Original Articles
Visual function in breast-fed term infants weaned to formula with or without long-chain polyunsaturates at 4 to 6 months: A randomized clinical trial,☆☆

https://doi.org/10.1067/mpd.2003.213Get rights and content

Abstract

Objective Breast-fed infants receive docosahexaenoic acid (DHA) and arachidonic acid (ARA) in their diet. Upon weaning, infants lose this dietary source of long-chain polyunsaturates because many commercial formulas do not contain these important constituents for neural membrane biogenesis. We evaluated the benefits of postweaning dietary supplementation of DHA + ARA on visual maturation. Study design Healthy term infants (n = 61) were breast-fed to 4 to 6 months, then were randomly assigned to commercial formula or formula supplemented with DHA (0.36%) + ARA (0.72%). Measurements of red blood cell (RBC) fatty acids, visually evoked potential (VEP) acuity, and stereoacuity were done before and after weaning. Results At 1 year of age, RBC-DHA in the commercial formula-fed group was reduced by 50% from the weaning level, whereas there was a 24% increase in the DHA + ARA-supplemented group. The primary outcome measure, VEP acuity, was significantly more mature in supplemented infants at 1 year of age. Elevated RBC-DHA levels were associated with more mature VEP acuity. There were no significant diet-related differences in stereoacuity. Conclusions These data extend through the first year of life the critical period in which a dietary supply of DHA and ARA can contribute in optimizing visual development in term infants. (J Pediatr 2003;142:669-77)

Section snippets

Participants/eligibility

Healthy term infants were recruited primarily from two hospitals in the north Dallas area, Presbyterian Medical Center and Medical City Columbia Hospital. All infants were born at 37 to 40 weeks postmenstrual age as determined by early sonograms, date of last menstrual period, and physical/neurodevelopmental assessment at birth. Only singleton infants and infants with birth weight appropriate for gestational age were included. Exclusion criteria were family history of milk-protein allergy,

Cohort demographics

Of the subjects who completed the 12-month trial (n = 61), the majority was male (54%) and white (93%); there was one Hispanic and one Asian participant in the commercial formula group and 2 Hispanic participants in the LCP group. No significant differences were found between the two diet groups (P > .3) for sex, race, or maternal variables of age (31.3 years; 30.7 years), body weight (63.3 kg; 59.9 kg), or height (164 cm; 165 cm) or paternal variables of age (32.2 years; 32.2 years), weight

Discussion

The results of this randomized clinical trial provide evidence for a continued need for DHA in the infant diet or LCP-enriched formula beyond 4 months of age to optimize visual development during the first year of life. Furthermore, a postweaning supply of LCPs was found to sustain DHA blood lipid levels present at weaning out to 12 months of age. In this trial, a commercial formula with a recommended ratio of the dietary essential fatty acids, LA/LNA of 10:1 resulted in a 50% postweaning

Acknowledgements

Important contributions in the conduct of this study were made by Maia Lapus, BS, Sarah Morale, BS, Solange Salomão, PhD, and by Dr Yi-Zhong Wang, who developed a MatLab program for computing growth Z scores based on NHANES III. We appreciate the collaboration of the newborn nursery and postpartum care staff of Columbia Hospital Medical City (Dallas, Tex) and of the Margot Perot Women's and Children's Hospital at Presbyterian Medical Center (Dallas, Tex). We are grateful for continuing

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    Supported by NIH grant HD22380. Infant formulas were generously provided by Mead Johnson Nutritionals (Evansville, Indiana).

    ☆☆

    Reprint requests: Dennis R. Hoffman, PhD, Retina Foundation of the Southwest, 9900 North Central Expressway, Ste 400, Dallas, TX 75231. E-mail: [email protected].

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