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American Journal of Clinical Nutrition, Vol. 85, No. 1, 152-159, January 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Infant nutrition and stereoacuity at age 4–6 y1,2,3

Atul Singhal, Ruth Morley, Tim J Cole, Kathy Kennedy, Patricia Sonksen, Elizabeth Isaacs, Mary Fewtrell, Alun Elias-Jones, Terence Stephenson and Alan Lucas

1 From the Medical Research Council Childhood Nutrition Research Center (AS, RM, KK,EI, MF, and AL), the Neurodevelopmental & Neurodisability Unit, Department of Neurology, The Wolfson Center (PS), and the Centre for Paediatric Epidemiology and Biostatistics (TJC), Institute of Child Health, London, United Kingdom; the Department of Pediatrics and the Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia (RM); Leicester General Hospital NHS Trust, Leicester, United Kingdom (AE-J); and the Faculty of Medicine and Health Sciences, Academic Division of Child Health, University of Nottingham, Nottingham, United Kingdom (TS)

Background: Breastfeeding has been reported to benefit visual development in children. A higher concentration of docosahexaneoic acid (DHA) in breast milk than in formula has been proposed as one explanation for this association and as a rationale for adding DHA to infant formula, but few long-term data support this possibility.

Objective: The objectives of the study were, first, to test the hypothesis that breastfeeding benefits stereoscopic visual maturation and, second, if that benefit is shown, to ascertain whether it is mediated by the dietary intake of DHA.

Design: Stereoacuity was measured by using the random dot E test (primary outcome), and visual acuity was measured by using the Sonksen-Silver acuity system (secondary outcome) in previously breastfed (n = 78) or formula-fed (n = 184) children aged 4–6 y who had been followed prospectively from birth. In the formula-fed group, children were randomly assigned to receive formula with either DHA or arachidonic acid (n = 94) or a control formula (n = 90) for the first 6 mo.

Results: Breastfed children had a significantly (P = 0.001) greater likelihood of foveal stereoacuity (high-grade or <100 s/arc) than did formula-fed children (odds ratio: 2.5; 95% CI: 1.4, 4.5) independent of potential confounding (P = 0.005). Stereoacuity did not differ significantly between children randomly assigned to DHA-supplemented or control formula. None of the groups differed in Sonksen-Silver visual acuity.

Conclusions: These findings support the hypothesis that breastfeeding benefits long-term stereoscopic development. An effect of DHA cannot be excluded, but the lack of difference in stereoacuity between infants randomly assigned to DHA-containing and those assigned to control formula raises the hypothesis that factors in breast milk other than DHA account for the observed benefits.

Key Words: Polyunsaturated fatty acids • stereoacuity • vision • breastfeeding • randomized trial






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