This issue of Pediatrics contains a meta-analysis by Qawasmi et al1 that is an evaluation of the effects of long-chain polyunsaturated fatty acid (LCPUFA) supplementation of infant formula on what is claimed to be measures of “infant cognition.” The analysis is based on performance of different dietary groups on the Bayley Scales of Infant Development (BSID) at ages up to 18 months. The authors conclude that LCPUFA supplementation provides no benefit for either term or preterm infants. There are now at least 4 meta-analyses or systematic reviews on this topic published in the past 7 years.2,4 All include only (or mainly) studies that have measured the BSID, and all reach a similar conclusion.

We do not disagree with the conclusion that the BSID is generally unaffected by LCPUFA supplementation; however, we are concerned with the nature of the outcome measure used to anchor this and...

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