Infant nutrition and stereoacuity at age 4-6 y.
BACKGROUND
Breastfeeding has been reported to benefit visual development in children. A higher concentration of docosahexaneoic acid (DHA) in breast milk than in formula has been proposed as one explanation for this association and as a rationale for adding DHA to infant formula, but few long-term data support this possibility.


OBJECTIVE
The objectives of the study were, first, to test the hypothesis that breastfeeding benefits stereoscopic visual maturation and, second, if that benefit is shown, to ascertain whether it is mediated by the dietary intake of DHA.


METHODS
Stereoacuity was measured by using the random dot E test (primary outcome), and visual acuity was measured by using the Sonksen-Silver acuity system (secondary outcome) in previously breastfed (n = 78) or formula-fed (n = 184) children aged 4-6 y who had been followed prospectively from birth. In the formula-fed group, children were randomly assigned to receive formula with either DHA or arachidonic acid (n = 94) or a control formula (n = 90) for the first 6 mo.


RESULTS
Breastfed children had a significantly (P = 0.001) greater likelihood of foveal stereoacuity (high-grade or < 100 s/arc) than did formula-fed children (odds ratio: 2.5; 95% CI: 1.4, 4.5) independent of potential confounding (P = 0.005). Stereoacuity did not differ significantly between children randomly assigned to DHA-supplemented or control formula. None of the groups differed in Sonksen-Silver visual acuity.


CONCLUSIONS
These findings support the hypothesis that breastfeeding benefits long-term stereoscopic development. An effect of DHA cannot be excluded, but the lack of difference in stereoacuity between infants randomly assigned to DHA-containing and those assigned to control formula raises the hypothesis that factors in breast milk other than DHA account for the observed benefits.
Singhal
Atul
A
Medical Research Council Childhood Nutrition Research Center, Institute of Child Health, London, United Kingdom. a.singhal@ich.ucl.ac.uk
Morley
Ruth
R
Cole
Tim J
TJ
Kennedy
Kathy
K
Sonksen
Patricia
P
Isaacs
Elizabeth
E
Fewtrell
Mary
M
Elias-Jones
Alun
A
Stephenson
Terence
T
Lucas
Alan
A
D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage* / Q000032:analysis / Q000378:metabolism; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000032:analysis / Q000378:metabolism; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry*; D007227:Infant Nutritional Physiological Phenomena; D008137:Longitudinal Studies; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D011446:Prospective Studies; D014792:Visual Acuity / Q000187:drug effects* / Q000502:physiology
D004042:Dietary Fats, Unsaturated; D004281:Docosahexaenoic Acids