BF: Dietary Factors, Breast Milk and Infant Outcomes (2008)


Eilander A, Hundscheid DC, Osendarp SJ, Transler C, Zock PL. Effects of n-3 long chain polyunsaturated fatty acid supplementation on visual and cognitive development throughout childhood: A review of human studies. Prostaglandins, Leukotrienes and Essential Fatty Acids 2007; 76: 189-203.

PubMed ID: 17376662
Study Design:
Meta-analysis or Systematic Review
M - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To evaluate the effect of long chain polyunsaturated fatty acids (LCPUFA) during pregnancy and lactation on visual and cognitive function during infancy and later childhood.

Inclusion Criteria:
  • Randomized controlled trials (include observational studies only if there are less than three trials on a particular topic)
  • LCPUFA supplementation lasted at least four weeks
  • LCPUFA as sole variable differing between treatment and controls
  • Measured visual or cognitive development.
Exclusion Criteria:

None except not meeting all inclusion criteria.

Description of Study Protocol:



Literature databases of Web of Science. Search year was not reported.

Search terms

Long chain polyunsaturated fatty acids, docosahexaenoic acid, eicosapentaenoic acid, linolenic acid, arachidonic acid, linoleic acid, omega-3 fatty acids, omega-6 fatty acids" with "infants, children, pre-schoolers, toddlers, complementary feeding, neonates, offspring, babies", with "cognition, development, mental, learning, brain, visual acuity, neurology". 


Systematic review.

Meta-analysis methods

No meta-analysis was performed.

Data Collection Summary:

Data extraction tools and personnel was not described. No methodological quality assessment for primary studies.

Study characteristics collected include:

  • Study year
  • Study country of origin
  • Number of subjects
  • Treatment timing, duration and dose
  • Outcome assessment timing and method.

Outcomes collected include:

  • Visual development: Retinal function per electroretinography, visual acuity per visual evoked potentials
  • Cognitive development: Including Bayley Scales of Infant Development, Kaufman Assessment Battery for Children, Wechsler tests.



Description of Actual Data Sample:
  • Total number of studies identified from the search: Not reported
  • Total number of studies meeting the inclusion criteria: Six
  • Location of these studies vary: United Kingdom, Bangladesh, Norway, Australia, Denmark, and United States of America
  • Two CRTs studied the effect of supplementation during pregnancy only, one studied supplementation during pregnancy and lactation, and three studied supplementation during lactation only.
Summary of Results:

Overview of RCTs on effect of omega-3 supplementation in pregnant and lactating women on visual and cognitive development of infants.

Author, Location, Year


Supplementation to Mothers

Functional Measurements: Age at Assessment

Significant Effects of Supplementation




Dose per Day



United Kingdom, 2003


Week 15 to delivery

I: 200mg DHA+36mg

Flash VEP: Zero to five days





C: 400mg oleic acid

Flash and pattern-reversal VEP: 50, 66 weeks PCA






ERG: zero to seven days


Tofail, Bangladesh, 2006


Week 25 to delivery

I: 1,200mg DHA+1,800mg EPA

BSID: 10 months





C: 2,250mg LA+270mg ALA



Helland, Norway, 2001


Week 17–19 to three months post-partum

I: 1,183mg DHA+803mg EPA+160mg LA

EEG: Two days, three months





C: 8.3mg DHA+4,747mg LA

FT: 27, 39 weeks


Helland, Norway, 2003


Week 17–19 to three months post-partum

I: 1183 mg DHA+803 mg EPA+160 mg LA

IQ (K-ABC): Four years

Positive: IQ 4.1 points higher in I vs. C




C: 8.3 mg DHA+4747 mg LA



Gibson, Australia, 1997


12 weeks post-partum

I1: 0g DHA

VEP: 12, 16 weeks





I2: 0.2g DHA

BSID: One, two year





I3: 0.4g DHA






I4: 0.9g DHA






I5: 1.3g DHA



Lauritzen Denmark, 2004, 2005


16 weeks post-partum


VEP: Two, Four months

Positive: MPS intention scores 2.0 points higher in I vs. C in girls




C: Olive oil

Motor function: Two, four, nine months

Negative: MACI vocabulary comprehension 17 points lower in I vs. C; 33 points lower in I vs. C in boys; sentence complexity 3.0 points lower in I vs. C in boys





MPS: Nine months






MACI: 12, 24 months


Jensen, USA, 2005


Four months post-partum

I: 200mg DHA

TAC, VEP: Four, eight months GGM, CLAMS

Positive: BSID-PDI 8.4 points higher in I vs. C




C: Soy+corn oil

CAT: 12, 30 months


I, intervention group; C, control group; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; LA, linoleic acid; ALA, α-linolenic acid; DPA, docosapentaenoic acid; VEP, visual evoked potential; PCA, post-conceptional age; ERG, electroretinography; BSID, Bayley Scales of Infant Development; EEG, electroencephalogram; FT, Fagan Test of Infant Intelligence, K-ABC, Kaufman Assessment Battery for Children; MPS, Means-end Problem Solving; MACDI, MacArthur Communicative Development Inventories; TAC, Teller Acuity Card procedure; GGM, Gesell Gross Motor; CLAMS, Clinical Linguistic and Auditory Milestone Scale; CAT, Clinical Adaptive Test; IQ, Intelligence Quotient; PDI, Psychomotor Development Index; ND, not determined; HM, human milk.

Author Conclusion:

Maternal DHA supplementation during pregnancy and lactation has no effect on visual development, and may have some positive effects on psychomotor and cognitive development.

Funding Source:
Reviewer Comments:


Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? ???