长链多不饱和脂肪酸与足月儿智能和精神运动发育关系的Meta分析

摘要 目的 对添加长链多不饱和脂肪酸（LCPUFAs）配方奶喂养足月儿的智能和精神运动发育进行评价。方法 使用相关的检索词检索Cochrane 图书馆、PubMed、EMBASE、中国生物文献数据库和中文科技期刊全文数据库，获取添加LCPUFAs配方奶喂养的相关RCT文献，由2名评价者进行资料提取和文献质量评价，对同质资料运用RevMan 4.3.2软件进行Meta分析。结果 共6项研究（n=894）符合纳入标准进入Meta分析。根据随机方法、分配隐藏、盲法和随访情况评分，文献质量A级5篇，B级1篇。按年龄分为12月龄和18月龄亚组。Meta分析结果显示：①对智力发育指数的影响：12月龄亚组加权均数值（WMD)＝-1.66（95％CI：-4.09～0.76，P＝0.18），18月龄亚组WMD＝-0.70（95％CI：-2.90～1.51，P＝0.54），两亚组合并分析，合并WMD＝-1.13（95％CI：-2.76～0.50，P＝0.17）；②对精神运动发育指数的影响：12月龄亚组WMD＝-1.14（95％CI：-4.39～2.12，P＝0.49），18月龄亚组WMD＝0.70（95％CI：-0.88～2.27，P＝0.39），两亚组合并分析：合并WMD＝0.35（95％CI：-1.07～1.77，P＝0.63）。提示添加LCPUFAs配方奶喂养足月儿的智力发育指数和精神运动发育指数与未添加LCPUFAs配方奶组的差异均无统计学意义。 结论包现有的证据显示，添加LCPUFAs的配方奶对足月儿智能及精神运动发育无积极或消极影响。

Meta-analysis of early dietary supply of lon-chain polyunsaturated fatty acids on mental and psychomotor development in term infants

Abstract Objective To assess whether supplementation of formula with LCPUFAs is beneficial to mental development of term infants.Methods Eligible studies were identified by searching Cochrane library, PubMed,EMBASE, CMBdis and CNKI. No language restrictions were applied. Two reviewers assessed the quality of included studies and extracted data and processed meta analysis. All randomized and quasi randomized trials comparing LCPUFAs supplemented formula vs non supplemented formula and with clinical endpoints were reviewed. Neuro developmental outcomes and physical growth were measured by Bayley scales of infant development (BSID). RevMan 4.3.2 was used to do the statistical analyses. Results There were six randomized clinical trials that met with the inclusion criteria of this systematic review,including 894 term infants. Studies were graded in term of randomization, allocation concealment and blinding. Five studies were graded A and one studies were graded B. Sub groups were divided according to the age. Meta analysis basing on included studies showed that the effect on MDI ,WMD of 12 month subgroup was -1.66(95％CI：-4.09 to 0.76，P＝0.18)，WMD of 18 month subgroup was -0.70(95％CI：-2.90 to 1.51，P＝0.54) and pooled WMD was -1.13(95％CI：-2.76 to 0.50，P＝0.17. The effect on PDI, WMD of 12 month subgroup was -1.14(95％CI：-4.39 to 2.12，P＝0.49），WMD of 18 month subgroup was 0.70(95％CI：-0.88 to 2.27，P＝0.39) and pooled WMD was -0.35（95％CI：-1.07 to 1.77，P＝0.63. There were no significant differences in the psychomotor development index of term infants between two groups. Pooled meta-analysis of the data did not show any statistically significant benefit of LCPUFAs supplementation on either mental or psychomotor developmental index of BSID. The evidence was not strong enough to judge whether the formula fortified with LCPUFAs had beneficial effects on the mental development of term infants than that without.Conclusions The results of most of the well conducted RCTs had not show beneficial effects of LCPUFAs supplementation of formula on the neuro developmental outcomes of term infants.