Effect of Docosahexaenoic Acid (DHA) Supplementation of Preterm Infants on Growth, Body Composition, and Blood Pressure at 7-Years Corrected Age: Follow-Up of a Randomized Controlled Trial

Abstract

Aim: To determine if supplementation of infants born <33 weeks’ gestation with higher dose docosahexaenoic acid (DHA) affects growth, body composition, and blood pressure at 7 y corrected age (CA) and if treatment effects differed by infant sex at birth and birth weight strata (<1250 and ≥1250 g). Methods: Seven-year follow-up of an Australian multicenter randomized controlled trial in which 657 infants were fed high-DHA (≈1% total fatty acids) enteral feeds or standard-DHA (≈0.3% total fatty acids) from age 2–4 d until term CA. Seven-year CA outcomes were growth (weight, height), body composition (lean body mass, fat mass, waist, and hip circumference), and blood pressure. Results: There was no effect of high-DHA enteral feeds compared with standard-DHA on growth, body composition, and blood pressure at 7-year CA either overall or in subgroup analysis by sex. There was a significant interaction between high-DHA and birthweight strata on height at 7-y CA (p = 0.03). However, the post-hoc analyses by birthweight strata did not reach significance (p > 0.1). High-DHA group infants were more likely to be classified as obese (relative risk 1.6 (95% CI 1.0, 2.6); p = 0.05). Conclusions: DHA supplementation of premature infants did not affect growth, body composition, or blood pressure at 7-year CA overall by sex and birthweight strata. The finding of a higher risk of obesity in children who receive high-DHA needs to be interpreted with caution due to the small number of children classified as obese.

Evidence on docosahexaenoic acid and arachidonic acid supplementation for preterm infants

“…Early visual acuity improved at 4 months corrected age and at 18 months of age, the risk for very low MDI score was significantly reduced, and MDI score was significantly improved in girls. Numerous other developmental, behavioral, or health parameters tested showed no significant or only subtle differences between the supplemented and nonsupplemented groups up to 7 years of age [24][25][26][27][28][29][30]. Further analysis did not show any trend for an effect of the DHA supplementation on developmental outcomes in the subgroup of preterm infants born before 29 weeks of gestation [31].…”

“…Both human milk [12] and intravenous lipid emulsions [13 ▪ ] strongly influence circulating LC-PUFA levels in preterm infants. The greatest changes occur in the first weeks after birth, and interestingly the relative levels of DHA and ARA also decrease when fish-oil contain lipids are administered [13 ▪ ,14].…”

Early Nutrition Must Be Safe and Should Have Positive Impacts on Long-Term Health

“…However, a multicenter randomized controlled trial (DINO trial) on the supplementation of infants born <33 weeks’ gestation ( n = 657) with higher dose DHA showed no effect on weight, height, body composition, and blood pressure at 7 years corrected gestational age. Interestingly, the high-DHA group infants were more likely to be classified as obese, but this finding needs to be interpreted with caution because it was a secondary outcome variable and the number of children classified as obese was small [ 7 ].…”