(P27-076-25) Long-Term Effects of Docosahexaenoic Acid Supplementation in Toddlerhood for Children Born Preterm on Risk and Severity of Neurodevelopmental Disorders: Omega Tots Trial

Objectives: Premature birth and the transition from formula/human milk to solids in toddlerhood are risk factors for low docosahexaenoic acid (DHA) intake in young children. These factors are also linked to increased risk of neurodevelopmental disorders autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Our objective was to determine whether 6 months of daily DHA + arachidonic acid (AA) supplementation at age 1-year reduced inattention symptoms and risk of ADHD and ASD diagnoses at 8-10-years of age in children born preterm.

Methods: A 6-month randomized placebo-controlled trial (Omega Tots, NCT01576783) of daily DHA (200mg) + AA (200mg) supplementation versus placebo (400mg corn oil) was conducted in children born at < 35 weeks’ gestation at 10-16 months’ corrected age. Children were followed to age 8-10 years. Outcomes were attention problems [Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Flanker Inhibitory Control and Attention Test score and response time variability (RTV)], and ASD or ADHD diagnoses. Linear and log binomial regression models estimated the effect of DHA+AA vs. placebo on outcomes. Sub-group analyses were by sex, birthweight, family income, dietary DHA + eicosapentaenoic acid (EPA), and plasma omega-3 status (interaction p< 0.2 considered significant).

Results: Among 377 randomized, 317 (84%) participated at age 8-10. DHA+AA group demonstrated better inhibitory control and attention vs placebo (Flanker: difference=3.29, p=0.03). Among children with below median dietary DHA+EPA, the DHA+AA group performed better on Flanker vs. placebo (interaction p=0.19; difference=5.07, p=0.02). Among children with birthweight >1500g, the DHA+AA group had fewer teacher-reported attention problems (TRF) vs. placebo (interaction p=0.07; difference=-2.96, p=0.01). CBCL, Flanker RTV, and risk of ADHD/ASD did not differ between groups.

Conclusions: DHA+AA showed slight benefit over placebo for attention and inhibitory control at age 8-10, particularly among children with birthweight >1500g and those with below median omega-3 intake. Further research on DHA+AA supplementation in toddlerhood to improve attention outcomes is warranted.

Funding Sources: National Institutes of Health, Health Resources and Services Administration, March of Dimes, Allen Foundation, Cures Within Reach, internal support.