Thread by @stableisotope

This is generally a good article, but I would like to note this statement about Euro formulas "the safety standards are arguably higher. (European formulas cannot contain corn syrup, for example, and require higher levels of the omega-3 fatty acid DHA.)/1

https://twitter.com/NewYorker/status/1531061082395131906

I'll leave the corn syrup issue for others, except to note that there is no strong reason to believe this is actually a safety issue for infants, rather lets look at the DHA part of it /2

First, DHA is not mandated in formulas in the US at all. There is no RDA for DHA and the evidence for benefit is mixed in full-term infants. DHA was first added as a GRAS (Generally Recognized as Safe) additive by the FDA in infant formula 20 years ago /3

GRAS notification focuses on safety of the additive as specific levels. Euro authorities just recently went with the current mandated levels but this is controversial and nothing is stopping US companies from adding DHA at the Euro level /4

The bottom line is that Euro formulas are NOT safer because they mandate a high level of DHA. DHA is a bioactive additive and the optimal intake level is uncertain as is the issue of supplementing breastfeeding moms with a low dietary DHA intake (mostly fish). /5

Families may choose the higher level and be willing to pay for it and other bioactives (e.g. oligosaccharides and probiotics) in infant formula, but the US standards are not less safe because these are not mandates. /6

We need a lot more research on all bioactives and optimizing their content in formula. This research should be federally funded, not relying on corporate sponsorship and must be long-term in nature and look at clinically relevant outcomes /7

When we have this data, we will be in a position to establish an RDA (or AI, EAR, etc) for DHA and other bioactives and make statements about safety. If and when this happens, we must ensure that they are in fact mandated in infant formulas /8

Meanwhile, nearly all US formulas have some DHA, one is at Euro levels, some others are very close and may go up. All of that is safe as is the presence or absence of other bioactives until we have more clinically relevant research to go on. /9

For those interested in bioactives, take a few hours and watch this NIH conference recently held on the topic and research goals for bioactives nichd.nih.gov/about/meetings… #infantformula #DHA #NIH /10

One other point, all of this discussion is strictly related to full-term infants. For preterm infants, there is a whole different set of research data. DHA seems more likely to be important for preterms, but the exact needed level is uncertain. /11