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Mother's Milk vs. Formula: New Info
July 17, 2001
PERSONAL HEALTH
A Human Touch Is Added to Infant Formulas
By JANE E. BRODY
By early next year, infant formulas sold in this country may have had an important change in their ingredients. The Food and Drug Administration has just approved the addition of two fatty acids that can enhance the neurological and visual development of children who are not breast-fed.
These fatty acids, which are naturally present in breast milk, are already being added to formulas in 60 countries and have been endorsed as beneficial to infant development by the World Health Organization.
But before formula producers in this country can start using them, the companies must file premarket labeling statements with the F.D.A. And once the modified products are on the market, the companies will be required to do postmarketing surveillance to assure that babies who consume the formulas experience no bad effects. The cost of these requirements will almost certainly be passed on to consumers, and prices most likely will rise 10 percent to 15 percent.
Dr. William E. Connor, professor of clinical nutrition at Oregon Health and Science University and an expert on fatty acids, praised the F.D.A.'s move, saying, "It will improve the health of children by making infant formula more comparable to human milk."
Breast Is Still Best
There is still no question that breast milk is the ideal food for a vast majority of infants for at least their first six months. Not only does breast milk contain the right amount and balance of nutrients needed to foster normal growth and development, it also contains immunological factors from the mother that can protect infants against infections. And, of course, breast-feeding fosters maternal-infant bonding that can enhance a child's emotional development.
But there is also no question that many mothers in this country are unable to breast-feed their babies for months on end. And some mothers, for health or other reasons, are unable or unwilling to nurse at all.
These days a very large proportion of mothers with newborns work full-time outside the home and cannot afford to take more than a few weeks or months off from work when their babies are born. Pumping enough breast milk to cover a day's feedings, or more than that for women whose jobs take them out of town, is often not practical or possible.
The alternative, feeding babies infant formula, is an excellent second-best option, one that has clearly succeeded in nourishing millions of healthy children. In fact, formula-fed babies tend to grow faster than those who are breast-fed, probably because formula contains proteins different from those in breast milk. Pediatric experts, including those who are staunch advocates of breast- feeding, emphasize that women who give their babies formula instead of breast milk should not feel guilty.
Making Formulas Better
Through the years, formula manufacturers have made many changes in their products to make them more like mother's milk. But DHA and A.A., two fatty acids found in breast milk and fish, have been missing from the formulas sold in the United States. In full-term infants and adults, the acids are formed slowly from other dietary fats.
These two fatty acids, which belong to a larger group known as omega-3 fatty acids, have been shown to enhance mental and retinal development in infants. They are especially important to babies who are born prematurely and who lack the ability to convert other fats into these two fatty acids. Full-term newborns are able to manufacture some DHA and A.A., but studies suggest that this may not be enough to foster optimal brain and visual development. Over time, adults can accumulate DHA and A.A. and store it in body fat.
DHA and A.A. are believed to be important to brain function throughout life. Fatty cold-water fish — like salmon, mackerel, sardines, tuna and trout — acquire DHA and A.A. from eating algae, and people who regularly eat these fish get ample amounts of these fatty acids. In a study published in February in The American Journal of Clinical Nutrition, researchers at Bristol University in England reported that women who ate fatty fish in pregnancy gave birth to children who experienced better visual development at age 3.
In nursing women, DHA and A.A. are naturally transferred from body fat to breast milk. But because the amount of DHA in the typical American diet is low, DHA levels in breast milk of American women are among the lowest in the world, said Dr. Barbara Levine, co-director of the human nutrition program at Rockefeller University in New York. So some nursing mothers who consume little or no fatty fish may want to supplement their babies' diets with DHA-enriched formula when it becomes available.
Although Martek petitioned the F.D.A. five years ago for approval to add DHA and A.A. to formulas, the agency moved cautiously, awaiting studies to show not just that the substances were effective in enhancing infant development but also that they brought on no unwanted results. One factor slowing approval was the use of fish oil as the source of DHA and A.A. in initial studies instead of the purified vegetarian product from algae. Fish oil contains other fatty acids as well, and some of those were found to impair infant growth. Also, unlike fish, algae can be grown in the laboratory under pharmaceutical-like conditions, and the fatty acids can be extracted free of pollutants, toxins and other contaminants.
Dr. Ronald Kleinman, a pediatrician and nutrition expert at Massachusetts General Hospital in Boston, endorsed the F.D.A.'s caution in approving changes. After all, he noted, formula-fed babies do very well in this country now, and changes that may be harmful should not be made to these products. But, he added: "Formulas should be made as good as they can be. There's no reason to put babies who are not breast-fed at a disadvantage." Brain development occurs rapidly in the first months of life.
How Certain Acids Can Help
Another limitation of the initial studies was in the comparisons, which were made between the development of babies who were breast-fed and those given formula supplemented with DHA and A.A. That, Dr. Levine said, was like "comparing apples to oranges," since breast-fed babies, for many reasons, typically do better. Instead, federal authorities needed to see results showing differences between infants on regular formulas and those using formulas with the added fatty acids.
In a study published in The Lancet and conducted at the University of Dundee among full-term infants assigned to receive regular formula or formula supplemented with a mixture of omega-3 fatty acids, those given supplemented formula showed better problem-solving ability at 10 months.
Dr. Connor's center, in Oregon, was among eight that participated in a long- term study of the effects of formula supplemented with DHA and A.A. in premature babies. The study found that, when compared with babies fed ordinary formula, those given formula containing the fatty acids showed better motor and cognitive performance at 1 year. The babies who were fed fatty acids also had improved visual development, as demonstrated by electrical changes in the brain when the infants were shown certain things.
Dr. Connor said that in addition to improving the nervous and visual systems, consuming DHA and A.A. as an infant might have "other beneficial effects" later in life, to the heart and immune system, for example. Adults who consume fatty fish just once a week have significantly lower rates of fatal heart attacks. Omega-3 fatty acids may also inhibit the development of autoimmune disorders like rheumatoid arthritis.
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