Do infants of breast-feeding mothers benefit from additional long-chain PUFA from fish oil? A 6-year follow-up

Abstract

Fish-oil supplements are marketed as enhancing intelligence and cognitive performance. However, empirical data concerning the utility of these products in healthy term infants are mixed, particularly with respect to lasting effects into childhood. We evaluated whether fish-oil supplementation during infancy leads to better neurocognitive/behavioural development at 6 years. We conducted a double-blind randomised controlled trial of supplementation with n-3 long-chain PUFA in 420 healthy term infants. Infants received either fish oil (containing at least 250 mg DHA and at least 60 mg EPA) or placebo (olive oil) daily from birth to 6 months of age. Neurodevelopmental follow-up was conducted at a mean age of 6 years (sd 7 months), whereby 335 children were assessed for language, executive functioning, global intelligence quotient and behaviour. No significant differences were observed between the groups for the main neurocognitive outcomes. However in parent-report questionnaire, fish-oil supplementation was associated with negative externalising (P = 0·035, d = 0·24) and oppositional/defiant behaviour (P = 0·006, d = 0·31), particularly in boys (P = 0·01, d = 0·45; P = 0·004, d = 0·40). Our results provide evidence that fish-oil supplementation to predominantly breast-fed infants confers no significant cognitive or behavioural benefit to children at 6 years.

The Influence of DHA on Language Development: A Review of Randomized Controlled Trials of DHA Supplementation in Pregnancy, the Neonatal Period, and Infancy

“…There were eight RCTs involving n = 2532 infants [ 29 , 30 , 31 , 59 , 60 , 61 , 71 , 72 , 73 , 74 , 86 , 87 , 88 , 89 , 90 ]. Only two trials included infants that were breastfed [ 74 , 90 ] and the majority included only term-born infants [ 29 , 30 , 31 , 59 , 60 , 71 , 72 , 73 , 74 , 86 , 87 , 88 , 90 ].…”

“…There were 16 studies that used a clinician-administered test specifically designed to assess language or a clinician-administered global development assessment with a subscale capturing overall language abilities; five prenatal trials [ 25 , 28 , 75 , 77 , 78 , 82 , 83 ], five preterm infant trials [ 24 , 54 , 65 , 66 , 85 ], 2 postnatal trials for breastfed infants [ 53 , 62 ], and six postnatal trials for infants [ 29 , 30 , 31 , 73 , 74 , 86 , 87 , 89 , 90 ] Of these 16 studies, there were 10 language-specific assessments [ 28 , 29 , 31 , 62 , 73 , 75 , 77 , 78 , 80 , 89 ] and 16 global developmental assessments with an overall language subscale [ 24 , 25 , 28 , 30 , 53 , 54 , 65 , 66 , 74 , 75 , 82 , 83 , 85 , 86 , 87 …”

“…The Peabody Picture Vocabulary Test (PPVT), as used in five trials, [ 28 , 29 , 31 , 73 , 75 , 80 ] is designed to measure receptive vocabulary for individuals 2.5 years an older. The Clinical Evaluation of Language Fundamentals (CELF) assesses general language ability and included studies used editions for preschool children [ 77 ] as well as school aged-children [ 78 , 89 ]. The Clinical Linguistic and Auditory Milestone Scale (CLAMS) provides a language development quotient that was used in one trial at 2 ages, but with limited details available about the assessment [ 62 ].…”

“…There were 12 trials reporting a parent-rated global or domain specific language assessment; five in prenatal trials [ 26 , 28 , 58 , 75 , 76 , 80 ], three in preterm infants [ 57 , 64 , 69 ], one in breastfeeding mothers [ 32 ], and in three postnatal trials in infants [ 30 , 71 , 72 , 74 , 89 ]. There were 11 parent-completed assessments specifically targeting language [ 28 , 30 , 32 , 64 , 69 , 71 , 72 , 74 , 76 , 80 , 89 ] and five assessments of another neurological domain that included a language-related score [ 26 , 57 , 58 , 74 , 75 ].…”

“…The MCDI was used in nine studies and involves a Words and Gestures form for children 8–18 months and a Words and Sentences form for children age 16–30 months [ 28 , 30 , 32 , 64 , 69 , 71 , 72 , 74 , 80 ]. The Children’s Communication Checklist (CCC) likewise specifically targets language and was developed as a screen for communication difficulties (both expressive and receptive) and pragmatic impairments in children aged 4 to 16 years and was used in two trials [ 76 , 89 ].…”