Long-Chain Polyunsaturated Fatty Acids and Cognition in VLBW Infants at 8 years: an RCT

Abstract

OBJECTIVE: To test the hypothesis that supplementation with the long chain polyunsaturated fatty acids docosahexaenoic acid (DHA) and arachidonic acid (AA) to very low birth weight (VLBW) infants would improve long-term cognitive functions and influence neuroanatomical volumes and cerebral cortex measured by MRI. METHODS:The current study is a follow-up of a randomized, double-blinded, placebo-controlled study of supplementation with high-dose DHA (0.86%) and AA (0.91%) to 129 VLBW infants fed human milk. Ninety-eight children participated at 8 years follow-up and completed a broad battery of cognitive tests. Eighty-one children had cerebral MRI scans of acceptable quality.RESULTS: There were no significant differences between the intervention group and the control group on any of the cognitive measures. Equally, MRI data on segmental brain volumes and cerebral cortex volume, area, and thickness suggested no overall group effect.CONCLUSIONS: This study is the first long-term follow-up of a randomized controlled trial with supplementation of DHA and AA to human milk fed VLBW infants investigating both cognitive functions and brain macrostructure measured by MRI. No cognitive or neuroanatomical effects of the supplementation were detected at 8 years of age.

Postnatal polyunsaturated fatty acids associated with larger preterm brain tissue volumes and better outcomes

“…Considering that DHA accretion relative to brain weight is highest during fetal development and early infancy (21), and its preferential placental transfer to the fetus during the third trimester, it is not surprising that, as the most abundant ω-3 fatty acid in the mammalian brain, DHA is essential to brain development (5,7,21,22). This study finds that for only DHA levels, both near-birth and near-term blood samples are associated with increased brain tissue volumes at near-term age, albeit differences in affected brain regions.…”

“…Nutrition, including polyunsaturated fatty acids (PUFAs), plays a central role in brain development (5, 6). Most brain PUFAs, are accumulated between the last trimester of gestation and 2 years of life, during the phase of rapid brain growth (7–9).…”

“…MRI studies investigating the effects of nutrition, including PUFAs, on brain volumes of people born preterm are limited and results are variable (5,10–12). Limitations of prior studies include variability in nutritional interventions and lack of postnatal MRI scanning.…”

Differential Effects of Omega-3 Fatty Acid, Docosahexaenoic Acid (DHA), In Animals and Humans

“…Preterm infants born to women on a DHA rich diet had no effect on normal development but provided some benefit for children from poor quality home environment [20]. Benefits of DHA supplementation in school-age children with regards to growth, visual function and cognitive development are inconclusive as clinical trials conducted yielded mixed results [21][22][23][24].…”

Docosahexaenoic Acid and Arachidonic Acid Nutrition in Early Development

“…A study in Norway that provided DHA and ARA supplementation to human milk until discharge from the hospital found no effect of the randomization on several tests at 20 months [83] or on cognitive function or brain macrostructure on MRI at age 8 years [84]. A large cohort from the Australian DHA for the Improvement of Neurodevelopmental Outcome in Preterm Infants (DINO) trial compared neurodevelopment at 7 years of age in children who were fed ~0.35% DHA compared with 1% DHA until term CA and found no evidence of benefit; however, group mean scores on the Wechsler Abbreviated Scale of Intelligence were high, ranging from 98.0 to 98.8 for both the primary and secondary assessments of IQ [85].…”