Abstract 1640 Poster Session III, Monday, 5/3 (poster 68)

Background. DHA and ARA are components of human milk and high in CNS neurons. PT infants may need dietary DHA+ARA during the early life for optimal neural function. Infants who consume DHA+ARA from human milk have higher brain DHA than those fed formulas with their fatty acid precursors. Three earlier studies found higher visual grating acuity in PT infants fed formula (F) with DHA (0.2 to 0.4% of total dietary fatty acids) from fish oil compared to F providing >1% energy from α-linolenic acid, the essential fatty acid precursor of DHA. Visual acuity of infants fed DHA was higher at 2 and/or 4 mo of age (0 mo = 40 wk gestation) but not later. Despite apparent "catch up" in acuity development, positive effects on visual attention were noted at 6, 9 and/or 12 mo of age in two of the studies. Methods. The present study provided DHA (0.13%) and ARA (0.4%) from egg phospholipids (EPL) and tested two hypotheses related to visual acuity: 1) EPLF would increase visual acuity compared with a commercial (C)F. 2) The effect of feeding EPLF near birth would differ from the effect of feeding near term. EPLF was prepared by replacing 9% of coconut oil in the fat blend of CF with EPL. Infants were assigned (random, double-masked) to three diet treatments in three birth weight ranges (725-949 g; 950-1149 g; 1150-1375 g). Infants were enrolled at <8 d of age (n=119, see Pediatr Res. 1998;44:491-498 for study design and in-hospital results). Unsupplemented infants (U) were fed CF from -3 to 12 mo. Infants supplemented with EPLF near birth (S-B) received EPLF from -3 to 12 mo. Infants supplemented with EPLF near term (S-T) received CF from -3 to -1 mo and EPLF from -1 to 12 mo. Acuity was tested with the Teller Acuity Card procedure at 2, 4, 6, 9 and 12 mo of age. Only infants with normal ophthalmic exams (28 U, 28 S-B, 29 S-T) were included in the analysis for treatment and age effects using preplanned contrasts. Results. Compared to U, only S-B had higher acuity at 2 mo (p<0.02) and a trend toward higher acuity at 6 mo (p<0.07). S-B also had higher acuity than S-T at 2 mo (p<0.05). First year acuity continued to increase (p<0.05) between consecutive ages until 6 mo in S-B and 9 mo in U and S-T. All groups had similar acuity at 9 and 12 mo. Summary. EPLF containing DHA and ARA increased early acuity analogous to F containing fish oil DHA in three studies published earlier. S-B but not S-T had higher acuity than U, implying that S-B accumulated higher neural DHA under the conditions of the study. Conclusion. These data could be interpreted to suggest a critical window for increasing neural DHA. Because EPLF provided relatively low DHA (0.13% compared with 0.2 to 0.4% in previous studies), however, a case could be made that the additional 2 months of early supplementation were needed to increase neural DHA concentration above some critical but as yet undefined threshold needed for higher early visual development.

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