Nov. 28, 2001 -- All agree that when it comes to feeding babies, breast milk is best. Infant formula manufacturers even market their products by claiming they are as close as possible to mother's milk.
But in the United States, at least, commercial baby formulas are missing key ingredients of breast milk, which studies suggest help improve both visual and cognitive development. That could all change within the next year, however, if the FDA approves the addition of two essential fatty acids to infant formulas.
The fats docosahexaenoic acid (DHA) and arachidonic acid (AA) are already available in commercial infant formulas in 60 countries. And proponents say adding the fats found in breast milk to formulas in this country is a no-brainer.
"Pediatricians who are educated about DHA have been trying to get it into infant formula for the last decade," says California pediatrician Bill Sears, MD, who has written more than 30 books on infant development and parenting.
"The science is overwhelming that it is beneficial in terms of cognitive development. But even without the science it would be obvious because nature makes very few mistakes. And there is a large amount of DHA in breast milk."
Sears points out that an infant's brain triples in size during the first year of life, and that the brain is 60% fat. The natural conclusion, he says, is that one of the most important nutrients for the human brain is fat.
"If the formula companies are going to make the claim that they are close to mother's milk, then wouldn't it make sense to put in the fat that mother's milk has?," he says.
Last May, the FDA officially affirmed the safety of DHA and AA for use in infant formulas, but it still must approve specific requests by formula manufacturers to put the oils in their products.
"I would be very surprised if we don't see formula on the shelves with DHA and AA within the next year," says Angela Tsetsis, director of marketing for Martek Biosciences of Columbia, Md., which manufacturers the algae-derived fatty acid oils.
Tsetsis says formula companies will probably not put the fatty acids in all of their products. Instead, they will offer formulas with and without them until they determine consumer demand.
"Five years ago you wouldn't find too many parents, and not even many doctors, who knew about DHA and AA," says nutritionist Barbara Levine, PhD, an associate professor of medicine at New York City's Rockefeller University. "Now it has been in the press, and people are becoming more aware of it. And the recent studies have been very favorable."
In a widely-cited recent study, researchers from Dallas' Retina Foundation of the Southwest, reported that babies fed infant formula enriched with DHA and AA were cognitively advanced when compared with babies who received commercially available formulas without the fatty acids.
Babies consuming enriched or standard formulas from birth to four months of age, underwent standardized tests at 18 months of age to gauge mental and physical development. The babies who drank enriched formulas scored seven points higher on the mental development index than those receiving non-enriched formulas. Their average score of 105 was virtually identical to a group of babies who had been breastfed from birth.
The children will be retested when they turn 4, and again when they turn 9, to determine if the advantage in early brain development can be seen later on.
In a similar study , published three years ago in The Lancet, infants given formula with or without DHA and AA for four months were assessed at 10 months of age. Researchers from the University of Dundee, Scotland, found that infants who received the enriched formulas were significantly more developed in terms of problem-solving ability.
Both of these investigations included a small number of infants -- 44 in the U.K. and 56 in the Dallas study -- and both involved term infants. Findings reported last August, from the largest study to date involving both pre-term and term infants, were less than conclusive.
Toronto researchers compared brain and visual development in more than 400 premature and 239 term infants fed either DHA and AA-fortified or standard formulas for a year. They found that premature infants fed the fatty-acid enriched formula had advanced brain and visual development compared with pre-term infants fed standard formulas. The developmental advantage was not seen in the full-term infants.
Available to all?
Those who favor adding fatty acids to commercial formulas worry that babies who might benefit most will not have access to the enriched products. Because the fats are costly, enriched formulas are likely to be more expensive and may not be made available to those on government assistance. The U.S. government, through its Women, Infants, and Children (WIC) program, is the largest single buyer of infant formula in the world.
"If the formula companies market their products with and without DHA -- in other words, regular and super formulas -- this could be disastrous," Sears says. "There is no doubt in my mind that mother's receiving formula through WIC will only be offered the cheaper formula. There is just no scientific or ethical reason for leaving DHA out of any infant formula."
Studies have shown that low-income women are less likely than more affluent women to breastfeed. Because they are the largest consumers of commercial formula, it is critical that they have access to enriched formula when it becomes available, advocates say.
"These are working moms and, unfortunately, the work environment is still not very friendly to breastfeeding," Levine says. "There is no question that breast milk is best. If a mom can do it for three or four months, we need to applaud that. But if she can't do it for six, eight, or 12 months, then we have to give her a chance to offer her baby infant formula that is as close to breast milk as we know how to make it."