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

Citation:

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
Class:
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:

 

Database

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". 

Design

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

N

Supplementation to Mothers

Functional Measurements: Age at Assessment

Significant Effects of Supplementation

 

  

Period

Dose per Day

 

Functional

Malcolm,
United Kingdom, 2003

63

Week 15 to delivery

I: 200mg DHA+36mg

Flash VEP: Zero to five days

None

 

 

 

C: 400mg oleic acid

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

 

 

 

 

 

ERG: zero to seven days

 

Tofail, Bangladesh, 2006

249

Week 25 to delivery

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

BSID: 10 months

None

 

 

 

C: 2,250mg LA+270mg ALA

 

 

Helland, Norway, 2001

341

Week 17–19 to three months post-partum

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

EEG: Two days, three months

None

 

 

 

C: 8.3mg DHA+4,747mg LA

FT: 27, 39 weeks

 

Helland, Norway, 2003

90

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

52

12 weeks post-partum

I1: 0g DHA

VEP: 12, 16 weeks

None

 

 

 

I2: 0.2g DHA

BSID: One, two year

 

 

 

 

I3: 0.4g DHA

 

 

 

 

 

I4: 0.9g DHA

 

 

 

 

 

I5: 1.3g DHA

 

 

Lauritzen Denmark, 2004, 2005

97

16 weeks post-partum

I: 1.3g DHA+EPA+DPA

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

160

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:
Industry:
Reviewer Comments:

None.

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? ???