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The addition of long-chain polyunsaturated fatty acids to infant formulas has raised concerns about a possible increased risk of oxidative damage both to formula components and to the infants fed these products. Vitamin E, the principal lipid-soluble biologic antioxidant, is composed of a mixture of several derivatives of tocol and tocotrienol (1,2). Sufficient availability of vitamin E is of major importance for the response to oxidative stress that may damage lipids and lipoproteins, proteins and enzymes, and DNA, as well as membrane systems and their functions(3). Such oxidative stress and damage appear to be important in the pathophysiology of many disorders, including retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary disease, haemolytic anemia, chronic liver disease, malnutrition, and infection. A key factor in the development of such diseases is the relative balance of the oxidative stress and intrinsic antioxidant defense mechanisms. Thus, low birth weight infants, in whom the latter mechanisms might be inadequate, are at particular risk.

A Position Paper of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition