"Breast milk still remains the feeding of choice." This has always been and will remain the mantra of the medical community. Yet, recent concerns that breastfeeding may not be as protective against allergies as previously thought touched a raw nerve, to say the least.
An article published in the prestigious journal, Lancet, in September 2002, suggested in some cases, breastfed babies might not receive protection against asthma and allergies. This previously purported protection against allergies is now questionable.The reasons why the reputation of breastfeeding has been dented remain complex and controversial. Suffice it to say that more research is needed to sort things out.
Meanwhile, some nursing mothers remain confused by the tarnished image of breastfeeding, much to the chagrin of the Laleche League and others. At least recent research has forced us to talk about some of the potential dark sides of breastfeeding.
It is not only breastfeeding mothers who are confused – bottle-fed babies are about to get a wider choice in Canada and they already have that wider choice in the USA. This will require more careful discussions about which formulas are the best, knowing that the best formula will always be second best to breast milk.
In May 2002, formulas containing long chain polyunsaturated formulas (LC-PUFAs) were introduced in the USA with the US Food and Drug Administration's blessing as "probably safe." It is anticipated the same introduction will take place in Canada this year.
What are these so-called LC-PUFAs? Why were they marketed with such zest and overzealous enthusiasm, as some of the critics would argue? Are the extra-cost formulas, approximately 15% more in cost, containing LC-PUFAs justified? And, perhaps most importantly, what do we know about its long term safety?
Martek, the American company that markets this formula, has a marketing slogan that reads, "We're putting more thought into formula." Their advertisements to professionals suggest, correctly, that LC-PUFAs are vital nutrients essential for proper infant brain and eye development. Two types, referred to as arachidonic acid (ARA) and docosahexonoic acid (DHA) are naturally found in breast milk. ARA and DHA are major fatty acids in neural tissue. DHA is also an important component of the photoreceptor of the retina.
Even months before the marketing campaign took off, the widely read and well-respected Jane Brody of the New York Times, wrote about the possible benefits of adding LC-PUFAs to infant formulas. Subsequently, her influence led to other media outlets picking up on this potential "breakthrough" toward raising smarter babies and improving children's vision. Understandably, the public, in their fervour to do what is best, especially in the early, pliable years of a child's life, showed a keen interest in LC-PUFAs – at least in the USA.
These fatty acids are supplied to the fetus from maternal plasma during pregnancy and it is believed the preterm infant, born during the third trimester, is at much greater risk for deficiency of these LC-PUFAs than the term infant.
It is hypothesised that the addition of DHA to infant formula will improve infant visual function and the addition of both DHA and ARA will improve cognitive development. However, up until now, the relatively few studies testing the hypothesis have yielded inconsistent and variable results.
In July 2002, an article appeared in "Pediatrics," looking at the outcome of a double blind randomized trial of LC-PUFAs supplementation in formulas fed to specifically preterm infants. The authors concluded that efficacy was not demonstrated in the first 18 months. However, there was some advantage in the developmental scores of infants born before 30 weeks gestation, but it was not statistically significant. The study, done by British and Australian
Scientists raised some potential safety issues.
Reduced linear growth (babies’ length) in the LC-PUFAS group became amplified over time and was seen 18 months after dietary randomization ceased. The authors concluded residual efficacy and safety issues in the LC-PUFAS supplementation of formula for preterm infants require additional testing.
The FDA approved the addition of these oils in formulas in 2002 by giving it a GRAS (generally regarded as safe) status, but the FDA also expects infant formula manufacturers to sponsor further scientific studies and pursue rigorous post marketing surveillance. Yet, it remains unclear how the FDA will assure that such studies are completed.
What do paediatric organizations have to say about LC-PUFAs being added to formulas? Given the foggy research and the paucity of data, the AAP (American Academy of Pediatrics) has recommended there should not be an official stand at this time. Its Committee guides the AAP on Nutrition. The Canadian Paediatric Society is also still awaiting more research before they take a formal position.
Meanwhile, paediatricians and family doctors are encouraged to discuss with parents what is known about these formulas, which could be marketed in Canada in the near future. A free medical guide, provided by Martek Biosciences Corporation (the manufacturer) is available to professionals. More information is also available on their website at www.martekbio.com
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