OBJECTIVE:
To derive combined estimates of visual resolution acuity differences between healthy preterm infants consuming different compositions and ratios of essential fatty acids (EFAs) and docosahexaenoic acid (DHA), an omega-3 (n-3) long-chainpolyunsaturated fatty acid (LCPUFA).
DATA SOURCES:
Electronic biomedical reference database (Medline and Health Star from 1965 to July 1999) searches with index terms omega-3, n-3, infant, vision, acuity, and human. Current review article, monograph, and book chapter bibliography/reference section hand searches.
STUDY SELECTION:
A total of 5 original articles and 4 review chapters were reviewed for details on study design, conduct, and outcome. Four prospective trials of EFA/LCPUFA supplementation were included in these analyses. For behaviorally based outcomes, there were 2 randomized comparisons each at DATA EXTRACTION:
Dietary composition and EFA/LCPUFA balance, study design, and analytic characteristics (duration of feeding, source of EFAs/LCPUFAs, number of subjects in study population, number of subjects analyzed, and basis for estimating age), and experiment-based characteristics (location, number or sites, design, vision tests employed, testing protocol, and ophthalmic examination) were recorded independently by 2 researchers with a standardized protocol.
DATA SYNTHESIS:
The relative difference in visual resolution acuity between groups of infants who received a source of dietaryEFAs/LCPUFAs and groups who did not was computed and then analyzed with the DerSimonian and Laird random-effects method.
RESULTS:
Analysis of the randomized comparisons (DHA-supplemented formula vs DHA-free formula) showed significant differences in visual resolution acuity at 2 and 4 months of age. Combined estimates of behaviorally based visual resolution acuity differences at these ages were.47 +/-.14 octaves and.28 +/-.08 octaves, respectively. A 1-octave difference is a reduction in the width of the stimulus elements by 50%.
CONCLUSION:
These results support efficacy of n-3 LCPUFA intake in early visual system development, although supplementation safety issues still must be addressed through larger randomized trials. Whether n-3 intake confers lasting advantage in visually based process development across the life-span is still to be determined.