• Evaluating development of school-age children exposed to variable EPA/DHA levels in utero and postnatally with measures of distractibility, disruptive behavior, and oppositional defiant behavior, as well as more commonly assessed cognitive outcomes and more sophisticated tests of visual function.

Recommendation 4: Additional data is needed to better define optimum intake levels of EPA/DHA for infants and toddlers.

Children

Recommendation 5: Better-designed studies about EPA/DHA supplementation in children with behavioral disorders are needed.

Adults at Risk for Chronic Disease

Recommendation 6: In the absence of meta-analyses that systematically combine quantitative data from multiple studies, further meta-analyses and larger randomized trials are needed to assess outcomes other than cardiovascular, in particular total mortality, in order to explore possible adverse health effects of EPA/DHA supplementation.

Recommendation 7: Additional clinical research is needed to assess a potential effect of seafood consumption and/or EPA/DHA supplementation on stroke, cancer, Alzheimer’s disease, and depression.

Recommendation 8: Future epidemiological studies should assess intake of specific species of seafood and/or biomarkers, in order to differentiate the health effects of EPA/DHA from those of contaminants, such as methylmercury.

REFERENCES

Agostoni C, Trojan S, Bellu R, Riva E, Giovannini M. 1995. Neurodevelopmental quotient of healthy term infants at 4 months and feeding practice: The role of long-chain polyunsaturated fatty acids. Pediatric Research 38(2):262–266.

Agren JJ, Vaisanen S, Hanninen O. 1997. Hemostatic factors and platelet aggregation after a fish-enriched diet or fish oil or docosahexaenoic acid supplementation. Prostaglandins Leukotrienes & Essential Fatty Acids 57(4–5):419–421.

Al MDM, van Houwelingen AC, Kester ADM, Hasaart THM, de Jong AEP, Hornstra G. 1995. Maternal essential fatty acid patterns during normal pregnancy and their relationship to the neonatal essential fatty acid status. British Journal of Nutrition 74(1):55–68.

Alberman E, Emanuel I, Filakti H, Evans SJ. 1992. The contrasting effects of parental birthweight and gestational age on the birthweight of offspring. Paediatric and Perinatal Epidemiology 6(2):134–144.

Al-Marzouki S, Evans S, Marshall T, Roberts I. 2005. Are these data real? Statistical methods for the detection of data fabrication in clinical trials. British Medical Journal 331(7511):267–270.



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