The Implications of Undernutrition in Children

Discuss about the Long-Chain Polyunsaturated Fatty Acids.

In the last year it has been observed that the world population have reached about 7.6 billion. Satisfactory nutrition is essential for the better health and development of children. It is estimated from the global studies that under nutrition of children, is the main cause, directly or indirectly, for at least 35% of child deaths, less than age of five years. The disability of children, preventing them from full development potential is due to under nutrition. Around 32% or 186 million children of age below five years in developing countries are diminutive. First 2 or 3 years of a child are crucial for the normal physical and mental development. And children under the age of 3 years are vulnerable to poor nutrition. Children, especial of low birth weight or vulnerable to nutrition, are at the highest risk of morbidity (Beveridge et al. 2013). In this report a complete discussion about the infant nutrition requirements and the main components of their most desirable nutrition. This report also discusses the consideration of the safety issues about infant nutrition.

Child feeding is multidimensional and it changes rapidly in the first year of development. Breast feeding is an exclusive practice of child feeding. Even it is the best option for complete infant nutrition. Fatty acids present in the breast milk are the main source of energy and other lipid soluble vitamins.  These fatty acids present in breast milk are long-chain polyunsaturated acids generally knows as LCPs. LCPs are the most essential component for the development of an infant. Decosahexanoic (DHA) and Arachadonic Acid (AA) are most attention attracting component of breast milk, for nutrition consultants as these are the essential required components for infant development. DHA is responsible for nervous and retinal system development. And AA is responsible for eicosanoid synthesis (regulator for homeostasis and response to the injury) and growth of an infant (Ismail et al. 2010). These LCPs can be obtained directly from breast milk but they are not available in any commercial formula sold most of the countries. DHA is synthesised from an omega-3 fatty acid called linolenic acid (ALA) and AA is synthesised from an omega-6 fatty acid known as linoleic acid (LA) (Uauy & Dangour 2009).

Babies, who are artificially fed, must rely on the endogenous synthesis of DHA and AA obtained from ALA and LA respectively. These LCP fatty acids naturally present in breast milk. Another natural source for these acids is not present; therefore, these have to be produced artificially (Su 2010). These artificially produced LCP fatty acids are called Formula acids. Mainly two formula acids are essential for infants that are DHA and AA DHA and AA acids can be synthesised from Linolenic Acid (ALA) and Linoleic Acid (LA) respectively. Then after the LCP synthesis is further compromised by balancing in LA and ALA in the desired formula. The relative amount of fatty acids present in the nutrition of an infant. In the formulation all the members of omega-3 and omega-6 families interact in a very complex manner (University of Granda 2008). In there is not an inappropriate ratio of LA and ALA, this may create condition of LCP deficiency. And since both of these acids have different biological roles, this inappropriate ration may lead to any functional abnormality in the early age of child or sometimes beyond the infancy (INFACT Canada 1998).

Nutrition Requirements for Infants

Fat and fatty acids are very important for human beings. These acids play their respective role during the entire life but their influences vary at different stages. In this context some acids are essential at the time of infancy age as they are the essential elements for physical and mental development of the human body. Among these fatty acids Omega-3 and omega-6 supplementation in infants and mothers is associated with several positive health outcomes in both mother and infant. Both the Arachidonic Acid (AA) and Decosahexaenoic Acid (DHA) are present in the breast milk. And tissues from the breast fed infants are showing higher LCP fatty acids than are those of the tissues from the formula fed infants (Kulisic et al. 2007). This kind of results states the necessity of DHA and AA in the infant formulas. Therefore, a nutrient product containing these two essential acids will have a market advantage relative to the other nutrient products without these acids. Introducing these acids companies can attract the attention of parents for such type of nutrition products for their children and this will show a higher growth of company’s market (Birch et al. 2002). Even nutrition consultants recommend these two essential acids for better development growth of an infant. And this makes the nutrition industry to introduce such products to increase their market (Agostoni & Riva 2002).

Strong evidence, linking the breast-milk feeding (having higher quantity of DHA and AA to the advance development (higher IQ) due to higher level of DHA, found in the relative neuronal structure of breast feeding infants and formula fed infants. These evidences are not limited to the brain only, because the vivo observations of infants undergoing the minor orthopaedic surgery have shown that a proper supply diet of long-chain polyunsaturated fatty acids affect the internal fatty acid composition of the skeleton muscle membrane phospholipid too (Gill et al. 2012). Generally it is observed that the biological effect of these LCP fatty acids are mediated by the simple modification of the physical properties of the membranes that are leading the enzymatic activities linked with the membranes (Fan et al. 2018). Therefore, by imparting the particular fluid properties to the bilayers of membrane, DHA can play an important role in the neural and synaptic network development. It has been found that DHA c3ontributes a total of 50% in the disc of membrane of retinal photoreceptors and responsible for about 75-100 % of fatty acids. Arachidonic acid (AA) is found to perform as neurotransmitter as a second messenger and sometimes even as a primary messenger for synaptic cleft of the brain (Agostoni & Riva 2002).

The Role of Long-Chain Polyunsaturated Fatty Acids in Infant Development

Today there is a wide range of opinions that state that the visual development of the infants, either enriched formula fed or breast fed, in preterm is higher for the infants fed with the formulas/diet containing LCP fatty acids regardless the outcomes were by electroretinography, preferential looking or visual evoked potentials. In two different intervention studies it is shown that the visual development of the infants either breast fed or DHA supplement fed was superior to that of the non-supplemented formula fed infants (Koletzko et al. 2001).

Some studies on preterm infants have suggested an operational correlation between the early intake of DHA and an improved neurodevelopmental performance in short term. But at the same time some studies find no beneficial effects of long-chain polyunsaturated fatty acids supplements.

A scoring advantage has been reported on development quotient (DQ) testing of a population of 4 month old term infants whose nutrition had included DHA and AA, when compared with that of the similar formula fed groups. And further it was found that DHA was the only polyunsaturated fatty acid in the given erythrocytes which was significantly liked with the higher development quotient (DQ) (Agostoni & Riva 2002).

On the other hand it has been found that low level of DHA and other LCP fatty acids in the skeletal muscle membrane phospholipids are related with the obesity and insulin resistance in the adulthood.

For better understanding the interrelationship between the type of skeletal muscle phospholipid fatty acid composition and glucose regulation, for the type of early infant feeding have been observed in group of children undergoing the selective surgery. Biopsies of skeletal muscle and fasting blood samples were obtained from normally nourished group of 56 young children of less than 2 years age (Lien et al. 2008). Then the subgroups of formula fed and breast fed infants were compared and the results reported a higher percentage of DHA in breast fed infants to that of the formula fed infants (Nordgren et al. 2017).

In short term the consequences, of LCP deficiency and imbalance of LA and ALA, are sleep pattern disturbance, spontaneous heart rate variability change, reduction in the sensitivity of rod photoreceptors, visual acuity etc. (Fontani et al. 2005). Change in heart rate variability is a marker for brain maturation. Similarly in long term there are many consequences of LCP deficiency and imbalance of LA and ALA in the formulation. Long term consequences are inferior cognitive function, hither body fat, weight, visual maturation, and increase of rate of respiratory illness. Studies show that in adulthood there is an association between formula feeding and the arising lipid abnormalities as well as the higher rate of neurodegenerative incidences (Fattty Acids in Infant Development 2018).

The Importance of Breastfeeding

Infancy being the most critical post-partum stage for the development of the neurologic structure, some variations have been found in content of DHA in the prefrontal brain cortex of a breastfed infant and that of the formula fed infant. This study provides sufficient evidences regarding the effects of dietary supply of LCP fatty acids in form of breast feeding or by means of formula feeding on the structure of brain cortex in an infant. Research states that some studies on supplementation of LCP fatty acids have shown beneficial effects, whereas others show no improvement. Some common neurological deficits have been seeing in adulthood of those with phenylketonuria (PKU) and some studies observed that these neurological deficits may be caused by poor consumption of long-chain polyunsaturated fatty acids present naturally in breast milk and artificially in synthesised DHA and AA. DHA status is highest of its all-time level in the age of infancy, and a continuous supplement of these LCPs can prevent the decline rate of DHA in later age (Meher et al. 2016).

All the studies show their own perception on the basis of their findings and states that in the crucial age of infancy there are some essential requirements of some specific nutrients like Long-chain polyunsaturated fatty acids. And these fatty acids are responsible for both the physical as well as the mental development of the infant. Since infancy is the age of development these essential requirements are need to be fulfil effectively. But the issue is, these LCPs are naturally present only in breast milk and breast feeding is discontinued after a certain age therefore, there is arisen of decline rate of DHA and AA (different LCPs) which may cause a defect in matured development. In order to prevent this declined rate of DHA and AA supply there must be supplement consumption in the form of formula acids. These formula acids are synthesised form of omega-3 and omega-6 family members. These formula acids are beneficial for the matured development of physical as well as mental health in adulthood. Today there are many supplements available in the market, in the form of formula acids, by different companies. These supplements must be provided to the infants for their complete development and for the prevention of abnormality or physical and mental disorder of the child. Therefore, it is highly recommended to get a proper supplement of formula fats in order to prevent many developmental disorders in the later age. This supplementation may be in form of breast milk at the age of infancy or in the form of formula fats in child-age.

Artificial Feeding and LCP Synthesis

Conclusion

This study has examined the necessity of LCP fatty acids, especially DHA and AA, for infants and concludes that the consumption of long-chain polyunsaturated fatty acids is essential in the age of infancy. These LCP fatty acids are naturally present only in breast milk but in breast milk also the quantity may vary and cause any physical or mental disorder in the early age or may be in the later age. Therefore, synthesised forms of some LCPs are to be fed for the normal development of an infant. Proper supplement of formula LCP fatty acids is essential to prevent other physical disorders like weak visual development from the early age. This requirement of proper supplement of fatty acids can achieved with the help of proper nutrition diets containing the appropriate amount of fatty acids.

References

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