Recommended Intakes of DHA for Infants, Pregnant and Lactating Women
Koletzko B. et al., J. Perinat. Med. 36:5-14, 2008.
Department of Pediatrics, University of Munich, Munich, Germany
Dr. Berthold Koletzko (M.D.) and 18 colleagues with expertise in the area of polyunsaturated fatty acids for human health, with special interest in infant and maternal nutrition as well as infant development, have co-authored this present review which includes consensus recommendations for health-care providers as supported by the World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation.
The following provides a brief summary of the key recommendations and guidelines for health-care providers with respect to the recommended intakes of long-chain omega-3 fatty acids as DHA (docosahexaenoic acid):
1) Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg of DHA in order to provide DHA for deposition in adequate amounts in brain and other tissues during fetal and early postnatal life. The authors indicate that several studies have shown an association between maternal dietary intakes of fatty fish/oils providing long-chain omega-3 fatty acids in pregnancy and/or lactation and visual and cognitive development along with other functional outcomes of the infants in some of these studies. They indicate that daily intakes of DHA up to 1000 mg/day (and up to 2700 mg/day of long-chain omega-3 fatty acids as DHA+EPA) have been used in randomized trials without evidence for the occurrence of significant adverse effects.
2) For healthy term infants, it is recommended and fully endorsed that breast feeding, as a source of pre-formed long-chain omega-3 fatty acids, is the preferred method of feeding. When breastfeeding is not possible, the use of an infant formula is recommended which provides DHA at levels of at least 0.2% of the total fat (fatty acids) with the DHA levels not to exceed 0.5% of total fatty acids.
Dr. Holub's Comments:
It should be pointed out that daily average intakes of DHA (from fish and/or supplementation and/or functional foods containing DHA) of 200 mg/day during lactation can be expected to give rise to breast milk levels of DHA to be approximately 0.30-0.35% of total milk fat. Current average intakes of DHA during pregnancy and lactation in North America and many other countries are well below the 200 mg/day level with average intakes reported (from our group) to be approximately 80 mg/day (Denomme et al., J. Nutr., 135:206-211 (2005)). Consequently, the mean level of DHA on North American breast milk is generally below 0.30-0.35% of total milk fat. In contrast, the breast milk of Japanese women approaches 1.0% of total milk fat and reflects daily intakes of DHA averaging 500-850 mg/day. Since fish contains EPA (eicosapentaenoic acid) in addition to DHA, this raises the question as to whether recommended intakes of long-chain omega-3 fatty acids in pregnancy, lactation, and infancy should include DHA plus some EPA as opposed to DHA alone. The vast majority of studies showing beneficial health effects from the consumption of fish/fish oils during pregnancy and lactation have provided DHA + EPA (with more DHA in the majority of studies). An active area for future research can be expected to be on the potential health benefits provided by EPA in addition to those attributed to DHA. It is of interest to note that extensive analyses of human milk fatty acid compositions from nine countries (Yuhas et al., Lipids, 41:851-858 (2006)) indicated the levels of DHA to range from and average of 0.17 to 0.99% of total fatty acids with EPA levels ranging from 0.07 to 0.26% of total fatty acids. The DHA:EPA ratio in the Japanese breast milk averaged at 4:1 where DHA and EPA represented 0.99% and 0.26%, respectively, of the total fatty acids present.