title: Long-chain PUFA supplementation in rural African infants: a randomized controlled trial of effects on gut integrity, growth, and cognitive development.
abstract: BACKGROUND
  Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries. Evidence has suggested that supplementary omega-3 (n-3) long-chain PUFAs (LC-PUFAs) might ameliorate this damage by reducing gastrointestinal inflammation. LC-PUFA supplementation may also benefit cognitive development.
  
  
  OBJECTIVE
  We tested whether early n-3 LC-PUFA supplementation improves infant intestinal integrity, growth, and cognitive function.
  
  
  METHODS
  A randomized, double-blind, controlled trial [200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo] was conducted in a population of 172 rural Gambian infants aged 3-9 mo. The primary endpoints were anthropometric measures and gut integrity [assessed by using urinary lactulose:mannitol ratios (LMRs)]. Plasma fatty acid status, intestinal mucosal inflammation (fecal calprotectin), daily morbidity, and cognitive development (2-step means-end test and an attention assessment) were secondary endpoints.
  
  
  RESULTS
  PUFA supplementation resulted in a significant increase in plasma n-3 LC-PUFA concentrations (P < 0.001 for both DHA and EPA) and midupper arm circumference (MUAC) (effect size: 0.31 z scores; 95% CI: 0.06, 0.56; P = 0.017) at 9 mo of age. At 12 mo, MUAC remained greater in the intervention group, and we observed significant increases in skinfold thicknesses (P ≤ 0.022 for all). No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes.
  
  
  CONCLUSIONS
  Fish-oil supplementation successfully increased plasma n-3 fatty acid status. However, in young, breastfed Gambian infants, the intervention failed to improve linear growth, intestinal integrity, morbidity, or selected measures of cognitive development. The trial was registered at www.isrctn.org as ISRCTN66645725.
authors.affiliation: Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Liandré F
authors.initials: LF
authors.lastname: van der Merwe
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Moore
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Fulford
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Halliday
authors.forename: Saikou
authors.initials: S
authors.lastname: Drammeh
authors.forename: Stephen
authors.initials: S
authors.lastname: Young
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Prentice
mesh_terms: D001942:Breast Feeding; D003071:Cognition / Q000187:drug effects*; D003906:Developing Countries; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage* / Q000097:blood; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage* / Q000097:blood; D023381:Endpoint Determination; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D005500:Follow-Up Studies; D005714:Gambia; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000502:physiology*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D016014:Linear Models; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D005395:Fish Oils; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid