配方奶粉添加长链多不饱和脂肪酸对婴幼儿大脑发育影响的Meta分析

Effect of supplementation with long-chain polyunsaturated fatty acid on infant cerebral development： a meta-analysis

目的 评价配方奶粉添加长链多不饱和脂肪酸对婴幼儿大脑发育的影响. 方法 检索自建库至2013年5月,Pubmed、Medline、Science Online、EMBASE、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库,获得有关配方奶粉添加长链多不饱和脂肪酸（LCPUFAs）对婴幼儿大脑发育影响的RCT文献.根据Jadad量表对文献质量进行评估.配方奶粉中添加LCUPFAs为LCUPFAs组,配方奶粉中未添加LCUPFAs为对照组,以Bayley婴儿发育量表（BSID）、Fagan婴儿智商测试量表（FTII）、麦克阿瑟语言沟通及发展量表（MCDI）的测量结果为效果判定指标,进行Meta分析. 结果 根据纳入和排除标准共纳入13篇（n=1 577）RCT研究进行Meta分析,12篇文献中的BSID测量结果合并,智力发育指数、精神运动指数比较,差异均无统计学意义;以足月产儿和早产儿,12月龄和18月龄分别进行亚组分析,18月龄早产儿亚组MDI和12月龄足月儿亚组PDI比较,差异均有统计学意义,其他各亚组差异均无统计学意义.FTII和MCDI量表的测量结果合并后,婴幼儿新异偏好、熟悉事物的平均注意时间、对新异事物的平均注意时间、14月龄时婴幼儿语言理解能力和表达能力得分,差异均无统计学意义. 结论 现有研究结果不足以证明配方奶粉中添加LCUPFAs对婴幼儿的大脑发育有促进作用,鉴于研究间的异质性和评价方法的局限性,结论需谨慎看待.

Objective To assess the efficacy of supplementation with long-chain polyunsaturated fatty acid （LCP- UFAs） on infant cerebral development by conducting a meta-analysis. Methods Literature search was performed in Pubmed, Medline, Science Online, EMBASE, CNKI, VIP, and Wangfang data as of May 2013 to obtain randomized con- trolled clinical trails that assessed the efficacy of LCPUFA supplementation in infant formula on the cerebral development. JADAD measuring scale was used to evaluate the methodological quality. The experimental group was defined as infants feeding on formulas with LCPUFAs supplementation, and the control group as infants feeding on control formulas without LCPUFAs. The testing results of Bayley Scales of Infant Development （BSID） at 12 and 18 months, Fagan Test of Infant Intelligence （FFII） at 12 months and MacArthur Communicative Development Inventories （MCDI） at 14 months were measured as efficacy index. RevMan 5.0 software was used for meta-analysis. Results Thirteen RCT trials involving 1577subjects were included according to the inclusion and exclusion criteria. Twelve trials reported both MDI and PDI with BSID. There were no significant difference between the two groups both in MDI and in PDI. Subgroup analyses were carried out for the preterm and term infants at both 12 and 18 months respectively. The MDI measured in the preterm at 18 months and the PDI measured in the term infant at 12 months had significant difference between two groups. No other subgroups showed significant difference in the MDI and PDI. The testing results of FFII and MCDI also showed no significant differ- ence between groups. Conclusion This meta-analysis suggests that supplementation with LCPUFAs in infant formulas has no effect on cerebral development.