University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Do long chain polyunsaturated fatty acids enhance the cognitive, motor, and/or visual development of healthy, term infants?

Clinical Bottom Lines

1. Supplemental infant formulas with long chain polyunsaturated fatty acids are becoming prevalent and there is increasing pressure for physicians to recommend them to their patients.
2. There are studies showing both an advantage and no advantage for LCPUFA supplementation. After reviewing the literature, I did not feel there is convincing evidence that these formulas provide a significant developmental benefit for healthy term infants.1,3,4
   
3. Evidence supports the fact that supplemental formulas are safe and as well tolerated as traditional formulas. 2

Summary of Key Evidence

1. A prospective double-blinded randomized study compared infant development over the first 14 months of life for those fed formula supplemented with LCPUFA and those fed unsupplemented formula. This study was sufficiently powered. Fifty four infants were needed to detect 1SD of difference in growth, 47 were needed to detect 0.75 SD difference in vocabulary, and 27 were needed to detect 1SD difference in fatty acid levels.1
   
2. No difference was found between infants receiving supplemented and non-supplemented formulas for the following parameters:
   a. general motor and cognitive scores from Bayley Scales of Infant Development.1
   b. novelty look preference as a measure of information processing (Fagan Test of Infant Intelligence)1
   c. visual acuity using Teller Acuity Card Procedure1
   d. expressive or comprehensive language using MacArthur Communicative
   Developmental Inventories1
   
3. Other studies have shown an advantage in motor and cognitive scores for infants fed formulas with LCPUFA supplemented in greater amounts than in the aforementioned study.3,4 One of these studies found a 7 point advantage in the Mental Developmental Index for the supplemented cohort3. Another study found an advantage in neurodevelopmental scores for the supplemented patients that were not significant because of inadequate power.4

Additional Comments

• It is difficult to find a significant advantage for one formula versus another because development is affected by many factors other than nutrition.
  
• The cost difference is approximately $2.00 per 28.5 oz of dry powder.
  

Citation

1. Auestad N, Halter R, Hall RT, et al. Growth and development in term infants fed long-chain polyunsaturated fatty acids: a double-masked, randomized, parallel, prospective, multivariate study. Pediatrics 2001; 108(2):372-81.
2. Lucas A, Stafford M, Morley R, eat a. Efficacy and safety of long-chain polyunsaturated fatty acid supplementation of infant-formula milk: a randomised trial. Lancet 1999; 354(9194):1948-54.
3. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Developmental Medicine & Child Neurology 2000; 42(3):174-81.
   
4. Voigt RG, Jensen CL, Fraley JK, Rozelle JC, Brown FR 3rd,. Heird WC. Relationship between omega3 long-chain polyunsaturated fatty acid status during early infancy and neurodevelopmental status at 1 year of age. Journal of Human Nutrition & Dietetics 2002; 15(2):111-20.

CAT Author: Kristen Samaddar, MD

CAT Appraisers: Jonathan Fliegel, MD

Date appraised: March 24, 2003