Tufts Friedman School of Nutrition & Science Policy, Boston, MA.
University of Michigan Medical School, Ann Arbor, MI.
J Nutr. 2018 Mar 1;148(3):409-418. doi: 10.1093/jn/nxx031.
Epidemiologic studies link maternal seafood and n-3 (ω-3) polyunsaturated fatty acid (PUFA) consumption with improved childhood cognitive development; trials show mixed results.
We investigated effects of n-3 PUFA supplementation on child cognitive and visual outcomes.
We systematically reviewed and meta-analyzed randomized controlled trials of n-3 PUFA supplementation in mothers or infants (age ≤2 y) and evaluated standardized measures of cognitive or visual development up to age 18 y. Of 6286 abstracts and 669 full-text articles, 38 trials with 53 intervention arms were included. Data were extracted independently in duplicate. Findings were pooled using random-effects meta-analysis across supplementation periods (maternal, preterm, term infant); we also explored subgroup analyses stratified by supplementation period. Heterogeneity was explored using I2, stratified analysis, and meta-regression. Cognitive development was assessed by Bayley Scales of Infant Development mental and psychomotor developmental indexes (MDI, PDI) and intelligence quotient (IQ); visual acuity was assessed by electrophysiological or behavioral measures.
The 38 trials (mothers: n = 13; preterm infants: n = 7; term infants: n = 18) included 5541 participants. When we explored effects during different periods of supplementation, n-3 PUFA supplementation improved MDI in preterm infants (3.33; 95% CI: 0.72, 5.93), without statistically significant effects on PDI or IQ in different intervention period subgroups. Visual acuity [measured as the logarithm of the minimum angle of resolution (logMAR)] was improved by supplementation in preterm (-0.08 logMAR; 95% CI: -0.14, -0.01 logMAR) and term infants (-0.08 logMAR; 95% CI: -0.11, -0.05 logMAR), with a nonsignificant trend for maternal supplementation (-0.02 logMAR; 95% CI: -0.04, 0.00 logMAR). In main analyses pooling all supplementation periods, compared with placebo, n-3 PUFA supplementation improved MDI (n = 21 trials; 0.91; 95% CI: 0.005, 1.81; P = 0.049), PDI (n = 21 trials; 1.06 higher index; 95% CI: 0.10, 2.03; P = 0.031), and visual acuity (n = 24; -0.063 logMAR; 95% CI: -0.084, -0.041 logMAR; P < 0.001) but not IQ (n = 7; 0.20; 95% CI: -1.56, 1.96, P = 0.83), although few studies assessed this endpoint. Potential publication bias was identified for MDI (Eggers P = 0.005), but not other endpoints. Significant differences in findings were not identified by world region, race, maternal education, age at outcome assessment, supplementation duration, DHA or EPA dose, DHA:AA ratio, or study quality score (P-interaction > 0.05 each).
n-3 PUFA supplementation improves childhood psychomotor and visual development, without significant effects on global IQ later in childhood, although the latter conclusion is based on fewer studies.
流行病学研究表明，母体海鲜和 n-3（ω-3）多不饱和脂肪酸（PUFA）的摄入与儿童认知发育改善有关；试验结果喜忧参半。
我们研究了 n-3 PUFA 补充对儿童认知和视觉结果的影响。
我们系统地回顾和荟萃分析了 n-3 PUFA 补充在母亲或婴儿（年龄≤2 岁）中的随机对照试验，并评估了至 18 岁时认知或视觉发育的标准化测量。在 6286 篇摘要和 669 篇全文文章中，纳入了 38 项试验和 53 个干预组。数据由两名独立人员提取。使用随机效应荟萃分析在补充期（母亲、早产儿、足月婴儿）中汇集结果；我们还探索了按补充期分层的亚组分析。使用 I2、分层分析和荟萃回归探索异质性。认知发育通过贝利婴幼儿发展量表的精神运动发育指数（MDI、PDI）和智商（IQ）进行评估；视觉敏锐度通过电生理学或行为测量进行评估。
这 38 项试验（母亲：n=13；早产儿：n=7；足月儿：n=18）共纳入 5541 名参与者。当我们探索不同补充期的影响时，n-3 PUFA 补充可改善早产儿的 MDI（3.33；95%CI：0.72，5.93），但在不同干预期亚组中，对 PDI 或 IQ 没有统计学意义的影响。视觉敏锐度[以最小角分辨率的对数（logMAR）表示]在早产儿（-0.08 logMAR；95%CI：-0.14，-0.01 logMAR）和足月儿（-0.08 logMAR；95%CI：-0.11，-0.05 logMAR）中通过补充得到改善，而在母亲补充中则呈非显著趋势（-0.02 logMAR；95%CI：-0.04，0.00 logMAR）。在汇总所有补充期的主要分析中，与安慰剂相比，n-3 PUFA 补充可改善 MDI（n=21 项试验；0.91；95%CI：0.005，1.81；P=0.049）、PDI（n=21 项试验；1.06 更高指数；95%CI：0.10，2.03；P=0.031）和视觉敏锐度（n=24 项试验；-0.063 logMAR；95%CI：-0.084，-0.041 logMAR；P<0.001），但对 IQ 没有影响（n=7 项试验；0.20；95%CI：-1.56，1.96，P=0.83），尽管很少有研究评估这个终点。MDI（Eggers P=0.005）存在潜在的发表偏倚，但其他终点没有。按世界区域、种族、母亲教育程度、结局评估年龄、补充持续时间、DHA 或 EPA 剂量、DHA:AA 比或研究质量评分（P 交互>0.05），发现的差异无统计学意义。
n-3 PUFA 补充可改善儿童精神运动和视觉发育，对儿童后期的整体智商无显著影响，但后一种结论基于较少的研究。
