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Meta-Analysis
. 2012 Jun;129(6):1141-9.
doi: 10.1542/peds.2011-2127. Epub 2012 May 28.

Meta-analysis of long-chain polyunsaturated fatty acid supplementation of formula and infant cognition

Ahmad Qawasmi  1 , Angeli Landeros-Weisenberger, James F Leckman, Michael H Bloch
Affiliations
Meta-Analysis

Meta-analysis of long-chain polyunsaturated fatty acid supplementation of formula and infant cognition

Ahmad Qawasmi et al. Pediatrics. 2012 Jun.

Abstract

Background and objective: Infant formula is supplemented with long-chain polyunsaturated fatty acids (LCPUFAs) because they are hypothesized to improve cognition. Several randomized controlled clinical trials have examined the effect of LCPUFA supplementation of infant formula on cognitive development. We conducted this meta-analysis to examine the efficacy of LCPUFA supplementation of infant formula on early cognitive development.

Methods: Two authors searched PubMed, PsychInfo, and Scopus for randomized controlled clinical trials assessing the efficacy of LCPUFA supplementation of infant formulas on cognition. Our analysis was restricted to randomized controlled clinical trials that examined the effect of LCPUFA supplementation on infant cognition using Bayley Scales of Infant Development. Our primary outcome was the weighted mean difference in Bayley Scales of Infant Development score between infants fed formula supplemented with LCPUFA compared with unsupplemented formula. We conducted secondary subgroup analyses and meta-regression to examine the effects of study sample, LCPUFA dose, and trial methodologic quality on measured efficacy of supplementation.

Results: Twelve trials involving 1802 infants met our inclusion criteria. Our meta-analysis demonstrated no significant effect of LCPUFA supplementation of formula on infant cognition. There was no significant heterogeneity or publication bias between trials. Secondary analysis failed to show any significant effect of LCPUFA dosing or prematurity status on supplementation efficacy.

Conclusions: LCPUFA supplementation of infant formulas failed to show any significant effect on improving early infant cognition. Further research is needed to determine if LCPUFA supplementation of infant formula has benefits for later cognitive development or other measures of neurodevelopment.

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Figures

FIGURE 1
FIGURE 1
Selection of eligible trials. This flow diagram depicts reasons for exclusion of identified citations. There were 50 citations that were identified through multiple sources. Each of these citations is counted only once in the flow diagram for clarity. aThe number of articles was 336; duplicated articles were omitted. RCTs, randomized controlled clinical trials.
FIGURE 2
FIGURE 2
Effect of LCPUFA supplementation on infant cognition. This forest plot compares the difference between BSID scores of infants who were fed formula with LCPUFA supplementation and infants fed unsupplemented formula. There was no significant effect of LCPUFA supplementation on BSID score. IV, inverse-variance method.
FIGURE 3
FIGURE 3
Funnel plot evaluating publication bias. This funnel plot graphs trial variance (SE) versus effect size (mean difference [MD]), which is designed to evaluate the presence of publication bias among trials included in this meta-analysis. The funnel plot appears symmetrical, indicating no evidence of publication bias.
FIGURE 4
FIGURE 4
Effect of LCPUFA supplementation on Mental and Psychomotor Development Index of the BSID. Forest plots comparing the difference in the (A) Mental Development Index and (B) Psychomotor Development Index subscales of the BSID between infants who were fed formula supplemented with LCPUFAs and infants who were fed unsupplemented formula. IV, inverse-variance method.
FIGURE 5
FIGURE 5
Effect of LCPUFA supplementation on infant cognition stratified by prematurity. This forest plot compares BSID scores between infants who were fed formula supplemented with LCPUFAs versus those who were fed unsupplemented formula stratified by whether trials enrolled premature or full-term infants. LCPUFA supplementation of infant formula did not significantly improve cognition in either subgroup. IV, inverse-variance method.
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