SIROY DHA

(PURE DHA DROPS 100mg per ml)

Essential fatty acids & Infant nutrition

Pure DHA preparation is widely available in western country. However
supplementing of Pure DHA as per guideline is difficult in India, no Pure DHA in
form of drops was available. The SIROY LIFE SCIENCES have made this
supplementation possible by making in pure form of DHA drops 100mg per ml
named as SIROY DHA.

What is DHA & how does it work?

Essential fatty acids (EFA) are being discussed for their important role in brain
development and functioning as well as their cardio protective role. There is also a
growing evidence of their role in protection from infection and allergy disorders. It is
important to understand the differences amongst the various EFA and also to understand
role of one versus the other. Here we will be discussing some basic facts about essential
fatty acids and their role in infant nutrition & psychneuroimmune development.
Fats provide the main source of energy for infants and young children. It is not
only important to provide flavor and texture to the food but is needed by all cell
membranes including neuronal connections. It is also important for absorption of fat
soluble vitamins and provides us with the EFA. EFA are so called because they cant be
manufactured in the body and are essential for bodys growth. Mammalian cells are
unable to insert double bonds more proximal to methyl terminal of fatty acid than the 7 th
carbon. The most abundant essential fatty acids are:
Linolenic acid (LA) 18 carbon: 2 n-6 (means it has 18 carbons ; two
double bonds ; last double bond at 6th carbon from the methyl terminal of
the fatty acid)
Linolenic acid (ALA) 18 carbon: 3 n-3
By the process of desaturation and chain elongation, LA is converted to Arachidonic acid
20 carbon: 4 n-6 (AA) and ALA is converted to Eicosapetanenoic acid 20 carbon: 5 n-3
(EPA) and Docosahexaenoeic acid 22 carbon: 6 n-3(DHA). This conversion is affected by
many factors like age, alcohol intake, smoking and certain drugs. At extreme of ages and
in pregnancy, this conversion is not sufficient enough to meet the increased needs for
brain, retina development or to meet the fetal requirements. To summarize, Omega 3 fatty
acids are ALA, EPA and DHA and Omega 6 fatty acids are LA and AA.
Brief History on DHA:
It has been seen documented as early as 1950 that infants given skimmed milk
and hydrogenated coconut oil failed to gain wt and develop typical skin lesions c.f. those
given small amounts of corn oil as well. Similarly in 1960 it was shown that the use of

parenteral nutrition with proteins and glucose alone led to poor growth and altered visual
functions compared to PN+n-6 fatty acids emphasizing the importance of EFA.
All EFA are not same:There are important differences between Omega 6 and Omega 3 fatty acids and some of
the differences are very important from clinical point of view.
Omega 6 LCPUFA (Eicosanoids) are more potent, are proinflammatory and
adipogenic
Omegas 3 LCPUFA (Eicosanoids) on the other hand are anti inflammatory and
decreases fat deposition. Fish oil (EPA & DHA) has been used in Rheumatoid
arthritis emphasizing its anti inflammatory properties. There are various
differences between EPA and DHA as well. DHA has been shown to prevent CVS
disease by reducing blood vessel inflammation and atherosclerosis 1.There are less
heart diseases in Eskimos and Japanese fisherman which has been attributed to
higher blood DHA/EPA levels c.f. Omega 6 LCPUFA in them. Triglyceride levels
fall more with 26% in DHA (26%) compared to EPA (21%). So evidence is in
favor of DHA compared to EPA for the beneficial effects seen with Omega 3 fatty
acids. More over EPA concentration in mothers milk in negligible making its
importance very doubtful in infant nutrition.

When to recommend:Recommendation for first 6 months of life: Understanding that Mothers

Milk Is the Best for the Baby one need to look at the lipid composition in mothers
milk first to draw some logical conclusions.
50% of energy as lipids
12% LA, 0.6% AA (12.6% Omega 6 FA), 0.5% ALA, 0.3% DHA (0.8%Omega 3
FA)
Actual amount of LCPUFA depend on maternal diet.
Baby should be given exclusive mothers milk for first six months of life and
mothers diet should have sufficient amounts of EFA and especially DHA. But Indian
diet is very inadequate for Omega 3 FA content.

Ratio of Omega 6: Omega 3 FA in various diets across the world:

Ideal diet
Indian Diet
USA
Japan

5-10:1
30-70:1
12:1
2:1

The main reason for poor Omega 3 FA in Indian diet is lack of animal products especially
fish and excess intake of animal milk and milk products. There are a number of vegetable
sources of EFA and one must have knowledge so that the same can be advised to the
mother.

Sources of Omega 3/6 fatty acids

Omega 3 fatty acids

Omega 6 fatty acids

Flaxseed or linseed

Sunflower

Rapeseed or canola

Safflower

Peanut

Sesame

Olive

Palmolive

Perilla

Corn

Walnut

Primrose

Soya

Borage

Green leafy vegetables, dry fruits

Invisible fats

Fish / Fish oil

Supplementation of DHA during Pregnancy:It has shown to improve cord Omega 3 levels and neonatal short follow up 3- 6
mths has not shown any benefits (Malcom et al. Helland et al but long term follow up till
4 yrs has shown beneficial effects on mental ability 2 Some studies also show less atopy
and lower type I IDDM in supplemented infants. We must remember that these studies
are done in west in mothers with better DHA content in their diet and if we reciprocate
the results for Indian mother with poor DHA content in their diet, the beneficial effects
are bound to be more.
Pregnancy & LCPUFA DHA accretion occurs in III rd trimester mainly and
the transfer depends on the age of the mother (at elderly age transfer would be less),
primi or second gravida (primi expected to have better transfer), interval between the
pregnancies (less the interval, less is the transfer in the second baby), Maternal diet (Fish,
Marine products) and alcohol intake (reduces DHA transfer).
Supplementation during Lactation:It has also shown to improve breast milk DHA content but clinical effects shown
in different studies are not consistent. In Indian Context, DHA supplementation should
help the neurodevelopment of the infants and children.

Recommendation:WHO Guidelines recommend at least 2.6 gm of Omega 3 LCPUFA and 100-300

mg DHA/Day during pregnancy and lactation.
Infant Nutrition and EFA:-

All infants should be fed on exclusive mothers milk for first six months and in
case mothers milk is not sufficient, alternative milk with sufficient amounts of EFA
should be provided. As unmodified bovine milk (cow or buffalo or goat) does not contain
any EFA, the only option is a balanced infant formula with ratio of LA/ALA between5:1
to 15:1.
DHA supplementation in term formula:Cochrane (2001) reviews after analyzing 10 trials have concluded that there are
contradictory results on beneficial effects on developmental indices. Certain trials show
better problem solving (finding a hidden toy) 3 or higher scores on Bayley Mental
Development Index until 17 weeks of age4 while others show no benefits5 / Transient
benefit6 There is some effect seen in reduction of BP and Type I DM with no documented
side effects.
LCPUFA and preterm formula:There is no ambiguity as far as preterm milk formula and their supplementation is
concerned. Meta analysis by San Giovanni show better visual acuity at 2&4 months.
There is strong recommendation by AAP that preterm formulae should contain both AA
and DHA.
Infant nutrition 6months to one year:Recommendations for fat intake
First 6 months
40-60% of total energy
Omega 6: omega 3 ratio 5-10:1
<1% trans fats
After 2 yrs
Fat 30-35% calories
Omega 6: 4-10% energy
Omega 3: 1-2% energy
Transfats <2% energy
Infants must be continued breast milk or term baby follow-up formula along with
addition of semisolid diet with emphasis on addition of vegetable oils with high Omega 3
FA (Soyabean oil, canola oil, mustard oil, fish oil, rapseed oil etc.)

Prime Key Messages:Essential fatty acids are important for brain, retina and growth
All essential fatty acids are not same
Omega 3 LCPUFA have anti allergic properties, good for brain and heart
Maternal diet should contain enough DHA, otherwise supplementation is a good
idea
Supplementation during lactation is less rewarding
Breast feeds till 6 months is best strategy

If not
Cows milk is absolutely no
Term baby formulae is second best option
Preterm formulae should be supplemented with DHA
For infants and bigger children: fat content should come down, DHA still
important
References:
1. Grimble RF. Dietary lipids and the inflammatory response. Proceedings of the
Nutrition Society 1998; 57:535-542.
2. Helland. Pediatrics 2003; 111(1): e 39-440.
3. Williatts P. Lancet 1998; 352:688-91)
4. Birch EE.Dev Med Child Neurol 2000; 42:174-81)
5. Makrides M. Pediatrics 2000; 105:32-38.
6. Carlson SE. J Pediatr 1992; 120:S159-67.

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