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Seafood Choices: Balancing Benefits and Risks (2007)

Chapter: Appendix B Data Tables

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
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B
Data Tables

Note: Abbreviations/acronyms included in the following data tables are included in the Glossary (see Appendix A).

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
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Studies on Women, Infants, and Children

TABLE B-1a Studies on Preeclampsia: Effects on Women Who Increase Seafood and/or Omega-3 Fatty Acid Intake

Author

Study Type

Subjects

Exposure

Timing of Exposure

Sibai, 1998

Review

3 randomized controlled trials

Fish-oil supplement

 

Sindelar et al., 2004

Randomized Controlled Trial

Men (n=8)

Women (n=4)

Mean age of 33 years

Lincoln, NE

Non-Hispanic White

Recruited at YMCA marathon and triathlon training group meetings and word of mouth

Exercising regularly as members of a running training group sponsored by the local YMCA

No being treated with eating disorders or depression, or those unable to eat eggs, or those using medications known to affect serum lipids

n-3 PUFA-enriched eggs

2 weeks baseline period, 4 weeks treatment period (crossover design), 4 weeks washout period between treatments

Haugen and Helland, 2001

Randomized Controlled Trial

Pregnant women (n=37)

Mean age about 27-31 years

Oslo, Norway

Normotensive without proteinuria, had uncomplicated term pregnancies, randomly taken from another study investigating the influence of omega-3 fatty acids on fetal, neonatal, and child development

Another group had moderate preeclampsia

Cod-liver oil supplement

16-20 weeks gestation through pregnancy

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“The beneficial effects of fish oil on the incidence of preeclampsia are supported by observational studies and 1 large, uncontrolled early trial.”

Three randomized trials “reveal no reduction in the incidence of preeclampsia in the fish oil group.”

N

n-3 PUFA-enriched eggs:

flaxseed added to hens’ diet

350 mg n-3 PUFA/60 g egg

0.25 g LA, 0.10 g DHA/60 g egg

1 egg/day for 6 days and no eggs on day 7

Conventional eggs:

60 mg of n-3 PUFA/60 g egg

0.04 g LA, 0.02 g DHA/60 g egg

1 egg/day for 6 days and no eggs on day 7

LA, DHA, and total n-3 dietary intake of those randomized to n-3 PUFA-enriched egg treatment were significantly higher than at baseline and compared to the conventional egg treatment (p<0.05).

There were no significant differences in serum total cholesterol, LDL-C and HDL-C in physically active adults from baseline to end of treatment or between groups.

Serum triglycerides were significantly higher with n-3 PUFA-enriched egg treatment than those from baseline and compared to the conventional egg treatment (p<0.05).

N/A

Cod-liver oil group:

10 mL/day

Corn oil group:

10 mL/day

“The pressure increase was significant in both groups, but no significant differences in the constrictory response or in the proportions of preparations displaying dilatatory responses were observed when compared to appropriate control groups.”

“Neither preeclampsia nor dietary supplementation with cod-liver oil had any significant effect on the vasoactive response to PGF2α in umbilical cord arteries.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Salvig et al., 1996

Randomized Controlled Trial

Pregnant women (n=533)

Aged 18-44 years

Aarhus, Denmark

No history of placental abruption in an earlier pregnancy or a serious bleeding episode in the present pregnancy, no prostaglandin inhibitors regularly, no allergy to fish and regular intake of fish oil

Fish-oil supplement

30th week gestation through pregnancy

Onwude et al., 1995

Randomized Controlled Trial

Pregnant women (n=233)

Aged 18-39 years for fish oil group

Aged 16-40 for placebo group

Leeds, UK

Multigravida with a history of one or more small babies, a history of proteinuric or nonproteinuric pregnancy-induced hypertension, or a history of unexplained stillbirth

Primigravida with abnormal uterine arcuate artery Doppler blood flow at 24 weeks gestation

EPA/DHA supplement

Until 38th week gestation; enrollment time unspecified

Bulstra-Ramakers, 1995

Randomized Controlled Trial

Pregnant women (n=63)

Groningen, Netherlands

Birth weight below the 10th percentile in association with pregnancy-induced hypertension or chronic renal disease, or with placenta abnormalities

EPA supplement

12-14 weeks gestation until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil group:

2.7 g/day

(4 capsules/day, each capsule contains 32% EPA, 23% DHA, 2 mg tocopherol/ml)

Olive oil group:

1 g; 72% oleic acid and 12% LA/capsule

4 capsules/day

Control = no capsule

“Mean blood pressure increased during the course of the 3rd trimester,” but this change was not statistically different among the three groups.

“No differences were seen between the groups in proportions of women with a systolic blood pressure above 140 mmHg or a systolic blood pressure above 90 mmHg, although the proportion of women with diastolic above 90 mmHg tended to be lower in the fish oil group compared to the olive oil group (RR=0.48, p=0.07).”

N

2.7 g/day

(1.62 g/day of EPA)

(1.08 g/day of DHA)

There were no significant differences between the two groups for proteinuric pregnancy-induced hypertension, nonproteinuric pregnancy-induced hypertension, birth weight, gestation length, perinatal death, duration of labor, onset of labor (spontaneous, induced, or prelabor section), or mode of delivery.

N

4 capsules 3 times/day

(each capsule contains 0.25 mg EPA ) vs. placebo

“Addition of 3 g/day of EPA to the diet did not result in either a lowering of the incidence of pregnancy induced hypertension or intrauterine growth retardation.”

“Birth weight centiles were slightly lower and the recurrence rate of pregnancy-induced hypertension was slightly higher in the EPA group,” compared to the control group, although these differences were not significant.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Schiff et al., 1993

Controlled Trial

Pregnant women (n=16)

Aged 25-34 years

Nulliparous

Nonsmokers, no history of hypertension, coagulation disorders, thrombocytopenia, or chronic vascular, renal, or other disease

Fish-oil supplement

32-34 weeks through the next 21 days

Olsen and Secher, 1990

Randomized Controlled Trial

Pregnant women (n=5022)

Aged 15-44 years

London

People’s League of Health, 1946

Attending antenatal clinics of 10 hospitals

No disease or physical abnormality

EPA/DHA supplement

Enrolled at <24 weeks gestation; treatment lasts for <15 weeks (n=288), 16-19 weeks (n=411), 20-23 weeks (n=414), or 24+ weeks (n=417)

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

6 capsules/day

(each capsule contains 1000 mg of concentrated fish oil, 26% of which is n-3 fatty acids)

“Mean excretion of 11-dehydro-thromboxane B2 before and after 21 days of fish oil consumption was reduced among the fish oil-treated women from 1606±411 pg/mg of creatinine to 779±299 pg/mg after treatment (p<0.0001, paired t test). In all 11 patients the decreased excretion of this metabolite was considerable, ranging from 32% to 71%.”

No significant change was detected among the control women.

B

0.1 g/day of EPA+DHA from halibut oil in supplement vs. no supplement

Supplement includes 0.26 g ferrous iron; 0.26 g calcium; minute quantities of iodine, manganese and copper; 0.60 g thiamin/g; 0.10 g vitamin C; 0.36 g halibut liver oil

In primiparae, the OR for preeclampsia was significant when comparing the treatment to the control group (OR=0.689, 95% CI 0.50-0.95).

In primiparae, the OR for albuminuria was statistically significant when comparing the treatment to the control group (OR=0.717, 95% CI 0.54-0.96).

In primiparae, the OR for hypertension was not significant when comparing the treatment to the control group (OR=0.862, 95% CI 0.73-1.02).

In multiparae, these statistics were OR=0.677 (95% CI 0.43-1.07), OR=0.675 (95% CI 0.44-1.04), and OR=1.121 (95% CI 0.89-1.42).

There were no significant effects on the occurrences of stillbirths, early neonatal deaths (before 8 days), perinatal deaths, sepsis, or the duration of labor.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Clausen et al., 2001

Cohort

Pregnant women (n=3133)

Mean age 29.8 years

51.8% nulliparous

Representing all socioeconomic classes

Aker University Hospital, Oslo, Norway

No pregestational diabetes or twin/triplet pregnancies

Fatty acids from food

17-19 weeks gestation until after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Tertiles of saturated fatty acids (%energy) Mean = ≤12.0, 12.0-15.0, >15.0

Tertiles of monounsaturated fatty acids (%energy) Mean = ≤10.5, 10.5-13.0, >13.0

Tertiles of polyunsaturated fatty acids (%energy) Mean = ≤5.2, 5.2-7.5, >7.5

Tertiles of omega-3 fatty acids (%energy) Mean = ≤0.9, 0.9-1.6, >1.6

Tertiles of omega-6 fatty acids (%energy)

Mean = ≤3.8, 3.8-5.8, >5.8

After adjusting for energy, age, smoking, BMI, systolic blood pressure for 20 weeks’ gestation, nullipara and energy:

Statistically significant ORs for preeclampsia, comparing the highest group to the lowest group of fatty acid intakes, were observed for polyunsaturated fatty acids (p=0.01) and omega-6 fatty acids (p=0.05); and

Statistically nonsignificant ORs for preeclampsia, comparing the highest group to the lowest group of fatty acid intakes, were observed for saturated fat (p=0.10), monounsaturated fat (p=0.59), and omega-3 fatty acids (p=0.06).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Velzing-Aarts et al., 1999

Case-control

Cases (n=27) = preeclamptic women

Controls (n=24) = normotensive, nonproteinuric women

Pregnant women

Mean age about 27 years

Curacao

Fatty acid composition in maternal and umbilical platelets and umbilical arteries and veins

During delivery or within 2 hours after birth

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Mean fatty acid composition in maternal platelets (in mol%):

Controls = 9.66±2.75 LA; 0.27±0.10 ALA; 0.29±0.14 EPA; 2.03±0.62 DHA

Cases = 7.0±21.91 LA; 0.22±0.11 ALA; 0.21±0.07 EPA; 2.16±0.93 DHA

Mean fatty acid composition in umbilical cord platelets (in mol%):

Controls = 3.73±0.76 LA; 0.14±0.10 ALA; 0.16±0.07 EPA; 2.33±0.58 DHA

Cases = 4.16±1.51 LA; 0.21±0.11 ALA; 0.17±0.07 EPA; 1.97±0.30 DHA

Mean fatty acid composition in umbilical veins (in mol%):

Controls = 2.69±0.44 LA; 0.10±0.05 ALA; 0.09±0.04 EPA; 4.26±0.85 DHA

Cases = 2.89±0.56 LA; 0.11±0.05 ALA; 0.07±0.02 EPA; 3.35±0.96 DHA

Mean fatty acid composition in umbilical arteries (in mol%):

Controls = 1.87±0.39 LA; 0.10±0.04 ALA; 0.09±0.03 EPA; 4.83±0.76 DHA

Cases = 1.74±0.75 LA; 0.10±0.06 ALA; 0.06±0.03 EPA; 3.73±1.03 DHA

“Newborns of preeclamptic women had significantly lower birth weights and gestational ages at delivery,” compared to newborns of non-preeclamptic women.

Preeclamptic women had significantly lower maternal platelet levels of LA (p<0.001) and EPA (p<0.05) compared to normotensive women.

Preeclamptic women had significantly lower umbilical arteries levels of EPA (p<0.01) and DHA (p<0.001) compared to normotensive women.

No other significant differences were found for LA, ALA, EPA, or DHA.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Kesmodel et al., 1997

Nested case-control

Cases = women with preeclampsia (n=43), pregnancy-induced hypertension (n=179), intrauterine growth retardation (n=182), delivering preterm (n=153), delivering postterm (n=189)

Control = sample from whole cohort (n=256)

Pregnant women

Aarhus, Denmark

Seafood and fish-oil supplement

Between 6 months and 3 1/2 years after delivery

Williams et al., 1995

Case-control

Cases (n=22) = preeclamptic

Controls (n=40) = normotensive

Pregnant women

Mean age 28.6-31.2 years

White (n=17 in preeclamptic group, n=23 in non-preeclamptic group)

Seattle, Washington

About 21% Medicaid recipient

Maternal erythrocytes fatty acid profiles

Day after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Low intake = Maximum of 1 fish snack/week and 1 fish meal/month and no fish oil

High intake = Minimum of 4 fish snacks/week or 4 fish meals/month or intake of fish oil during pregnancy

Middle intake = Everyone else

After adjusting for maternal smoking habits, maternal height, maternal weight before pregnancy, parity, maternal social status, and average daily calcium intake:

There were no significant ORs of pregnancy-induced hypertension, preeclampsia, intrauterine growth retardation, preterm delivery or postterm delivery for the middle-intake group or the high-intake group compared to the low-intake group.

N

Tertiles of EPA:

Median = 0.20, 0.26, 0.36

Tertiles of DPA:

Median = 1.54, 1.75, 2.02

Tertiles of DHA:

Median = 4.38, 5.14, 6.40

Tertiles of total long-chain n-3 fatty acids:

Median = 6.23, 7.09, 8.50

After adjusting for parity and pre-pregnancy BMI, the OR of preeclampsia for the lowest tertile of EPA, compared to the highest tertile of EPA was 5.54 (95% CI 1.06-28.79).

After adjusting for parity and pre-pregnancy BMI, the OR of preeclampsia for the lowest tertile of DPA, compared to the highest tertile of DPA was 3.33 (95% CI 0.65-16.99).

After adjusting for parity and pre-pregnancy BMI, the OR of preeclampsia for the lowest tertile of DHA, compared to the highest tertile of DHA was 7.54 (95% CI 1.23-46.22).

After adjusting for parity and pre-pregnancy BMI, the OR of preeclampsia for the lowest tertile of the sum of long-chain omega-3 fatty acids, compared to the highest tertile of long-chain omega-3 fatty acids was 7.63 (95% CI 1.43-40.63).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Wang et al., 1991

Case-control

Cases (n=9) = preeclamptic women

ControlsA (n=11) = normal pregnant women

ControlsB (n=10) = nonpregnant women

Aged 20-40 years

Term (pregnant women)

Not on oral contraceptives (nonpregnant women)

Plasma fatty acid analysis

During pregnancy

*N = Evidence of no association or no clear association; B = Evidence of a benefit; N/A = A conclusion is not available; these data are presented for background information only.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Nonpregnant women (mg/L±SE):

79.51±3.47 total PUFA, 60.79±2.28 LA, 10.99±1.01 AA, 1.88±0.17 ALA, 0.26±0.04 EPA, 5.58±0.60 DHA

Normal pregnant women (mg/L±SE):

90.60±6.68 total PUFA, 62.93±4.69 LA, 12.81±0.87 AA, 3.68±0.99 ALA, 1.08±0.33 EPA, 10.40±0.94 DHA

Preeclamptic women (mg/L±SE):

67.42±3.88 total PUFA, 45.98±2.80 LA, 11.44±1.00 AA, 1.11±0.25±ALA, 0.11±0.11 EPA, 8.94±0.69 DHA

Plasma total polyunsaturated fatty acid levels, LA, ALA, and EPA were all significantly higher in the normal pregnant women than in the preeclamptic women (p<0.05, p<0.01, p<0.05, p<0.05, respectively).

EPA and DHA were significantly lower in the nonpregnant women compared to the pregnant women (p<0.05 and p<0.01, respectively).

No other significant differences between the plasma polyunsaturated fatty acid levels in the three groups were found.

“No statistical differences were noted in the five polyunsaturated fatty acid levels between fasting and non-fasting states in both non-pregnant and normal pregnant subjects.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1b Studies on Postpartum Depression: Effects on Women Who Increase Seafood and/or Omega-3 Fatty Acid Intake

Author

Study Type

Subjects

Exposure

Timing of Exposure

Marangell et al., 2004

Open trial

Pregnant women (n=7)

Aged 31-42 years

Married, Caucasian (except for one married, Hispanic)

Baylor College of Medicine

History of a depressive episode in the postpartum period, not suffering from a current depressive episode

No psychotropic medications within 2 weeks of baseline, history of nonreponse to two or more antidepressants, serious comorbid medical or psychiatric illness, or significant risk of dangerousness to self or others

Fish-oil supplement

34-36 weeks gestation until 12 weeks postpartum

Llorente et al., 2003

Randomized Controlled Trial

Pregnant women (n=89)

Aged 18-42 years

No chronic medical condition, no dietary supplements other than vitamins, no smoking, who had not been pregnant >5 times

Planned to breastfeed infants exclusively for at least 4 months

Part of a larger cohort study on effects of DHA on breastfeeding mothers and their infants

Algae-derived triglyceride supplement

Within a week of delivery to 4 months after delivery

Hibbeln and Salem, 1995

Review

Summary of three cohorts

DHA depletion

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil group:

2960 mg fish oil/day

173 mg EPA and 123 mg DHA per day

10 capsules/day

Trial was terminated because of a high relapse rate observed after enrolling only seven participants.

N

Algae-derived triglyceride capsule (about 200 mg DHA/day) vs. placebo

“Repeated measures analysis of variance, with the use of data only from the women who completed the questionnaires at both baseline and 4 months, showed no difference between the two groups at any time” with regards to postpartum depression.

“There were no significant differences between groups in the EPDS and SCID-CV scores, particularly in current or past episodes of depression, as detected by the SCID-CV.”

“There were no significant correlations between plasma phospholipid DHA content and BDI, EPDS, or SCID-CV scores.”

N

 

“The relative maternal depletion of DHA may be one of the complex factors leading to increased risk of depression in women of childbearing age and in postpartum periods.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Timonen et al., 2004

Cohort

Live female births (n=2968)

Live male births (n=2721)

Unselected, genetically homogeneous

Northern Finland 1966 Birth Cohort

Seafood

Previous 6 months (during pregnancy) until 31 years of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Rare eaters: ≤1 time/month

Regular eaters: ≥1 time/week

Serving size unspecified

After adjusting for body mass index, serum total cholesterol level, and socioeconomic situation, women who ate fish rarely had a higher OR for depression, compared to women who ate fish regularly. This statistic was observed by various measurements:

Doctor-diagnosis:

OR=1.3 (95% CI 0.9-1.9);

HSCL-25 <2.01:

OR=1.4 (95% CI 1.1-1.9);

HSCL-25 <2.01 and doctor-diagnosis:

OR=2.6 (95% CI 1.4-5.1).

After adjusting for alcohol intake, smoking, physical inactivity, and marital status, women who ate fish rarely had a higher OR for depression, compared to women who ate fish regularly. This statistic was observed by various measurements:

Doctor-diagnosis:

OR=1.2 (95% CI 0.9-1.6);

HSCL-25 <2.01:

OR=1.4 (95% CI 1.1-1.8);

HSCL-25 <2.01 and doctor-diagnosis:

OR=2.4 (95% CI 1.4-4.2).

Among men, none of these ORs were significant.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Otto et al., 2003

Cohort

Participated in 2 earlier studies

Pregnant women (n=112)

Mean age around 30 years

Caucasian

Southern Limburg, Netherlands

Fish intake <2 times/week

No metabolic, cardiovascular, neurologic, renal, or psychiatric disorders

No medications, except for multivitamins and iron supplements

Singleton pregnancy

Term delivery

No blood transfusions in the perinatal period

Gestational age <14 weeks at entry, Caucasian, fish consumption <2 times a week (for Study 2 only)

Venous (plasma) blood fatty acid composition

36 weeks gestation, at delivery, and 32 weeks postpartum

Otto et al., 2001

Cohort

Pregnant women (n=57)

Mean age around 30 years

Southern Limburg, Netherlands

No metabolic, cardiovascular, neurologic, or renal disorders

No medications, except multivitamins and iron supplements

Singleton pregnancy

Term delivery

No blood transfusions in the perinatal period

Diet and venous blood fatty acid profiles

36-37 weeks gestation; 2-5 days after delivery; 1, 2, 4, 8, 16, 32, 64 weeks postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Absolute amount not specified

No significant relationship was observed between DHA, n-6DPA, or their ratio and the EPDS scores at delivery or at 32 weeks postpartum.

No statistically significant relationships between depression and fatty acid status were observed with DHA or n-6DPA, neither for the levels at delivery, nor for their postpartum changes.

“The improvement of the DHA status during the postpartum period, as reflected by the increase of the DHA/n-6DPA ratio during this period, was higher in the non-depressed than in the depressed women (OR=0.90, p=0.04).”

Similar results remained after adjusting for Study 1 or 2, parity, education level, maternal age at test moment, breastfeeding, smoking, and alcohol use (OR=0.88, p=0.03).

N

Absolute amount not specified

“After delivery, total fatty acids in plasma phospholipids decreased significantly over time in the lactating and nonlactating women (p<0.0001).”

“The amounts of ALA, DHA, and total n-3 fatty acids showed significant downward trends postpartum in both groups, whereas the amounts of EPA and DPA increased significantly after delivery.”

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Al et al., 1995

Cohort

Pregnant women (n=110)

Aged 19-43 years

Maastricht, Netherlands

Caucasian

Singleton pregnancy

DBP <90 mmHg

No metabolic, cardiovascular, neurological or renal disorder

Maternal venous and umbilical vein fatty acid profiles

10, 14, 18, 22, 26, 30, 32, 34, 36, 38, 40 weeks gestation; after delivery; 6 months after delivery

Holman, 1991

Cohort

Pregnant women (n=19)

Aged 24-36 years

Caucasian

Normotensive, normal singleton pregnancies

Mayo Clinic, Minnesota

Controls (n=59) = staff and students from the University of Minnesota, aged 19-48 years

Blood fatty acid composition

36 weeks gestation, during labor, 6 weeks postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Absolute amount not specified

“The average total amount of fatty acid (TF) in maternal venous plasma PL increased significantly (p<0.0001) during pregnancy, but the rise in TF became less pronounced towards the end of gestation (p<0.0001).”

“Total fatty acids increased from 1238.11 mg/L at week 10 to 1867.84 mg/L at week 40 of gestation, and all of the fatty acid families showed a similar course.”

“The mean amount of total fatty acids in umbilical plasma phospholipids was substantially lower (p<0.0001) than all maternal values” for all fatty acid families.

“In contrast to the absolute amounts of AA and DHA, the mean relative amounts of AA and DHA in umbilical plasma phospholipids were significantly (p<0.0001) higher than all maternal values.”

N/A

Normal controls of nonpregnant women of childbearing age

All in mol%±SEM: 24.1±0.39 LA, 12.5±0.24 AA, 0.22±0.01 ALA, 0.53±0.03 EPA, 1.04±0.04 DPA, 3.71±0.14 DHA

All individual PUFA were less than normal in pregnant women at 36 weeks of pregnancy than in the nonpregnant women, where EPA was 42% of normal values.

“The fatty acid profile of plasma phospholipids during labor was similar to that at 36 weeks except for the subnormal LA and ALA values became significant at p<0.01 and p<0.05, respectively, and the elevated 22:5n-6 became significant at 0.001.”

The fatty acid profile of plasma phospholipids for lactating women 6 weeks postpartum was similar to those during pregnancy and labor except that AA status improved, diminished ALA, and increased EPA and DPA toward normal.

The fatty acid profile of plasma phospholipids for nonlactating women 6 weeks postpartum was similar to that of the lactating women, expect that abnormalities were less severe or of lower significance.

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Hibbeln, 2002

Cross-sectional

Pregnancy women (n=14,532)

23 countries

41 different studies

Seafood

During pregnancy, unspecified

*N = Evidence of no association or no clear association; B = Evidence of a benefit; N/A = A conclusion is not available; these data are presented for background information only.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Absolute amount not specified

“Greater apparent seafood consumption predicted DHA content of mothers’ milk (p<0.006)” and “higher DHA content in mothers’ milk predicted a lower prevalence rate of postpartum depression (p<0.0001).”

“Higher national seafood consumption predicted lower prevalence rates of postpartum depression (p<0.0001).”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1c Studies on Gestation and Birth Weight: Effects on Infants of Mothers Who Increase Seafood and/or Omega-3 Fatty Acid Intake

Author

Study Type

Subjects

Exposure

Timing of Exposure

de Groot et al., 2004

Randomized Controlled Trial

Pregnant women (n=79)

Mean age of 29-30 years

Maternal education about 4 (on an 8-point scale)

Maastricht, Heerlen, Sittard, southeastern Netherlands

White origin, gestational age <14 weeks, normal health, fish consumption <2 times/week

No hypertensive, metabolic, cardiovascular, renal, psychiatric, or neurologic disorder

ALA-supplemented margarine

14 weeks gestation until delivery

Smuts et al., 2003a

Randomized Controlled Trial

Pregnant women (n=73)

Mainly African-American

Aged 16-35 years

Reachable by telephone

Planned to deliver at the Regional Medical Center in Memphis, TN

No more than four pregnancies

DHA-enriched egg

24-28 weeks gestation until delivery

Smuts et al., 2003b

Randomized Controlled Trial

Pregnant women (n=291)

Aged 16-36 years

Mainly African-descent

Plan to deliver at Truman Medical Center in Kansas City, MO

Able and willing to consume eggs, access to refrigeration

Singleton gestation

No weight >240 pounds at baseline, cancer, lupus, hepatitis, infectious disease, diabetes, gestational diabetes, elevated blood pressure at baseline

DHA-enriched egg

24-28 weeks gestation until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Experimental group (% total fatty acids):

ALA-enriched high-LA margarine

25 g margarine

45.36 LA, 14.18 ALA

Control group (% total fatty acids):

No ALA high-LA margarine

25 g margarine/day

55.02 LA, 0.17 ALA

Newborns in the experimental group had a significantly higher mean birth weight than those in the control group (p=0.043).

No significant differences in gestational age, APGAR score, or umbilical plasma DHA concentrations in phospholipids were found between the two groups.

B (birth weight only)

High-DHA egg group:

mean = 183.9±71.4 mg DHA/day

ranged from 27.6 to 264.9 mg/day

Ordinary egg group:

mean = 35.1±13.2 mg DHA/day

ranged from 0 to 36 mg/day

Low egg intake group:

mean = 10.8±4.0 mg DHA/day

ranged from 0 to 36 mg/day

“Mean weight, length, and head circumference of infants in the high-DHA egg group were greater than in the ordinary egg group, and gestation was 5.6 days longer.”

B

High-DHA egg group:

mean = 133±15 mg DHA/egg

ranged from 108 to 165 mg/ egg

Ordinary egg group:

mean = 33±11 mg DHA/egg

ranged from 22 to 51 mg/egg

After controlling for maternal BMI at enrollment and number of prior pregnancies, the mean difference in gestational age between the two groups was 6.0±2.3 days (p=0.009).

After controlling for maternal BMI at enrollment and maternal race, the mean difference in birth weight between the two groups was not significant.

B (gestation only)

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Haugen and Helland, 2001

Randomized Controlled Trial

Pregnant women (n=37)

Mean age about 27-31 years

Oslo, Norway

Normotensive without proteinuria, had uncomplicated term pregnancies, randomly taken from another study investigating the influence of omega-3 fatty acids on fetal, neonatal, and child development

Another group had moderate preeclampsia

Cod-liver oil supplement

16-20 weeks gestation through pregnancy

Helland et al., 2001

Randomized Controlled Trial

Pregnant women (n=590)

Aged 19-35 years

Oslo, Norway

Single pregnancies, Nulli- or primipara

Intention to breastfeed

No supplement of n-3 LCPUFA earlier during the pregnancy

No premature births, birth asphyxia, infections, and anomalies in the infants that required special attention

Cod-liver oil supplement

17-19 weeks gestation until 3 months after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Cod-liver oil group: 10 mL/day

Corn-oil group: 10 mL/day

There were no significant differences in gestational age between the four groups (cod-liver oil group, corn oil group, preeclamptic group, and the normotensive group).

Birth weight was significantly higher in the corn oil group compared to the cod-liver oil group (p<0.05) and significantly higher in the normotensive group compared to the preeclamptic group (p<0.0001).

A (birth weight only)

10 mL/day cod-liver oil vs. corn oil

Cod-liver oil group:

803 mg of EPA/10 mL; 1183 mg DHA/10 mL

Corn-oil group:

0 mg of EPA/10 mL; 8.3 mg DHA/10 mL

“There were no significant differences in gestational length or birth weight between the two supplement groups. Birth length, head circumference, and placental weight were also similar in the 2 supplement groups.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Olsen et al., 2000

Randomized Controlled Trial

Pregnant women (n=1619)

19 hospitals in Denmark, Scotland, Sweden, England, Italy, Netherlands, Norway, Belgium, and Russia

Participated in one of six previous trials (four prophylactic trials and two therapeutic trials)

Fish-oil supplement

20 weeks (prophylactic) or 33 weeks (therapeutic) gestation, delivery

Olsen et al., 1992

Randomized Controlled Trial

Pregnant women (n=533)

Mean age 29 years

Aarhus, Denmark

Main midwife clinic, covers a well-defined geographic area

No placental abruption in previous pregnancy or serious bleeding in current pregnancy; no prostaglandin inhibitors regularly

No multiple pregnancy, allergy to fish, and regular intake of fish oil

Fish-oil supplement

Enrolled at 30 weeks gestation; end time not specified

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

2.7 g/day fish oil vs. olive oil in the prophylactic trials

6.1 g/day fish oil vs. olive oil in the therapeutic trials

In the trial of women who experienced preterm delivery in an earlier pregnancy, those randomized to fish oil had statistically significant longer gestation duration (difference = 8.5 days) compared to those randomized to olive oil (p=0.01).

In the trial of women who experienced preterm delivery in an earlier pregnancy, those randomized to fish oil had children with a significantly higher mean birth weight (difference = 208.7 g) compared to those randomized to olive oil (p=0.02).

In the trial of women with threatening preeclampsia in the current pregnancy, the mean difference of duration until delivery was 8.8 days less for those randomized to fish oil compared to those randomized to olive oil (p=0.19).

In the trial of women with suspected intrauterine growth retardation in the current pregnancy, the mean difference of weight for gestational age was 29 g higher in those randomized to fish oil compared to those randomized to olive oil (p=0.75).

B

2.7 g/day fish oil vs. olive oil

The average gestational length for those in the fish-oil group was 4 days longer (95% CI 1.5-6.4, p<0.005) than those in the olive oil group.

The average gestational length for those in the fish-oil group was 2.8 days longer (95% CI 0.8-4.8, p<0.01)) than those in the olive-oil and control groups.

Birth weight (p=0.07) and length (p=0.1) trended higher in the fish-oil group than in the olive-oil group (3 way ANOVA between fish oil, olive oil, no oil).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Olsen and Secher, 1990

Randomized Controlled Trial

Pregnant women (n=5022)

Aged 15-44 years

London

People’s League of Health, 1946

Attending antenatal clinics of 10 hospitals

No disease or physical abnormality

EPA/DHA supplement from halibut oil

Enrolled at <24 weeks gestation; treatment lasts for <15 weeks (n=288), 16-19 weeks (n=411), 20-23 weeks (n=414), or 24+ weeks (n=417)

People’s League of Health, 1946

Randomized Controlled Trial

Pregnant women (n=5022)

London

Not beyond the 24th week of pregnancy

No physical disease or abnormality

n-3 supplement

 

People’s League of Health, 1942

Randomized Controlled Trial

Pregnant women (n=5022)

London

Additional diet, which includes hali-but liver oil

Enrolled if due date more than 16 weeks away; until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

0.1 g/day of EPA+DHA from halibut oil in supplement vs. no supplement

Supplement includes 0.26 g ferrous iron; 0.26 g calcium; minute quantities of iodine, manganese, and copper; 0.6 g thiamin/g; 0.1 g vitamin C; 0.36 g halibut liver oil

“In primiparae, a 19.9% (p=0.012) reduction in the odds of delivering earlier than 40 weeks was seen in the treatment group, whereas in multiparae a reduction of 21.2% (p=0.028) was seen,” compared to the control group.

“No significant effects were seen on the odds of delivering after 40 weeks of gestation.”

“No significant effects were seen on average birth weight.”

B (gestation only)

 

“A smaller incidence of prematurely was revealed among the treated women, and this is particularly significant since about 50% of infant deaths under 1 month are due to prematurely.”

B

Weekly intake score for consumption of “the more important foodstuffs” such as milk, butter, wholemeal bread, fresh vegetables, fatty fish, fruit, eggs, etc.

Additional diet:

0.26 g ferrous iron; 0.26 g calcium; minute quantities of iodine, manganese, and copper; 1 g adsorbate of vitamin B1; 100 mg vitamin C; 0.36 g halibut liver oil (vitamins A and D)

Among primigravida women, 20.1±1.10% of those who received additional diet experienced a preterm delivery compared to 23.9±1.10% of those who did not receive additional diet. This difference was statistically significant.

Among multiparae women, 20.1±1.33% of those who received additional diet experienced a preterm delivery compared to 24.2±1.33% of those who did not receive additional diet. This difference was statistically significant.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Lucas et al., 2004

Cohort

Postpartum women (n=491) and their infants

Mean age of 23.7 years Inuit

14 coastal villages of Nunavik and southern Quebec

Delivered at Tulattavik Health Center (Ungava Bay) or Inuulitsivik Health Center (Hudson Bay)

Cord venous sample

At delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Tertiles of EPA (% of total fatty acids):

Tertile 1 = <0.21

Tertile 2 = 0.21-0.39

Tertile 3 = >0.39

Tertiles of DHA (% of total fatty acids):

Tertile 1 = <2.99

Tertile 2 = 2.99-4.03

Tertile 3 = >4.03

Tertiles of %n-3 HUFA (% of total HUFA):

Tertile 1 = <18.60

Tertile 2 = 18.60-22.96

Tertile 3 = >22.96

After adjusting for weight gain during pregnancy, gestational diabetes, cord blood mercury, lead, and PCB congener 153, those in the third tertile of n-3 HUFA (% of total HUFA) had significantly longer gestation (278.4 days) compared to those in the first tertile (273.0 days) (p<0.05).

After adjusting for pre-pregnancy weight, weight gain during pregnancy, parity, smoking status during pregnancy, gestational diabetes, age, cord blood mercury, and PCB congener 153, those in the third tertile of n-3 HUFA (% of total HUFA) had babies with a higher birth weight (3551 g) compared to those in the first tertile (3475 g), but this difference was not significant.

There were no significant differences in birth weight or gestation based on the tertiles of EPA and DHA in the cord blood.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Oken et al., 2004

Cohort

Pregnant women (n=2109)

Aged 14-44 years

16% Black, 7% Hispanic-American, 6% Asian-American

Massachusetts

Project Viva

Seafood

Last menstrual period until enrollment, 3 months prior to 26-28 weeks of gestation, the month prior to delivery

Olsen and Secher, 2002

Cohort

Pregnant women (n=8729)

Aarhus, Denmark

Gave birth to singleton, liveborn babies without detected malformations

Had not consumed fish-oil supplements

Seafood

From when first knew of pregnancy until completion of questionnaires at 16 and 30 weeks gestation

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Seafood tertiles:

None or <1 serving/month, the remaining subjects were divided into tertiles with the highest intake group used as the referent

First trimester quartiles of EPA+DHA:

Quartile 1 = 0.00-0.05

Quartile 2 = 0.06-0.12

Quartile 3 = 0.12-0.24

Quartile 4 = 0.24-2.53

Second trimester quartiles of EPA+DHA:

Quartile 1 = 0.00-0.05

Quartile 2 = 0.06-0.12

Quartile 3 = 0.12-0.23

Quartile 4 = 0.24-2.71

Third trimester quartiles of EPA+DHA:

Quartile 1 and 2 = 0.00-0.06

Quartile 3 = 0.60-0.11

Quartile 4 = 0.11-1.72

After adjusting for enrollment site, infant sex, and maternal age, height, intrapartum weight gain, pre-pregnancy BMI, race/ethnicity, smoking during pregnancy, education, and gravidity:

Significant negative trends based on EPA+DHA intake were found for the first trimester [birth weight (p=0.01) and fetal growth (p=0.001)], the second trimester [fetal growth (p=0.03)], and the third trimester [birth weight (p=0.001) and fetal growth (p=0.003)];

No other significant trends were observed for change in birth weight, fetal growth or length of gestation with EPA+DHA intake during the three trimesters;

Significant negative trends were observed for change in birth weight and fetal growth with seafood consumption, but only during the first trimester (p=0.05 and p=0.08, respectively); and

No other significant trends were observed for change in birth weight, fetal growth, or length of gestation with seafood intake during the first two trimesters.

B

0.0, 0.5, 2.0, 4.0, 20.0, 28.0 serving/28 days

Hot fish meal:

144 g fish/serving

1627 µg n-3 fatty acids/serving

Fish sandwich:

29 g fish/serving

431 µg n-3 fatty acids/serving

Fish salad:

50 g fish/serving

149 µg n-3 fatty acids/serving

“Low birth weight, preterm birth, and intrauterine growth retardation all tended to decrease with increasing fish consumption, and mean birth weight, duration of gestation, and birth weight adjusted for gestational age tended to increase with increasing fish consumption.”

Low consumption of seafood was a strong risk factor for preterm delivery and low birth weight. The associations were strongest below a daily intake of 0.15 g long change n-3 fatty acids or 15 g fish.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Grandjean et al., 2001

Cohort

Singleton term births (n=182)

Faroe Islands

Delivered at the National Hospital in Torshavn

Birth at >36 weeks of gestation; no congenital neurological disease

Maternal and cord serum and seafood intake

Maternal blood taken at week 34, cord blood taken at delivery, questionnaire administered 2 weeks after parturition

Olsen et al., 1991

Cohort

Mothers of live-born singleton infants (n=99)

Mean age about 27 years

Faroese (n=62) and Danish women (n=37)

Delivered at the Landssjukrahusid and Aarhus Kommenehospital

No preeclampsia, rhesus immunization, insulin-dependent diabetes mellitus, or twin pregnancies

Peripheral venous blood sample

5-48 hours after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Information on fish species or portion sizes was not collected

Fish dinners/week:

0, 1, 2, ≥3

Whale meat dinners/month:

0, 1, ≥2

Whale blubber dinners/month:

0, 1-2, >2

Gestational length showed a significant positive association with cord serum DHA concentration (p<0.001) and DTA (p=0.004).

After adjusting for nonsmoking, average-height and nulliparous mother with term birth of male baby, birth weight showed a significant positive association with cord serum ETA (p=0.001), EPA (p=0.015), and DPA (p=0.002).

After adjusting for gender, parity, gestational length, smoking, and maternal height, birth weight decreases by 246 g for every one unit increase in cord serum EPA concentration (%) (p=0.037).

B

Faroese women:

Mean of 0.83±0.039% EPA

Mean of 2.08±0.059% DPA

Mean of 5.87±0.12% DHA

Mean of 12.07±0.15% AA

Danish women:

Mean of 0.61±0.051% EPA

Mean of 2.08±0.076% DPA

Mean of 4.65±0.159% DHA

Mean of 12.07±0.19% AA

There were no significant differences in gestational age (p=0.3) and birth weight (p=0.1) between the two groups.

After controlling for maternal pre-pregnant weight, height, age, parity, marital status, smoking, and employment during pregnancy a significant association was found between the (3/6) ratio from blood and gestational age in the Danish women (p=0.02) but not in the Faroese women (p=0.6).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Harper et al., 1991

Case-control

Cases = born to Orkney Island residents, delivered in Orkney Islands (n=899) or Aberdeen (n=116)

Controls = born to Aberdeen City district residents (n=2997)

Singleton live births

Scotland

Resident of Orkney (a proxy for eating more seafood)

 

*B = Evidence of a benefit; A = Evidence of an adverse effect; N = Evidence of no association or no clear association.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

The Orcandians eat 30% more fish than the Aberdonians, but absolute amount undetermined

Mean birth weight of the infants born to residents of Orkney Islands was 3521 g and for residents of Aberdeen was 3287 g (p=0.01).

Gestational age was 0.36 weeks longer in the Orkney women than in the Aberdeen women (p=0.01).

18.3% of infants born to Orkney women and 10.0% of infants born to Aberdeen women were over the 90th percentile for birth weight (corrected for gestational age and parity) (p=0.01).

4.8% of infants born to Orkney women and 12.2% of infants born to Aberdeen women were below the 10th percentile for birth weight (corrected for gestational age and parity) (p=0.01).

Being a resident of Orkney explains a significant proportion of the difference in birth weights between Orkney and Aberdeen women (R2 = 0.489).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1d Studies on Development (Anthropometry, Visual Acuity, and Cognition): Effects on Infants of Mothers Who Increase Seafood and/or Omega-3 Fatty Acid Intake

Author

Study Type

Subjects

Exposure

Timing of Exposure

Cohen et al., 2005

Review

Aggregated 8 randomized controlled trials (one study of maternal dietary supplementation and seven studies of formula supplementation)

DHA supplement

 

Jensen et al., 2005

Randomized Controlled Trial

Pregnant women (n=114 in DHA group; n=113 in control group)

Aged 18-40 years

Houston, TX

White (75% DHA group; 79% control group)

African American (19% DHA group; 13% control group)

Gestational age >37 weeks

Infant birth weight 2500-4200 g

No chronic maternal disorders as well as major congenital anomalies and obvious gastrointestinal or metabolic disorders of the infant

DHA supplement

Day 5 after delivery until 4 months postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

An increase in maternal intake of DHA during pregnancy of 1 g/day will increase child IQ by 0.8-1.8 points.

“Prenatal maternal DHA intake increasing the child plasma (RBC) DHA phospholipid fraction by 1% has the same impact on cognitive development as formula DHA supplementation that increases the child’s plasma (RBC) DHA phospholipid fraction by 1%.”

“Because typical DHA intake associated with fish consumption is well under 1 g/day, changes in fish consumption will result in IQ effects amounting to a fraction of a point,” but they are not clinically detectable.

B

DHA capsule:

Algal triacylglycerol

200 mg DHA/day

Control capsule:

Soy and corn oil

There were no significant differences in visual acuity (from either the Teller Acuity Card or Sweep VEP) at 4 or 8 months of age between the two groups.

There were no significant differences in mean transient VEP latency at 4 and 8 months of age between the two groups; but the transient VEP amplitude was significantly lower in the infants of the DHA group compared to the infants of the control group.

There were no significant differences in Gesell Gross Motor Inventory, CAT, CLAMS DQ, or Bayley MDI between the two groups at 12 or 30 months of age; but Bayley PDI at 30 months of age was 8.4 points higher (p=0.005) in infants of the DHA group compared to infants of the control group.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Dunstan et al., 2004

Randomized Controlled Trial

Pregnant women (n=83)

Atopic pregnancies

Western Australia

History of doctor diagnosed allergic rhinitis and/or asthma

One or more positive skin prick test to house mites; grass pollens; molds; cat, dog, or cockroach extracts

Nonsmokers

No other medical problems, complicated pregnancies, seafood allergy, or >2 fish meals/week

Term, healthy infants considered at high risk of allergic disease

Fish-oil supplement

20 weeks gestation until delivery

Jensen et al., 2004

Randomized Controlled Trial

Breast-feeding mothers (n=89 in treatment group; n=85 in placebo group)

DHA supplement

Delivery until 4 months postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish-oil group:

3.7 g/day fish oil

56% DHA and 27.7% EPA

4 capsules/day

Olive-oil group: 66.6% n-9 oleic acid and <1% n-3 PUFA

4 capsules/day

Breast milk concentrations of DHA, DPA, and EPA were significantly higher (p<0.001) and AA was significantly lower (p=0.045) in fish-oil supplemented mothers compared with controls.

“There were no significant differences in the detection or level of free cytokines or IgA between the 2 groups.”

N/A

200 mg/day of DHA vs. placebo

There were no significant differences between the two groups in visual function or neurodevelopment until 30 months of age.

At age 30 months, the Bayley PDI of infants whose mothers were randomized to DHA was 0.55 standard deviations higher (p<0.01) than that of infants whose mothers were randomized to the placebo.

There were no significant differences between the two groups in visual function; transient VEP; sweep VEP; stereoacuity; and gross and fine motor, executive, perceptual/visual or verbal domains at age 5.

At age 5, infants whose mothers were randomized to DHA had significantly higher Sustained Attention Subtest of the Leiter International Performance Scale than those whose mothers were randomized to the placebo (p<0.008).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Helland et al., 2003

Randomized Controlled Trial

Pregnant women (n=48 in cod-liver oil group; n=36 in corn oil group)

Aged 19-35 years

Oslo, Norway

Healthy women with, singleton pregnancy, nulli- or primiparous, intention to breastfeed

No supplement of n-3 LCPUFA earlier during pregnancy, premature births, birth asphyxia, general infections, or anomalies in the infants that required special attention

Cod-liver oil supplement

From 18 weeks of pregnancy until 3 months after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Cod-liver oil:

10 mL/day

1183 mg DHA, 803 mg EPA

Corn oil:

10 mL/day

4747 mg LA, 92 mg ALA

K-ABC scores were significantly higher for the subset MPCOMP among children from the cod-liver oil group compared to the corn oil group (p=0.049). The scores for the other subtests (SEQPROC, SIMPROC, NONVERB) were also higher in the cod-liver oil group compared to the corn oil group, but they were not significant.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Auestad et al., 2001

Randomized Controlled Trial

Infants (n=294 formula fed; n=165 breastfed)

Kansas City, MO; Little Rock, AR; Pittsburgh, PA; Tucson, AZ

Good health, term status, either ≤9 days of age (formula group) or ≤11 days of age and currently breastfeeding (breastfeeding group), birth weight ≥2500 g, 5-minute APGAR score ≥7, ability to tolerate milk-based formula or breast milk, guardian or parent agreement to feed the assigned study formula ad libitum according to the study design

No evidence of significant cardiac, respiratory, ophthalmologic, gastrointestinal, hematologic, or metabolic disease; milk-protein allergy; or a maternal medical history known to have proven adverse effects on the fetus, tuberculosis, HIV, perinatal infections, or substance abuse

61-74% European American

60-80% mothers married

Mean mother’s age about 29 years

Mean mother’s education about 14 years

Fish oil/fungal oil and egg-derived triglyceride supplemented formulas

9-11 days after birth until 12 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil and fungal oil supplemented preterm formula:

0.46 g AA/100 g total fatty acids

≤0.04 g EPA/100 g total fatty acids

0.13 g DHA/100 g total fatty acids

Egg-derived triglyceride supplemented preterm formula:

0.45 g AA/100 g total fatty acids

No detected EPA

0.14 g DHA/100 g total fatty acids

Control formula:

No detected AA, EPA, DHA

The vocabulary expression score at 14 months was significantly higher in the fish/fungal group than in the egg-TG group (p<0.05).

Smiling and laughter was significantly higher in the control group than in the egg-TG group (p=0.05).

No other development, cognition, vocabulary, or temperament outcomes presented were significantly difference between the formula groups.

No significant differences were found between groups for weight, length, and head circumference or visual acuity.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Helland et al., 2001

Randomized Controlled Trial

Pregnant women (n=590)

Aged 19-35 years

Oslo, Norway

Single pregnancies, nulli-or primipara

Intention to breastfeed

No supplement of n-3 LCPUFA earlier during the pregnancy

No premature births, birth asphyxia, infections, and anomalies in the infants that required special attention

Cod-liver oil supplement

17-19 weeks gestation until 3 months after delivery

McCann and Ames, 2005

Review

Summary of observational, RCTs, other experimental and animal studies

LCPUFA supplement

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

10 mL/day cod-liver oil vs. corn oil

Cod-liver oil:

803 mg of EPA/10 mL; 1183 mg DHA/10 mL

Corn oil:

0 mg of EPA/10 mL; 8.3 mg DHA/10 mL

“There were no significant differences in gestational length or birth weight between the 2 supplement groups. Birth length, head circumference, and placental weight were also similar in the 2 supplement groups.”

N

 

“Evidence from chronic dietary restriction rodent studies … shows that the addition of DHA to diets of animals whose brain concentration of DHA have been severely reduced restored control performance levels.”

“Formula comparison and maternal supplementation studies in humans and ALA dietary restriction studies in nonhuman primates both link the availability of n-3 LCPUFAs to the development of visual attention” and higher DHA status to enhanced neuromotor development.

RCTs in humans have often shown no effect of “LCPUFA supplementation on cognitive or behavioral performance and some reviewers have considered that, overall, the evidence was insufficient to conclude that LCPUFA supplementation benefited development.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Koletzko et al., 2001

Review

Studies published in full or in abstract form

LCPUFA supplement

Prenatal and postnatal periods

Makrides and Gibson, 2000

Review

Summary of the evidence

LCPUFA supplement

During pregnancy and lactation

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“Breastfeeding, which supplies preformed LCPUFA, is the preferred method of feeding for healthy infants and is strongly supported.”

“Infant formulas should contain at least 0.2% of total fatty acids as DHA and 0.35% as AA; formulas for preterm infants should include at least 0.35% DHA and 0.4% AA.”

There is an absence of published studies showing direct functional benefits of supplementation of LCPUFA and studies to determine if the variability in LCPUFA status among pregnant women is related to functions in either the mother or infant.

“It seems prudent for pregnant and lactating women to include some food sources of DHA in their diet.”

B

 

“There appears to be no detectable reduction in plasma n-3 LCPUFA concentrations during pregnancy, whereas there is a clear decline during the early postpartum period.”

“Results of randomized clinical studies suggest that n-3 LCPUFA supplementation during pregnancy does not affect the incidences of pregnancy-induced hypertension and preeclampsia without edema.”

“n-3 LCPUFA supplementation may cause modest increases in the duration of gestation, birth weight, or both.”

“To date there is little evidence of harm as a result of n-3 LCPUFA supplementation during either pregnancy or lactation.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Leary et al., 2005

Cohort

Mother-child pairs (n=6944)

Bristol, England

Avon Longitudinal Study of Parents and Children (ALSPAC)

Diet

During pregnancy, unspecified

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Carbohydrate (g) 182-218, 218-258, >258

Protein (g) 55-66, 66-79, >79

Total fat (g) 55-68, 68-84, >84

Saturated fat (g) 21-27, 27-35, >35

Polyunsaturated fat (g) 9-12, 12-16, >16

Monounsaturated fat (g) 19-24, 24-30, >30

Calcium (mg) 759-938, 939-1127, >1127

Potassium (mg) 2177-2582, 2583-3021, >3021

Magnesium (mg) 207-254, 255-308, >308

Protein/carbohydrate 0.26-0.30, 0.31-0.35, >0.35

Animal protein (g) 35-44, 44-53, >53

Omega-3 fatty acids (g) 0.03-0.09, 0.10-0.27, >0.27

After adjusting for sex, child’s age for blood pressure, and maternal pregnancy energy intake, a significant inverse association was found between omega-3 fatty acids and offspring blood pressure at age 7.5 years (p=0.04).

After adjusting for sex, child’s age for blood pressure, and maternal pregnancy energy intake, there were no significant differences in offspring blood pressure at age 7.5 years based on maternal intake of carbohydrate, protein, total fat, saturated fat, polyunsaturated fat, monounsaturated fat, calcium, potassium, magnesium, protein/carbohydrate or animal protein.

After adjusting for measurement factors, current anthropometry, maternal and social factors, birth weight, and gestation, there was a significant positive association found between maternal intake of carbohydrates and offspring blood pressure at 7.5 years (p=0.04).

After adjusting for measurement factors, current anthropometry, maternal and social factors, birth weight, and gestation, there were no significant differences between the tertiles of maternal intake of protein, total fat, saturated fat, polyunsaturated fat, monounsaturated fat, calcium, potassium, magnesium, protein/carbohydrate, animal protein, or omega-3 fatty acid and offsprings’ systolic blood pressure at age 7.5 years.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Oken et al., 2005

Cohort

Mother-infant pairs (n=135)

Aged <30 years (n=16)

Aged 30-34 years (n=53)

Aged ≥35 years (n=31)

82% White; 18% non-White

80% college or graduate degree

Massachusetts

Singleton pregnancy, were able to complete forms in English, did not plan to move out of the study area before delivery

Project Viva

Seafood

Second trimester of pregnancy

Colombo et al., 2004

Cohort

Infants (n=70)

Mean gestation 39.29 weeks

Mean birth weight 3248.57 g

Mean APGAR score (1 min) 7.94

Mean APGAR score (5 min) 8.80

Mean education (11.77 years for mother and 11.88 for father)

77% African American

21% Caucasian

1% Hispanic

Kansas

DHA-enriched egg

24-28 weeks gestation until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Number of servings/week:

Canned tuna fish (3-4 oz/serving)

Shrimp/lobster/scallop/clam (1 serving)

Dark meat fish (3-5 oz/serving)

Other fish (3-5 oz/serving)

6 responses from never or less than 1/month to 1 or more servings/day

After controlling for maternal hair mercury level, age, race/ethnicity, education, marital status, infant sex, gestational age at birth, birth weight for gestational age, breast-feeding duration and age at cognitive testing:

Each 1 serving/week increase of fish intake increases the VRM score by 4 points (%novelty preference; 95% CI 1.3-6.7).

After controlling for maternal seafood intake, age, race/ethnicity, education, marital status, infant sex, gestational age at birth, birth weight for gestational age, breast-feeding duration, and age at cognitive testing:

Each 1 ppm increase in maternal hair mercury levels decreases the VRM score by 7.5 points (%novelty preference; 95% CI −13.7 to −1.2).

B

This study is a follow-up to an RCT

High-DHA eggs: 135 mg DHA/egg

Ordinary eggs: 35 mg DHA/egg

“Infant red blood cell DHA level was unrelated to subsequent attentional measures, but maternal red blood cell DHA was consistently predictive of later attentional outcomes.”

“Infants whose mothers had higher levels of DHA at birth showed accelerated developmental courses in attention across the 1st year.”

Percent of time spent looking in orienting increased over time in both the high- and low-DHA groups, but it was larger in the high-DHA group compared to the low-DHA group at 4, 6, and 8 months.

Percent of time spent looking in sustained attention declined over time in both groups, but it was smaller in the high-DHA group compared to the low-DHA group at 4, 6, and 8 months.

Percent of time spent looking in attention termination was larger at 4 months in the low-DHA group compared to the high-DHA group, and then declined and leveled off at 6 months in both groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Daniels et al., 2004

Cohort

Infants (n=1054)

Mothers’ mean age = 29 years

Majority of mothers with at least an O (moderate) level education

Bristol, UK

Singleton, term births

Avon Longitudinal Study of Parents and Children (ALSPAC)

Seafood

Maternal fish intake: 32 weeks of gestation

Breastfeeding practices: 15 months after birth

Infant fish intake: 6 and 12 months after birth

Total mercury concentration: Cord blood at birth

Sakamoto et al., 2004

Cohort

Pregnant women (n=63)

Aged 21-41 years

Japan

Planning to deliver at Munakata Suikokai General Hospital, Fukuoka

Healthy

Maternal blood and umbilical cord blood lipids

Umbilical cord blood at birth and maternal blood 1 day after parturition before breakfast

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Maternal fish intake categories (during pregnancy):

1 = Rarely/never

2 = 1 meal/2 weeks

3 = 1-3 meals/week

4 = 4+ meals/week

Child fish intake categories (6 months of age):

1 = Rarely/never

2 = 1+ meal/week

Child fish intake categories (12 months of age):

1 = Rarely/never

2 = 1+ meal/week

Children whose mothers ate 1-3 fish meals/week and 4+ fish meals/week had significantly lower odds of low MCDI scores for social activity (OR=0.6, 95% CI 0.5-0.8 and OR=0.7, 95% CI 0.5-0.9, respectively) than the children whose mothers rarely or never ate fish during pregnancy.

Children whose mothers ate 1-3 fish meals/week and 4+ fish meals/week had significantly lower odds of low DDST scores for language (OR=0.7, 95% CI 0.5-0.9 and OR=0.7, 95% CI 0.5-0.9, respectively) than the children whose mothers rarely or never ate fish during pregnancy.

Children who ate 1+ fish meals/week had significantly lower odds of low MCDI scores for vocabulary comprehension (OR=0.7, 95% CI 0.5-0.8) and social activity (OR=0.7, 95% CI 0.6-0.9) and total DDST scores (OR=0.8, 95% CI 0.6-0.9).

All other odds ratios presented were nonsignificant.

B

Unspecified

In all cases, fetal RBC-Hg levels (13.4 ng/g) were statistically higher than maternal RBC-Hg levels (8.41 ng/g) (p<0.01).

“A strong correlation was observed in RBC-Hg between mothers and fetuses (r=0.92, p<0.001).”

“Maternal RBC-Hg concentrations showed significant correlation coefficients with maternal plasma EPA (r=0.36, p<0.001) and DHA (r=0.33, p<0.005) concentrations.”

“Fetal RBC-Hg concentrations showed a significant positive correlation with fetal plasma EPA (r=0.32, p<0.05) and DHA (r=0.35, p<0.01).”

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Willatts et al., 2003

Cohort

Mother and infant pairs (n=96)

Term pregnancy and infant birth weight >2499 g

Dundee

DHA and AA content in maternal red blood cells

34-36 weeks gestation

Cheruku et al., 2002

Cohort

Pregnant women (n=17)

Men aged 29 years in the high-DHA group

Men aged 24 years in the low-DHA group

White (n=14)

Hispanic (n=3)

Windham, CT

≥4 hours of crib time in the first and second days postpartum

No history of chronic hypertension, hyperlipidemia, renal or liver disease, heart disease, thyroid disorders, multiple gestations, or pregnancy-induced complications

No drugs that affect the respiration of newborns, such as magnesium sulfate and butorphanol

Maternal plasma DHA

Day 1 and day 2 postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Absolute DHA and AA levels in blood unspecified

After adjusting for maternal education, social class, birth weight, gestation, type of feeding at birth, and infant age at time of assessment:

“There was a significant negative relation between maternal DHA and peak look duration (p<0.05), and a significant positive relation between maternal DHA and visual acuity (p<0.01)” at 4 months of age. The relation between AA and peak look duration and visual acuity at 4 months of age were not significant.

“These results suggest that higher maternal DHA status is related to more efficient information processing and improved visual acuity development in 4-month-old infants.”

B

High-DHA group (maternal plasma):

>3.0% by weight of total fatty acids

Low-DHA group (maternal plasma):

≤3.0% by weight of total fatty acids

On day 2 postpartum, the low-DHA group had significantly higher sleep-wake transition (% of time in crib) and less wakefulness (% time in crib) than the high-DHA group (p<0.05).

There was a significant group effect for active sleep time (p=0.004) and active:quick sleep time (p=0.001), these times being shorter in the high-DHA group than in the low-DHA group.

“Differences in the prenatal supply of LCPUFAs, especially DHA, may modify brain phospholipids and affect neural function.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Haggerty et al., 2002

Cohort

Mothers, smokers (n=11)

Mothers, nonsmokers (n=13)

Aberdeen, Scotland

Uncomplicated, full-term pregnancies

Perfusion on term placentas delivered vaginally or by elective Caesarean section from otherwise uncomplicated pregnancies

Placental tissue lipids

Within 20 minutes of delivery

Innis et al., 2001

Cohort

Infants (n=83)

Term

Birth weight 2500-4500 g

Mean mother’s age of 32 years

British Colombia

Intend to breast-feed for 3 months, no solid foods for at least the first 4 months after birth

No mothers with substance abuse, communicable diseases, metabolic or physiologic problems, infections likely to influence fetal growth, or multiple births

No infants with evidence of metabolic or physical abnormalities

Fatty acids in blood from infants and milk from mothers

2 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Unspecified

The rates of transfer of LA and AA per perfused area were not different between the groups; “neither was the rate of placental transfer of ALA and DHA affected by smoking during pregnancy.”

“In the non-smoking control group the placenta selectively transferred polyunsaturated fatty acids to the fetus in the order DHA > AA > ALA > LA. The order of selectivity was unaltered in placentas from smokers, but the addition of ethanol to the perfusion medium altered the order of selectivity to AA > ALA > LA > DHA.”

“The presence of ethanol in the perfusate at a concentration of 2 mg/ml significantly reduced (p<0.01) the absolute rate of transfer of ALA and DHA.”

N/A

Infant DHA: (g/100 g fatty acids)

Plasma phospholipids = 2.2-8.0

RBC PE = 6.3-13.0

PC = 1.4-4.6

Infant AA: (g/100 g fatty acids)

Plasma phospholipids = 8.1-15.8

RBC PE = 20.2-27.8

PC = 5.6-9.7

Mother’s milk: (g/100 g milk fatty acids)

DHA = 0.10-2.50

AA = 0.20-0.81

LA = 6.30-21.50

LNA = 0.50-4.10

“The ability to correctly discriminate a retroflex compared with dental phonetic contrast at 9 months of age was positively correlated with the plasma phospholipid DHA (p<0.02) and the RBC PE at 2 months of age (p=0.02).”

“There were no significant correlations between the infants’ AA status and the ability to discriminate the native or nonnative language contrasts.”

“There were no significant correlations between the infant DHA or AA status at 2 months of age and test scores for novelty preference, or the job search task, with adjustments for covariates included in the model.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Otto et al., 2001

Cohort

Pregnant women (n=57)

Mean age around 30 years

Southern Limburg, Netherlands

No metabolic, cardiovascular, neurologic, or renal disorders

No medications, except multivitamins and iron supplements

Singleton pregnancy

Term delivery

No blood transfusions in the perinatal period

Plasma phospholipids

36-37 weeks gestation; 2-5 days after delivery; 1, 2, 4, 8, 16, 32, 64 weeks postpartum

Williams et al., 2001

Cohort

Boys and girls (n=435)

Mean age of 3.5 years

Born in last 6 months of the Avon Longitudinal Study of Parents and Children (ALSPAC) enrollment period

Healthy term infants

Seafood

During pregnancy for the mothers and at 4 weeks, 4 months, and 6 months for the infants

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Absolute amount not specified

“After delivery, total fatty acids in plasma phospholipids decreased significantly over time in the lactating and nonlactating women (p<0.0001).”

“The amounts of ALA, DHA, and total n-3 fatty acids showed significant downward trends postpartum in both groups, whereas the amounts of EPA and DPA increased significantly after delivery.”

N/A

Oily fish consumption categories:

1 = Never or rarely

2 = Once every 2 weeks

3 = More than once every 2 weeks

White fish = cod, haddock, plaice, and fish fingers

Oily fish = pilchards, sardines, mackerel, tuna, herring, kippers, trout, and salmon

After adjusting for breastfeeding, sex, maternal education, maternal age, housing tenure, financial difficulties, maternal smoking, number of older siblings in household, child care, maternal job status, mother is a vegetarian, mother’s fish eating habits:

“Mothers who ate oily fish at least once every 2 weeks during pregnancy were more likely to have children who achieved foveal steroacuity than were the mothers who never ate oily fish (OR=1.57, 95% CI 1.00-2.45),” but this was not significant.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Haggerty et al., 1999

Cohort

Pregnant women (n=10)

Mean age of 31.3 years

In last trimester of pregnancy

31-38 weeks gestational age

Aberdeen, Scotland

Healthy

Fatty acid composition of maternal perfusate

31-38 weeks gestation

Haggerty et al., 1997

Cohort

Term placentae (n=9)

Mean weight of 566 g

Delivered vaginally or by elective caesarean section

Uncomplicated pregnancies

Nonsmokers

Placental tissue lipids

Within 20 minutes of delivery

Al et al., 1995

Cohort

Pregnant women (n=110)

Aged 19-43 years

Maastricht, Netherlands

Caucasian

Singleton pregnancy

DBP <90 mmHg

No metabolic, cardiovascular, neurological or renal disorder

Maternal venous and umbilical vein fatty acid profiles

10, 14, 18, 22, 26, 30, 32, 34, 36, 38, 40 weeks gestation; after delivery; 6 months after delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Unspecified

“When perfused with fatty acids in the ratios found in maternal circulating triglyceride, the human placenta selectively transfers PUFA to the fetus in the order: DHA > ALA > LA > AA.”

“The ultimate source of fatty acids for the placenta is important for estimates of the likely supply of individual PUFA/LCPUFA to the fetus in utero.”

“The biggest determinant of transfer of individual fatty acids from the mother to fetus is the supply of fatty acids available in the maternal circulation.”

N/A

Unspecified

“The order of selectivity for placental transfer to the fetal circulation was DHA > ALA > LA > oleic acid, whilst the proportion of AA transferred was actually lower than that for oleic acid.”

“There was no evidence of chain elongation of LA or ALA to any LCPUFA of the n-6 or n-3 series in the perfused placenta.”

N/A

Absolute amount not specified

“The average amount of total fatty acid in maternal venous plasma phospholipids increased significantly (p<0.0001) during pregnancy, but the rise in total fatty acids became less pronounced towards the end of gestation (p<0.0001).”

Total fatty acids increased from 1238.11 mg/L at week 10 to 1867.84 mg/L at week 40 of gestation, and all of the fatty acid families showed a similar course.

“The mean amount of total fatty acids in umbilical plasma phospholipids was substantially lower (p<0.0001) than all maternal values” for all fatty acid families.

“In contrast to the absolute amounts of AA and DHA, the mean relative amounts of AA and DHA in umbilical plasma phospholipids were significantly (p<0.0001) higher than all maternal values.”

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Clandinin et al., 1980b

Cohort

Male infants (n=14)

Female infants (n=7)

Died within 3 days of birth

Toronto, Canada

Infants died from intrapartum asphyxia, congenital heart disease, sudden infant death syndrome, diaphragmatic hernia, and accidental causes

Infants were of normal body weight and weight for length, with the exception of two infant males; infants had normal head circumference, with the exception of one infant male

No infections or gastrointestinal disorders, apparently normally nourished, and growing reasonably well until the time of death

Tissue fatty acid content from frontal and occipital brain lobes and cerebellum

16 hours postmortem

Bjerve et al., 1993

Case-control

Cases = adults (n=156)

Controls = normal human serum stored at −80 degrees C

Aged >40 years

Nord-Trondelag, Norway

Previously undiagnosed diabetic patients

Preterm infants (n=21)

Very low birth weight, with birth weight <1500 g seen consecutively at the Department of Pediatrics

Seafood and dietary DHA and AA intake

10 weeks for adults and 1 year for the preterms

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“Postnatal brain growth, expressed as wet weight of brain tissue, increased during the postpartum period, but was not as rapid as intrauterine brain growth.”

“In contrast to the fatty acid components, postpartum levels of LA increased 4-fold relative to prenatal levels; postpartum brain levels of AA do not differ from those observed in brain during the third trimester.”

“Chain elongation-desaturation of AA and LA to longer-chain homologues does not occur at maximal rates for several weeks postnatally or, alternatively, that these long-chain homologues if synthesized in extracerebral tissues may not be directed into synthesis of brain tissue during this early period of infant development.”

N/A

Number of fish meals per week: <2, 2, 3, and ≥4

Mean AA intake of these groups: (g/day)

1.22, 1.19, 1.31, 1.59

“After controlling for age, gender, BMI, alcohol intake, and smoking, there was a statistically significant positive correlation based on individual observations between increasing number of fish meals and the concentration of plasma phospholipid EPA (p<0.001) and DHA (p<0.001).”

After controlling for APGAR score and weight at 1 year, 82% of the variance in MDI was explained by a model including the inverse of both DHA and EPA (p=0.0001).

After controlling for weight at 1 year, 64% of the variance in PDI was explained by a model including the inverse of DHA (p=0.0001).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Uauy et al., 1990

Case-control

Case = infants fed formula by day 10 (n=32)

Control = infants fed their own mother’s milk from birth (n=10)

Birth weight appropriate for gestational age, able to receive enteral feedings, free of major neonatal morbidity by day 10

Human milk and milk formula

Day 10 until 36 weeks old

Makrides et al., 1994

Cross-sectional

Male infants (n=16)

Female infants (n=19)

Died between weeks 2 and 48

South Australia

All but two born at term

Human milk and milk formula

Within 48 weeks of birth

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Human milk:

12.7 g/100 g AA, 1.5 g/100 g n-6 > C18, 0.8 g/100 g ALA, 0.5 g/100 g n-3>C18

Formula A:

24.2 g/100 g AA, 0.0 g/100 g n-6 > C18, 0.5 g/100 g ALA, 0.0 g/100 g n-3>C18

Formula B:

20.8 g/100 g AA, 0.0 g/100 g n-6 > C18, 2.7 g/100 g ALA, 0.0 g/100 g n-3>C18

Formula C:

20.4 g/100 g AA, 0.1 g/100 g n-6 > C18, 1.4 g/100 g ALA, 1.0 g/100 g n-3>C18

“Group C was comparable to the human milk-fed group, but Group A had lower DHA and n-3 LCPUFA in plasma and RBC membranes.”

“Cone function was not affected by dietary essential fatty acids.”

“Rod electroretinogram thresholds were significantly higher for Group A relative to the human milk-fed infants and Group C and significantly correlated with RBC n-3 LCPUFA (p<0.0001).”

“Rod electroretinogram amplitude was significantly lower for Group A relative to the human milk-fed infants and Group C and related to plasma DHA and total n-3 LCPUFA (p<0.0001).”

N/A

Breast-feeding index = length of breastfeeding as a % of age at death:

Breast-fed: ≥85%

Formula fed: <30%

LA in formula ranged from 12.0% to 15.0% and ALA in formula ranged from 1.0% to 1.6%

Erythrocyte fatty acid composition of tissues were significantly lower in total saturated fatty acids (p<0.05), AA (p<0.05), and DHA (p<0.05) and significantly higher in DGLA (p<0.05), EPA (p<0.05), and DPA (p<0.05) for infants fed formula compared to those fed from the breast.

Cortex fatty acid composition of tissues were significantly higher in 22:4n-6 (p<0.05), 22:5n-6 (p<0.05), and total n-6 (p<0.005) and lower in DHA (p<0.005) and total n-3 (p<0.005) for infants fed formula compared to those fed from the breast.

There were no significant differences in retina fatty acid composition of tissues between the formula-fed and breast-fed infants.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Farquharson et al., 1992

Cross-sectional

Term infants (n=20)

Preterm infants (n=2)

Greater Glasgow Health Board area

Died within 43 weeks of birth

Previously well infants who died suddenly in the home, “cot deaths”

Human milk and milk formula

Within 43 weeks of birth

Martinez, 1992

Cross-sectional

Infants born at different gestational ages and died soon after birth of acute causes that were not related to the central nervous system

Not fed but mothers well-nourished

Infants nourished in utero and after birth

PUFA supplementation and PUFA-enriched formula

After infant died (they died shortly after birth)

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Breast milk or the formula milks SMA Gold Cap and/or White Cap, Cow and Gate Premium, or Osterfeed

“Breast fed infants had greater concentrations of DHA in their cerebral cortex phospholipids than either the mixed fed group or the older SMA and CGOST groups.”

“No significant differences in phospholipid fatty acid content of cerebral cortex were found between the age-comparable SMA and CGOST groups.”

N/A

Prenatal fatty acid amounts not specified

“Long-chain fatty acids accumulate in the human brain during the brain’s growth spurt unless a serious imbalance in the supply of LA and ALA occurs.”

“The active formation of synaptic structures and dendritic arborizations increases significantly between 31 weeks of gestation and term.”

“It seems highly desirable to enrich parenteral lipids and milk formulas with DHA to provide between 0.5% and 1% of total fatty acids similar to those in human milk.”

“A total n-6/n-3 fatty acid ratio between 5 and 7 seems appropriate according to our analysis of human milk from others consuming complete, balanced Mediterranean diets rich in fish.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Kodas et al., 2004

Animal

2 generations of female Wistar rats

ALA-deficient diet

Control group: Control diet at birth to 60 days after birth

Deficient group: Deficient diet at birth to 60 days after birth

Diet reversed group 1: Control diet at day of birth until 60 days after birth

Diet reversed group 2: Deficient diet until day 7 of life and then control diet from day 7 to day 60 of life

Diet reversed group 3: Deficient diet until day 14 of life and then control diet from day 14 to day 60 of life

Diet reversed group 4: Deficient diet until day 21 of life and then control diet from day 21 to day 60 of life

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

ALA-deficient diet:

6% fat African peanut oil

<6 mg ALA/100 g diet

1200 mg LA/100 g diet

Control diet:

60% peanut oil, 40% rapeseed oil

200 mg ALA/100 g diet

1200 mg LA/100 g diet

The fatty acid composition of phosphatidylcholine in the hippocampus of 2-month-old rats was as follows:

AA was not significantly different among the different diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05); these differences were not significant between the control group and the diet reversed groups.

The fatty acid composition of phosphatidylethanolamine in the hippocampus of 2-month-old rats was as follows:

AA was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05); DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05); these differences were not significant between the control group and the diet reversed groups.

The fatty acid composition of phosphatidylserine in the hippocampus of 2-month-old rats was as follows:

AA was not significantly different among the different diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05); these differences were not significant between the control group and the diet reversed groups; and

Basal 5-HT levels were significantly higher in the deficient group compared with the control group (p<0.05); there were no significant differences in basal 5-HT levels between the diet reversed groups 1, 2, and 3 and the control group; there were no significant differences in basal 5-HT levels between the diet reversed group 4 and the control group, deficient group, and all other diet reversed groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Korotokova et al., 2004

Animal

Pregnant Sprauge-Dawley rats

n-6:n-3 diet, n-3 diet, and n-6 diet

10 days before delivery

10-16 days of lactation, dam fed water with ovalbumin or just water

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

n-6:n-3 diet (in mol%):

7.0% soybean oil

56.0% LA, 6.2% ALA, 9.0% n-6:n-3

n-3 diet (in mol%):

7.0% linseed oil

14.0% LA, 33.0% ALA, 0.4% n-6:n-3

n-6 diet (in mol%):

7.0% sunflower oil

65.0% LA, 0.3% ALA, 216.0% n-6:n-3

In the pups not exposed to ovalbumin:

Delayed-type hypersensitivity responses against ovalbumin, as well as against human serum ovalbumin were not significantly different between the dietary groups;

IgG anti-avalbumin and IgG anti-human serum ovalbumin antibodies were not significant different between the three diet groups;

IgM anti-ovalbumin antibodies in the n-3 diet group are significantly higher than those in the n-6:n-3 diet group (p<0.05); and

IgM anti-human serum ovalbumin antibodies in the n-3 diet group are significantly higher that those in the n-6: n-3 diet group (p<0.05).

In the pups exposed to ovalbumin:

Delayed-hypersensitivity responses against ovalbumin were significantly higher in the n-6:n-3 diet group compared to the n-3 diet group and the n-6 diet group, while delayed-hypersensitivity responses to human serum ovalbumin were significantly higher in the n-6:n-3 diet group compared to the n-3 diet group (p<0.05);

IgG anti-human serum ovalbumin antibodies were significantly higher in the n-6:n-3 diet group than those in the n-3 diet group (p<0.05); and

IgM anti-human serum ovalbumin antibodies in the n-3 diet group are significantly lower than those in the n-6: n-3 diet group and the n-6 diet group (p<0.05).

Those in the n-3 diet group exposed to ovalbumin have significantly lower IgG ovalbumin, IgG anti-human serum ovalbumin, IgM anti-ovalbumin, and IgM anti-human serum ovalbumin antibodies than those not exposed to ovalbumin (p<0.05).

Those in the n-6 diet group exposed to ovalbumin have significantly lower IgG ovalbumin and IgM anti-ovalbumin antibodies than those not exposed to ovalbumin (p<0.05).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Levant et al., 2004

Animal

Adult female Long-Evans rats

LCPUFA-deficient diet

Control diet: Day 1 of pregnancy until end of study

Deficient diet: Day 1 of pregnancy until postnatal day 21. Postnatal day 21, half on deficient diet were changed to remediation diet and half stayed on deficient diet

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control diet: 0.35 kg/5 kg diet from soybean oil; no detected AA, EPA, DPA, or DHA

Deficient diet: 0.35 kg/5 kg diet from sunflower oil; no detected AA, EPA, DPA, or DHA

Remediation diet: 0.3275 kg/5 kg diet from sunflower oil and 0.0225 kg/5 kg diet from fish oil

0.1 g/100 g fatty acids AA, 1.6 g/100 g fatty acids EPA, 0.4 g/100 g fatty acids DPA, 3.5 g/100 g fatty acids DHA

“Rats raised on the deficient diet exhibited a decrease in brain DHA content to 80% of control animals at maturity (p<0.05)” and an “increase in DPA content to 575% of control animals at maturity (p<0.001).”

The remediation diet restored brain DHA and DPA content to levels similar to those on the control diet.

Catalepsy score was significantly lower in the deficient diet group compared to the control group (p<0.05) and the remediation diet group (p<0.05).

In a test of locomotor activity in a novel environment, the deficient diet group exhibited 187% of the activity of the control diet group during the 2-hour observation (p<0.05); results were similar between the deficient diet group and the remediation diet group.

In the test of amphetamine-stimulated locomotor activity, the deficient diet group exhibited 144% of the activity of the control group (p<0.05).

A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Neuringer et al., 1986

Animal

Adult female rhesus monkeys

n-3-deficient diet

2 months before conception and throughout pregnancy

*B = Evidence of a benefit; N = Evidence of no association or no clear association; N/A = A conclusion is not available; these data are presented for background information only; A = Evidence of an adverse effect.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Semipurified diet:

Deficient in n-3 fatty acids

Safflower oil was sole fat source

High n-6:n-3 ratio

Controls:

Soybean oil was sole fat source

High in LA

At all ages, animals of the “deficient group had considerably lower levels of n-3 fatty acids in tissue phospholipids than their controls.”

Based on the occipital cortex, perinatal 22:5n-6 (p<0.01) and total n-6 (p<0.05) were significantly higher and perinatal DHA (p<0.01) and total n-3 (p<0.01) were significantly lower in the deficient group compared to the control group.

Based on the occipital cortex, 22:4n-6 (p<0.01), 22:5n-6 (p<0.01), and total n-6 (p<0.01) at 22 months were significantly higher and DHA (p<0.01) and total n-3 (p<0.01) at 22 months were significantly lower in the deficient group compared to the control group.

Based on the frontal cortex, perinatal 22:5n-6 (p<0.01) was significantly higher and perinatal DHA (p<0.01) and total n-3 (p<0.01) were significantly lower in the deficient group compared to the control group.

Based on the frontal cortex, 22:5n-6 (p<0.01) and total n-6 (p<0.01) at 22 months were significant higher and DHA (p<0.01) and total n-3 (p<0.01) at 22 months were significantly lower in the deficient group compared to the control group.

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1e Studies on Allergies: Effects on Infants and Children of Mothers Who Increase Seafood and/or Omega-3 Fatty Acid Intake

Author

Study Type

Subjects

Exposure

Timing of Exposure

Denburg et al., 2005

Randomized Controlled Trial

Pregnant women (n=83)

Booked for delivery at St. John of God Hospital

Subiaco, Western Australia

With confirmed allergy

No smoking, other medical problems, complicated pregnancies, seafood allergy; normal dietary intake did not exceed two meals of fish per week

Fish-oil supplement

20 weeks of pregnancy until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil group:

3.7 g of n-3 PUFA

56.0% as DHA and 27.7% as EPA

Placebo group:

2.6 g olive oil

26 g/day oleic acid

Infants of those in the fish oil group had a significantly higher %CD34 expression than infants of those in the placebo group (p<0.002).

There was no significant difference between the two groups with respect to expression of all cytokine and chemokine receptors.

There was a significant association found between CD34+ in cord blood and AEDS (OR=3.93; 95% CI 1.05-14.64, p=0.042) at one year of age; however, there were no significant associations found for food allergy, moderate severe AEDS, asthma, chronic cough, or recurrent wheeze.

There were significant associations found between cord blood progenitor responsiveness to IL-5 and AEDS (OR=1.09, 95% CI 1.00-1.18, p=0.039) and recurrent wheeze (OR=1.11, 95% CI 1.02-1.21, p=0.022) at one year of age; however, there were no significant associations found for food allergy, moderate severe AEDS, asthma, or chronic cough.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Dunstan et al., 2003a

Randomized Controlled Trial

Pregnant women (n=83)

Atopic women

Booked for delivery at St. John of God Hospital

Subiaco, Western Australia

Physician-diagnosed allergic rhinitis and/or asthma

Allergic to house dust mites, grass pollens, molds, cat, dog, feathers, and cockroach and/or asthma

No medical problems, no smoking, no complicated pregnancies, no seafood allergy; normal diet did not exceed two meals of fish per week

Fish-oil supplement

20 weeks of pregnancy until delivery

Dunstan et al., 2003b

Randomized Controlled Trial

Pregnant women (n=83)

Atopic women

Booked for delivery at St. John of God Hospital

Subiaco, Western Australia

Physician-diagnosed allergic rhinitis and/or asthma

Allergic to house dust mites, grasses, molds, cat, dog, feathers, and cockroach and/or asthma

No medical problems, no smoking, no complicated pregnancies, no seafood allergy; normal diet did not exceed two meals of fish per week; no preterm deliveries

Fish-oil supplement

20 weeks of pregnancy until delivery

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil group:

Four 1 g fish oil capsules/day

3.7 g of n-3 PUFA

56.0% as DHA and 27.7% as EPA

Placebo group:

Four 1 g olive oil capsules/day

66.6% n-9 oleic acid and <1.0% n-3 PUFA

Neonatal in vitro IL-10 response to cat allergen was significantly lower in the fish oil group than in the placebo group (p=0.046).

At birth, no significant differences were found in the neonates’ cytokine response to allergens and mitogens in the two groups at birth.

IFN-γ responses to OVA were detected more frequently in the control group than in the fish oil group (p=0.009).

There were no significant differences found in the frequency of detectable IL-5, IL-10, or IL-13 responses between the two groups.

“The detection of a lymphoproliferative response to allergens also tended to be lower in the fish oil group compared with the control group,” although this difference was not always significant (OR=4.48, 95% CI 0.87-23.07 for response to OVA allergen and OR=2.02, 95% CI 0.69-5.88 for response to cat).

B

Fish oil group:

Four 1 g fish oil capsules/day

3.7 g of n-3 PUFA

56.0% as DHA and 27.7% as EPA

Placebo group:

Four 1 g olive oil capsules/day

66.6% n-9 oleic acid and <1.0% n-3 PUFA

IL-13 levels were significantly lower (p=0.025) in neonates whose mothers received fish-oil supplements in pregnancy compared to the placebo group.

There were no significant differences in IFN-γ levels in cord plasmas or in IgE in plasma between the two groups.

There were no significant differences in the frequency of lymphocyte subsets for total T cells, T helper cells, T suppressor cells, NK cells, and B cells between the two groups.

After adjusting for parity, gender, and delivery method, there were significant associations between cord plasma IL-13 levels and neonatal red cell membrane DHA levels (β=−0.25, 95% CI −0.49 to −0.01) and total n-3 fatty acid levels (β=−2.70, 95% CI −5.35 to −0.05).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Hawkes et al., 2002

Randomized Controlled Trial

Women (n=120)

Aged 20-42 years, mean about 30 years

Delivered full-term singleton infants, intended to breast-feed ≥12 weeks

Adelaide, South Australia

No known history of inflammatory disorders, not currently taking anti-inflammatory medication or fish-oil supplements

Excluded women who had ceased lactating by 4 weeks postpartum

DHA supplement

Day 3-week 12 postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Asked to limit fish and seafood intake to a maximum of 1 meal/week

Placebo:

500 mg placebo oil

Low-DHA capsule group:

70 mg EPA/day, 300 mg DHA/day

High-DHA capsule group:

140 mg EPA/day, 600 mg DHA/day

“There was no significant difference between the dietary groups in mean rank concentrations of IL-6 or TNF-α in the aqueous phase of milk” at 4 weeks postpartum.

“There was no significant difference in mean rank concentrations between the dietary groups for any of the cytokines produced by cells isolated from human milk or peripheral blood after in vitro stimulation with lipopolysaccharide or in the absence of stimulation” at 4 weeks postpartum.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Hodge et al., 1998

Randomized Controlled Trial

Boys and girls (n=39)

Aged 8-12 years

Sydney, Australia

Asthmatic with a history of episodic wheeze in the last 12 months, AHR to histamine

Omega-3 diet and omega-6 diet

6 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Omega-3 diet group:

Canola oil and canola-based margarines and salad dressings to replace usual oils and margarines

Supplement capsules = 0.18 g EPA and 0.12 g DHA/capsule

4 capsules/day = 1.20 g omega-3/day

Omega-6 diet group:

Sunflower oil and sunflower oil-based margarines and salad dressings to replace usual oils and margarines

Supplement capsules = 0.45 g safflower oil, 0.45 g palm oil, 0.10 g olive oil/capsule

No EPA or DHA

“There was no significant change in spirometric function, dose-response ratio to histamine or asthma severity score at either 3 or 6 months in either group.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Newson et al., 2004

Cohort

Children (n=1238 with cord blood fatty acid data and eczema at 18 to 30 months data; n=2945 with maternal blood fatty acid data and eczema data; n=2764 with maternal blood fatty acid data and wheezing data)

Bristol, England

Avon Longitudinal Study of Parents and Children (ALSPAC)

Cord blood and maternal blood red cell fatty acid analysis

20 weeks of pregnancy and at delivery

*B = Evidence of a benefit; N = Evidence of no association or no clear association.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Cord blood (percentages of total red blood cell membrane phospholipid):

Medians: 0.02 ALA, 0.11 EPA, 0.22 DPA, 2.00 DHA, 4.65 LA, and 7.80 AA

Maternal blood (percentages of total red blood cell membrane phospholipid):

Medians: 0.14 ALA, 0.23 EPA, 0.60 DPA, 2.02 DHA, 11.46 LA, and 5.88 AA

After controlling for sex, gestational age at birth, birth weight, mother’s age, education level, housing tenure, parity, ethnicity, smoking in pregnancy, maternal atopic disease, child’s head circumference at birth, child’s crown to heel length at birth, mother’s BMI, breastfeeding in first 6 months, and day care use in first 6 months:

All associations between fatty acid exposure (based on cord blood levels and maternal blood levels) and eczema at 18 to 30 months were found to be nonsignificant;

All associations between fatty acid exposure (based on both cord blood levels and maternal blood levels) and wheezing at 30 to 42 months of age were found to be nonsignificant;

LA:ALA levels in cord blood were significantly associated with later-onset wheeze (OR=1.30, 95% CI 1.04-1.61), as was the ratio of ALA:sum of n-3 products (OR=0.86, 95% CI 0.75-0.99); and

No other significant associations were found between fatty acid exposure and transient infant wheeze, later-onset wheeze, or persistent wheeze.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1f Studies on Visual Acuity: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula

Author

Study Type

Subjects

Exposure

Timing of Exposure

Simmer, 2005

Cochrane Review

9 Randomized Controlled Trials

LCPUFA-supplemented formula

 

Gibson et al., 2001

Review

Randomized Controlled Trials (11 on preterm and 10 on term infants)

Involving healthy preterm infants fed preterm formula

Involving healthy term infants fed formulas from near birth

Systematic literature review

DHA-supplemented formula

 

Uauy et al., 2001

Review

Summary of Randomized Controlled Trials on preterm and term infants

LCPUFA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“There is little evidence from randomized trials of LCPUFA supplementation to support the hypothesis that LCPUFA supplementation confers a benefit for visual or general development of term infants.”

“Minor effects on VEP acuity have been suggested, but appear unlikely when all studies are reviewed.”

N

 

“Benefits of adding DHA to formulas (with or without AA) on VEP acuity have been reported in some studies, whereas other studies have failed to detect a benefit of LC-PUFA supplementation.”

B

 

There is evidence supporting “the view that dietary essential fatty acid supply affects visual development of preterm and term infants.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

SanGiovanni et al., 2000a

Meta-analysis

Studies done in industrialized countries

Healthy, term infants

Randomized studies:

DHA supplemented (n=114)

DHA-free (n=87)

Nonrandomized studies:

Milk-fed/behavioral-based (n=117 at 2 months; n=148 at 4 months)

Milk-fed/electrophysiological tasks (n=146 at 4 months)

DHA-free/behavioral-based (n=174 at 2 months; n=113 at 4 months)

DHA-free/electrophysiological tasks (n=108 at 4 months)

All study designs:

DHA-supplemented/behavioral-based at 2 months (n=219)

DHA-supplemented/electrophysiological tasks at 4 months (n=265)

DHA-free/behavioral-based at 2 months (n=86)

DHA-free/electrophysiological tasks at 4 months (n=109)

DHA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

Based on behavioral tests of visual acuity, the randomized studies showed a significant difference in the estimates for those fed DHA-supplemented formula vs. those fed unsupplemented formula at 2 months of age (p≤0.0005). This difference was not significant at any other age presented.

Based on behavioral tests of visual acuity, the non-randomized studies showed a significant difference in the estimates for those fed human milk vs. those fed unsupplemented formula at 2 months of age (p≤0.0005) and 4 months of age (p≤0.05). This difference was not significant at any other age presented.

Based on electrophysiological tests of visual acuity, the randomized studies showed a significant difference in the estimates for those fed (DHA-supplemented) formula vs. those fed unsupplemented formula at 7 months of age (p≤0.05). This difference was not significant at any other age presented.

Based on electrophysiological tests of visual acuity, the nonrandomized studies showed a significant difference in the estimates for those fed human milk vs. those fed unsupplemented formula at 4 months of age (p≤0.0005), 5 months of age (p≤0.05), and 7 months of age (p≤0.05). This difference was not significant at any other age presented.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

SanGiovanni et al., 2000b

Meta-analysis

5 original papers (4 prospective trials)

4 review chapters

Preterm infants

Randomized studies:

DHA-supplemented/behavioral-based (n=48 at 2 months; n=70 at 4 months)

DHA-supplemented/VEP at 4 months (n=13)

DHA-free/behavioral-based (n=49 at 2 months; n=56 at 4 months)

DHA-free/VEP at 4 months (n=28)

All study designs:

DHA-supplemented/behavioral-based at 4 months (n=80)

DHA-supplemented/VEP at 4 months (n=37)

DHA-free/behavioral-based at 4 months (n=87)

DHA-free/VEP at 4 months (n=43)

DHA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

Based on behavioral tests of visual acuity, the randomized comparisons (between those fed DHA-supplemented formula and those fed unsupplemented formula) showed significant differences at 2 and 4 months of age (p≤0.001). This difference was not significant at any other age presented.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Hoffman et al., 2003

Randomized Controlled Trial

Infants (n=61)

Healthy, term, singleton infants

Birth weight appropriate for gestational age

Breast-fed to 4-6 months

North Dallas area, TX

95% White

No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia, or infection; presence of a congenital malformation or infection; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit

AA/DHA-supplemented formula

Enrolled at 6.5 weeks of age until 12 months of age (during time of weaning)

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Commercial formula (Enfamil with iron) or commercial formula supplemented with 0.36% of total fatty acids as DHA and 0.72% as AA

There were no significant differences in VEP acuity before weaning in the two groups, but at 12 months the supplemented group had significantly better VEP acuity than infants in the commercial formula group (p<0.0005).

There was a trend of better stereoacuity in the supplemented group compared to the commercial group at 9 months (p=0.12) and 12 months (p=0.13).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Birch et al., 2002

Randomized Controlled Trial

Infants (n=65)

Healthy, term, singleton births

Birth weight appropriate for gestational age

Weaned from breastfeeding at 6 weeks of age

Dallas area, TX

Mean maternal age about 30 years

75-78% White

Majority of mothers with at least a college degree

No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia, or infection; presence of a congenital malformation or infection; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit

AA/DHA-supplemented formula

6 weeks of age to 52 weeks of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Commercial formula (Enfamil with iron) or commercial formula supplemented with 0.36% of total fatty acids as DHA and 0.72% as AA

There were no significant differences in VEP acuity at age 6 weeks between the two groups.

The control group had significantly poorer visual acuity at week 17 (p<0.003), week 26 (p<0.001), and week 52 (p<0.001) compared to the supplemented group.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Innis et al., 2002

Randomized Controlled Trial

Infants (n=194)

Premature

Healthy, very low birth weight infants (846-1560 g), formula-fed

Multi-center study (16 neonatal centers in North America)

Not small for gestational age or >24 days postnatal age when full enteral feeds ≥375 kJ/kg/day were achieved

No necrotizing enterocolitis or other gastrointestinal disease, impaired visual or ocular status, or a history of underlying disease or congenital malformation that could interfere with growth

Reference group = term infants whose mothers anticipated breastfeeding for at least 4 months

AA/DHA-supplemented formula

Preterm formulas: At least 28 days after enteral intake of 375 kJ/kg/day reached

Term formulas: After hospital discharge until 57 weeks of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Preterm formula 1 = Control formula (no AA or DHA)

Preterm formula 2 = DHA formula (0.34% fatty acids as DHA)

Preterm formula 3 = DHA+AA formula (0.33% fatty acids as DHA, 0.60% fatty acids as AA)

Term formula = no AA or DHA

Breast-fed term infants = no solid foods during the study unless otherwise instructed by their physicians

At 57 weeks, visual acuity of the breast-fed term infants was significantly higher than in the premature infants, but not at 48 weeks; at 48 or 57 weeks, visual acuity was not significantly different among the premature infant groups.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Van Wezel-Meijler et al., 2002

Randomized Controlled Trial

Infants (n=42)

Preterm, admitted to neonatal intensive- or high-care unit of hospital

Birth weight <1750 g

Leiden, Netherlands

Mothers not breast-feeding

Normal neurological examination throughout the neonatal period

Repeated ultrasound of the brain being normal or showing, at most, minor abnormalities

No abnormalities of the central nervous system; abnormal neurological examination or occurrence of seizures; any systemic disease with potential negative influence on future growth or development; serious nutritional or gastrointestinal problems preventing initiation of enteral feeding after the first week postpartum or complete enteral feeding after the third week postpartum; retinopathy of prematurity grade 3 or more

AA/DHA-supplemented formula

2-3 weeks after birth until weighing 3000 g

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Supplemented preterm formula:

4.4 g fat/100 mL

0.015 g/100 mL of added DHA (microalgae)

0.031 g/100 mL of added AA (fungi)

Control formula:

4.4 g fat/100 mL

No addition of AA and DHA

There were no significant differences found in Flash VEP at 3 and 12 months between the two groups.

There were no significant differences found in visual acuity at 3, 6, 12, or 24 months between the two groups.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Makrides et al., 2000

Randomized Controlled Trial

Infants (n=73 in formula groups; n=63 in breastfed group)

White

Full-term and appropriate weight for gestational age

Mean mothers’ education was mid-secondary school level for formula-fed infants and completion of secondary school for breastfed infants

No congenital disease or complications during pregnancy

AA/DHA-supplemented formula

Age at entry not specified, up to 34 weeks of age

Bougle et al., 1999

Randomized Controlled Trial

Infants (n=40)

Mean age about 33 weeks

Enrolled the 2nd day of enteral feeding

Healthy, appropriate weight for gestational age

Premature

Free of respiratory, metabolic or neurological disease; malformations; infections; intrauterine asphyxia

Fed by digestive route within the first 7 days of life

LCPUFA-supplemented formula

Within the first 2 days of enteral feeding, then for 30 days

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Placebo formula (% total fatty acids):

16.8% LA, 1.5% ALA

DHA formula (% total fatty acids):

16.80% LA, 1.20% ALA, 0.10% EPA, 0.35% DHA

DHA+AA formula (% total fatty acids):

16.60% LA, 0.34% AA, 1.00% ALA, 0.34% DHA

Breast milk (% total fatty acids, mean±SE):

13.40±2.90% LA, 0.39±0.07% AA, 0.95±0.32% ALA, 0.09±0.03% EPA, 0.20±0.07% DHA

After adjusting for gender, postconceptional age, birth weight, and maternal smoking, there were no significant differences in VEP between any of the groups at 16 or 34 weeks of age.

N

Breast milk (% total fatty acids, mean±SE):

14.1±2.0% LA, 0.4±0.2% GLA, 0.9±0.2% AA, 0.5±0.1% ALA, 0.5±0.1% DHA

Formula A (% total fatty acids):

14.1% LA, 1.3% ALA

Formula B (% total fatty acids):

17.7% LA, 0.4% GLA, 0.1% AA, 1.2% ALA, 0.1% EPA, 0.6% DHA

There were no significant differences between the groups based on electrophysiological data, except that the maturation of the motor nerve conduction was significantly slower in the Formula B group than in the breast milk group and the Formula A group (p<0.05).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Carlson et al., 1999

Randomized Controlled Trial

Infants (n=119)

AA/DHA-supplemented formula

<8 days of age until about 12 months of age

Infants fed supplemented formula near birth received commercial formula from term less 3 months until 12 months of age; infants fed supplemented formula near term received commercial formula from term less 3 months to term less 1 month, and then supplemented formula until 12 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Commercially available standard formula contained no EPA or DHA

Supplemented formula 0.13% DHA and 0.40% AA from egg phospholipids

Compared to the infants not supplemented, “only those supplemented near birth had higher acuity at 2 months (p<0.02) and a trend toward higher acuity at 6 months (p<0.07).”

Infants supplemented at birth “also had higher acuity than those supplemented at term at 2 months (p<0.05).”

“First year acuity continued to increase (p<0.05) between consecutive ages until 6 months” in those supplemented at birth and 9 months in those unsupplemented and supplemented at term.

“All groups had similar acuity at 9 and 12 months.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Birch et al., 1998

Randomized Controlled Trial

Infants (n=108)

Healthy, term, birth weight appropriate for gestational age

Singleton births

Dallas, TX

75% White, 12% Black, 12% Hispanic, 1% other

Mean maternal age 29 years

67.6% mothers completed at least 2 years of college

No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia, or infection; presence of a congenital malformation or infection; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit

AA/DHA-enriched formula

0-4 days postpartum through 17 weeks of age

Carlson et al., 1996a

Randomized Controlled Trial

Infants (n=58)

Born at term (37-43 weeks)

Birth weight 747-1275 g

Memphis, TN

Predominantly Black

No growth retardation in utero and no medical problems likely to influence long-term growth and development

Mothers education mean of about 12 years

DHA-supplemented formula

24 hours after birth; end point not specified

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Enfamil + iron

Enfamil + iron + 0.35% DHA

Enfamil + iron + 0.36% DHA + 0.72% AA

Visual acuity was significantly poorer in the control group than in the DHA or DHA+AA groups and the breast-fed group.

At 6, 17, 26, and 52 weeks the association between RBC AA and sweep VEP was not statistically significant. The association was also nonsignificant for RBC EPA.

At 6, 17, 26, and 52 weeks, the association between RBC DHA was significantly associated with lower sweep VEP (p<0.001, p=0.01, p=0.05, p<0.001, respectively).

At 6, 17, and 52 weeks, the association between RBC n-3:n-6 was significantly associated with lower sweep VEP (p<0.001, p=0.03, p<0.001, respectively); the association was not statistically significant at 26 weeks.

B

Formula with AA+DHA = 2 g AA/100 g total fatty acids; 0.1 g DHA/100 g total fatty acids

Formula without DHA = 2.2 g ALA/100 g total fatty acids

“Term infants fed formulas with added AA and DHA had higher grating acuity at 2 months of age but not at 4, 6, 9, or 12 months of age compared with infants fed an unsupplemented formula.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Carlson et al., 1996b

Randomized Controlled Trial

Infants (n=59)

Memphis, TN

Maternal mean age about 22.5 year

No intraventricular or periventricular hemorrhage > grade 2; a history of maternal cocaine or alcohol abuse; congenital anomalies likely to affect long-term growth and development; or intrauterine growth retardation

Full enteral feeding of 418 kJ/kg/day by 6 weeks of age and tolerated enteral feeding thereafter

EPA/DHA-supplemented formula (marine oil)

Between 3-5 days postpartum until 2 months from expected term of 48±1 week post-menstrual age

Carlson et al., 1993

Randomized Controlled Trial

Infants (n=67)

Birth weight 748-1398 g

Mean gestational age 29 weeks

Memphis, TN

Did not require mechanical ventilation; have intraventricular hemorrhage > grade 2; have retinopathy of prematurity > stage 2; require surgical intervention for necrotizing enterocolitis; have severe intrauterine growth retardation; or a history of maternal substance abuse

Predominantly Black and from lower socioeconomic groups

Maternal age about 23 years

EPA/DHA-supplemented formula (marine oil)

Preterm formula from when infant tolerated enteral intakes >462 kJ/kg body weight/day for 5-7 days (≈3 weeks of age) until discharge

Term formula from discharge until 9 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Standard preterm formula = LA at 2.5% of total fatty acid

Marine-oil supplemented formula = 0.20% DHA and 0.06% EPA of total fatty acids

“Visual acuity improved significantly between successive ages of 0 and 2 months, 2 and 4 months … Between 6 and 12 months visual acuity plateaued.”

B

Commercially available standard formula contained no EPA or DHA

Marine-oil supplemented formula contained 0.2% DHA and 0.3% EPA of total fatty acids

Visual acuity development was significantly higher in the marine-oil group compared to the control group at 2 months (p<0.014) and 4 months (p<0.002).

There were no significant differences found at the other ages reported.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Birch et al., 1992

Randomized Controlled Trial

Male infants (n=32)

Female infants (n=41)

Born 27-33 weeks gestation

Birth weight 1000-1500 g

No respirator treatment for more than 7 days or congenital infections; gross congenital malformations; retinopathy of prematurity; or grade III or IV intracranial hemorrhages

EPA/DHA-supplemented formula (soy/ marine oil)

10 days of age until 6 months of age

Lauritzen et al., 2001

Review

Summary of the literature (animal, observational, RCTs)

DHA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Soy/marine oil-supplemented formula (preterm/follow-up formula, g/100 g lipids):

LA = 20.4/18.1

ALA = 1.4/1.4

EPA+DHA = 1.0/0.9

Corn oil-based formula (preterm/follow-up formula, g/100 g lipids):

LA = 24.2/21.1

ALA = 0.5/0.5

EPA+DHA = 0.0/0.0

Soy oil-based formula (preterm/follow-up formula, g/100 g lipids):

LA = 20.8/20.3

ALA = 2.7/2.8

EPA+DHA = 0.0/0.1

There were significant differences in VEP acuity for the different formula groups (p<0.025), with the corn oil group having poorer VEP acuity than the soy/marine oil group (p<0.05) at 36 weeks.

The corn oil group (p<0.05) and the soy oil group (p<0.05) had significantly poorer VEP acuity than the soy/marine oil group at 57 weeks.

B

 

“Observational studies in general show better retinal function in breast-fed infants than in infants fed formula without DHA, but approximately half of the intervention studies show no effect.”

Animal studies do offer evidence that DHA plays a role in retinal function, but these results cannot easily be extrapolated to humans.

4 RCTs with “preterm infants have all shown a positive effect of dietary DHA on visual development;” the results from term infants are not as conclusive.

More data is needed to see if the “variation in DHA content of human milk has a functional effect.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Williams et al., 2001

Cohort

Boys and girls (n=435)

Mean age of 3.5 years

Born in last 6 months of the Avon Longitudinal Study of Parents and Children (ALSPAC) enrollment period

Healthy term infants

Seafood (mother) and breast milk (child)

Seafood = during pregnancy (mother)

Breast milk = until 4 months of age (child)

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Oily fish consumption categories:

1 = Never or rarely

2 = Once every 2 weeks

3 = More than once every 2 weeks

White fish = cod, haddock, plaice, and “fish fingers”

Oily fish = pilchards, sardines, mackerel, tuna, herring, kippers, trout, and salmon

After adjusting for breast-feeding, sex, maternal education, maternal age, housing tenure, financial difficulties, maternal smoking, number of older siblings in household, child care, maternal job status, mother being vegetarian, mother’s fish-eating habits:

“Mothers who ate oily fish at least once every 2 weeks during pregnancy were more likely to have children who achieved foveal stereoacuity than were the mothers who never ate oily fish (OR=1.57, 95% CI 1.00-2.45),” but this was not significant; and

“The results of this study suggest that for full-term infants, breast-feeding is associated with enhanced stereopsis at age 3.5 years, as is a maternal DHA-rich antenatal diet, irrespective of later infant feeding practice.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Carlson et al., 1986

Cohort

Infants (n=27)

Born on or before 32 weeks gestation (range 24-32 weeks)

University of Mississippi Medical Center

Weighed <1500 g at birth and were on full feedings of at least 60 kcal/kg without intravenous supplementation

Free of major congenital malformations and did not have any ongoing major disease process

Discharged at about 1800 g

Human milk and milk formula

Delivery to an average of 7 weeks later

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Expressed, previously frozen milk produced by their own mothers or formula

Infants fed formula started with enteral feeding with Portagen and then Enfamil Premature and Similac Special Care as tolerated. Those followed after discharge were fed term formulas also produced by Enfamil and Similac

Human milk (in mol%, mean±SE):

LA = 16.00±1.30, AA = 0.59±0.04, ALA = 0.62±0.04, EPA = 0.03±0.00, DPA = 0.09±0.03, DHA = 0.19±0.03

Portagen (in mol%, mean±SE):

LA = 8.1, AA = None, ALA = Trace, EPA = None, DPA = None, DHA = None

Enfamil Premature (in mol%, mean±SE):

LA = 22.4, AA = None, ALA = 0.6, EPA = None, DPA = None, DHA = None

Similac Special Care (in mol%, mean±SE):

LA = 17.4, AA = None, ALA = 0.9, EPA = None, DPA = None, DHA = None

Based on phosphatidylethanolamine composition of fatty acids (in mol%): EPA was significantly lower (p<0.005) in those breast-fed after the feedings than in the pre-study samples; LA and DPA were significantly higher (p<0.001) and DHA was significantly lower (p<0.005) in those breast-fed after the feedings than in the preterm cord blood; LA was significantly higher (p<0.005) and EPA was significantly lower (p<0.005) in those formula-fed after the feedings than in the pre-study samples; LA was significantly higher (p<0.005) and DHA was significantly lower (p<0.001) in those formula-fed compared to those breast-fed; LA (p<0.005) and DPA (p<0.001) were significantly higher and AA (p<0.005) and DHA (p<0.001) were significantly lower in those formula-fed after the feedings than in the preterm cord blood; LA was significantly higher (p<0.005) and EPA was significantly lower (p<0.005) in those formula-fed after the feedings than in the pre-study samples.

Based on phosphatidylcholine composition of fatty acids (in mol%): LA was significantly higher (p<0.005) in those breast-fed after the feedings than in the pre-study samples; LA was significantly higher (p<0.005) and AA (p<0.001) and DHA (p<0.005) were significantly lower in those breast-fed after the feedings than in the preterm cord blood; LA was significantly higher (p<0.001) and AA was significantly lower (p<0.001) in those formula-fed after the feedings than in the pre-study samples; LA was significantly higher (p<0.005) and AA and DHA were significantly lower (p<0.001) in those formula-fed compared to those breast-fed; LA was significantly higher (p<0.005) and AA and DHA were significantly lower (p<0.001) in those formula-fed after the feedings than in the preterm cord blood.

Based on phosphatidylserine composition of fatty acids (in mol%): LA and DHA were significantly higher (p<0.005) in those breast-fed after the feedings than in the preterm cord blood; AA was significantly lower (p<0.005) in those breast-fed after the feedings than in the pre-study samples; LA and DHA were significantly higher (p<0.005) in those formula-fed after the feedings than in the pre-study samples; AA was significantly lower (p<0.005) and DHA was significantly higher (p<0.025) in those formula-fed after the feedings than in the pre-study samples.

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Putnam et al., 1982

Cohort

Infants (n=40)

Enrolled at birth

Well-baby clinic at the University of South Florida Medical Clinics

At least 90% of energy from human milk or formula before sample collection

Human milk and milk formula

3 weeks of age to 6 months of age

Breast milk collected at 8 weeks and infants’ blood drawn between 4.5 and 6 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Mothers were encouraged to follow the recommendations of the American Academy of Pediatrics Committee on Nutrition (food other than human milk or humanized formula be omitted from infant’s diet until he/she was 4-6 months of age)

Human milk (% of total, mean):

15.80±0.61 LA, 0.60±0.03 AA, 0.80±0.09 ALA, 0.10±0.03 EPA, 0.10±0.01 DPA, 0.10±0.01 DHA

Enfamil + iron (% of total, mean):

45.1 LA, No AA, 5.0 ALA, No EPA, No DPA, No DHA

SMA formula (% of total, mean):

14.0 LA, No AA, 1.2 ALA, No EPA, No DPA, No DHA

“Human milk-fed infants had lower concentrations of membrane LA than SMA-fed infants despite the equivalent relative intakes of dietary LA.”

“These diets did not influence the relative contributions of PE, PC, Sp, and PS to erythrocyte membrane phospholipid nor did they influence the lipid phosphorous/cholesterol ratio.”

Significant differences in fatty acid composition of infant erythrocyte ethanolamine are as follows (weight % of total fatty acid methyl esters):

Infants fed human milk had significantly higher AA (p<0.05), DPA (p<0.05), and DHA (p<0.001) than those fed SMA formula; and

Infants fed human milk had significantly higher AA (p<0.01) and significantly lower LA (p<0.001), ALA (p<0.001), EPA (p<0.05), and DHA (p<0.001) than those fed Enfamil formula with iron.

N/A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Sanders and Naismith, 1979

Cross-sectional

Infants (n=18)

Aged 14 weeks

Fed from birth a modified cow’s milk formula or had been breast-fed

Participated in an earlier study

Human milk and milk formula

14 weeks of age

Neuringer et al., 1984

Animal

Adult female rhesus monkeys

Diet deficient in n-3 fatty acids

2 months before conception and throughout pregnancy

*N = Evidence of no association or no clear association; B = Evidence of a benefit; N/A = A conclusion is not available; these data are presented for background information only.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Breast milk (% total fatty acids, mean±SE):

LA = 6.90±0.81, ALA = 0.80±0.05, EPA = 0.20±0.08, DPA = 0.52±0.27, DHA = 0.59±0.23

Milk formula (% total fatty acids, mean):

LA = 1.60, ALA = 0.70, EPA = 0.08, DPA = 0.11, DHA = 0.02

LA, AA, DHA are significantly lower in the formula-fed infants than in the breast-fed infants (p<0.01, p<0.05, p<0.01, respectively).

EPA and DPA are significantly higher in the formula-fed infants than in the breast-fed infants (p<0.05).

“The minimum requirement of the young infant for LA is substantially less than 1% of the dietary energy, the value most widely quoted.”

N/A

Experimental group:

Semipurified diet deficient in n-3 fatty acids

Safflower oil sole fat source

76.0% LA, 0.3% GLA, 0.2% DGLA, 0.3% ALA, 225.0% n-6:n-3 of total fatty acids

Control group:

Soy bean oil sole fat source

53.1% LA, 0.0% GLA, 0.3% DGLA, 7.7% ALA, 7.0% n-6:n-3 of total fatty acids

AA and total n-6 fatty acids were significantly higher in the experimental group infants compared to the control group infants (p<0.005).

ALA, EPA, DPA, DHA and total n-3 fatty acids are all significantly lower in the experimental group infants compared to the control group infants (p<0.001).

At 4, 8, and 12 weeks, the visual acuity threshold in the experimental group was significantly lower than in the control group (p<0.05, p<0.0005, p<0.005, respectively).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1g Studies on Cognitive and Motor Development: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula

Author

Study Type

Subjects

Exposure

Timing of Exposure

Cohen et al., 2005

Review

Aggregated 8 randomized controlled trials

(1 study of maternal dietary supplementation and 7 studies of formula supplementation)

n-3 supplement

 

Simmer and Patole, 2005

Cochrane Review

11 randomized controlled trials

LCPUFA-supplemented formula

 

Simmer, 2005

Cochrane Review

9 randomized controlled trials

LCPUFA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

An increase in maternal intake of DHA during pregnancy of 1 g/day will increase child IQ by 0.8-1.8 points.

“Prenatal maternal DHA intake increasing the child plasma (RBC) DHA phospholipid fraction by 1% has the same impact on cognitive development as formula DHA supplementation that increases the child’s plasma (RBC) DHA phospholipid fraction by 1%.”

“Because typical DHA intake associated with fish consumption is well under 1 g/day, changes in fish consumption will result in IQ effects amounting to a fraction of a point,” but they are not clinically detectable.

B

 

“No long-term benefits were demonstrated for infants receiving formula supplemented with LCPUFA. There was no evidence that supplementation of formula with n-3 and n-6 LCPUFA impaired the growth of preterm infants.”

N

 

“There is little evidence from randomized trials of LCPUFA supplementation to support the hypothesis that LCPUFA supplementation confers a benefit for visual or general development of term infants.”

“Minor effects on VEP acuity have been suggested, but appear unlikely when all studies are reviewed.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Gibson et al., 2001

Review

Randomized controlled trials (11 on preterm and 10 on term infants)

Involving healthy preterm infants fed preterm formula

Involving healthy term infants fed formulas from near birth

Systematic literature review

LCPUFA-supplemented formula

 

Uauy et al., 2001

Review

Summary of randomized controlled trials on preterm and term infants

AA/DHA-supplemented formula

 

Carlson and Neuringer, 1999

Review

Summary of animal studies and randomized controlled trials

Based on a session from the AOCS 1996 meeting: PUFA in Infant Nutrition: Consensus and Controversies

Neural DHA accumulation

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“Although there are still some concerns on safety issues regarding the addition of LCPUFA to preterm infant formula, the evidence in support of a beneficial effect of such supplementation on visual function is relatively compelling.”

“It seems that the possible negative effects of n-3 LCPUFA on growth of preterm infants have been overcome through improved study design and/or the addition of a balance of n-6 and n-3 LCPUFA.”

“There is also mixed evidence for the support of an effect of dietary LCPUFA on more global measures of development (Bayley’s Scales of Infant Development or Brunet-Lezine test).”

B

 

“Evidence for a beneficial effect of AA+DHA supplementation on CNS development is strong.”

“The preliminary information on cognitive development is insufficient to fully establish a relationship between LCPUFA and mental development.”

B

 

Studies in deficient monkeys suggest that “lower brain accumulation of DHA may influence neural domains such as sensation, motivation or temperament, but not cognition.”

“The most consistent effect identified to date in human and animal studies has been that of look duration and tests of visual attention.”

“A limited number of behavioral studies in animals and humans address the question of neural DHA accumulation and developmental measures other than vision.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Bouwstra et al., 2005

Randomized Controlled Trial

Infants (n=256 to 446, depending on assessment)

Term, healthy

Groningen, Netherlands

University and Martini Hospitals in Groningen and at midwife clinics

No congenital disorders that interfered with adequate functioning in daily life; infants from multiple births; infants whose mothers did not have mastery of the Dutch language or suffered from significant illness or disability; adopted or foster infants; or formula-fed infants who had received human milk >5 days

LCPUFA-supplemented formula

Birth to 2 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control formula (in mol%):

11.56 LA, 1.27 ALA

Supplemented formula (in mol%):

11.00 LA, 0.18 GLA, 0.03 DGLA, 0.39 AA, 1.30 ALA, 0.06 EPA, 0.23 DHA

Breastfed (in mol%, mean±SE):

13.62±4.24 LA, 0.11±0.03 GLA, 0.34±0.06 DGLA, 0.34±0.06 AA, 1.11±0.35 ALA, 0.06±0.04 EPA, 0.19±0.11 DHA

“The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices at 18 months.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Clandinin et al., 2005

Randomized Controlled Trial

Infants (n=361)

Preterm

Multi-site study

First phase:

Gestational age ≤35 weeks postmenstrual age

<10 total days of enteral feeding of >30 mL/kg/day

No congenital abnormalities of the gastrointestinal tract, hepatitis, hepatic or biliary pathology, necrotizing enterocolitis confirmed before enrollment, or history of underlying disease or congenital malformations likely to interfere with evaluation

Second phase:

Successful completion of the first phase, ≥80% of enteral intake from study formula during hospitalization, and 100% caloric intake from study formula at completion of the first phase

Algal-DHA- and fish-DHA-supplemented formulas, human milk

Premature formula: ≥14 days of age until at/near hospital discharge (40 weeks of age)

Discharge formula: 40 weeks until 53 weeks post-menstrual age

Term formula: 53 weeks until 92 weeks post-menstrual age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control formula:

No DHA or AA

Algal-DHA formula:

17 mg DHA/100 kcal from algal oil, 34 mg AA/100 kcal from fungal oil

0.3% fatty acids from DHA, 0.6% fatty acids from AA

Fish-DHA formula:

17 mg DHA/100 kcal from tuna fish oil, 34 mg AA/100 kcal from fungal oil

0.3% fatty acids from DHA, 0.6% fatty acids from AA

Worldwide human milk:

0.3% DHA and 0.6% AA (weight of fatty acids)

At 118 weeks, breast-fed term infants had significantly higher MDI and PDI scores compared to the control formula group, the algal-DHA formula group, and the fish-DHA formula group (p<0.05).

At 118 weeks, the algal-DHA formula group had a higher MDI score (p=0.056), although it was not significant, and a significantly higher PDI score (p<0.05) compared to the control formula group.

At 118 weeks, the fish-DHA formula group had significantly higher MDI and PDI scores (p<0.05) compared to the control formula group.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Jensen et al., 2005

Randomized Controlled Trial

Pregnant women (n=227)

Aged 18-40 years

Houston, TX

White (75% DHA group; 79% control group)

African American (19% DHA group; 13% control group)

Women plan to breastfeed exclusively for ≥4 months

Infant gestational age >37 weeks

Infant birth weight 2500-4200 g

No chronic maternal disorders; major congenital anomalies and obvious gastrointestinal or metabolic disorders of the infant

DHA supplement

Within 5 days after delivery until 4 months postpartum

Fewtrell et al., 2004

Randomized Controlled Trial

Infants (n=238)

Preterm

Glasgow, UK

Birth weight ≤2000 g

Mean maternal age about 29 years

Social class 1 or 2 (18% in controls; 27% in LCPUFA group)

Mothers with degree or higher (2% in controls; 7% in LCPUFA group)

LCPUFA-supplemented formula

Preterm formulas: when pediatrician decided that preterm formula should be started, to discharge

Discharge formulas: from discharge until 9 months after term

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

High-DHA capsule (algal triacylglycerol):

0.8% LA and 41.7% DHA by weight

200 mg DHA/day

Control capsule (soy and corn oil):

56.3% LA, 3.9% ALA by weight

There were no significant differences in visual acuity from the Teller Acuity Card at 4 or 8 months of age or from the Sweep VEP at 4 months of age between the two groups.

There were no significant differences in mean transient VEP latency at 4 and 8 months of age between the two groups; but the transient VEP amplitude was significantly lower in the infants of the high-DHA capsule group compared to the infants of the control capsule group (p<0.03).

There were no significant differences in Gesell Gross Motor, CAT, or CLAMS DQ scores at 12 and 30 months of age or in Bayley MDI at 30 months of age between the two groups; but Bayley PDI at 30 months of age was 8.4 points higher in infants of the high-DHA capsule group compared to infants of the control capsule group.

N

LCPUFA-supplemented formulas (g/100 g fat):

12.30 LA, 0.04 AA, 1.50 ALA, 0.10 EPA, 0.50 DHA

Control formulas (g/100 g fat):

11.5 LA, 1.6 ALA, no AA, EPA, or DHA

At 18 months of age, the Bayley MDI and PDI scores did not differ significantly between the groups.

At 9 months of age, overall development scores and individual subscale scores did not differ significantly between the groups.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Bouwstra et al., 2003

Randomized Controlled Trial

Infants (n=397)

Term, healthy

Groningen, Netherlands

University and Martini Hospitals in Groningen and at midwife clinics

No congenital disorders that interfered with adequate functioning in daily life; infants from multiple births; infants whose mothers did not have mastery of the Dutch language or suffered from significant illness or disability; adopted or foster infants; or formula-fed infants who had received human milk >5 days

LCPUFA-supplemented formula

Birth to 2 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control formula (in mol%):

11.56 LA, 1.27 ALA

Supplemented formula (in mol%):

11.00 LA, 0.18 GLA, 0.03 DGLA, 0.39 AA, 1.30 ALA, 0.06 EPA, 0.23 DHA

Breast-fed (in mol%, mean±SE):

13.62±4.24 LA, 0.11±0.03 GLA, 0.34±0.06 DGLA, 0.34±0.06 AA, 1.11±0.35 ALA, 0.06±0.04 EPA, 0.19±0.11 DHA

After controlling for profession of mother’s partner requiring a university or vocational-college education, Obstetrical Optimality Score, and age at assessment:

The control formula group had a significantly lower OR of occurrence of normal-optimal general movements at age 3 months when compared to the breastfed infants (OR=0.55; p=0.038); and

Those in the supplemented formula group had a significantly lower OR of occurrence of normal-optimal general movements at age 3 months when compared to the breast-fed infants (OR=0.42; p=0.006), but the OR was not significant when compared to the control formula group (OR=0.77; p=0.41).

After controlling for marital status, family history of diabetes, gestational age at birth, condition of perineum, and age at assessment:

The control formula group had a significantly higher OR of mildly abnormal general movements at age 3 months when compared to the breast-fed infants (OR=2.03; p=0.039); and

The supplemented formula group had a significantly lower OR of mildly abnormal general movements at age 3 months when compared to the control formula group (OR=0.49; p=0.032), but the OR was not significant when compared to the breast-fed infants (OR=0.94; p=0.87).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Helland et al., 2003

Randomized Controlled Trial

Pregnant women (n=48 in cod-liver oil group; n=36 in corn oil group)

Aged 19-35 years

Oslo, Norway

Healthy women with, singleton pregnancy, nulli- or primiparous, intention to breast-feed

No supplement of n-3 LCPUFA earlier during pregnancy, premature births, birth asphyxia, general infections, or anomalies in the infants that required special attention

Cod-liver oil supplement

From 18 weeks of pregnancy until 3 months after delivery

Fewtrell et al., 2002

Randomized Controlled Trial

Infants (n=195 formula-fed; n=88 breast-fed)

Preterm

Birth weight <1750 g

Nottingham and Leicester, UK

No congenital malformation known to affect neurodevelopment

Mothers decided not to breast-feed by 10 days of age; tolerated enteral feeds at that time (for randomized groups)

Social class 1 or 2 (19% in controls; 26% in LCPUFA group; 33% in breast-fed group)

LCPUFA-supplemented formula

10 days of age until discharge

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Cod-liver oil:

10 mL/day

1183 mg DHA, 803 mg EPA

Corn oil:

10 mL/day

4747 mg LA, 92 mg ALA

K-ABC scores were significantly higher for the subset MPCOMP among children from the cod-liver oil group compared to the corn oil group (p=0.049). The scores for the other subtests (SEQPROC, SIMPROC, NONVERB) were also higher in the cod-liver oil group compared to the corn oil group, but they were not significant.

B

LCPUFA-supplemented formula (g/100 g fat):

12.00 LA, 0.31 AA, 0.60 ALA, 0.04 EPA, 0.17 DHA

Control formula (g/100 g fat):

10.6 LA, 0.7 ALA, no detected AA, EPA, DHA

There were no significant differences in KPS quotients at 9 months of age and neurological status at 9 or 18 months of age between the two formula groups.

There were no significant differences found in Bayley MDI or PDI at 18 months of age between the two formula groups.

Breast-fed infants had significantly higher KPS quotients (overall, adaptive, gross motor, fine motor, and personal-social) at 9 months of age (p<0.005) and significantly higher Bayley MDI and PDI at 18 months of age (p<0.005) compared to the control formula-fed infants.

Breast-fed infants had significantly higher KPS quotients (overall, adaptive, gross motor, fine motor, and personal-social) at 9 months of age (p<0.005; p<0.05 for gross motor quotient) and significantly higher Bayley MDI and PDI at 18 months of age (p<0.005) compared to the LCPUFA-supplemented formula infants.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Van Wezel-Meijler et al., 2002

Randomized Controlled Trial

Infants (n=42)

Preterm, admitted to neonatal intensive-or high-care unit of hospital

Birth weight <1750 g

Leiden, Netherlands

Mothers not breast-feeding

Normal neurological examination throughout the neonatal period

Repeated ultrasound of the brain being normal or showing, at most, minor abnormalities

No abnormalities of the central nervous system; abnormal neurological examination or occurrence of seizures; any systemic disease with potential negative influence on future growth or development; serious nutritional or gastrointestinal problems preventing initiation of enteral feeding after the first week postpartum or complete enteral feeding after the third week postpartum; retinopathy of prematurity grade 3 or more

AA/DHA-supplemented formula

2-3 weeks after birth until weighing 3000 g

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Supplemented preterm formula:

4.4 g fat/100 mL

0.015 g/100 mL of added DHA (microalgae)

0.031 g/100 mL of added AA (fungi)

Control formula:

4.4 g fat/100 mL

No addition of DHA and AA

There were no significant differences found in Bayley MDI and PDI at 3, 6, 12, or 24 months between the two groups.

There were no significant differences found in myelination at 3 and 12 months between the two groups.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Auestad et al., 2001

Randomized Controlled Trial

Infants (n=294 formulafed; n=165 breast-fed)

Kansas City, MO; Little Rock, AR; Pittsburgh, PA; Tucson, AZ

Good health, term status, either ≤9 days of age (formula group) or ≤11 days of age and currently breast-feeding (breast-feeding group), birth weight ≥2500 g, 5-minute APGAR score ≥7, ability to tolerate milk-based formula or breast milk, guardian or parent agreement to feed the assigned study formula ad libitum according to the study design

No evidence of significant cardiac, respiratory, ophthalmologic, gastrointestinal, hematologic, or metabolic disease; milk-protein allergy; or a maternal medical history known to have proven adverse effects on the fetus, tuberculosis, HIV, perinatal infections, or substance abuse

61-74% European American

60-80% mothers married

Mean mothers’ age about 29 years

Mean mothers’ education about 14 years

Fish oil/fungal oil and egg-derived triglyceridesupplemented formulas

9-11 days after birth until 12 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Fish oil and fungal oil-supplemented preterm formula:

0.46 g AA/100 g total fatty acids

≤0.04 g EPA/100 g total fatty acids

0.13 g DHA/100 g total fatty acids

Egg-derived triglyceride-supplemented preterm formula:

0.45 g AA/100 g total fatty acids

No detected EPA

0.14 g DHA/100 g total fatty acids

Control formula:

No detected AA, EPA, DHA

The vocabulary expression score at 14 months was significantly higher in the fish/fungal group than in the egg-TG group (p<0.05).

Smiling and laughter was significantly higher in the control group than in the egg-TG group (p=0.05).

No other development, cognition, vocabulary, or temperament outcomes presented were significantly different between the formula groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

O’Connor et al., 2001

Randomized Controlled Trial

Infants (n=470)

Preterm

Birth weight 750-1800 g

Cleveland, OH; Kansas City, MO; Little Rock, AR; Nottingham and Leeds, UK; Louisville, KY; Portland, OR; New York, NY; Santiago, Chile

White (n=81 controls; n=80 fish/fungal; n=85 egg-TG)

No serious congenital abnormalities that could affect growth and development; major surgery before randomization; periventricular/intra-ventricular hemorrhage greater than grade II; maternal incapacity; liquid ventilation; asphyxia resulting in severe and permanent neurologic damage; or uncontrolled systemic infection at the time of enrollment

Fish oil/fungal oil and egg-derived triglyceride/fish oil-supplemented formulas

In hospital formula from within 72 hours of first enteral feeding until term-corrected age

Post-discharge formula from term-corrected age until 12 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

All in g/100 g total fatty acids (mean±SE)

In-hospital control:

16.0±0.9 LA, 2.4±0.1 ALA, no AA, EPA, DHA

In-hospital AA+DHA (fish/fungal oil):

16.80±1.00 LA, 2.60±0.30 ALA, 0.43±0.02 AA, 0.08±0.01 EPA, 0.27±0.04 DHA

In-hospital AA+DHA (egg-TG/fish oil):

17.50±0.90 LA, 2.50±0.30 ALA, 0.41±0.00 AA, no EPA, 0.24±0.01 DHA

Post-discharge control:

19.1±1.1 LA, 2.4±0.2 ALA, no AA, EPA, DHA

Post-discharge AA+DHA (fish/fungal oil):

19.50±0.70 LA, 2.40±0.20 ALA, 0.43±0.01 AA, no EPA, 0.16±0.01 DHA

Post-discharge AA+DHA (egg-TG/ fish oil):

20.30±0.40 LA, 2.40±0.20 ALA, 0.41±0.02 AA, no EPA, 0.15±0.02 DHA

The mean novelty preference of the egg-TG/fish oil formula group was significantly greater than the control group (p=0.02) and the fish/fungal formula group (p=0.003) at 6 months corrected age.

Using a Bonferroni adjusted alpha level of 0.0083, the difference between the fish/fungal formula group and the egg-TG/fish formula group was statistically significant.

“Vocabulary comprehension did not differ among the 3 study formula groups at either 9 or 14 months corrected age in either the intent-to-treat or subgroup analysis.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Birch et al., 2000

Randomized Controlled Trial

Infants (n=56)

Healthy, term, birth weight appropriate for gestational age

Singleton births

Dallas, TX

Predominantly White

About 65% mothers had a college or postgraduate education

No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia; or infection; presence of a congenital malformation or infection; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit

AA-enriched formula

0-4 days of age to 17 weeks of age

Lucas et al., 1999

Randomized Controlled Trial

Infants (n=309 formula-fed; n=138 breast-fed)

Healthy, term, singleton pregnancies, appropriate size for gestational age

Nottingham and Leicester, UK

Mean maternal age about 27 years

93.5% married

About 70% with no higher school qualifications

LCPUFA-supplemented formula

Birth until 6 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Enfamil + iron

Enfamil + iron + 0.35% DHA

Enfamil + iron + 0.36% DHA + 0.72% AA

The mean Bayley MDI score at 18 months was significantly higher in the DHA/AA-supplemented formula group than in the control formula group (p<0.05).

The mean Bayley PDI score at 18 months was not statistically different among the three groups (p=0.13).

The mean Behavioral Rating Scale score at 18 months was not statistically different among the three groups (p=0.30).

B

LCPUFA-supplemented formula:

15.90% LA, 0.30% AA, 1.40% ALA, 0.01% EPA, 0.32% DHA

Control formula:

12.4% LA, 1.1% ALA

There were no significant differences in Bayley MDI and PDI at 18 months or in Knobloch, Passamanick, and Sherrard’s test at 9 months between the two formula groups.

There were no significant differences in stools to 6 months, crying time (minutes/day) to 6 months, or formula intake to 6 months between the two formula groups.

There were no significant differences in the OR of infection-related outcomes or the prescription of antibiotics at 9 months between the two formula groups.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Scott et al., 1998

Randomized Controlled Trial

Infants (n=274)

Healthy, full-term

Kansas, MO; Portland, OR; Seattle, WA

No prematurity, intrauterine growth retardation, congenital anomalies, 5-minute APGAR score <7, or other significant perinatal medical complications

AA/DHA-supplemented formula

Those randomized, formula from first week after delivery

Those exclusively breastfeeding, breast milk for first 3 months and then supplementation with Similac + iron

Solid food supplementation at 4 months

Willatts et al., 1998a

Randomized Controlled Trial

Infants (n=44)

Term

UK

Mothers from a single maternity hospital

LCPUFA-supplemented formula

Birth to 4 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control formula:

No added LCPUFA

DHA formula group (fish oil):

0.2wt% DHA

DHA+AA formula group (egg yolk phospholipid):

0.12wt% DHA, 0.43wt% AA

There were no significant differences in Bayley scores among the groups for either the Mental Index or the Motor Index.

After controlling for maternal education and site, when comparing all four groups, the vocabulary comprehension score at 14 months was significantly lower in the DHA formula group compared to the breast-feeding group (p=0.017).

After controlling for maternal education and site, when comparing only the three formula groups, the vocabulary production score at 14 months was significantly lower in the DHA formula group compared to the control formula group (p=0.027).

No other reported associations between MacArthur Communicative Development Inventories at 14 months and the formula groups and those breast-feeding were found to be significant.

A

Unsupplemented formula (g/100 g fat):

11.40 LA, 0.70 ALA, <0.10 AA, no DHA

LCPUFA-supplemented formula (g/100 g fat):

11.50-12.80 LA, 0.60-0.65 ALA, 0.30-0.40 AA, 0.15-0.25 DHA

The median quartiles for entire problem intention score (p=0.035) and the cover step intention score (p=0.032) were significantly higher in the LCPUFA-supplemented group compared to the unsupplemented group.

The median quartiles for entire problem intentional solutions score (p=0.021) and cover step intentional solutions (p=0.005) were significantly higher in the LCPUFA-supplemented group compared to the unsupplemented group.

There were no significant differences in the median quartiles for the barrier step or cloth step for either the intention score or the intentional solutions score.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Willatts et al., 1998b

Randomized Controlled Trial

Infants (n=40)

Term

Birth weight 2500-4000 g

Dundee, UK

Mean maternal age about 27 years

Mean maternal education about 17 years

Demonstrated either an early or late peak fixation on the habituation assessment undertaken at 3 months of age

LCPUFA-supplemented formula

Birth to 4 months of age

Carlson and Werkman, 1996

Randomized Controlled Trial

Infants (n=59)

Mean gestational age about 28 weeks

Birth weight 747-1275 g

Predominantly Black

Memphis, TN

Mean mothers’ education about 12 years

No need for mechanical ventilation at that time; intraventricular hemorrhage > grade 2; retinopathy of prematurity > stage 2; surgery for necrotizing enterocolitis; weight < the fifth percentile for gestational age; history of maternal substance abuse

DHA-supplemented formula

Preterm formula from 3 days to 2 months of age

Term formula from 2 months to 12 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Unsupplemented formula (g/100 g fat):

11.40 LA, 0.70 ALA, <0.10 AA, no DHA

LCPUFA-supplemented formula (g/100 g fat):

11.50-12.80 LA, 0.60-0.65 ALA, 0.30-0.40 AA, 0.15-0.25 DHA

There were no significant differences in 9-month problem-solving scores (intention score and number of solutions) between the two groups.

For those who had an early peak fixation at 3 months, there were no significant differences in 9-month problem-solving score (intention score or intentional solutions) between the two groups (p=0.18).

For those who had a late peak fixation at 3 months, the number of intentional solutions was significantly higher in the LCPUFA-supplemented group compared to the unsupplemented group (p<0.02).

B

All in g/100 g total fatty acids

Preterm control formula:

21.20 LA, 2.40 ALA, no EPA or DHA

Preterm DHAsupplemented formula:

21.20 LA, 2.40 ALA, 0.06 EPA, 0.20 DHA

Term formula:

34.30 LA, 4.80 ALA, no EPA or DHA

At 12 months of age, the DHA-supplemented group had statistically more number of looks to familiar (p<0.05) and less seconds of time/novel looks (p<0.05) compared to the controls.

No other statistically significant results were reported on visual attention.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Werkman and Carlson, 1996

Randomized Controlled Trial

Infants (n=67)

Mean gestational age 29 weeks

Birth weight 748-1398 g

Can tolerate enteral; intakes >462 kJ/kg body weight/day for 5-7 days

Predominantly Black

Memphis, TN

Mean maternal age 23 years

Mean mothers’ education about 11.5 years

No need for mechanical ventilation at that time; intraventricular hemorrhage > grade 2; retinopathy of prematurity > stage 2; surgery for necrotizing enterocolitis; weight < the fifth percentile for gestational age; history of maternal substance abuse

DHA-supplemented formula

Preterm formula until discharge

Term formula from discharge until 9 months past term

Other foods gradually added to diet at about 4 months past term

Mixed diet, including whole cow’s milk from 9 to 12 months

Agostoni et al., 1995

Randomized Controlled Trial

Infants (n=86)

Mothers’ mean age = about 30 years

Gestational age between 37-42 weeks, weight at birth appropriate for gestational age

Milan, Italy

APGAR score better than 7 at 5 minutes, absence of disease

LCPUFA-supplemented formula

Within 3 days until 4 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

All in g/100 g total fatty acids

Preterm control formula:

19.1 LA, 3.0 ALA, no EPA or DHA

Preterm DHA-supplemented formula:

18.7 LA, 3.1 ALA, 0.3 EPA, 0.2 DHA

Term control formula:

33.2 LA, 4.8 ALA, no EPA or DHA

Term DHA-supplemented formula:

32.6 LA, 4.9 ALA, 0.3 EPA, 0.2 DHA

“Diet did not significantly influence look duration during familiarization, but there was a trend toward shorter look duration in DHA-supplemented infants compared to the controls.”

At 6.5 months of age, the DHA-supplemented group had a statistically higher number of total looks (p<0.01), number of looks to novel (p<0.01), and number of looks to familiar (p<0.05) compared to the controls.

At 9 months of age, the DHA-supplemented group had a statistically higher number of total looks (p<0.01), number of looks to novel (p<0.01), number of looks to familiar (p<0.05), and less seconds for average time/look (p<0.05) compared to the controls.

At 12 months, the DHA-supplemented group had a statistically shorter novel time as a percentage of total time (p<0.05), more seconds of time to familiar (p<0.05), and a higher number of total looks (p<0.01), number of looks to novel (p<0.05), and number of looks to familiar (p<0.05) compared to the controls.

No other significant results were reported for visual attention.

B

Supplemented formula (g/100 g fat):

10.80 LA, 0.30 GLA, 0.73 ALA, 0.44 AA, 0.05 EPA, 0.30 DHA

Standard formula (g/100 g fat):

11.10 LA, 0.70 ALA

Human milk (g/100 g fat):

6.9-16.4 LA, 0.1-0.9 GLA, 0.7-1.3 ALA, 0.2-1.2 AA, 0.0-0.6 EPA, 0.1-0.6 DHA

The mean developmental quotient (DQ) at 4 months for those in the standard formula group was statistically lower from the DQ in the supplemented formula group (p<0.05) and the breast-feeding group (p<0.05).

There was no statistical difference between the mean DQ at 4 months of the supplemented formula group and the breast-feeding group.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

McCann and Ames, 2005

Review

Summary of observational, RCTs, other experimental and animal studies

DHA status and LCPUFA-supplemented formula

 

Bryan et al., 2004

Review

Summary of the literature (all designs)

PUFA from breast milk or formula

 

Jacobson, 1999

Review

Mostly 2 prospective longitudinal studies

Detroit study on effects of prenatal exposure to alcohol

Michigan study of effects of pre- and postnatal exposure to PCBs

LCPUFA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“Evidence from chronic dietary restriction rodent studies … shows that the addition of DHA to diets of animals whose brain concentration of DHA have been severely reduced restored control performance levels.”

“Formula comparison and maternal supplementation studies in humans and ALA dietary restriction studies in nonhuman primates both link the availability of n-3 LCPUFAs to the development of visual attention” and higher DHA status to enhanced neuromotor development.

RCTs in humans have often shown no effect of “LCPUFA supplementation on cognitive or behavioral performance and some reviewers have considered that, overall, the evidence was insufficient to conclude that LCPUFA supplementation benefited development.”

B

 

“There is moderate evidence that PUFAs, and long-chain omega-3 PUFAs in particular, from either breast milk or supplemented infant formula, are beneficial in the development of visual acuity and cognitive performance in infants.”

“There is very limited empirical evidence, due to the small number of extant studies, for the beneficial effects of PUFAs, and omega-3 PUFAs in particular, on cognitive performance in older children.”

“Evidence suggest that omega-3 PUFAs may have a role in the control of the symptoms of neurological disorders such as ADHD and dyslexia.”

B

 

“Any comparisons between breastfed and supplemented groups should include measures of maternal IQ and quality of parenting on which these groups tend to differ.”

“Animal and human studies indicating a relation between LCPUFA supplementation and enhanced visual acuity and shorter visual fixations may, in fact, represent relatively independent effects of supplementation on both acuity and cognitive processing speed.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Daniels et al., 2004

Cohort

Infants (n=1054)

Mothers’ mean age = 29 years

Majority of mothers with at least an O level (moderate) education

Bristol, UK

Singleton, term births

Avon Longitudinal Study of Parents and Children (ALSPAC)

Seafood

Maternal fish intake: 32 weeks of gestation

Breast-feeding practices: 15 months after birth

Infant fish intake: 6 and 12 months after birth

Total mercury concentration: Cord blood at birth

Innis et al., 2001

Cohort

Infants (n=83)

Term

Birth weight 2500-4500 g

Mean mothers’ age 32 years

British Columbia

Intend to breast-feed for 3 months, no solid foods for at least the first 4 months after birth

No mothers with substance abuse, communicable diseases, metabolic or physiologic problems, infections likely to influence fetal growth, or multiple births

No infants with evidence of metabolic or physical abnormalities

Fatty acids in blood from infants and milk from mothers

2 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Maternal fish intake categories (during pregnancy):

1 = Rarely/never

2 = 1 meal/2 weeks

3 = 1-3 meals/week

4 = 4+ meals/week

Child fish intake categories (6 months of age):

1 = Rarely/never

2 = 1+ meal/week

Child fish intake categories (12 months of age):

1 = Rarely/never

2 = 1+ meal/week

Children whose mothers ate 1-3 fish meals/week and 4+ fish meals/week had significantly lower odds of low MCDI scores for social activity (OR=0.6, 95% CI 0.5-0.8 and OR=0.7, 95% CI 0.5-0.9, respectively) than the children whose mothers rarely or never ate fish during pregnancy.

Children whose mothers ate 1-3 fish meals/week and 4+ fish meals/week had significantly lower odds of low DDST scores for language (OR=0.7, 95% CI 0.5-0.9 and OR=0.7, 95% CI 0.5-0.9, respectively) than the children whose mothers rarely or never ate fish during pregnancy.

Children who ate 1+ fish meals/week had significantly lower odds of low MCDI scores for vocabulary comprehension (OR=0.7, 95% CI 0.5-0.8) and social activity (OR=0.7, 95% CI 0.6-0.9) and total DDST score (OR=0.8, 95% CI 0.6-0.9).

All other odds ratios presented were nonsignificant.

B

Infant DHA: (g/100 g fatty acids) Plasma phospholipids = 2.2-8.0 RBC PE = 6.3-13.0 PC = 1.4-4.6

Infant AA: (g/100 g fatty acids) Plasma phospholipids = 8.1-15.8 RBC PE = 20.2-27.8 PC = 5.6-9.7

Mother’s milk: (g/100 g milk fatty acids) DHA = 0.10-2.50 AA = 0.20-0.81 LA = 6.30-21.50 LNA = 0.50-4.10

“The ability to correctly discriminate a retroflex compared with dental phonetic contrast at 9 months of age was positively correlated with the plasma phospholipid DHA (p<0.02) and the RBC PE at 2 months of age (p=0.02).”

“There were no significant correlations between the infants’ AA status and the ability to discriminate the native or nonnative language contrasts.”

“There were no significant correlations between the infant DHA or AA status at 2 months of age and test scores for novelty preference, or the job search task, with adjustments for covariates included in the model.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Kodas et al., 2004

Animal

2 generations of female Wistar rats

ALA-deficient diet

Control group: Control diet at birth to 60 days after birth

Deficient group: Deficient diet at birth to 60 days after birth

Diet reversed group 1: Control diet at day of birth until 60 days after birth

Diet reversed group 2: Deficient diet until day 7 postpartum and then control diet from day 7 to day 60 postpartum

Diet reversed group 3: Deficient diet until day 14 postpartum and then control diet from day 14 to day 60 postpartum

Diet reversed group 4: Deficient diet until day 21 postpartum and then control diet from day 21 to day 60 postpartum

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

ALA-deficient diet:

6% fat African peanut oil

<6 mg ALA/100 g of diet

1200 mg LA/100 g of diet

Control diet:

60% peanut oil, 40% rapeseed oil

200 mg ALA/100 g of diet

1200 mg LA/100 g of diet

The fatty acid composition of phosphatidylcholine in the hippocampus of 2-month-old rats was as follows: AA was not significantly different among the different diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05). These differences were not significant between the control group and the diet reversed groups.

The fatty acid composition of phosphatidylethanolamine in the hippocampus of 2-month-old rats was as follows:

AA was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05); DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05). These differences were not significant between the control group and the diet reversed groups.

The fatty acid composition of phosphatidylserine in the hippocampus of 2-month-old rats was as follows: AA was not significantly different among the different diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05); n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05). These differences were not significant between the control group and the diet reversed groups.

Basal 5-HT levels were significantly higher in the deficient group compared with the control group (p<0.05); there were no significant differences in basal 5-HT levels between the diet reversed groups 1, 2, and 3 and the control group; there were no significant differences in basal 5-HT levels between the diet reversed group 4 and the control group, deficient group, and all other diet reversed groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Levant et al., 2004

Animal

Adult female Long-Evans rats

AA/EPA/DPA/DHA-deficient diet

Control diet: Day 1 of pregnancy until end of study

Deficient diet: Day 1 of pregnancy until postnatal day 21. Postnatal day 21, half on deficient diet were changed to remediation diet and half stayed on deficient diet

Chalon et al., 2001

Animal

Male rats 2-3 months old

ALA-deficient diet

2-3 months of age

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Control diet: 0.35 kg/5 kg diet from soybean oil; no detected AA, EPA, DPA, or DHA

Deficient diet: 0.35 kg/5 kg diet from sunflower oil; no detected AA, EPA, DPA, or DHA

Remediation diet: 0.3275 kg/5 kg diet from sunflower oil and 0.0225 kg/5 kg diet from fish oil

AA = 0.1 g/100 g fatty acids

EPA = 1.6 g/100 g fatty acids

DPA = 0.4 g/100 g fatty acids

DHA = 3.5 g/100 g fatty acids

“Rats raised on the deficient diet exhibited a decrease in brain DHA content to 80% of control animals at maturity (p<0.05)” and an “increase in DPA content to 575% of control animals at maturity (p<0.001).”

The remediation diet restored brain DHA and DPA content to levels similar to those on the control diet.

Catalepsy score was significantly lower in the deficient diet group compared to the control group (p<0.05) and the remediation diet group (p<0.05).

In a test of locomotor activity in a novel environment, the deficient diet group exhibited 187% of the activity of the control diet group during the 2-hour observation (p<0.05); results were similar between the deficient diet group and the remediation diet group.

In the test of amphetamine-stimulated locomotor activity, the deficient diet group exhibited 144% of the activity of the control group (p<0.05).

A

ALA-deficient diet:

1200 mg LA/100 g diet, <6 mg ALA/100 g diet

African peanut oil

Diet balanced in n-6 and n-3 PUFA:

1200 mg LA/100 g diet, 200 mg ALA/100 g

African peanut oil and rapeseed oil

“Intake of PUFA constitutes an environmental factor able to act on the central nervous system function.”

“Chronic dietary deficiency in ALA in rats induces abnormalities in several parameters of the mesocortical and mesolimbic dopaminergic systems.”

“It is proposed that strong links exist among PUFA status, neurotransmission processes, and behavioral disorders in humans.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

de la Presa, Owens, and Innis, 1999

Animal

Newborn male piglets

Birth weight >1 kg

<12 hours old

GLA/AA/DHA-supplemented formula

<12 hours old to 18 days of age

Delion et al., 1996

Animal

2 generations of female Wistar rats

ALA-deficient diet

2 weeks before mating (second generation)

*B = Evidence of a benefit; N = Evidence of no association or no clear association; A = Evidence of an adverse effect.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

4 formula diets (all in g/100 g):

Diet 1 (Diet D-):

1.6 LA, 0.1 ALA, no GLA, AA, or DHA

Diet 2 (Diet D+):

1.9 LA, 0.1 GLA, 0.4 AA, 0.1 ALA, 0.3 DHA

Diet 3 (Diet C-):

15.6 LA, 1.5 ALA, no GLA, AA, or DHA

Diet 4 (Diet C+):

16.4 LA, 0.1 GLA, 0.4 AA, 1.6 ALA, 0.3 DHA

There were no significant differences in brain weight, brain protein, DNA, cholesterol or phospholipid concentrations, or CNPase activity among the different diet groups.

Piglets fed formulas with AA and DHA had significantly higher frontal cortex dopamine, HVA, norepinephrine, tryptophan and serotonin concentrations than piglets fed formulas without AA and DHA.

The concentrations of all frontal cortex monoamines and metabolites in piglets fed Diet 2 formula were not different from those of piglets fed Diets 3 and 4.

The inclusion of AA and DHA in Diet 4 had no significant effect on any of the frontal cortex monoamines or metabolites measured, compared to Diet 3.

B

ALA-deficient diet:

6% fat as peanut oil

6 mg ALA/100 g diet

1200 mg LA/100 g diet

Control diet:

60% peanut oil, 40% rapeseed oil

200 mg ALA/100 g diet

1200 mg LA/100 g diet

In the control diet group, n-3 (mostly DHA) levels reached a maximum in the stratium and a minimum in the frontal cortex at 12 months of age and remained unchanged during aging in the cerebellum.

“In the deficient diet group, DHA content considerably reduced as compared with controls.”

No specific effects of the deficient diet were found on the proportion of any phospholipid classes.

In the control diet group, dopamine levels reached a maximum at 6 months of age, were decreased up to 12 months of age, and then stabilized in the stratium and frontal cortex. However, “the levels were not diet related in the stratium but were dramatically reduced in the frontal cortex of deficient rats and remained unchanged throughout all ages.”

In the control diet group, 5-HT levels increased between 2 and 6 months of age in the stratium and then stabilized; they did not change in the frontal cortex or cerebellum during aging.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1h Studies on Allergies: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula

Author

Study Type

Subjects

Exposure

Timing of Exposure

Calder, 2001

Review

Summary of animal studies and human trials

Fish-oil supplement

 

Field et al., 2001

Review

Summary of animal studies and human trials

AA/DHA-supplemented formula

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

 

“Animal studies have shown that dietary fish oil results in altered lymphocyte function and in suppressed production of proinflammatory cytokines by macrophages.”

“Clinical studies have reported that fish-oil supplementation has beneficial effects in rheumatoid arthritis, inflammatory bowel disease, and among some asthmatics.”

“The effect of fatty acids during pregnancy upon the maternal immune system and upon that of the infant are not known.”

B

 

“Recent research has been directed at the neurological, retinal, and membrane benefits of adding AA and DHA to infant formula. In adults and animals, feeding DHA affects T-cell function. However, the effect of these lipids on the development and function of the infant’s immune system is not known.”

“The addition of small amounts of DHA and AA (at levels similar to that in human milk) to preterm infant formula can influence the concentration, proportion, maturation, and cytokine production of peripheral blood lymphocytes.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Field et al., 2000

Randomized Controlled Trial

Infants (n=44)

Preterm, medically stable

Edmonton, AB, Canada

Appropriate weight for gestational age and receive 100% daily fluid and energy requirements enterally by day 14 postpartum

No major congenital infection, significant neonatal morbidity, or acute illness that precluded feeding by mouth; no mixed feedings or corticosteroids, red cell, and plasma transfusions, or intravenous lipid emulsion beyond day 8 postpartum

AA/DHA-supplemented formula

Before day 8 postpartum until day 42 postpartum

*B = Evidence of a benefit; N = Evidence of no association or no clear association.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion*

Standard commercial preterm formula group (% weight of total fatty acids):

12.8 LA, 1.4 ALA, no AA or DHA

Supplemented preterm formula group

(% weight of total fatty acids):

12.10 LA, 1.50 ALA, 0.49 AA, 0.35 DHA

At 14 days postpartum, infants in the supplemented formula group had significantly higher hematocrit (L/L) concentrations compared to those in the human milk group (p<0.05).

At 14 days postpartum, infants in the human milk group had significantly higher monocytes compared to both the standard formula group and the supplemented formula group (p<0.05).

At 42 days postpartum, infants in the standard formula group had significantly higher T helper phenotypes and CD4/CD8 phenotypes compared to both the supplemented formula group and the human milk group (p<0.05).

At 42 days postpartum, infants in the standard formula group had significantly lower monocytes compared to the human milk group (p<0.05).

At 42 days postpartum, infants in the human milk group had significantly higher B cells compared to those in both formula groups (p<0.05).

At 42 days postpartum, infants in the standard formula group had significantly higher sIL-2R production compared to the supplemented formula group (p<0.05) and significantly lower IL-10 production compared to the human milk group (p<0.05).

No other reported results were found to be significant.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1i Studies on ADHD: Effects on Children Supplemented with Omega-3 Fatty Acids in Foods Other Than Exclusively Breast Milk or Infant Formula Experimental Studies in Humans

Author

Study Type

Subjects

Exposure

Timing of Exposure

Richardson, 2004

Review

Summary of RCTs

HUFA supplement

 

Hirayama et al., 2004*

Randomized Controlled Trial

Children (n=40)

Aged 6-12 years

Recruited from a summer camp for children with psychiatric disorders

Diagnosed or suspected as ADHD

DHA supplement

2 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

 

Omega-3 fatty acids, particularly EPA, may be beneficial in the management of dyslexia, dyspraxia, and ADHD.

There is no evidence that omega-6 fatty acids are beneficial in the management of dyslexia, dyspraxia, and ADHD, but positive results have been found using an omega-3:omega-6 combination for both ADHD and dyslexia.

B

DHA group:

Fermented soybean milk 3 times/week (600 mg DHA/125 mL)

Bread rolls 2 times/week

(300 mg DHA/45 g)

Steamed bread 2 times/week

(600 mg DHA/60 g)

Total = 3600 mg DHA, 700 mg EPA/week

Control group:

Placebo food containing olive oil instead of DHA-rich fish oil

Short-term visual memory was significantly improved in the control group from baseline until the end of the study (p=0.02), but not in the DHA group. The short-term visual memory was significantly better in the control group than in the DHA group (p=0.02).

The number of errors of omission and commission were significantly improved in the continuous performance test in the control group from baseline until the end of the study (p=0.02 and p=0.01, respectively).

The number of errors of commission were significantly higher in the DHA group than in the control group (p=0.001).

A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Harding et al., 2003*

Trial

Boys and girls (n=20)

Aged 7-12 years

Diagnosed with ADHD

No other medication or treatment, street drugs, other nutritional or botanical supplements, comorbid disorders

Multivitamin, multiple mineral, phytonutrients, essential fatty acid supplements

4 weeks

Stevens et al., 2003*

Randomized Controlled Trial

Boys and girls (n=47)

Aged 6-13

Central Indiana = 100-mile radius of West Lafayette

Those with diagnosed ADHD and those without ADHD

No chronic health problems

Presence of 1+ severe symptoms or several mild symptoms

PUFA supplement

4 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Groups determined by parental choice

Ritalin group:

5-15 mg Ritalin 2-3 times daily

Supplement group:

A multivitamin, multi-mineral, phytonutrients, essential fatty acids (180 mg EPA and 120 mg DHA from salmon oil and 45 mg GLA from borage oil) and phospholipids (soy lecithin), probiotics, and amino acids

Both the Ritalin group and the supplement group showed significant gains in the Full Scale Response Control Quotient and the Full Scale Attention Control Quotient scores (p≤0.01 and p≤0.001, respectively).

There were no significant differences in improvement between the two groups.

B

PUFA group:

8 capsules of PUFA/day

60 mg DHA, 10 mg EPA, 5 mg AA, 12 mg GLA, 3 mg vitamin E/capsule

Placebo group:

8 capsules of placebo/day

0.8 g olive oil/capsule

Based on those who completed the intervention, the change in teacher hit reaction time (measured both in ms and T-score) was significantly greater in the PUFA group than in the placebo group (p=0.05 and p=0.02, respectively) at 4 months.

At baseline, there were no significant differences in parents’ DBD and teachers’ DBD scores between the two groups; after 4 months of treatment the number of children who improved on the parents’ DBD attention and oppositional/defiant disorder scales was significantly higher in the PUFA group than in the placebo group (p=0.09 and p=0.02, respectively).

No other significant differences were found between the two groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Richardson and Puri, 2002*

Randomized Controlled Trial

Boys and girls (n=41)

Aged 8-12 years

Northern Ireland

Referred to a school for children with specific literacy problems

No official diagnosis of ADHD or any other psychiatric disorder; use of fatty acid supplements in last 6 months; consumption of oily fish >2 times/week; history of any other neurological or major psychiatric disorder or other significant medical problems; not in treatment for ADHD

HUFA supplement

12 weeks

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Supplement group:

186 mg EPA/day, 480 mg DHA/day, 96 mg GLA/day, 60 IU vitamin E/day, 864 mg LA/day, 42 mg AA/day, 8 mg thyme oil/day

Placebo:

Olive oil

At 3 months, the mean psychosomatic ADHD subscale, mean Conners’ ADHD index score, and mean DSM inattention score were significantly lower in the supplemented group than in the placebo group (p=0.05, p=0.03, p=0.05, respectively).

At 12 weeks, the improvements were significantly greater for the supplemented group compared to the placebo group for the cognitive problems (p=0.01), the anxious/shy subscales (p=0.04), and the Conners’ index global scale (p=0.02).

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Brue et al., 2001

Randomized Controlled Trial

Boys and girls (n=51)

Aged 4-12 years

Referred by parents, pediatricians, psychologists, psychiatrists, and educators

ADHD diagnosed by a physician or psychologist

No serious and preexisting medical or psychological condition or taking a stimulant medication other than Ritalin

Essential fatty acid supplement

Two 12-week trials

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Trial 1:

Treatment Group and Ritalin + Treatment Group:

10 mg Ginkgo biloba, 200 mg Melissa officinalis, 30 mg Grapine, 35 mg dimethylaminoethanol, 100 mg 1-glutamine

Placebo Group and Ritalin + Placebo Group:

200 mg Slippery elm supplement

Trial 2:

Double Treatment Group and Ritalin + Double Treatment Group:

20 mg Ginkgo biloba, 400 mg Melissa officinalis, 60 mg Grapine, 70 mg dimethylaminoethanol, 200 mg 1-glutamine

Double Treatment + EFA Group and Ritalin + Double Treatment + EFA Group:

20 mg Ginkgo biloba, 400 mg Melissa officinalis, 60 mg Grapine, 70 mg dimethylaminoethanol, 200 mg 1-glutamine, 1000 mg flaxseed

Based on parent and teacher reports from Trial 1, there were no significant differences in inattentiveness or hyperactive-impulsive subscales between any of the treatment groups and their respective controls.

Based on parent reports from Trial 2, those in the double treatment + EFA group had a significantly lower hyperactive-impulsive subscale score than the double treatment group (p=0.03).

Based on teacher reports from Trial 2, those in the Ritalin + double treatment + EFA group had a significantly higher inattentive subscale score than the Ritalin + double treatment group (p=0.04).

Based on teacher reports from Trial 2, those in the double treatment + EFA group had a significantly higher hyperactive-impulsive subscale score than the double treatment group (p=0.04).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Voigt et al., 2001*

Randomized Controlled Trial

Boys and girls (n=63)

Aged 6-12 years

100% White in DHA group; 85% White in placebo group

Texas

No ineffective treatment with stimulant medication; treatment with other psychotropic medications; previous diagnosis of other childhood psychiatric disorders; use of dietary supplements; occurrence of a significant life event within 6 months; history of head injury or seizures; receipt of special education services for mental retardation or a pervasive developmental disorder; premature birth; exposure to tobacco, alcohol, or other drugs in utero; diagnosis of a disorder of lipid metabolism or other chronic medical condition

Previous diagnosis of ADHD

Being treated successfully with stimulant medication

Algae-derived triglyceride supplement

4 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Algae-derived TG capsule:

345 mg DHA/day

Between baseline and 4 months, TOVA errors of omission significantly increased (p=0.03-0.01) and color trails 1 (p=0.03-0.01) and color trails 2 (p=0.001) significantly decreased for the supplemented group.

Between baseline and 4 months, TOVA errors of commission (p<0.0003) and color trails 2 (p<0.0003) significantly decreased and TOVA total response time (p=0.03-0.01) significantly increased for the placebo group.

“There were no differences between groups at any time on any behavior measure by the parental Conners’ Rating Scales.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Stevens et al., 1995*

Case-control

Cases = boys with ADHD (n=53)

Control = healthy boys (n=43)

Aged 6-12 years

North central Indiana

Primarily White

Plasma fatty acid analysis

At time of visit

Mitchell et al., 1987*

Case-control

Cases = hyperactive children (n=48)

Controls = from two local primary schools (n=49)

Boys and girls

Mean age about 9 years

92% European

About 95% mothers in top three socioeconomic groups

Auckland, New Zealand

Serum fatty acid levels

At time of visit

Mitchell et al., 1983*

Case-control

Cases = from a residential school for “maladjusted” children (n=23)

Controls = from a normal intermediate school (n=20)

Boys and girls

Aged 10-13 years for controls

Aged 7.5-13 years for cases

Auckland, New Zealand

Level of red blood cell essential fatty acids

At time of visit

*Included in Schachter HM, Kourad K, Merali Z, Lumb A, Tran K, Miguelez M. 2005. Effects of Omega-3 Fatty Acids on Mental Health. Summary, Evidence Report/Technology Assessment No. 116 (Prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02-0021). Rockville, MD: Agency for Healthcare Research and Quality.

**B = Evidence of a benefit; A = Evidence of an adverse effect; N = Evidence of no association or no clear association.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Omega-3 fatty acids as continuous variables

Boys with ADHD had significantly lower mean levels of plasma AA, EPA, and DHA than the controls (p<0.02, p<0.02, p<0.03, respectively).

Boys with ADHD had significantly lower mean levels of red blood cell AA (p<0.02), 22:4n-6 (p<0.03), and DHA (p<0.06), and significantly higher mean levels of red blood cell 22:5n-6 (p<0.05) compared to the controls.

B

Omega-3 fatty acids as continuous variables

The mean level of DHA from nonfasting blood samples was significantly lower in the hyperactive children than in the controls (p=0.045).

The mean levels of DGLA and AA from nonfasting blood samples were significantly lower in the hyperactive children than in the controls (p=0.007 and p=0.027, respectively).

No significant differences in blood serum n-3 or n-6 fatty acids were found.

B

Omega-3 fatty acids as continuous variables

The mean levels of LA, DGLA, and AA from fasting blood samples were lower in the “maladjusted” children than in the normal children (0.05<p<0.01), although the differences were not significant.

The mean level of 22:5n-6 from fasting blood samples was higher in the “maladjusted” children than in the normal children (0.05<p<0.1), although this difference was not significant.

No other significant differences were found between the two groups in terms of fatty acid levels in fasting blood samples.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

TABLE B-1j Studies on Allergies and Asthma: Effects on Children Supplemented with Omega-3 Fatty Acids in Foods Other Than Exclusively Breast Milk or Infant Formula

Author

Study Type

Subjects

Exposure

Timing of Exposure

Peat et al., 2004

Randomized Controlled Trial

Pregnant women (n=616)

Mean age about 29 years

About 47% tertiary educated

Sydney, Australia

At least one parent or sibling with current asthma or frequent wheeze; fluency in English; a telephone at home; residence within 30 km of the recruitment center

No pet at home; vegetarian diet; multiple births; or less than 36 weeks gestation

The Childhood Asthma Prevention Study (CAPS)

Tuna-fish oil supplement

Child’s age of 6 months to 3 years

Hodge et al., 1998*

Randomized Controlled Trial

Boys and girls (n=39)

Aged 8-12 years

Sydney, Australia

Asthmatic with a history of episodic wheeze in the last 12 months and airway hyperresponsiveness to histamine

No other significant diseases; taking regular oral corticosteroids or with known aspirin or dietary salicylate sensitivity

EPA/DHA supplement

6 months

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Intervention group:

500 mg/day tuna fish oil

184 mg omega-3 fatty acids

Placebo group:

Sunola oil

83% monounsaturated oil

At 3 years of age, there were no significant differences in prevalence of asthma, wheezing, eczema, and atopy between the intervention group and the placebo group. However, those in the intervention group had significantly lower prevalence of mild or moderate coughing (p=0.03) and atopic coughing (p=0.003) than the placebo group.

N

Omega-3 group:

0.18 g EPA and 0.12 g DHA/capsule

4 capsules/day = 1.2 g omega-3/day

Omega-6 group:

0.45 g safflower oil, 0.45 g palm oil, 0.10 g olive oil/capsule

No EPA or DHA

“There was no significant change in spirometric function, dose response ratio to histamine or asthma severity score at either 3 or 6 months in either group.”

“There were no significant differences between groups in TNFα production over time (p=0.22).”

“Dietary enrichment of omega-3 fatty acids over 6 months increased plasma levels of these fatty acids, reduced stimulated tumour necrosis factor α production, but had no effect on the clinical severity of asthma in these children.”

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Denny et al., 2003

Review

18 cross-sectional studies

4 case-control studies

3 cohort studies

Dietary PUFA

 

Smit et al., 1999

Review

All epidemiological evidence

Seafood

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

 

“Very few studies investigated the effects of polyunsaturated fatty acids (PUFAs) on chronic obstructive pulmonary disease (COPD) and asthma, and the results of those that were found showed conflicting results.”

“It is very difficult to draw any conclusions on the true impact of dietary PUFA intake on respiratory health.”

“The evidence in this review suggests that diet does play a role in asthma and COPD, but the causality of association cannot be confirmed because of the observational nature of most of the studies.”

N

 

“The findings of several large studies in adults suggest that high fish intake has beneficial effects on lung function.”

“The relationship between fish intake and respiratory symptoms and clinical disease is less evident.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Peat et al., 1998*

Review

Longitudinal cohort studies and cross-sectional studies

Diet

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

 

In cross-sectional studies, the risk factors for presence in:

  1. Airway narrowing are atopy, family history of asthma, gender (male), and parental smoking;

  2. Airway size are low birth weight, parental smoking, and diet (low magnesium or antioxidant intake);

  3. Airway hyperresponsiveness are atopy, family history of asthma, high allergen exposure, and diet (high sodium/magnesium or low omega-3 fatty acid intake).

In longitudinal studies, the risk factors for ongoing conditions from:

  1. Airway narrowing are atopy early in childhood, gender (female), parental smoking, symptoms that begin before age 5, persistent wheeze in childhood in the absence of respiratory infection, and reduced expiratory flow rate;

  2. Airway size are atopy, gender (female), and airway hyperresponsiveness;

  3. Airway hyperresponsiveness are atopy in early childhood, airway hyperresponsiveness in childhood, reduced expiratory flow rate, and gender (female).

Important future longitudinal studies will be those that divide the broad spectrum of asthma into phenotypic groups.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Takemura et al., 2002*

Case-control

Cases = currently asthmatic students (n=1673)

Controls = students who were never asthmatic (n=22,109)

Boys and girls

Elementary and junior high school students

Aged 6-15 years,

Tokorozawa City, Japan

Tokorozawa Childhood Asthma and Pollinosis Study

Seafood

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Fish intake categories:

1 = Almost none

2 = 1-2 times/month

3 = 1-2 times/week

4 = ≥3-4 times/week

Serving size unspecified; cited that “most of the variation is explained by frequency of use rather than differences in serving sizes”

After adjusting for age, gender, parental history of asthma:

The OR for current asthma was slightly significantly higher for those who ate fish 1-2 times/week compared to those who ate fish 1-2 times/month (OR=1.133, 95% CI 1.021-1.258); and

Although the ORs for current asthma were not significant for those who ate fish almost never (OR=0.957, 95% CI 0.725-1.263) and ≥3-4 times/week (OR=1.334, 95% CI 0.907-1.963) compared to those who ate fish 1-2 times/month, there was a significant positive trend with an increase of fish consumption (p for trend = 0.0078).

After adjusting for age, gender, parental history of asthma, and vegetable and fruit intake:

The OR for current asthma was slightly significantly higher for those who ate fish 1-2 times/week compared to those who ate fish 1-2 times/month (OR=1.117, 95% CI 1.005-1.241); and

Although the ORs for current asthma were not significant for those who ate fish almost never (OR=1.039, 95% CI 0.785-1.376) and ≥3-4 times/week (OR=1.319, 95% CI 0.896-1.943) compared to those who ate fish 1-2 times/month, there was a significant positive trend with an increase of fish consumption (p for trend = 0.0349).

A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Hodge et al., 1996*

Case-control

Boys and girls (n=468)

Aged 8-11

Sydney, Australia

With airway hyperresponsiveness, wheeze in the last 12 months, and 3-in-5 sample of children with no airway hyperresponsiveness or wheeze in the last 12 months

Seafood

In the past year

Ellwood et al., 2001

Ecological

Children

Aged 6-7 and 13-14 years

53 countries

The International Study of Asthma and Allergies in Childhood (ISAAC)

Data from FAO Food Balance Sheet

PUFA and seafood intake

 

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Total fish intake/week

Ever eat fresh fish, fresh oily fish, or fresh non-oily fish

There were no significant differences in total fish intake between children with normal airways (1.2 servings, 95% CI 1.0-1.3), airway hyperresponsiveness (1.2 servings, 95% CI 0.9-1.5), wheeze (1.2 servings, 95% CI 0.8-1.5) and current asthma (1.0 servings, 95% CI 0.8-1.2).

Significantly fewer children with asthma ever ate oil fish compared to children with normal airways (p<0.05); however, there was no significant difference between those with current asthma and normal children who ate exclusively oily fish.

After adjusting for atopy, parental asthma, parental smoking, ethnicity, country of birth, early respiratory illness, and sex:

Children who ate oily fish had a significantly lower OR of current asthma when compared to children who did not eat oily fish (OR=0.26, 95% CI 0.09-0.72); and

There were no other significant associations found between type of fish (fresh fish, oily fish, non-oily fish) and airway hyperresponsiveness, wheeze, or current asthma.

B

Percentage of total energy consumed as PUFA: 3%-12%

Range of fish intake not reported

There were no significant associations found between total PUFA intake (% of total fat) for current wheezing, severe wheezing, allergic rhinoconjunctivitis, and atopic eczema.

There was a significant inverse association found between all fish (fresh and frozen) consumption and asthma, allergic rhinoconjunctivitis, and atopic eczema, for the 13- to 14-year-old age group; the same inverse association remained for the 6- to 7-year-old age group, but the association was weaker.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Timing of Exposure

Satomi et al., 1994*

Ecological

Boys and girls (n=7742)

Aged 6-11 years

Japan

1st-, 3rd-, 5th-grade students

Coastal schools = fish harvest and consumption are high

Inland schools = located far from sea but close to the coast school district

Seafood

 

*Included in Schachter HM, Reisman J, Tran K, Dales B, Kourad K, Barnes D, Sampson M, Morrison A, Gaboury I, Blackman J. 2004. Health Effects of Omega-3 Fatty Acids on Asthma. Summary, Evidence Report/Technology Assessment No. 91 (Prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02-0021). AHRQ Publication No. 04-E013-2. Rockville, MD: Agency for Healthcare Research and Quality.

**N = Evidence of no association or no clear association; B = Evidence of a benefit; A = Evidence of an adverse effect.

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Fish consumption categories:

Very often = ≥4-5 times/week

Relatively often = 2-3 times/week

Often = 1 time/week

Infrequently = 1-2 times/month

Seldom = <1 time/month

Coastal school children who ate reddish fish (sardine, mackerel, pike) very often had a significantly lower prevalence of history of asthma than those who seldom ate reddish fish (p<0.01). There were no other significant differences for these children based on consumption of pale fish, shellfish, fish-paste, seaweed, and dried fish.

Inland school children who ate pale fish (flatfish, sea bream, turbot) and seaweed very often had significantly higher prevalence of history of asthma than those who seldom ate pale fish and seaweed (p<0.01; 0.01<p<0.05, respectively). There were no other significant differences for these children based on reddish fish, shellfish, fish-paste, and dried fish.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
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Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Studies on Adult Chronic Diseases

TABLE B-2a Secondary Prevention Studies with Cardiovascular Outcomes

Author

Study Type

Subjects

Exposure

Hooper et al., 2006

Meta-analysis

48 randomized controlled trials

41 cohorts

Omega-3 intake for ≥6 months in adults

Primary and secondary prevention

n-3 supplement

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

High omega-3 fat vs. low omega-3 fat/control

Intake differed by 0.1-0.6 g omega-3/day among the two groups (absolute levels not specified)

Based on RCTs, no significant differences were found between the high omega-3 fat group and the low omega-3 fat/control group with regards to risk of mortality (n=15 RCTs; RR=0.87, 95% CI 0.73-1.03), cardiovascular events (n=18 RCTs; RR=0.95, 95% CI 0.82-1.12), cancer or death from cancer (n=10 RCTs; RR=1.07, 95% CI 0.88-1.30), or stroke (n=9 RCTs; RR=1.17, 95% CI 0.91-1.51).

Based on cohorts, no significant differences were found between the high omega-3 fat group and the low omega-3 fat/control group with regards to risk of cardiovascular events (n=7 cohorts; RR=0.91, 95% CI 0.73-1.13), cancer or death from cancer (n=7 cohorts; RR=1.02, 95% CI 0.87-1.19), or stroke (n=4 cohorts; RR=0.87, 95% CI 0.72-1.04).

Based on three cohorts, those in the low omega-3 fat/control group had a significantly higher risk of mortality compared to those in the high omega-3 fat group (RR=0.65, 95% CI 0.48-0.88).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Hooper et al., 2005

Cochrane Review

48 randomized controlled trials

41 cohorts

Primary and secondary prevention

n-3 supplement or advice

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

 

Based on RCTs, no significant differences were found between those randomized to n-3 supplementation or advice and those not randomized to n-3 supplementation or advice with regards to total mortality (n=44 RCTs; RR=0.87, 95% CI 0.73-1.03), combined cardiovascular events (n=31 RCTs; RR=0.95, 95% CI 0.82-1.12), cancers (n=10 RCTs; RR=1.07, 95% CI 0.88-1.30), cardiovascular deaths (n=44 RCTs; RR=0.85, 95% CI 0.68-1.06), fatal myocardial infarction (n=38 RCTs; RR=0.86, 95% CI 0.60-1.25), non-fatal myocardial infarction (n=26 RCTs; RR=1.03, 95% CI 0.70-1.50), sudden death (n=37 RCTs; RR=0.85, 95% CI 0.49-1.48), angina (n=25 RCTs; RR=0.78, 95% CI 0.59-1.02), stroke (n=26 RCTs; RR=1.17, 95% CI 0.91-1.51), heart failure (n=20 RCTs; RR=0.51, 95% CI 0.31-0.85), peripheral vascular events (n=17 RCTs; RR=0.26, 95% CI 0.07-1.06), and re-vascularization (n=23 RCTs; RR=1.05, 95% CI 0.97-1.12).

Based on cohort studies, no significant differences were found between those randomized to n-3 supplementation or advice and those not randomized to n-3 supplementation or advice with regards to combined cardiovascular events (n=7 cohorts; RR=0.91, 95% CI 0.73-1.13), cancers (n=10 cohorts; RR=1.02, 95% CI 0.87-1.19), nonfatal myocardial infarction (n=4 cohorts; RR=0.93, 95% CI 0.69-1.26), stroke (n=4 cohorts; RR=0.87, 95% CI 0.72-1.04), peripheral vascular events (n=1 cohort; RR=0.94, 95% CI 0.84-1.04), and revascularization (n=2 cohorts; RR=1.07, 95% CI 0.76-1.50).

Based on cohort studies, significant differences were found between those randomized to n-3 supplementation or advice and those not randomized to n-3 supplementation or advice with regards to total mortality (n=3 cohorts; RR=0.65, 95% CI 0.48-0.88), cardiovascular deaths (n=11 cohorts; RR=0.79, 95% CI 0.63-0.99), fatal myocardial infarction (n=2 cohorts; RR=0.42, 95% CI 0.21-0.82), and sudden death (n=1 cohort; RR=0.44, 95% CI 0.21-0.91).

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Konig et al., 2005

Meta-analysis

7 observational studies (primary prevention)

4 RCTs (secondary prevention)

Seafood

Burr et al., 2005

Review

Review of two randomized controlled trials (Burr et al., 1989, 2003 below)

Secondary prevention

Dietary advice

Harper and Jacobson, 2005

Review

Systematic literature review of 14 randomized controlled trials

Northern Europe, Southern Europe, India

Excluded if trial involved >1 intervention unless in a prospective 2×2 design

Patients followed for ≥1 year

Secondary prevention

6 on fish oil

2 on fish

5 on ALA suppl.

2 on ALA-enriched diets

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Servings/week, a continuous number

1 serving = 100 g

Among those with no preexisting CHD (from observational studies), the linear regression model showed that each one serving increase in fish consumption per week reduces one’s risk of CHD death by 0.039 (95% CI −0.066 to −0.011) but does not significantly change one’s risk of nonfatal MI by (ΔRR=0.0083, 95% CI −0.012 to 0.028)

“The information available is insufficient for the purposes of quantitatively analyzing the impact of fish consumption on CHD risk for individuals with preexisting CHD” (from RCTs).

B

See Burr et al., 1989, 2003 below

“It appeared that fish oil, which protected post-MI male patients in DART, increased the risk of cardiac death in men with angina, being particularly associated with sudden death.”

“The apparently conflicting findings may be attributable to the different clinical conditions of the subjects … together with different effects of dietary fish and fish oil.”

N

 

“The evidence supports a role for fish oil (EPA or DHA) or fish in secondary prevention, because the clinical trials have demonstrated a reduction in total mortality, CHD death, and sudden death.”

“Evidence from these trials had indicated that EPA plus DHA supplementation in the range of 0.5-1.8 g/day provides significant benefit.”

“The data on the plant-based n-3 PUFA, ALA, is very promising. However, the existing studies were small, and a large randomized controlled trial is needed before recommendations can be definitely made for CHD prevention.”

“The data for ALA show possible reductions in sudden death and nonfatal myocardial infarction, suggesting other potential cardioprotective mechanisms other than a predominately antiarrhythmic role.”

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Leaf et al., 2005

Randomized Controlled Trial

Men and women (n=402)

Mean age about 65 years

18 US centers

Had a cardioverter defibrillator implanted because of a history of cardiac arrest, sustained ventricular tachycardia, or syncope with inductive, sustained ventricular tachycardia or ventricular fibrillation during electrophysiologic studies

Follow-up of 12 months

Secondary prevention

n-3 supplement

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Treatment:

Four 1 g gelatin capsules of an ethyl ester concentrate of n-3 fatty acids (2.6 g EPA+DHA)

Placebo:

Four 1 g capsules of olive oil

After controlling for sex, left ventricular ejection fraction (continuous), New York Heart Association class III congestive heart failure, history of myocardial infarction, history of prior defibrillator therapies for ventricular tachycardia or ventricular fibrillation, time from implanted cardioverter/defibrillator implant (continuous), and sustained ventricular tachycardia as the indication for the implanted cardioverter defibrillator:

The intent-to-treat analysis provided a significant relative risk of time to first event of 0.67 (95% CI 0.47-0.95, p=0.024) for all confirmed events among those in the treatment group compared to the placebo group;

The on-treatment analysis (for all who had taken any of their prescribed supplements) provided a significant relative risk of time to first event of 0.67 (95% CI 0.46-0.98, p=0.037) for all confirmed events among those in the treatment group compared to the placebo group; and

The on-treatment analysis (for all on-treatment at least 11 months) provided a significant relative risk of time to first event of 0.52 (95% CI 0.32-0.83, p=0.0060) for all confirmed events among those in the treatment group compared to the placebo group.

Similar results were found when probable events were also included.

B

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Raitt et al., 2005

Randomized Controlled Trial

Men and women (n=200)

Mean age about 62

Patients at six medical centers in the United States

Receiving an implantable cardioverter defibrillator for an electrocardiogram-documented episode of sustained ventricular tachycardia or ventricular fibrillation that was not the result of acute myocardial infarction or a revisible cause or who had a preexisting implantable cardioverter defibrillator and had received implantable cardioverter/defibrillator therapy for an electrocardiogram-documented episode of sustained ventricular tachycardia or ventricular fibrillation within the last 3 months

No class I or class II antiarrhythmic medications; ≥1 fatty fish meal/week; flaxseed oil, cod-liver oil, or fish-oil supplements in the last month

Follow-up of 2 years

Secondary prevention

n-3 supplement

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Treatment:

1.8 g/day fish oil (42% EPA and 30% DHA)

Placebo:

Olive oil (73% oleic acid, 12% palmitic acid, 0% EPA+DHA)

There was a significant difference in the number of patients hospitalized for neurological conditions among those assigned to the placebo compared to those assigned to the treatment (p=0.04). However, there were no other significant differences found in mortality, hospitalizations, coronary revascularization, myocardial infarction, cancer, and diarrhea between the two groups.

There were no significant differences in the time to first episode of implantable cardioverter/defibrillator therapy for ventricular tachycardia or ventricular fibrillation after randomization between the two groups (p=0.19). However, among those with qualified arrhythmia at the time of study entry, those assigned to fish oil had significantly greater incidence of ventricular tachycardia or ventricular fibrillation treated by the implantable cardioverter defibrillator compared to those assigned to placebo (p=0.007).

A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Baer et al., 2004

Randomized Crossover Trial

Men (n=50)

Aged 25-60 years

All races

Beltsville, MD

In good health, with no hypertension, hyperlipidemia, diabetes, peripheral vascular disease, gout, liver or kidney disease, or endocrine disorders

Fasting plasma HDL-c >0.65 mmol/L, triacylglycerol <3.39 mmol/L, and 85-120% of their sex-specific ideal BMI

No lipid-lowering drugs, blood pressure medication, or dietary supplements, or eating habits inconsistent with the study protocol

30-week intervention (six diets for 5 weeks each)

Primary prevention

Diet

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Diets 1-5: 38.9% energy from fat, 15% energy from protein, 46.1% energy from digestible carbohydrates

Diet 6: 30.4% energy from fat, 54.6% energy from carbohydrate

Diet 1 (carbohydrate diet): 8.5% of energy from fat replaced by digestible carbohydrate

Diet 2 (oleic acid diet): 8% of energy enriched with oleic acid

Diet 3 (LMP diet): 8% of energy enriched with lauric (L), myristic (M), and palmitic (P) acids

Diet 4 (stearic acid diet): 8% of energy enriched with stearic acid

Diet 5 (trans fatty acid diet): 8% of energy enriched with trans fatty acids

Diet 6 (trans fatty acid + stearic acid diet): 4% energy enriched with trans fatty acids and 4% of energy enriched with stearic acid

After 5 weeks on the stearic acid diet, the least squares mean plasma fibrinogen levels were significantly higher than after 5 weeks on all other diets (p<0.05).

After 5 weeks on the trans fatty acid diet, the least squares mean plasma C-reactive protein levels were significantly higher than after 5 weeks on all other diets (p<0.05).

After 5 weeks on the oleic acid diet, the least squares mean plasma interleukin 6 levels were significantly lower than after 5 weeks on all other diets, except for the trans fatty acid + stearic acid diet (p<0.05).

After 5 weeks on the trans fatty acids diet, the least squares mean plasma C-reactive protein levels were significantly higher than after 5 weeks on the carbohydrate diet, the oleic diet, and the trans fatty acid + stearic acid diet (p<0.05).

After 5 weeks on the oleic acid diet, the least squares mean plasma interleukin 6 levels were significantly lower than after 5 weeks on the trans fatty acid diet, stearic acid diet, or the LMP diet (p<0.05).

After 5 weeks on the oleic acid diet, the least squares mean plasma E-selectin levels were significantly lower than after 5 weeks on all other diets, except for the carbohydrate diet (p<0.05).

After 5 weeks on the trans fatty acids diet, the least squares mean plasma E-selectin levels were significantly higher than after 5 weeks on all other diets (p<0.05).

There were no other significant differences reported between the diets with regards to fibrinogen, C-reactive protein, interleukin 6, or E-selectin levels.

N

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Burr et al., 2003

Randomized Controlled Trial

Men (n=3114)

Aged <70 years

South Wales, UK

Being treated with angina

Mortality ascertained at 3-9 years after enrollment

No exertional chest pain or discomfort; men awaiting coronary artery by-pass surgery, men who already ate oily fish twice a week, men who could not tolerate oily fish or fish oil, men who appeared to be unsuitable on other grounds (e.g., other serious illness, likelihood of moving out of area)

The Diet and Angina Randomized Trial (DART 2)

Follow-up of 3 years (after last subject was recruited)

Secondary prevention

Dietary advice

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Amount

Results

Conclusion**

Fish advice = eat at least 2 portions of oily fish each week or take up to 3 g of fish oil as a partial or total substitute

Fruit/vegetable advice = eat 4-5 portions of fruit and vegetables and drink at least 1 glass of natural orange juice daily, and also increase the intake of oats

Both = a combination of both of these forms of advice

Sensible eating = non-specific advice that did not include either form of advice

Those given fish advice had significantly higher percentage of cardiac deaths (p=0.02) and sudden deaths (p=0.02) compared to those who did not receive fish advice. There was not a significant difference in the number of total deaths between these two groups.

No significant differences were found between the fruit/vegetable advice group and the no fruit/vegetable advice group for total number of deaths, number of cardiac deaths, or number of sudden deaths.

After adjusting for age, smoking, previous MI, history of high blood pressure, diabetes, BMI, serum cholesterol, medication, and fruit advice or fish advice:

Those who received fish advice had a slightly significant higher hazard ratio for cardiac deaths (HR=1.26, p=0.047) and a significant higher hazard ratio for sudden death (HR=1.54, p=0.025), compared to those who did not receive fish advice.

There were no significant associations found between those who received fruit/vegetable advice vs. those who did not and all deaths, cardiac deaths, or sudden deaths.

A

Suggested Citation:"Appendix B Data Tables." Institute of Medicine. 2007. Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press. doi: 10.17226/11762.
×

Author

Study Type

Subjects

Exposure

Marchioli et al., 2002

Randomized Controlled Trial