes in diet formulas are made.


  1. Nutrition of Infants and Pre-school Children. Fact File No. 2. National Dairy Council. London. 1995
  2. Maternal and Fetal Nutrition. Fact File No. 11. National Dairy Council. London. 1994
  3. British Nutrition Foundation. Unsaturated fatty Acids. Nutritional and Physiological Significance. London: Chapman Hall. 1992
  4. Hoffman, D.R. et al. Dietary long-chain polyunsaturates (LCPs) for preterm and term infants? Controversies in visual function outcome. In: David, T.J. Major controversies in infant Nutrition. International Congress and Symposium Series 215. R. Soc. of Med. Press. 1996; pp: 45 – 55.
  5. McCall, R.B & Carriger, M.S. A meta-analysis of infant habituation and recognition memory performance as predictors of later IQ. Child. Dev. 1993; 64, 57 – 79.
  6. Willatts, P. et al. The effects of long-chain polyunsaturated fatty acids on infant attention and cognitive behaviour. In: David, T.J. Major controversies in infant Nutrition. International Congress and Symposium Series 215. R. Soc. of Med. Press. 1996; pp: 57 – 70.
  7. Innes, S,. Essential Dietary Lipids. In:Ziegler, E. & Filer, L.J. 1996. Present knowledge in Nutrition. Seventh Edition. ILSI Press, Washington DC. Ch 7. pp. 58 – 66.
  8. Farquharson, J. et al. Infant cerebral cortex phospholipid fatty-acid composition and diet. Lancet 1992; ii. 810 – 813.
  9. Makrides, M. et al. Fatty acid composition of brain tissue and erythrocytes in breast- and formula-fed infants. Am. J. of Clin. Nutr. 1994; 60, 189 – 194.
  10. Clark, K.J. et al. Determination of the optimal ratio of linoleic and alpha-linolenic acid in the infant Formulas. J. Ped. 1992; 120, S151 – S158.
  11. Forsyth, J.S. 1998. Lipids and Infant Formulas.
  1. Nutr. res. Rev. 11, 255 – 278.
  1. Makrides, M. et al. Are long chain polyunsaturates essential nutrients in infancy? Lancet. 1995; 345, 1463 – 1468.
  2. Birch, L.L. et al. Breast-feeding and optimal visual development. J.of Ped. Opth. And Strabismus. 1993; 30, 33 – 38.
  3. Makrides, M. et al. Erythrocyte docosahexaenoic acid correlates with the visual response in healthy term infants. Ped. Res. 1993; 34. 425 – 427.
  4. Lanting, C.I. et al. Neurological differences between 9-year old children fed breast-milk or formula milk as babies. Lancet. 1994; 344, 1319 – 1322.
  5. Lucas, A. et al. Breast milk and subsequent intelligence quotient in children born pre-term. Lancet 1992; i, 261 – 264.
  6. Carlson, S.E. et al. Long chain fatty acids and early visual acuity and cognitive development of pre-term infants. Eur. J. of Clin. Nutr. 1994; 48, Suppl. 2, S27 – S30.
  7. Carlson, S.E. et al. Visual acuity in term infants fed human milk or randomly assigned to a formula with or without long-chain N-3 and N-6 fatty acids. Ped. Res. 1995; 37, 303A.
  8. Auestad, N. et al. Visual acuity, RBC fatty acids and growth in term infants fed formulas with and without long chain polyunsaturated fatty acids (LCP). Ped. Res. 1995; 37, 302A.
  9. Agostini, C. et al. Developmental quotient and LC-PUFA feeding of healthy term infant at 4 months. 2nd International Congress of the International Society for the Study of Fatty Acids and Lipids. No 52. 1995