eLetters to:

ELECTRONIC ARTICLE: Nancy Auestad, David T. Scott, Jeri S. Janowsky, Cynthia Jacobsen, Robin E. Carroll, Michael B. Montalto, Robin Halter, Wenzi Qiu, Joan R. Jacobs, William E. Connor, Sonja L. Connor, James A. Taylor, Martha Neuringer, Kathleen M. Fitzgerald, and Robert T. Hall 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; 112: e177-e183 [Abstract] [Full text] [PDF]

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eLetters published:

Conclusion not supported by evidence

Michael J. Verive   (2 September 2003)

Experimental Design Flaw

Madonna Fasimpaur   (8 September 2003)

How do DHA and ARA support visual acuity and brain development?

Lance A Chilton   (13 September 2003)

Total Confusion

Alvin N. Eden   (22 January 2004)

Is this really science?

Christopher P. Indorf   (17 March 2006)

Conclusion not supported by evidence 2 September 2003
Michael J. Verive, Physician Sinai Children's Hospital Send letter to journal: Re: Conclusion not supported by evidence vermic{at}sinai.org Michael J. Verive	The last line of the conclusion: "In conclusion, adding both DHA and ARA when supplementing infant formulas with long-chain polyunsaturated fatty acids supports visual and cognitive development through 39 months." conflicts with the previously stated results: "When the infants were reassessed at 39 months using age-appropriate tests of receptive and expressive language as well as IQ, visual-motor function and visual acuity, no differences among the formula groups or between the formula and breastfed groups were found. The 14-month observation thus may have been a transient effect of DHA (without ARA) supplementation on early vocabulary development or may have occurred by chance." Additionally, the statement: "The absence of differences in growth achievement adds to the evidence that DHA with or without ARA supports normal growth in full-term infants." This is not correct, or at the very least, is quite biased. A more accurate assessment would be: "The addition of DHA with or without ARA does not appear to inhibit growth in full-term infants." There is no evidence given in this study to indicate that DHA or ARA "support" growth or development.
Experimental Design Flaw 8 September 2003
Madonna Fasimpaur, IBCLC Lactation Services,Inc. Send letter to journal: Re: Experimental Design Flaw lactserv{at}apk.net Madonna Fasimpaur	This research was skewed when the controll group was given the experimental product. Comparisons, to be valid, need to be measured equally to the Gold Standard,human milk. Even if you couldn't find exclusive breastfeeders to one year,feed human milk to one year. Not artificial breastmilk substitute. Since when is three months of breastfeeding equal to one year of artificial breastmilk substitute?
How do DHA and ARA support visual acuity and brain development? 13 September 2003
Lance A Chilton, pediatrician University of New Mexico Send letter to journal: Re: How do DHA and ARA support visual acuity and brain development? lancekathy{at}yahoo.com Lance A Chilton	I have read through this important article several times, and cannot find justification for the last sentence in the abstract and in the conclusion section of the paper: "In conclusion, DHA and ARA... support visual and cognitive development through 39 months of age." It appears to me that the gist of the article is that there is no difference among the groups, and therefore it would seem there is NO support for the assertion that DHA and ARa are necessary.
Total Confusion 22 January 2004
Alvin N. Eden, Pediatrician Wyckoff Heights Medical Center Send letter to journal: Re: Total Confusion babydoceden{at}hotmail.com Alvin N. Eden	LETTER TO THE EDITOR: I read with interest and then confusion the article by Auestad, et al, 1 a follow-up study of infants fed formulas containing long-chain polyunsaturated fatty acids to one year of age who were assessed at 39 months for visual, cognitive, and language development. The infants in the study were divided into four groups: control (unsupplemented formula), breast fed, supplemented formula with DHA, and supplemented formula with DHA and ARA. The results of the study were clear-cut. As Auestad correctly states "when the infants were reassessed at 39 months using age-appropriate tests of receptive and expressive language as well as I.Q., visual-motor function and visual acuity, no differences among the formula groups or between the breast fed and formula groups were found". What troubles me and what I found confusing was the authors' concluding statement "providing both DHA and ARA when supplementing infant formulas with long-chain polyunsaturated acids supports visual and cognitive development through 39 months". The results of their study indicate otherwise. In my opinion, this last sentence is at best misleading. 1 Auestad, N, Scott, D.T., Janowsky, J.S. et al. Visual, Cognitive and Language Assessments at 39 Months: A follow-up study of Children Fed Formulas Containing Long- Chain Polynsatured Fatty Acids to 1 Year of Age. Pediatr. 2003; 112: 660-661 Alvin N. Eden, M.D.
Is this really science? 17 March 2006
Christopher P. Indorf, Teacher/Concerned Parent Thornton Academy Send letter to journal: Re: Is this really science? chris.indorf{at}thornton.saco.org Christopher P. Indorf	After reading this publication three times, I have to throw my hands up in disgust. The Conclusion is completely contradictory, and that the AAP publishes such a flawed study is laughable! I came to this article because it was cited in a June 1, 2003 article in the New York Times about formula additives. I don't know who is more at fault: the study's authors for its myriad flaws, the AAP for allowing its publication, or the NYT for citing it. I asked my 10th graders to read this study and give me their feedback, and they universally agreed that the conclusion was flawed. Several were also concerned that an industry rep (with competing interests) was on the research panel. Conflict of Interest: None declared