Fatty acid composition in breastfeeding and school performance in children aged 12 years.
OBJECTIVE
Breastfeeding has been associated with improved cognition. It remains unclear whether long-chain polyunsaturated fatty acids (LC-PUFAs) play a role in this association. We assessed the association between LC-PUFA concentrations in infant feeding and school performance at age 12.


METHODS
Within a population-based birth cohort, we compared school performance of 277 non-breastfed children and 157 children who had fatty acid composition of their mothers' breast milk measured. Two indicators of school performance were: (1) the score on a standardized achievement test and (2) the teacher's advice regarding a child's potential performance level in secondary education. Linear regression and multinomial logistic regression analyses were performed to assess the independent association between LC-PUFA content of breast milk and school performance.


RESULTS
Girls, who received breast milk with a relative high content (above the median) of docosahexaenoic acid (DHA), had a higher Cito-test score (β = 2.96 points, 95 % CI 0.24; 5.69) than non-breastfed girls. Among the breastfed girls, each percentage point of higher content of total n-3 LC-PUFA (β = 4.55, 95 % CI 0.43; 8.66) and DHA (β = 7.09, 95 % CI 0.9; 13.3) was associated with a higher Cito-test score. The association between LC-PUFA content and teacher school advice showed a similar pattern. There was no association between LC-PUFA content and school performance in boys.


CONCLUSIONS
Although a large part of the association between infant milk feeding and cognition seems to be explained by sociodemographic and lifestyle-related factors, a relative high content of n-3 PUFAs, especially DHA, in breast milk is associated with better school performance in 12-year-old girls but not in boys.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508GA, Utrecht, The Netherlands.
Geertje W
GW
Dalmeijer
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Alet H
AH
Wijga
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Ulrike
U
Gehring
Department of Health Sciences, Faculty of Earth and Life Sciences, and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.
Carry M
CM
Renders
Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, and Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.
Gerard H
GH
Koppelman
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508GA, Utrecht, The Netherlands.
Henriette A
HA
Smit
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508GA, Utrecht, The Netherlands. L.vanRossem@umcutrecht.nl.
Lenie
http://orcid.org/0000-0002-0405-4781
L
van Rossem
D000124:Achievement; D002648:Child; D003071:Cognition; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000032:analysis*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000032:analysis*; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry; D007227:Infant Nutritional Physiological Phenomena; D016014:Linear Models; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D011446:Prospective Studies
D015525:Fatty Acids, Omega-3; D004281:Docosahexaenoic Acids
Birth cohort; Breastfeeding; Fatty acid composition; School performance