Effects of high-dose fish oil supplementation during early infancy on neurodevelopment and language: a randomised controlled trial.

The British journal of nutrition
Q1
Oct 2012
Citations:72
Influential Citations:5
Interventional (Human) Studies
81
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Methods
Double-blind, randomized, placebo-controlled trial of 420 healthy term infants in Perth, Western Australia; infants were randomly assigned to DHA-enriched fish oil (n=218) or olive oil placebo (n=202) from birth to 6 months; follow-up assessments at 3, 6, 12 and 18 months including BSID-III, MCDI (12 and 18 months) and CBCL (18 months); fatty acid analyses at 6 months.
Intervention
From birth to 6 months, daily DHA-enriched fish oil capsules delivering about 250-280 mg DHA and 60 mg EPA; capsules pierced and squeezed into the infant's mouth or added to the first daily feed.
Results
FO supplementation increased DHA status at 6 months (erythrocyte DHA higher; plasma phospholipid DHA higher; P=0.03 and P=0.01). In a small subset (~40%), gesture development was higher at 12 and 18 months (P=0.007; P=0.002) and total gestures (P=0.023; P=0.006). No significant differences in BSID-III standard or composite scores at 18 months. Overall, high-dose FO in the first 6 months did not improve global neurodevelopment; possible benefit to early communicative development, but a higher proportion of FO infants showed anxious/depressed CBCL scores (P=0.018). Adherence to supplementation was moderate and lower in the FO group. Authors conclude that direct high-dose FO in infancy did not confer clear neurodevelopmental benefits; adherence issues suggest maternal supplementation during lactation or FO in formula may be more effective; replication in diverse populations is needed.
Limitations
Adherence to supplementation was moderate and lower in the FO group (55.3% vs. 62.6%); withdrawals and loss to follow-up reduced sample size; language outcomes (MCDI) were based on a subset (~40%) with smaller samples; population was predominantly high-income, educated, and Caucasian, limiting generalizability; potential unblinding due to capsule odor (92.2% of FO group guessed allocation); multiple statistical comparisons without strict correction; potential confounding from higher DHA exposure via breast milk in all participants.

Abstract

n-3 Long-chain PUFA (LC-PUFA) intake during infancy is important for neurodevelopment; however, previous studies of n-3 LC-PUFA supplementation have been inconclusive possibly due to an insufficient dose and limited methods of assessment. The present...