U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.


Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.


Main content area

Neither n–3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia

Alemayehu Argaw, Lieven Huybregts, Mekitie Wondafrash, Patrick Kolsteren, Tefera Belachew, Berhanu N Worku, Teklu G Abessa, Kimberley P Bouckaert
Journal of nutrition 2019 v.149 no.3 pp. 505-512
brain, breast feeding, child development, children, complementary foods, developing countries, dietary supplements, docosahexaenoic acid, education, eicosapentaenoic acid, family size, fish oils, infants, lactation, long chain polyunsaturated fatty acids, long term effects, models, mothers, nutritional status, questionnaires, randomized clinical trials, Ethiopia
The n–3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n–3 LC-PUFA supplementation on child development in low-income countries. We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6–24 mo in rural Ethiopia. We conducted a double-blind randomized controlled trial of n–3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil–enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6–12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (β: −0.03 SDs/mo; 95% CI: −0.04, −0.01 SD/mo; P < 0.01). n–3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6–24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.