Breakthrough nutrition and development news, now VOLUME 1 | ISSUE NO.

1 2020

Brain Connectivity and Faster Brains: Connecting

the Dots With Nutrition
Be it brain connectivity, processing speed or efficiency, myelination is the key to it all!

Dr. Rahul Verma the central nervous system, specifically in the myelin sheath
Consultant and Head that surrounds neuronal axons.4 It promotes myelination,
Neonatology and General Paediatrics a process that enables the efficient and faster transfer of
Sir HN Reliance Foundation Hospital and Research Centre information in the brain.7
Mumbai
Lipid rafts extracted
Neurodevelopment during the early years of life is an
from the human cortex
intricate, multifaceted process. One of many dimensions of
brain development is cognition. Myelination of the central
have been shown to be
nervous system is pivotal in laying the foundation for brain comprised of nearly 38%
connectivity, maturation of brain networks, co-ordinated sphingomyelin!8
information processing, the advent of cognitive functioning,
and eventually cognitive performance in infants and children. Myelination is a significant aspect of early
At birth, human beings possess a virtually unmyelinated neurodevelopment.1 The level of sphingomyelin
central nervous system and widespread myelination is increases from 2% at birth to 15% at three years
witnessed during the first few years of life. No wonder (Figure 1), which is in line with its role in myelination.8
cognitive development is most rapid during the first four
years of life.1-4 Nutrition during the early years of life is not Figure 1: Phospholipid content of human brain.8
only a crucial, but also a modifiable factor that influences
myelination and therefore the development of cognition.2 Phosphatidylcholine
The development and maintenance of the lipid myelin sheath Sphingomyelin
60 Phosphatidylethanolamines
relies on optimal delivery of key nutrients such as long-chain
Total PL phospholipid (%)

polyunsaturated fatty acids, choline, iron, zinc, cholesterol, Phosphatidylserine

and phospholipids among others.5 40

Phospsholipids: Food for Brain Speed 20

Phospholipids are amphiphilic lipids (with hydrophilic 0

and lipophilic properties) that are an integral part of all 0 25 50 75 100
cell membranes.6 Sphingomyelin, a form of phospholipid,
Age (months)
assumes an important role in the structure of the neural cell
membrane.7 In fact, sphingomyelin is present abundantly in

IMPORTANT NOTICE: The World Health Organization (WHO*) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breast-
feeding – in particular the fact that it provides the best nutrition and protection from illness for babies.
Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy
and after delivery. Unnecessary introduction of partial formula-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding.
Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed.
Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively formula-fed,
more than 400g per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast-milk is not only the best, but also
the most economical food for babies.
If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles orincorrect
dilution can all lead to illness.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.
For healthcare professionals use only. Not intended for public distribution
 Breakthrough nutrition and development news, now VOLUME 1 | ISSUE NO. 1 2020

Not only is sphingomyelin present in breast milk but
accounts for approximately 37% of the phospholipid
fraction of breastmilk fat. Evidently, it is one of the major
phospholipid in breastmilk. The abundance of sphingomyelin
in the central nervous system and breastmilk and its role in
myelination indicates its important role in brain and cognitive
development during the early years of life.4
Phospholipids and Myelination: Evidence
and Experience
There are limited dietary intervention studies evaluating the
effect of sphingomyelin supplementation on myelination
and cognition in infants and young children. Let have us a
look at what researchers have unearthed so far.
Tanaka et al. evaluated the effects of sphingomyelin
on mental, motor, and behavioural development
in preterm infants (weighing less than
1500 g) through a double-blind, randomised, controlled,
pilot study. Within 24 hours of birth, 12 infants were fed
sphingomyelin-fortified milk, while 12 infants – who served as
the control group – were fed control milk. In the test group,
sphingomyelin comprised 20% of all phospholipids in the
milk, while in the control group, sphingomyelin comprised
13% of all phospholipids in the milk.7
At four, six, and eight weeks after birth, the percentage of
sphingomyelin in the total phospholipids was significantly
higher in the trial group than in the control group.
Additionally, at 18 months, compared to those in the control
group, preterm infants who were fed sphingomyelin-
fortified milk demonstrated better scores in the following
neurodevelopment tests:7
• Behaviour Rating Scale of the Bayley Scales of Infant
Development Second Edition (BSID-II)
• Fagan test of infant intelligence scores
• Visual evoked potential (VEP) latency
• Sustained attention score
This is one of the first study that contributes to our
understanding of sphingomyelin-fortified milk and enhanced
neurobehavioral development in low-birth–weight infants.7
The differences in the
myelination between
breastfed and formula
fed infants can
snowball into early
childhood!2
In yet another study, Deoni et al. explored the longitudinal
trajectories of brain and neurocognitive development in
infants who were either exclusively breastfed or formula-fed
for at least three months. They further analysed the effect
of different formula compositions on development. To
obtain longitudinal measures of development, the cognitive
parameters of the infants were scanned and assessed at
six-month increments from the time of recruitment until
two years of age, and yearly thereafter.2
Scientists found the that breastfed infants had significantly
increased myelination accompanied by higher general verbal
and nonverbal cognitive abilities compared with formula-fed
infants. The intake of different formulas resulted in differences
in myelination (Figure 2) and cognitive abilities, with some
formula trajectories closer to those of breastfed infants.2
Infants who received formula compositions with higher
levels of docosahexaenoic acid, arachidonic acid,
phosphatidylcholine, sphingomyelin, iron, and folic acid
showed increased levels of myelin development. Furthermore,
higher levels of phosphatidylcholine and sphingomyelin
were associated with increased myelination
across the brain, rather than in specific
regions.2

IMPORTANT NOTICE: The World Health Organization (WHO*) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breast-
feeding – in particular the fact that it provides the best nutrition and protection from illness for babies.
Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy
and after delivery. Unnecessary introduction of partial formula-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding.
Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed.
Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively formula-fed,
more than 400g per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast-milk is not only the best, but also
the most economical food for babies.
If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles orincorrect
dilution can all lead to illness.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.
For healthcare professionals use only. Not intended for public distribution
 Breakthrough nutrition and development news, now VOLUME 1 | ISSUE NO. 1 2020

Figure 2: Comparison of longitudinal maturation curves
(Early Learning Composite score of the Mullen Scales of
Early Learning) between children who received different
formula compositions; exclusively breastfed children used
for the reference trend.2
Figure 3: Mean whole-brain WM myelination trajectories
derived from children who either received a product
composition with high SM content (71 mg/L) or a lower
SM content (28 mg/L) composition.4

0.18 0.16
Myelin water fraction

Myelin water fraction

0.14 Exclusive
0.12
breast-feeding
(90 days)
0.09 0.08
Formula 1
Formula 2
0.05 Formula 3 0.04
High SM Content
Low SM Content
0.00 0.00
0 400 800 1200 1600 2000
0 25 50 75 100
Age (months) Age (GC Days)

The latest research is the investigations of Schneider et al.

This group of scientists studied the link between dietary Not only are higher levels
sphingomyelin during the early years of life, developmental of sphingomyelin linked
myelination, and later cognitive development. A cohort of
neurotypical infants and young children (n=88) were the with higher levels of
study subjects. The authors went a step ahead and explored myelin content at 12–24
the potential mechanisms for sphingomyelin-related effects months of age, but also
on myelination using in vitro models.4
more prolonged rates of
The sphingomyelin content was quantified in infant nutrition myelination in different
products fed to infants during the first three months of life.
Next, the intake of sphingomyelin was associated with myelin
brain areas.4
content (brain MRI), as well as cognitive development (Mullen
Scales of Early Learning; MSEL). The study found that higher The in vitro data demonstrated that sphingomyelin intake
levels of sphingomyelin were significantly associated with increased the proliferation, maturation, and differentiation
a higher rate of change in verbal development in the first of oligodendrocyte precursor cells. More importantly, it
two years of life.4 resulted in increased axon myelination. The authors
concluded that dietary sphingomyelin impacts
Overall, early life sphingomyelin content was significantly cognitive development in healthy children
related to myelin development profiles throughout the brain and increases axon myelination.4
(Figure 3).4

IMPORTANT NOTICE: The World Health Organization (WHO*) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breast-
feeding – in particular the fact that it provides the best nutrition and protection from illness for babies.
Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy
and after delivery. Unnecessary introduction of partial formula-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding.
Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed.
Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively formula-fed,
more than 400g per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast-milk is not only the best, but also
the most economical food for babies.
If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles orincorrect
dilution can all lead to illness.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.
For healthcare professionals use only. Not intended for public distribution
 Breakthrough nutrition and development news, now VOLUME 1 | ISSUE NO. 1 2020

KEY TAKEAWAYS
• Myelination is the key to brain connectivity, processing speed as well as efficiency.

• Nutrition is one of the crucial modifiable early life influencers of myelination.

• Phospholipids, specifically sphingomyelin is present abundantly in the central nervous system, specifically in the
myelin sheath and promotes myelination.

• Research shows us that sphingomyelin intake during the early years of life has a positive impression on myelination
as well as later cognitive development.

References:
1. Deoni SCL, O’Muircheartaigh J, Elison JT, et al. White matter maturation profiles through early childhood predict general
cognitive ability. Brain Struct Funct. 2016;221:1189–1203.

2. Deoni SCL, Dean III D, Joelson S, et al. Early nutrition influences developmental myelination and cognition in infants and
young children. NeuroImage. 2018;178:649–659.

3. Williamson JM, Lyons DA. Myelin dynamics throughout life: An ever-changing landscape? Front Cell Neurosci. 2018;12:424.

4. Schneider N, Hauser J, Oliveira M, et al. Sphingomyelin in brain and cognitive development: preliminary data. eNeuro.
2019;6(4):ENEURO.0421–18.2019.

5. Deoni SCL. Neuroimaging of the developing brain and impact of nutrition. Nestlé Nutr Inst Workshop Ser. 2018;89:155–174.

6. Küllenberg D, Taylor LA, Schneider M, et al. Health effects of dietary phospholipids. Lipids Health Dis. 2012;11:3.

7. Tanaka K, Kudo HW, Yoshikawa N, et al. The pilot study: Sphingomyelin-fortified milk has a positive association with the
neurobehavioural development of very low birth weight infants during infancy, randomized control trial. Brain Dev.
2013;35(1):45–52.

8. Dawson G. Measuring brain lipids. Biochim Biophys Acta. 2015;1851(8):1026–1039.

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