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Reply to FAJ Muskiet et al

Division of Nutritional Sciences
Savage Hall
Cornell University
Ithaca, NY 14853
E-mail: jtb4{at}cornell.edu

Deborah A Diersen-Schade and Julia A Boettcher

Mead Johnson & Company
Evansville, IN

Linda M Arterburn

Alba Therapeutics Corporation
Baltimore, MD

Dear Sir:

We find ourselves in substantial agreement with the comments of Kuipers et al concerning our recent article on worldwide breast-milk docosahexaenoic acid (DHA) and arachidonic acid (AA) concentrations (1). However, contrary to the characterization in their opening paragraph, a careful review of our article shows that we did not suggest that the calculated mean values for breast-milk DHA and AA, in some sense, are the best values against which infant feeding should be based. We suggested that the distribution of these fatty acids will be a valuable guide for infant feeding and are pleased to have the chance to amplify this point.

The distribution of breast-milk DHA and AA includes information about minimum, maximum, distribution breadth, and ratios of DHA to AA. Our intent in using the word guide was to convey that this and other information is of value in making recommendations concerning infant feeding, including breastfeeding. Certainly the mean (or median or mode) worldwide breast-milk DHA or AA concentrations calculated by any procedure should not be the only criteria used for establishing targets for DHA and AA contents in infant formulas for some of the very reasons that Kuipers et al discuss. Indeed, we explicitly noted in the beginning of our article's Discussion that there are multiple ways to calculate such figures-of-merit based on any particular data set. Although our calculations indicate that the means are robust to alternative calculation strategies, we did not suggest that these means are optimum for the average infant, let alone for any particular infant.

Studies of optimal DHA and AA for infant feeding beyond present mean values are indeed needed. Our long-standing interest in this matter is reflected, in part, in our recent publications reporting on studies of the influence of 1.0% DHA formula (with 0.67% AA) on tissue DHA and AA concentrations in animals (2). These concentrations support cerebral cortex DHA concentrations greater than for formulas with 0.33% and induce widespread alterations in gene expression (3). Notably, 0.33% DHA is the approximate level used in most, but not all, North American infant formulas. We argue, based on the worldwide distribution, that 1.0% DHA is within the high end of current breast-milk concentrations and, thus, is a nutritional and not a supranutritional level.

We are aware of ongoing studies into the origins of human diet and the implications for modern humans, as discussed in detail by others (4, 5). It is important to note that these ideas continue to be controversial. We believe that it is premature to draw definitive conclusions about contemporary infant feeding based solely on the dietary norms of hypothetical ancestors when contemporary physiology can be studied. However, the vigor with which such matters are argued reflects their proponent's contention that that they are of importance to contemporary humans as another guide to human nutrition. We agree.

ACKNOWLEDGMENTS

None of the authors declared a conflict of interest.

REFERENCES

1. Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr 2007;85:1457–64.[Abstract/Free Full Text]
2. Hsieh AT, Anthony JC, Diersen-Schade DA, et al. The influence of moderate and high dietary long chain polyunsaturated fatty acids (LCPUFA) on baboon neonate tissue fatty acids. Pediatr Res 2007;61:537–45.[Medline]
3. Kothapalli KS, Anthony JC, Pan BS, Hsieh AT, Nathanielsz PW, Brenna JT. Differential cerebral cortex transcriptomes of baboon neonates consuming moderate and high docosahexaenoic acid formulas. PLoS ONE 2007;2:e370.
4. Cunnane SC. Survival of the fattest: the key to human brain evolution. Hackensack, NJ: World Scientific Publishing Co Pte Ltd, 2005.
5. Simopoulos AP. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother 2006;60:502–7.[Medline]

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