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#194 Needed for Eye and Brain Development? Omega-3s in infant formula

Does adding omega-3 long-chain polyunsaturated fatty acids to infant formula improve brain and eye development in healthy, full-term infants?

Adding omega-3 to infant formula has no consistently meaningful effects on neurocognitive development. One group using one measure of visual acuity consistently found benefits (about 1-line difference on Snellen chart) at 12 months that others do not and long-term data is lacking. 

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  • Neuro-cognition: 
    • Five of seven highest quality Systematic Reviews (SR) found no consistent benefit.1-5  
    • Remaining two SR that found benefit: 6,7   
      • SR of four Randomized Controlled Trials [RCTs (376 patients)].6 Compared to no omega-3, omega-3 statistically improved: 
        • Mental and Psychomotor Development Indices, by standard mean differences of 0.27-0.33, which is difficult to interpret clinically (but suggest small). 
        • Limitations: Inconsistent data reporting, results mainly driven by one industry-funded trial.8  
      • SR of studies between 2008-2013.7    
        • Two meta-analyses found no effect on cognition.  
        • Seven RCTs not included in the meta-analyses provide inconsistent results. 
        • Limitations: Conclusions not based on the totality of the evidence. 
  • Vision: 
    • Within omega-3 Cochrane SR, eight RCTs examined visual acuity.2   
      • Four RCTs (495 participants) found no effect.   
      • Three RCTs (244 participants) pooled found omega-3 better on sweep visual evoked potentials (VEP), equivalent to approximately 1-line on Snellen chart.    
      • Another RCT (32 participants) found benefit at different time-points with different tests. 
      • Limitations: High drop-outs (follow-up 70-86% complete), most benefit seen by one research group.  
    • SR of nine RCTs (1,131 participants):9  
      • Omega-3 improved acuity using VEP at 2, 4, and 12 months (approximately 1-line better on Snellen chart, inconsistent results), but no difference using other methods. 
    • Other reviews found similar, inconsistent effects.1,10 
  • Limitations:  
    • Clinical relevance unknown.  
    • Multiple outcomes reported likely leading to ‘chance findings’. 
      • Example: One study found better vision in right eye with omega-3 at four years, but not left eye.10,11   
  • There is no optimal neurocognitive assessment measure for infants.  
  • The minimum clinically important differences in the most commonly used neurocognitive scales are unknown.4,8,12 
  • Formula containing omega-3 costs more than formula without omega-3. 

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  • Adrienne J Lindblad BSP ACPR PharmD
  • Christina Korownyk MD CCFP

1. Lewin GA, Schachter HM, Yuen D, et al. Evid Rep Technol Assess (Summ). 2005 Aug; (118):1-11.

2. Jasani B, Simmer K, Patole SK, et al. Cochrane Database Syst Rev. 2017 Mar 10; 3:CD000376.

3. Qawasmi A, Landeros-Weisenberger A, Leckman JF, et al. Pediatrics. 2012; 129(6):1141-9.

4. Sun H, Como PG, Downey LC, et al. J Perinatol. 2015; 35(10):867-74.

5. Beyerlein A, Hadders-Algra M, Kennedy K, et al. J Pediatr Gastroenterol Nutr. 2010; 50(1):79-84.

6. Jiao J, Li Q, Chu J, et al. Am J Clin Nutr. 2014; 100:1422-36.

7. Koletzko B, Boey CC, Campoy C, et al. Ann Nutr Metab. 2014; 65:49-80.

8. Drover JR, Hoffman DR, Castañeda YS, et al. Early Hum Dev. 2011; 87:223-30.

9. Qawasmi A, Landeros-Weisenberger A, Bloch MH. Pediatrics. 2013; 131:e262-72.

10. Campoy C, Escolano-Margarit MV, Anjos T, et al. Br J Nutr. 2012; 107:S85-S106.

11. Birch EE, Garfield S, Castañeda Y, et al. Early Hum Dev. 2007; 83:279-84.

12. Hess CR, Papas MA, Black MM. J Pediatr Psych. 2004; 29(5):321-30.

Authors do not have any conflicts of interest to declare.