Neurological differences between 9-year-old children fed breast-milk or formula-milk as babies

doi:10.1016/S0140-6736(94)90692-0

The Lancet

Volume 344, Issue 8933, 12 November 1994, Pages 1319-1322

https://doi.org/10.1016/S0140-6736(94)90692-0 Get rights and content

Abstract

Summary

The presence of minor neurological dysfunction is associated with behavioural and cognitive development at school age. We have previously shown a relation between minor neurological dysfunction and perinatal disorders, especially abnormal neonatal neurological condition. We have now investigated the relation between breastfeeding and long-term neurological development.

We studied 135 breastfed (for ≥3 weeks) and 391 formula-fed children, born at term in the University Hospital Groningen between 1975 and 1979. A standard neonatal neurological examination was used to classify the infants as normal (247), slightly abnormal (213), or frankly abnormal (66). At 9 years of age the children were re-examined. In 1993 their mothers were asked to complete a questionnaire about how the children were fed as infants. After adjustment for obstetric, perinatal, neonatal neurological, and social differences, a small advantageous effect of breastfeeding on neurological status at 9 years of age was found (odds ratio for neurological non-normality 0·54 [95% Cl 0·30-0·97]).

Although a retrospective design cannot lead to definite conclusions, our data suggest a beneficial effect of breast-feeding on postnatal neurological development. Longer-chain polyunsaturated fatty acids, which are present in breast-milk but not in most formula-milks, may have a role since they are vital for brain development.

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In recent decades, n−3 polyunsaturated fatty acid (n−3 PUFA), especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have received significant scientific attention because of their health benefits, which include improvement of immune function and prevention of heart disease and cancer (Khandelwal et al., 2013; Komprda, 2012; Kromhout, Bosschieter, & de Lezenne Coulander, 1985; Larsson, Kumlin, Ingelman-Sundberg, & Wolk, 2004). Consumption of n−3 PUFA has also been reported to provide important benefits with respect to functioning of the brain and retina, as well as accelerating the growth of preterm baby (Carlson, Werkman, Peeples, Cooke, & Tolley, 1993; Lanting, Fidler, Huisman, Touwen, & Boersma, 1994; Neuringer, Connor, Van Petten, & Barstad, 1984). Long-chain n−3 PUFAs are characteristic of marine oils and occur pervasively in the PLs of fish and marine species, with EPA and DHA commonly accounting for up to 50% of their fatty acid constituents (Haraldsson & Thorarensen, 1999).
n−3 Polyunsaturated fatty acids (n−3 PUFA)-enriched phosphatidylcholine (PC) was successfully produced with fatty acid from fish oil and PC from soybean by immobilized phospholipase A1-catalyzed acidolysis. Detailed studies of immobilization were carried out, and Lewatit VP OC 1600 was selected as a carrier for preparation of immobilized phospholipase A1, which was used for modification of PC by acidolysis. For acidolysis of PC with n−3 PUFA, the effects of several parameters, namely, water content, temperature, and enzyme loading on the reaction time course were investigated to determine optimum conditions. The optimum water content, temperature, and enzyme loading were 1.0%, 55 °C, and 20%, respectively. The highest incorporation (57.4 mol%) of n−3 PUFA into PC was obtained at 24 h and the yield of PC was 16.7 mol%. The yield of PC increased significantly by application of vacuum, even though a slight decrease of n−3 PUFA incorporation was observed.
Levels of PCDDs, PCDFs, and dioxin-like PCBs in human milk among Hong Kong mothers
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A study of their long-term effects on humans, from infancy onwards, would be of the greatest interest. While some such studies exist in Europe – such as the one by Lanting et al. (1994) on the neurological differences between breast-fed and formula-fed 9-year-olds in the Netherlands – none have yet been conducted for Chinese populations. Babies fed on breast milk should be monitored for their neurological and psychosocial development during childhood; this could perhaps provide local information demonstrating the beneficial effects of breast-feeding regardless of ethnicity, and allay any concerns over the intake of POPs in breast milk.
Dioxins are a family of persistent organic pollutants (POPs) listed under the Stockholm Convention, and include PCDDs, PCDFs, and dioxin-like PCBs. These toxic chemicals are carcinogenic, widely dispersed, and have long half-lives. They have contaminated the food web and, being fat-soluble, accumulate in adipose tissues and milk in the human body. To assess human exposure, we collected breast milk samples from 137 first-time mothers recruited from around Hong Kong. Samples were analysed by HRGC–HRMS in four pools, according to the subject's age and length of residency. Exposure was related to age, duration of stay, and possibly diet. Generally, older mothers, and mothers with a longer stay in Hong Kong, had higher levels of dioxins in their milk. This pattern was clearest for the PCBs, although deviations were observed for some of the PCDD/Fs. Mean concentrations, measured per gram of lipid weight in terms of WHO toxic equivalents (WHO-TEQs), were 7.48 pg/g for PCDD/Fs and 3.79 pg/g for PCBs, giving a total of 11.27 pg/g for PCDD/Fs and PCBs combined. Compared to an earlier Hong Kong study we conducted in 2002, the mean WHO-TEQ values in our latest findings were about 9% lower overall for PCDD/Fs and 19% lower for PCBs, with the mean total WHO-TEQ for PCDD/Fs and PCBs being around 13% lower in this study. This indicates a general declining trend in the levels of POPs in Hong Kong. However, our levels were still high when compared to those in some other Asian-Pacific countries. More stringent policies on reducing and eliminating POPs should help to lower these. Continued surveillance for POPs in human milk, as well as in common foodstuffs, will provide us with important information on human exposures that will be necessary for tracking our progress, and making future health risk assessments.
Minor neurological dysfunction and cognition in 9-year-olds born at term
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One of the results of the study design was that only 37% of the children were breastfed after birth, compared with 78% in a typical Dutch population [37]. Breastfeeding has been associated with a better neurological condition [5,38] and with less fine manipulative disability [13], which may have resulted in the high prevalence of MND found in this study compared to previous results [4]. However, whether this effect is a result of the type of feeding or due to factors associated with breastfeeding, such as maternal education or environmental factors, is unknown.
In children with developmental disorders, motor problems often co-occur with cognitive difficulties. Associations between specific cognitive deficits underlying learning problems and minor neurological dysfunction (MND) are still unknown.
To assess associations between specific types of MND as clinical markers of non-optimal brain function and performance in specific cognitive domains.
Part of a randomized controlled trial.
Three hundred and forty one 9-year-old children born at term (177 boys, 164 girls).
Children were neurologically assessed to detect eight types of MND: mild dysfunction in posture and muscle tone, reflexes, coordination, fine manipulative ability, sensory function, cranial nerve function, choreiform dyskinesia and excessive associated movements. Cognitive function in the domains of attention, memory and language was evaluated using the Test of Everyday Attention for Children (TEA-Ch), a developmental neuropsychological assessment (NEPSY) and the Children's Memory Scale.
Fine manipulative disability and coordination problems were associated with lower scores on attention, memory and learning and language, other types of MND were not. Girls with coordination problems performed significantly worse on attention/executive function than those without this dysfunction; however, in boys, such association was absent.
Particularly, fine manipulative disability and coordination problems were associated with worse cognitive function in the domains of attention, learning and memory and language. Previous and present data suggest a minor sex difference in neurocognitive associations: in girls dysfunction of the cerebello-thalamo-cortical pathways may be associated with cognitive deficits, while in boys cognitive impairment may be associated with dysfunction of cortico-striato-thalamo-cortical pathways.
Valorization of biodiesel derived glycerol as a carbon source to obtain added-value metabolites: Focus on polyunsaturated fatty acids
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Omega-3 PUFAs effectively regulate the plasma cholesterol, which is related to increased risk of suicide and depression (Hibbeln and Salem, 1995). PUFAs are also related to proper visual and neurological development in infants (Birch et al., 2007; Bourre, 2004; Das, 2003; Lanting et al., 1994; Makrides et al., 1995; Mazza et al., 2007; McCann and Ames, 2005; Rotstein et al., 1997). Therefore, an infant's diet with balanced omega-3 content contributes to the prevention of neuropsychological disorders.
The amount of glycerol derived from the biodiesel industry is exponentially increasing. The valorization of glycerol has acquired attention and resources with an obvious economic and environmental interest. Glycerol has the potential to improve the profitability of biodiesel in a biorefinery scenario. Added-value metabolites obtained from glycerol-based fermentations are the target of multiple research studies, primarily chemicals and biopolymers. Pigments and polyunsaturated fatty acids are exceptional examples as they have market presence as nutraceuticals. Most of the studies reviewed have been based on microalgae cultures. Depending on the strain and the engineering aspects of such cultures the final yield suffers notable variations. This is an emerging field which shows great potential from the perspective of a byproduct usage and the increasing yields (value) obtained from the bioprocess.
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ArticlesNeurological differences between 9-year-old children fed breast-milk or formula-milk as babies

Abstract

Soc Sci Med

Early Hum Dev

Lancet

Early Hum Dev

Early Hum Dev

Lancet

J Lipid Res

Early Hum Dev

Lancet

Am J Clin Nutr

Am J Clin Nutr

Early feeding history of children with learning disorders

Develop Med Child Neurol

Perinatal risk factors and minor neurological dysfunction: significance for behaviour and school achievement at nine years

Develop Med Child Neurol

The neurological examination of the full-term newborn infant

Perinatal correlates of major and minor neurological dysfuncton at school age: a multivariate analysis

Develop Med Child Neurol

Articles
Neurological differences between 9-year-old children fed breast-milk or formula-milk as babies