Clinical Briefs

With Comments from Russell H. Greenfield, MD

LCPUFAs, Infant Formula, and Blood Pressure

Source: Forsyth JS, et al. Long chain polyunsaturated fatty acid supplementation in infant formula and blood pressure in later childhood: Follow up of a randomised controlled trial. BMJ 2003;326:953.

Goal: To determine whether supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFAs) has an effect on blood pressure later in life.

Design: Follow-up of a randomized, controlled multicenter trial.

Subjects: A total of 147 formula-fed children and a reference group of 88 breast-fed children (mean age 70.1 months).

Methods: In 1992, children from six European centers were randomized to receive either standard infant formula, or a formula supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA) that was otherwise nutritionally similar, during the first four months of life. Blinding with respect to the type of formula received was maintained. Approximately six years later participants had their blood pressures determined and questionnaires were completed.

Results: The children who had received formula supplemented with LCPUFAs had a lower diastolic and lower mean blood pressure than those who received the non-supplemented formula. The blood pressure of breast-fed children did not differ significantly from those who had received LCPUFAs, but the diastolic blood pressure was noted to be significantly lower than that of the non-supplemented group.

Conclusion: Dietary supplementation with LCPUFAs in formula-fed infants is associated with lower blood pressure in later childhood when compared to those having received standard infant formulae.

Study strengths: Multicenter design that ensured sex matching; all centers used the same type of automated blood pressure monitor.

Study weaknesses: Many of the initial study participants were not available for follow-up (50/126 in the supplementation group, 40/111 in the non-supplemented group, and 51/139 in the breast-fed group)—the majority of those lost to follow-up could not be traced or had relocated; data on diet after age 4 months were not collected.

Of note: The authors state that direct comparison of the supplemented formula group and the breast-fed group was not possible due to confounding variables.

We knew that: Deviations from normal blood pressure in childhood trace into adulthood; breast milk contains LC-PUFAs, and breast-fed children have lower blood pressures than those fed standard formulae.

Clinical import: Tremendous advances have been made toward the treatment of cardiovascular disease, yet an increasing prevalence of hypertension, heart disease, and stroke clearly point to a need for added emphasis on prevention. For those mothers who cannot or who choose not to breast-feed, supplementation of infant formula with LCPUFAs may offer their children additional health benefits. Supplemented formulae, however, also are associated with additional cost, and programs must be developed to permit widespread availability across socioeconomic strata.

What to do with this article: Keep a hard copy in your file cabinet.

Dr. Greenfield, Medical Director, Carolinas Integrative Health, Carolinas HealthCare System, Charlotte, NC, is editor of Alternative Medicine Alert.