LC-PUFA enrichment in infant formula and neurodevelopment up to age 3.5 years in the French nationwide ELFE birth cohort

Purpose For decades, consistent associations between breastfeeding and children’s neurodevelopment have been attributed to breastmilk content in long-chain polyunsaturated fatty acids (LC-PUFAs). However, the beneficial effect of LC-PUFA enrichment of infant formula on neurodevelopment remains controversial. This study examined the association of LC-PUFA enrichment of infant formulas with neurodevelopment up to age 3.5 years. Methods Analyses were based on 9372 children from the French nationwide ELFE birth cohort. Monthly from 2 to 10 months, parents declared their infant’s feeding mode, including breastfeeding and the name of the infant formula, which allowed for identifying formulas enriched in arachidonic (ARA), eicosapentaenoic (EPA) and/or docosahexaenoic (DHA) acids. Neurodevelopment was assessed at age 1 and 3.5 years with the Child Development Inventory (CDI-1 and CDI-3.5); at 2 years with the MacArthur-Bates Communicative Development Inventories (MB-2); and at 3.5 years with the Picture Similarities subtest of the British Ability Scale (BAS-3.5). Associations were assessed by linear regression adjusted for any breastfeeding duration and main confounding factors, including socioeconomic characteristics. Results One-third of formula-fed infants consumed LC-PUFA-enriched formulas. Most of these formulas were enriched in both DHA and ARA, and about 10% of infants consumed formula further enriched in EPA. LC-PUFA enrichment of infant formula was not associated with neurodevelopmental scores at age 1 (CDI-1, − 0.16 [− 0.39, 0.07]), age 2 (MB-2, 0.78 [− 0.33, 1.89]), or age 3.5 (CDI-3.5, − 0.05 [− 0.27, 0.17]; BAS-3.5, − 0.93 [− 2.85, 0.98]). Conclusion In the ELFE study, LC-PUFA enrichment of infant formula was not associated with neurodevelopmental scores up to 3.5 years.