Suplementación en gestantes con ácido docosahexaenoico y su efecto en los procesos cognitivos infantiles: revisión sistemática

Yordanis Enríquez-Canto, Giovani Díaz-Gervasi, Daniel Crisóstomo-Robles

Resumen


Introducción: El ácido docosahexaenoico (DHA) se deposita en regiones cerebrales e interviene en la funcionalidad neuronal. Debido a esta importante participación se considera medular en el desarrollo del sistema nervioso central. El objetivo fue analizar los resultados de estudios sobre la influencia de la suplementación con ácido docosahexaenoico en gestantes sobre los procesos cognitivos de sus hijos.
Material y Métodos: Revisión sistemática de ensayos controlados aleatorizados con suplementación con DHA en embarazadas considerando los lineamientos del grupo Cochrane. Se buscaron artículos en MEDLINE, EMBASE, Scopus y la Biblioteca Cochrane desde enero del 2003 a mayo 2018. Se eligieron estudios que compararon los efectos de la suplementación en embarazadas con los del placebo respecto a evaluaciones de los procesos cognitivos. Se evaluó el riesgo de sesgo de los mismos con la herramienta de colaboración Cochrane.
Resultados: Se hallaron 147 artículos científicos eligiéndose 10 que tuvieron como características metodológicas el ser de doble ciego aleatorizados. Los estudios involucraron 4506 gestantes entre las 15 y 21 semanas y 2045 niños. La suplementación se dió entre la semana quince y los tres meses después del parto. Los niños fueron evaluados desde el año y medio hasta los cuatro años. Se utilizaron seis instrumentos y dos baterías de ejecución para medir 19 procesos cognitivos. Solamente dos de los estudios reportaron diferencias significativas entre los sujetos del grupo control y experimental. Debido a la heterogeneidad entre los estudios en relación a los tamaños muestrales, las dosis y a la forma de medir la variable de interés no fue posible realizar metaanálisis.
Conclusiones: Resulta insuficiente la evidencia científica para afirmar o negar un efecto positivo de la suplementación temprana con DHA en los procesos cognitivos infantiles. La recomendación del uso de suplementos con DHA durante el período gestacional para favorecerlos no se encuentra justificada.


Palabras clave


Ácidos Grasos; Fenómenos Fisiológicos Nutricionales del Lactante; Mujeres Embarazadas; Procesos Mentales; Revisión.

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Referencias


(1) Shahidi F, Ambigaipalan P. Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits. Annual review of food science and technology. 2018 Mar; 9(1):345-381.

(2) Fleith M, Clandinin MT. Dietary PUFA for preterm and term infants: review of clinical studies. Critical reviews in food science and nutrition. 2005 Apr ;45(3):205-29.

(3) Koletzko B, Lien E, Agostoni C, Böhles H, Campoy C, Cetin I, Decsi T, Dudenhausen JW, Dupont C, Forsyth S, Hoesli I. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. Journal of perinatal medicine. 2008 Jan ;36(1):5-14.

(4) Koletzko B, Agostoni C, Carlson SE, Clandinin T, Hornstra G, Neuringer M, Uauy R, Yamashiro Y, Willatts P. Long chain polyunsaturated fatty acids (LC‐PUFA) and perinatal development. Acta Paediatrica. 2001 Apr ;90(4):460-4.

(5) Czyż K, Bodkowski R, Herbinger G, Librowski T. Omega-3 fatty acids and their role in central nervous system-a review. Current medicinal chemistry. 2016 Mar 1;23(8):816-31.

(6) Rice D, Barone Jr S. Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environmental health perspectives. 2000 Jun ;108(3):511.

(7) Lauritzen LA, Hansen HS, Jørgensen MH, Michaelsen KF. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Progress in lipid research. 2001 Mar ;40(1):1-94.

(8) Vinot N, Jouin M, Lhomme-Duchadeuil A, Guesnet P, Alessandri JM, Aujard F, Pifferi F. Omega-3 fatty acids from fish oil lower anxiety, improve cognitive functions and reduce spontaneous locomotor activity in a non-human primate. PLoS One. 2011 Jun 7;6(6):e20491.

(9) Cutuli D, De Bartolo P, Caporali P, Laricchiuta D, Foti F, Ronci M, Rossi C, Neri C, Spalletta G, Caltagirone C, Farioli-Vecchioli S. n-3 polyunsaturated fatty acids supplementation enhances hippocampal functionality in aged mice. Frontiers in aging neuroscience. 2014 Aug 25;6:220.

(10) Martinez M. Tissue levels of polyunsaturated fatty acids during early human development. J Pediatr 1992;120:S129–38.

(11) Clandinin MT, Chappell JE, Leong S, Heim T, Swyer PR, Chance GW. Intrauterine fatty acid accretion rates in human brain: implications for fatty acid requirements. Early Hum Dev 1980;4:121–9.

(12) Clandinin MT, Chappell JE, Heim T, Swyer PR, Chance GW. Fatty acid utilization in perinatal de novo synthesis of tissues. Early Hum Dev 1981;5:355–66.

(13) Nettleton JA. Omega-3 fatty acids: comparison of plant and seafood sources in human nutrition. Journal of the American Dietetic Association. 1991 Mar;91(3):331-7.

(14) Daniels JL, Longnecker MP, Rowland AS, Golding J, ALSPAC Study Team. Fish intake during pregnancy and early cognitive development of offspring. Epidemiology. 2004 Jul 1;15(4):394-402.

(15) Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. The Lancet. 2007 Feb 17;369(9561):578-85.

(16) Freire C, Ramos R, Lopez-Espinosa MJ, Díez S, Vioque J, Ballester F, Fernández MF. Hair mercury levels, fish consumption, and cognitive development in preschool children from Granada, Spain. Environmental research. 2010 Jan 1;110(1):96-104.

(17) Mendez MA, Torrent M, Julvez J, Ribas-Fitó N, Kogevinas M, Sunyer J. Maternal fish and other seafood intakes during pregnancy and child neurodevelopment at age 4 years. Public health nutrition. 2009 Oct;12(10):1702-10.

(18) Vandenbroucke JP. When are observational studies as credible as randomised trials?. The Lancet. 2004 May 22;363(9422):1728-31.

(19) Vandenbroucke JP. Why do the results of randomised and observational studies differ?. BMJ: British Medical Journal (Online). 2011 Nov 7;343.

(20) Cole GM, Frautschy SA. DHA may prevent age-related dementia. The Journal of Nutrition 2010; 140:869–74.

(21) Kalmijn S, van Boxtel MP, Ocke M, Verschuren WM, et al. Dietary intake of fatty acids and fish in relation to cognitive performance at middle age. Neurology 2004; 62:275–280.

(22) Samieri C, Maillard P, Crivello F, Proust-Lima C, et al. Plasma long-chain omega-3 fatty acids and atrophy of the medial temporal lobe. Neurology 2012; 79:642–650.

(23) Waitzberg DL, Garla P. Contribución de los ácidos grasos Omega-3 para la memoria y la función cognitiva. Nutrición Hospitalaria. 2014 Sep; 30(3):467-77.

(24) Baleztena J, Arana M, Bes-Rastrollo M, Castellanos MC, Gozalo MJ, Ruiz-Canela M. ¿ La ingesta o suplementación con ácidos grasos omega-3 a partir de los 65 años influye en la función cognitiva? Resultados de una revisión sistemática. Anales Sis San Navarra. 2017 Dec; 40(3):433-442.

(25) Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics. 2003 Jan; 111(1):e39-44. doi: 10.1542/peds.111.1.e39

(26) Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment of children at age 2½ years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2008 Jan; 93(1):45-50.

(27) Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P. Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. Jama. 2010 Oct; 304(15):1675-83.

(28) Campoy C, Escolano-Margarit MV, Ramos R, Parrilla-Roure M, Csábi G, Beyer J, Ramirez-Tortosa MC, Molloy AM, Decsi T, Koletzko BV. Effects of prenatal fish-oil and 5-methyltetrahydrofolate supplementation on cognitive development of children at 6.5 y of age. The American journal of clinical nutrition. 2011 Aug; 94(6):1880S-8S.

(29) van Goor SA, Dijck-Brouwer DJ, Erwich JJ, Schaafsma A, Hadders-Algra M. The influence of supplemental docosahexaenoic and arachidonic acids during pregnancy and lactation on neurodevelopment at eighteen months. Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA). 2011 May; 84(5-6):139-46.

(30) Gould JF, Makrides M, Colombo J, Smithers LG. Randomized controlled trial of maternal omega-3 long-chain PUFA supplementation during pregnancy and early childhood development of attention, working memory, and inhibitory control. The American journal of clinical nutrition. 2014 Feb; 99(4):851-9.

(31) Makrides M, Gould JF, Gawlik NR, Yelland LN, Smithers LG, Anderson PJ, Gibson RA. Four-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation. Jama. 2014 May 7;311(17):1802-4.

(32) Campoy C, Altmäe S, Ramos R, Cruz F, Perez M, Salvatierra MT. Effects of prenatal fish oil and folic acid supplementation on infant psychomotor and mental Development: Results from NUHEAL randomized controlled trial. Journal Pregnancy & Child Health. 2015; 2(1). doi: https://doi.org/10.4172/2376-127X.1000131

(33) Ramakrishnan U, Stinger A, DiGirolamo AM, Martorell R, Neufeld LM, Rivera JA, Schnaas L, Stein AD, Wang M. Prenatal docosahexaenoic acid supplementation and offspring development at 18 months: randomized controlled trial. PloS one. 2015 Aug; 10(8):e0120065.

(34) Gould JF, Treyvaud K, Yelland LN, Anderson PJ, Smithers LG, McPhee AJ, Makrides M. Seven-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation. Jama. 2017 Mar; 317(11):1173-5.

(35) Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011 Oct; 343:d5928. doi: https://doi.org/10.1136/bmj.d5928

(36) Higgins JP, Green S, eds. Cochrane handbook for systematic reviews of interventions. Versión 5.0.1. [citado el 07 de junio de 2018]. Disponible en: http://handbook-5-1.cochrane.org/

(37) Kaufman AS, Kaufman NL. Kaufman assessment battery for children. John Wiley & Sons; 1983.

(38) Griffiths R. The abilities of young children. A comprehensive system of mental measurement for the first eight years of life. London, Child Development Research Centre; 1970.

(39) Dunn L, Dunn L. Examiners manual for the Peabody Picture Vocabulary Test. Third edition Form IIIA and IIIB. Circle Pines, MN: American Guidance Service; 1997.

(40) Bayley N. Bayley Scales of Infant and Toddler Development-Third Edition: Technical Manual. San Antonio, TX: Harcourt Assessment; 2006.

(41) Bayley N. Bayley Scales of Infant Development 2nd ed.(Bayley-II). Psychological Corporation; 1993.

(42) Bayley N. Bayley scales of infant development: Manual. Psychological Corporation; 1993.

(43) Smith LB, Thelen E. Development as a dynamic system. Trends in cognitive sciences. 2003 Aug 1;7(8):343-8.

(44) Elliott C. Differential Ability Scales, 2nd ed: Introductory and technical handbook. San Antonio, TX: The Psychological Corporation; 2007.

(45) Weschler D. Wechsler Abbreviated Scale of Intelligence - 2nd ed. (WASI-II). San Antonio, TX: NCS Pearson; 2011.

(46) Meldrum SJ, D'Vaz N, Dunstan J, Mori TA, Prescott SL. The Infant Fish Oil Supplementation Study (IFOS): Design and research protocol of a double-blind, randomised controlled n− 3 LCPUFA intervention trial in term infants. Contemporary clinical trials. 2011 Sep 1;32(5):771-8.

(47) Kris-Etherton PM, Grieger JA, Etherton TD. Dietary reference intakes for DHA and EPA. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2009 Aug ;81(2-3):99-104.

(48) Dziechciarz P, Horvath A, Szajewska H. Effects of n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and/or lactation on neurodevelopment and visual function in children: a systematic review of randomized controlled trials. Journal of the American College of Nutrition. 2010 Oct 1;29(5):443-54.

(49) Colombo J, Carlson SE, Cheatham CL, Shaddy DJ, Kerling EH, Thodosoff JM, Gustafson KM, Brez C. Long-term effects of LCPUFA supplementation on childhood cognitive outcomes. The American journal of clinical nutrition. 2013 Jun 26;98(2):403-12.

(50) Cheatham CL, Colombo J, Carlson SE. n− 3 Fatty acids and cognitive and visual acuity development: methodologic and conceptual considerations. The American journal of clinical nutrition. 2006 Jun ;83(6):1458S-66S.

(51) Colombo J, Brez CC, Curtindale LM. Infant perception and cognition. Handbook of Psychology, Second Edition. Hoboken, Wiley; 2012.

(52) Auestad N, Scott DT, Janowsky JS, Jacobsen C, Carroll RE, Montalto MB, Halter R, Qiu W, Jacobs JR, Connor WE, Connor SL. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003 Sep ;112(3):e177-83.

(53) Jensen CL, Voigt RG, Llorente AM, Peters SU, Prager TC, Zou YL, Rozelle JC, Turcich MR, Fraley JK, Anderson RE, Heird WC. Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants. The Journal of pediatrics. 2010 Dec ;157(6):900-5.

(54) Blair C, Zelazo PD, Greenberg MT. The measurement of executive function in early childhood. Developmental Neuropsychology. 2005; 28(2), 561–571. doi:10.1207/s15326942dn2802_1

(55) Burgard P. Critical evaluation of the methodology employed in cognitive development trials. Acta Pædiatrica. 2003 Aug 1;92(s442):6-10.

(56) Fiorello CA, Primerano D. Research into practice: Cattell‐Horn‐Carroll cognitive assessment in practice: Eligibility and program development issues. Psychology in the Schools. 2005 May ;42(5):525-36.

(57) Colombo J. The development of visual attention in infancy. Annual review of psychology. 2001 Feb ;52(1):337-67.

(58) Garon N, Bryson SE, Smith IM. Executive function in preschoolers: a review using an integrative framework. Psychological bulletin. 2008 Jan;134(1):31.

(59) Maehler C, Schuchardt K. Working memory in children with specific learning disorders and/or attention deficits. Learning and Individual Differences. 2016 Jul 1;49:341-7.

(60) Cabbage K, Brinkley S, Gray S, Alt M, Cowan N, Green S, Kuo T, Hogan TP. Assessing working memory in children: The Comprehensive Assessment Battery for Children–Working Memory (CABC-WM). Journal of visualized experiments: JoVE. 2017(124).

(61) Lam LF, Lawlis TR. Feeding the brain–The effects of micronutrient interventions on cognitive performance among school-aged children: A systematic review of randomized controlled trials. Clinical Nutrition. 2017 Aug 1;36(4):1007-14.

(62) Collett BR, Kapp-Simon KA, Wallace E, Cradock MM, Buono L, Speltz ML. Attention and executive function in children with and without single-suture craniosynostosis. Child Neuropsychology. 2017 Jan 2;23(1):83-98.




DOI: http://dx.doi.org/10.14306/renhyd.23.3.637

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