DHA AND INFANT DEVELOPMENT
Susan Carlson, Ph.D.
Midwest Dairy Council Professor of Nutrition
Departments of Dietetics and Nutrition and Pediatrics
University of Kansas Medical Center
[email protected]
Key Points
Fish (some sources) have the highest concentration of DHA found in foods
DHA is ?conditionally essential? nutrient for the developing infant (RCTs)
DHA may be equally or more important for the developing fetus (1 RCT/several observational studies/animal models)
Key Points (cont.)
Based on human milk DHA, US women?s DHA intake is among the lowest in the world
The best way to increase DHA intake to the fetus and breast fed infant is to increase DHA intake of their mothers
The good news is that ?clean? sources with DHA (fish oil, algal oil, high-DHA eggs) are marketed for use with women and infants
Key Points (cont.)
The bad news is that evidence point to optimal intakes being much higher than current US consumption making it important to retain viable food (fish) as well as supplements as options for women and children to consume this nutrient
Some Effects of Lower Brain DHA from Animal Models
lower visual acuity
changes in attention that suggest slower brain maturation
higher impulsivity and reactivity
increased stereotyped behavior
alterations in brain dopamine and serotonin
Randomized Trials of
DHA and Infant Development
Pre-term Infants
Uauy et al.
Carlson et al. (3)
Fink et al.
O?Connor et al.
Clandinin et al.
Term Infants
Makrides et al. (2)
Carlson et al. (2+)
Auestad et al.
Willatts et al.
Agostoni et al.
Clausen et al.
Birch et al. (4)
Lucas et al. (2)
Jorgensen et al.
Hadders-Algra
Positive Effects in Infants Supplemented with DHA
Higher visual acuity especially with higher doses and in infants born preterm
Higher Bayley MDI and Bayley PDI in some studies ? global tests
Higher problem solving ability
More mature attention in preterm infants
Positive Effects In Children Supplemented with DHA as Infants
Higher MFFT scores and speed at 6 yrs
Higher Bayley PDI at 30 months of age and longer sustained attention at 5 yrs*
Higher IQ at 4 yrs of age*
Lower Diastolic and Mean BP at 6 yrs
*Mother took DHA during pregnancy and/or lactation
Where and When Do Infants
Obtain DHA?
Convert From
Precursor
Highly Variable
Estimated 0.2-0.4% conversion
-Linolenic Acid
DHA
Preformed
From Human Milk
Or DHA-
Supplemented
Infant Formula
Preformed
In Utero
Human Milk DHA* is Highly Variable
Diet/Location %DHA
Sudan 0.07
US Women 0.12
Pastoral China 0.14
Netherlands 0.19
Germany 0.23
Australia 0.26
France 0.32
Spain 0.34
Nigeria 0.34
Israel 0.37
Norway 0.45
Rural China 0.68
Urban China 0.82
Japan 1.00
Marine China 2.78
*Reflects intake of DHA
Postnatal Diet With DHA Positively Influences Brain Cortex DHA Level
Makrides M, et al. Am J Clin Nutr. 1994;60:189-194 (mean milk DHA is 0.26% DHA in Australia).
Brain Cortex DHA, wt%
Age at Death, wk
Evidence that Prenatal DHA Exposure Is Positively Associated with Infant/Child Development
Helland trial ? Norway-Higher 4-yr IQ. Milk DHA was increased from 0.45 to 1.4%.
AVON trial ? higher maternal fish intake and higher stereoacuity at 3.5 yr.
Univ. of Conn. study showing more mature sleep behavior in newborns whose mother?s DHA was above median
Studies from Kansas City* and Dundee showing more mature attention in infants/toddlers and lower distractibility with maternal DHA above median
*Colombo et al., Child Devel. 2004
Latency to turn to television distracter at 18 mo (p