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Omega-3 Infant Formula Boosts Kids' Brains
Infants fed omega-3-enriched formula had sharper brains at ages three and six 08/19/2013 By Craig Weatherby
People need to consume two kinds of polyunsaturated fat, called omega-3 fatty acids and omega-6 fatty acids.
Both are essential to the structure and function of our cells, and regulate critical aspects of brain function, metabolism, and immune-system health.
We cannot make omega-3 and omega-6 fatty acids, so we have to get them from foods or supplements
Omega-3 DHA is essential for brain and eye development in children before and after birth, while and omega-6 AA is essential for brain development. (DHA stands for docosahexaenoic acid and AA is the acronym for arachidonic acid.)
In 1994, expert panels from the World Health Organization and the Child Health Foundation recommended that omega-3 DHA and omega-6 AA be added to infant formula.
The U.S. FDA approved the use of DHA in infant formula in 2001, and today most popular formulas are DHA-fortified.
Omega-fortified infant formulas: An misleading record
Babies derive DHA from their mothers before birth and from nursing.
But the typical American mother’s diet is deficient in the only dietary sources of DHA: fish and fish oil (or other marine oils).
Omega-6 AA abounds in American mothers’ breast milk, because the standard American diet is overloaded with omega-6 fatty acids (see “America’s Sickening ‘Omega Imbalance’”). 
The results of research testing the effects of omega-fortified infant formulas have been mixed, but generally favor addition of omega-3 DHA and omega-6 AA to infant formula (Auestad N et al. 2003; Fleith M, Clandinin MT 2005).
Most studies in pre-term (premature) infants fed omega-3-fortified formulas show improved visual development in these children.
Several studies show that when pregnant or nursing mothers eat diets rich in fish or fish oil, their infants gain brain and eye benefits.
But other studies detected no significant eye or brain benefits from omega-3-fortified formula.
Why would that be, if omega-3 DHA is essential to brain and eye development?
First, the failed studies stopped testing children’s visual, physical, and mental abilities before the toddlers reached two years of age.
Second, most of the failed studies used infant formulas that provided substantially less DHA than is found in the milk of mothers who eat fish or take fish oil frequently.
Finally, the evidence reviews and meta-analyses that have concluded that there is no benefit of omega-3-fortified formulas at 18 months after birth relied mainly on the toddlers’ performance on one particular measure, called the Bayley Scales of Infant Development.
However, there are many other such scales, and many other tests designed to detect subtle differences in a range of mental and physical capacities.
Now, the authors of a longer-term study that employed a range of tests shows that children who received a DHA-enriched formula in infancy showed improved brain performance in childhood.
Kansas study affirms the value of omega-fortified formulas
A University of Kansas team conducted a randomized, double-blind, controlled trial in 81 infants born in the Kansas City area between September of 2003 and October of 2005 (Colombo J et al. 2013).
The trial was led by Professors John Colombo and Susan E. Carlson, whose earlier work influenced FDA approval of omega-3-fortified formulas in 2001, and prompted formula makers to begin adding DHA in 2002.
The infants were divided into four groups, each fed a different formula from birth to 12 months. A control group got a formula without any added omega-3 DHA or omega-6 AA.
Three groups got formulas with omega-6 AA and varying levels of omega-3 DHA. Each of the fortified formulas contained AA (0.64% of total fatty acids / 34 mg/100 kcal), plus varying amounts of DHA:
  • 0.32% DHA (17mg/100 kcal)
  • 0.64% DHA (34 mg/100 kcal)
  • 0.96% DHA (51 mg/100 kcal)
The children were tested every six months from the age of 18 months until six years of age, using nine cognitive tests: 
  • Tower of Hanoi
  • Delayed Response
  • Bear-Dragon Go/No Go
  • Stroop (red/yellow and day/night)
  • Dimensional Change Card Sort task
  • Peabody Picture Vocabulary Test, 4th edition
  • Bayley Scales of Infant Development, 2nd edition 
  • MacArthur-Bates Communicative Development Inventory
  • Weschler Primary Preschool Test of Intelligence, 3rd edition
These tests were administered at age-appropriate times, and continued through the age of six years.
The results through the first 12 months showed improved attention and lower heart rate in all of the omega-3 groups (Colombo J et al. 2011). 
At 18 months, the omega-3 group children did not perform any better on standardized tests, and if the study had stopped there, it would have just added more mud to the waters.
But the Kansas team kept testing kids using various measures, and by age three, they began to see significant differences in the performance of children who were fed the enriched formulas.
These advantages emerged in the omega-3 groups’ superior performance on “finer-grained” measures of several aspects of cognitive function.
Versus the no-omega-3s (control) group, “significant positive effects” were seen in the omega-3 groups from ages three to six years, including better performance  on two standard tests of intelligence:
  • Pattern recognition
  • Rule-learning and inhibition
  • Peabody Picture Vocabulary Test, at age five
  • Weschler Primary Preschool Scales of Intelligence, at age six.
However, the omega-3 groups showed no advantages with regard to spatial memory, “simple” inhibition, or advanced problem solving.
As Professor Colombo said, “These results support the contention that studies of nutrition and cognition should include more comprehensive and sensitive assessments that are administered multiple times through early childhood.” (KU 2013)
“The results imply that studies of nutrition and cognitive development should … continue through early childhood,” added the researchers.
We hope his message gets through to other researchers, lest the scientific waters remain unnecessarily and inaccurately muddy.
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  • Beyerlein A, Hadders-Algra M, Kennedy K, Fewtrell M, Singhal A, Rosenfeld E, Lucas A, Bouwstra H, Koletzko B, VonKries R. Infant formula supplementation with long-chain polyunsaturated fatty acids has no effect on Bayley developmental scores at 18 months of age—IPD meta-analysis of four large clinical trials. J Pediatr Gastroenterol Nutr 2010;50:79–84.
  • Birch EE, Garfield S, Castaneda Y, Hughbanks-Wheaton D, Uauy R, Hoffman D. Visual acuity and cognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chain polyunsaturated fatty acid-supplemented infant formula. Early Hum Dev 2007;83:279–84.
  • 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. Dev Med Child Neurol 2000;42:174–81. 
  • Colombo J, Carlson SE, Cheatham CL, Fitzgerald-Gustafson KM, Kepler A, Doty T. Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention. Pediatr Res 2011;70:406–10.
  • Colombo J, Carlson SE, Cheatham CL, Shaddy DJ, Kerling EH, Thodosoff JM, Gustafson KM, Brez C. Long-term effects of LCPUFA supplementation on childhood cognitive outcomes. Am J Clin Nutr. 2013 Aug;98(2):403-12. doi: 10.3945/ajcn.112.040766. Epub 2013 Jun 26.
  • Delgado-Noguera MF, Calvache JA, Bonfill Cosp X. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD007901. doi: 10.1002/14651858.CD007901.pub2. Review.
  • Drover J, Hoffman DR, Castan˜eda YS, Morale SE, Birch EE. Three randomized controlled trials of early long-chain polyunsaturated fatty acid supplementation on means-end problem solving in nine month olds. Child Dev 2009;80:1376–84.
  • Drover JR, Hoffman DR, Castaneda YS, Morale SE, Garfield S, Wheaton DH, Birch EE. Cognitive function in 18-month-old term infants of the DIAMOND study: a randomized, controlled clinical trial with multiple dietary levels of docosahexaenoic acid. Early Hum Dev 2011;87:223–30.
  • Fleith M, Clandinin MT. Dietary PUFA for preterm and term infants: review of clinical studies. Crit Rev Food Sci Nutr. 2005;45(3):205-29. Review.
  • Hadders-Algra M, Bouwstra H, van Goor SA, Dijck-Brouwer DA, Muskiet FA. Prenatal and early postnatal fatty acid status and neurodevelopmental outcome. J Perinat Med 2007;35(suppl 1):S28–34.
  • Isaacs EB, Ross S, Kennedy K, Weaver LT, Lucas A, Fewtrell MS. 10-Year cognition in preterms after random assignment to fatty acid supplementation in infancy. Pediatrics 2011;128:e890–8.
  • Qawasmi A, Landeros-Weisenberger A, Leckman JF, Bloch MH. Meta-analysis of long-chain polyunsaturated fatty acid supplementation of formula and infant cognition. Pediatrics. 2012 Jun;129(6):1141-9. doi: 10.1542/peds.2011-2127. Epub 2012 May 28.
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