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SEP-OCT 2017

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Lutein, a dietary carotenoid common to fruits and vegetables, is well known for its role in ocular health. It has only recently been recognized that lutein may also function in another neural tissue — the brain. Lutein is the predominant carotenoid in both infant and adult brains. 1 - 2 In adults, lutein status is related to a better cognitive performance 3 - 5 and lutein supplementation improves cognition. 6 Lutein's effects on cognition in early life have only recently been considered. However, such a role is particularly compelling given that, among the carotenoids, lutein is preferentially taken up into breast milk 7 - 8 and that, in pediatric brains, the relative contribution of lutein to the total carotenoids is twice that found in adults, 1 - 2 accounting for more than half the concentration of total carotenoids. The preferential uptake of lutein into the brain may be due to a specific binding protein for which concentrations are related to levels of lutein, particularly in infancy. 9 The greater proportion of lutein in pediatric brains suggests a need for lutein during neural development as well. To date, the majority of the evidence evaluating the relationship between lutein and cognition comes from studies in young and older adults. While it is not known whether lutein's role in cognitive health is specific to the adult, the proposed mechanisms by which lutein may exert its effect (antioxidant, anti-inflammatory, structural) would apply to the infant as well. In fact, in a randomized, double-blind, placebo- controlled study of healthy-term newborns, supplemental lutein was found to significantly increase serum measures of antioxidant activity. 10 This is particularly important in the early neonatal period where oxidative stress plays a crucial role in pathological conditions. The brain is especially in need of antioxidants because of its high metabolic rate, and the human newborn brain has a relative deficiency of endogenous antioxidant enzymes. In addition, cellular membranes of brain tissues are rich in polyunsaturated fatty acids, 11 which are highly oxidizable. These same membranes are rich in lutein (and not other carotenoids). 11 Thus, the pairing of an antioxidant in a highly oxidizable environment would be of benefit in brain tissue. Of further interest are recent results from post-mortem metabolomic analyses (study of chemical processes involving metabolites) of human infant brain tissues. Lutein concentrations were positively correlated with metabolites of lipid and energy pathways. 12 Of note was the positive relationship of lutein with the neurotransmitters GABA and aspartate. GABA is thought to modulate neuronal proliferation and maturation, neurite outgrowth and synapse formation, 13 - 15 and aspartate is an excitatory neurotransmitter. 16 Therefore, lutein may play a biochemical role in the development or remodeling of neurons and have a direct ability to support neurotransmission. Infant formula is not routinely supplemented with lutein, whereas breast milk is a highly bioavailable source of lutein. 17 Given the meta-analysis of 11 studies that showed that breast feeding was associated with significantly higher scores for cognitive development than was formula feeding, 18 further investigation of the impact of lutein intake on cognitive development is warranted. There is unlikely a risk to added lutein to infant formulas. In a prospective, randomized, controlled and double-blind study of healthy-term infants fed either control formula or experimental formula containing 200 µg/L lutein for 16 weeks, both study formulas were well tolerated and there were no differences between treatment groups in any of the measures of growth. 19 In contrast, based on the evidence to date, there could be a potential risk posed on infants who are deprived of lutein in terms of their neural development. Given that the first year of life is a time of neural growth and development for which nutrition can have significant consequences, optimal lutein status during this time could be an important strategy towards long-term cognitive health outcomes. Additionally, the maternal diet may be of importance in this regard given that the sole source of lutein for the developing fetus is the mother's diet. Unfortunately, most Americans may not get enough lutein. In the United States, the average adult gets less than 2 mg per day, with even lower intakes in infancy. 20 While there is no recommended dietary intake for lutein, the epidemiological evidence suggests that at least 6 mg per day is important for ocular health in adults. 20 Kale, collards and spinach are rich dietary sources of lutein, but it can also be found in broccoli, avocados, corn and eggs. 21 Ideally, an expectant mother should consume a diet sufficient in lutein-rich foods. For those who do not consume food sources, supplementation may be warranted to fill the gap. About the Author – Elizabeth J. Johnson, PhD Elizabeth J. Johnson, PhD, is a Scientist I at the Jean Mayer USDA Human Nutrition Research Center on Aging and an Associate Professor at the Friedman School of Nutrition and Science Policy at Tufts University. Email address: elizabeth.johnson@tufts.edu Lutein's Role in Infant Nutrition From the eye to the brain ADVERTORIAL Elizabeth J. Johnson, PhD Citations available upon request from floraglo@kemin.com These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. © Kemin Industries, Inc. and its group of companies 2017. All rights reserved. ® ™ Trademarks of Kemin Industries, Inc., USA.

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