Abstract

Purpose. While it is widely recognized that breast-feeding provides optimal nutrition for healthy infants, approximately half of U.S. infants are formula-fed. In response to ongoing research, formula composition is revised to more closely mimic human milk in providing essential nutrients for optimal growth and development. There is an emerging consensus on the need to provide ?3 LCPUFAs in preterm infant formula in order to achieve fatty acid composition of red blood cells (RBCs), retinal function, visual function and developmental milestones comparable to those of breast-fed infants. This randomized trial was designed to investigate whether term infants require a dietary supply of pre-formed ?3 LCPUFAs for optimal development. Methods. Healthy term infants (n=112) were randomized to receive Enfamil® or Enfamil® supplemented with 0.32% docosahexaenoic acid (DHA) or DHA and 0.77% arachidonic acid (AA). Measurements at 6, 17, 26, 52, and 78 wks included growth, RBC fatty acids, visual function, and the Bayley© scales. The focus of this report is the visual function outcome at 6 and 17 wks. Electroretinographic (ERG) measures included the ISCEV standard protocol and rod and cone intensity-response functions. Visual acuity was assessed by swept visual evoked potential (VEP) and forced-choice preferential-looking (FPL). Results. At 6 wks (but not 17 wks), groups which received DHA had more mature rod and cone ERG function and, in addition, retinal maturity was significantly correlated with RBC-linolenic acid levels. At both 6 and 17 wks, VEP acuity was significantly less mature in the group with low RBC-DHA and VEP acuity was significantly correlated with RBC-DHA levels. FPL acuity did not differ among groups at either age. Conclusions. DHA-supplemented formula, with or without AA, is associated with more mature visual function during early infancy. These data support the role of ?3 LCPUFAs in promoting optimal development of the retina and brain of term infants.