Preterm infant language development: a role for breast milk fatty acids
Premature infants have an increased risk of developmental disabilities during infancy and childhood. A crucial period of fetal polyunsaturated fatty acid accretion bypassed with prematurity. Objective: to study how the fatty acid composition of breast milk in breast-fed premature infants is associated with cognitive, language, and motor development. Methods: participants included twenty-five healthy preterms, born adequate for gestational age at the Fernandez Figueira Institute, Rio de Janeiro, Brazil. Fatty acid composition of breast milk samples from the first week postpartum was analyzed using gas-liquid chromatography. Bayley-III developmental scales were applied at 9 or 12 months corrected age. Results: regression analyses revealed that the ratio of linoleic acid to alpha-linolenic acid was positively associated with receptive language development (â = 1.49, p = 0.03). Women with preterm infants showed breast milk long chain polyunsaturated fatty acids concentrations consistent with worldwide levels and a high ratio of linoleic acid to alpha-linolenic acid that might be beneficial for language development in the premature infant. Conclusion: a higher ratio of linoleic to alpha-linolenic acid in breast milk could exert beneficial effects for receptive language development in preterm infants fed breast milk. Larger adequately powered longitudinal studies are recommended to better understand the breast milk composition of this population and its association to developmental indices during infancy.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012, 379 (9832): 2162-72.
Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002,288(6):728-37.
Shah MD, Shah SR. Nutrient deficiencies in the premature infant. Pediatr Clin North Am. 2009, 56(5): 1069-83.
Al MD, van Houwelingen AC, Kester AD, Hasaart TH, de Jong AE, Hornstra G. Maternal essential fatty acid patterns during normal pregnancy and their relationship to the neonatal essential fatty acid status. Br J Nutr. 1995,74(1):55-68.
Makrides M, Collins CT, Gibson RA. Impact of fatty acid status on growth and neurobehavioural development in humans. Matern Child Nutr. 2011, 7 (Suppl 2): 80-8.
Smithers LG, Gibson RA, McPhee A, Makrides M. Effect of long-chain polyunsaturated fatty acid supplementation of preterm infants on disease risk and neurodevelopment: a systematic review of randomized controlled trials. Am J Clin Nutr. 2008,87(4):912-20.
Smithers LG, Collins CT, Simmonds LA, Gibson RA, McPhee A, Makrides M. Feeding preterm infants milk with a higher dose of docosahexaenoic acid than that used in current practice does not influence language or behavior in early childhood: a follow-up study of a randomized controlled trial. Am J Clin Nutr. 2010,91(3):628-34.
Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P, et al. Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. JAMA. 2010,304(15):1675-83.
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(4):e890-8.
Makrides M. Is there a dietary requirement for DHA in pregnancy? Prostaglandins Leukot Essent Fatty Acids. 2009,81(2-3):171-4.
Makrides M, Gibson RA. Long-chain polyunsaturated fatty acid requirements during pregnancy and lactation. Am J Clin Nutr. 2000,71(1 Suppl):307S-11S.
Kovács A, Funke S, Marosvölgyi T, Burus I, Decsi T. Fatty acids in early human milk after preterm and full-term delivery. J Pediatr Gastroenterol Nutr. 2005,41(4):454-9.
Maayan-Metzger A, Avivi S, Schushan-Eisen I, Kuint J. Human milk versus formula feeding among preterm infants: short-term outcomes. Am J Perinatol. 2012,29(2):121-6.
Azara CR, Maia IC, Rangel CN, Silva-Neto MA, Serpa RF, De Jesus EF, et al. Ethanol intake during lactation alters milk nutrient composition and growth and mineral status of rat pups. Biol Res. 2008,41(3):317-30.
Lepage G, Roy CC. Direct transesterification of all classes of lipids in a one-step reaction. J Lipid Res. 1986,27(1):114-20.
Bayley N. Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). San Antonio, TX: Harcourt Assessment, 2006.
Lowe JR, Duncan AF, Bann CM, Fuller J, Hintz SR, Das A, et al. Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22months. Early Hum Dev. 2013.
Tinoco SM, Sichieri R, Setta CL, Moura AS, do Carmo MG. Trans fatty acids from milk of Brazilian mothers of premature infants. J Paediatr Child Health. 2008,44(1-2):50-6.
Kuipers RS, Fokkema MR, Smit EN, van der Meulen J, Boersma ER, Muskiet FA. High contents of both docosahexaenoic and arachidonic acids in milk of women consuming fish from lake Kitangiri (Tanzania): targets for
infant formulae close to our ancient diet? Prostaglandins Leukot Essent Fatty Acids. 2005,72(4):279-88.
Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr. 2007,85(6):1457-64.
Di Natale C, Coclite E, Di Ventura L, Di Fabio S. Fortification of maternal milk for preterm infants. J Matern Fetal Neonatal Med. 2011,24 Suppl 1:41-3.
Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008,233(6):674-88.
Novak EM, Dyer RA, Innis SM. High dietary omega-6 fatty acids contribute to reduced docosahexaenoic acid in the developing brain and inhibit secondary neurite growth. Brain Res. 2008,1237:136-45.
Gibson RA, Muhlhausler B, Makrides M. Conversion of linoleic acid and alpha-linolenic acid to long-chain polyunsaturated fatty acids (LCPUFAs), with a focus on pregnancy, lactation and the first 2 years of life. Matern Child Nutr. 2011,7 (Suppl 2):17-26.
Innis SM. Omega-3 Fatty acids and neural development to 2 years of age: do we know enough for dietary recommendations? J Pediatr Gastroenterol Nutr. 2009,48 (Suppl 1):S16-24.
Bosch L. Precursors to language in preterm infants: speech perception abilities in the first year of life. Prog Brain Res. 2011,189:239-57.
Barre N, Morgan A, Doyle LW, Anderson PJ. Language abilities in children who were very preterm and/or very low birth weight: a metaanalysis. J Pediatr. 2011,158(5):766-74 e1.
Auestad N, Scott DT, Janowsky JS, Jacobsen C, Carroll RE, Montalto MB, et al. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003,112(3Pt 1):e177-83.
Capilouto GJ, Desai N, Winner R, Caldwell R, Bada H. Orotracheal intubation in the NICU and expressive language outcomes at 24-30 months. J Med Speech Lang Pathol. 2008,16(3):157-73.
Makrides M, Gibson RA, McPhee AJ, Collins CT, Davis PG, Doyle LW, et al. Neurodevelopmental outcomes of preterm infants fed high-dose docosahexaenoic acid: a randomized controlled trial. JAMA. 2009,301(2):175-82.
Torres AG, Trugo NM. Evidence of inadequate docosahexaenoic acid status in Brazilian pregnant and lactating women. Rev Saude Publica. 2009,43(2):359-68.
CODE OF CONDUCT FOR JOURNAL PUBLISHERS
Publishers who are Committee on Publication Ethics members and who support COPE membership for journal editors should:
- Follow this code, and encourage the editors they work with to follow the COPE Code of Conduct for Journal Edi- tors (http://publicationethics.org/files/u2/New_Code.pdf)
- Ensure the editors and journals they work with are aware of what their membership of COPE provides and en- tails
- Provide reasonable practical support to editors so that they can follow the COPE Code of Conduct for Journal Editors (http://publicationethics.org/files/u2/New_Code.pdf_)
- Define the relationship between publisher, editor and other parties in a contract
- Respect privacy (for example, for research participants, for authors, for peer reviewers)
- Protect intellectual property and copyright
- Foster editorial independence
Publishers should work with journal editors to:
- Set journal policies appropriately and aim to meet those policies, particularly with respect to:
– Editorial independence
– Research ethics, including confidentiality, consent, and the special requirements for human and animal research
– Transparency and integrity (for example, conflicts of interest, research funding, reporting standards
– Peer review and the role of the editorial team beyond that of the journal editor
– Appeals and complaints
- Communicate journal policies (for example, to authors, readers, peer reviewers)
- Review journal policies periodically, particularly with respect to new recommendations from the COPE
- Code of Conduct for Editors and the COPE Best Practice Guidelines
- Maintain the integrity of the academic record
- Assist the parties (for example, institutions, grant funders, governing bodies) responsible for the investigation of suspected research and publication misconduct and, where possible, facilitate in the resolution of these cases
- Publish corrections, clarifications, and retractions
- Publish content on a timely basis