Pre- and post-term growth in pre-term infants supplemented with higher-dose DHA: a randomised controlled trial

The effect of the dietary n-3 long-chain PUFA, DHA (22:6n-3), on the growth of pre-term infants is controversial. We tested the effect of higher-dose DHA (approximately 1% dietary fatty acids) on the growth of pre-term infants to 18 months corrected age compared with standard feeding practice (0.2-0.3% DHA) in a randomised controlled trial. Infants born < 33 weeks gestation (n 657) were randomly allocated to receive breast milk and/or formula with higher DHA or standard DHA according to a concealed schedule stratified for sex and birth-weight (< 1250 and >= 1250 g). The dietary arachidonic acid content of both diets was constant at approximately 0.4% total fatty acids. The intervention was from day 2 to 5 of life until the infant's expected date of delivery (EDD). Growth was assessed at EDD, and at 4, 12 and 18 months corrected age. There was no effect of higher DHA on weight or head circumference at any age, but infants fed higher DHA were 0.7 cm (95% CI 0.1, 1.4 cm; P=0.02) longer at 18 months corrected age. There was an interaction effect between treatment and birth weight strata for weight (P=0.01) and length (P=0.04). Higher DHA resulted in increased length in infants born weighing >= 1250 g at 4 months corrected age and in both weight and length at 12 and 18 months corrected age. Our data show that DHA up to 1% total dietary fatty acids does not adversely affect growth.