Fatty fish intake and cognitive function: FINS-KIDS, a randomized controlled trial in preschool children

Jannike Øyen, Ingrid Kvestad, Lisa Kolden Midtbø, Ingvild Eide Graff, Mari Hysing, Kjell Morten Stormark, Maria Wik Markhus, Valborg Baste, Livar Frøyland, Berthold Koletzko, Hans Demmelmair, Lisbeth Dahl, Øyvind Lie, Marian Kjellevold, Jannike Øyen, Ingrid Kvestad, Lisa Kolden Midtbø, Ingvild Eide Graff, Mari Hysing, Kjell Morten Stormark, Maria Wik Markhus, Valborg Baste, Livar Frøyland, Berthold Koletzko, Hans Demmelmair, Lisbeth Dahl, Øyvind Lie, Marian Kjellevold

Abstract

Background: Marine resources including fatty fish are important sources of n-3 long chain polyunsaturated fatty acids (n-3 LC-PUFAs), which are important for brain development. To our knowledge, this is the first randomized controlled trial (RCT) investigating the impact of fatty fish on cognition in preschool children. The purpose of the trial was to investigate whether an increased intake of fatty fish compared to meat improves cognitive function in children 4-6 years old.

Methods: The children (n = 232) in this two-armed RCT, Fish Intervention Studies-KIDS (FINS-KIDS) were recruited from 13 kindergartens in Bergen, Norway. They were randomly assigned to lunch meals with fatty fish (herring/mackerel) or meat (chicken/lamb/beef) three times a week for 16 weeks. The fish and meat were weighed before and after the meals to record the exact consumption (dietary compliance). The primary outcome was cognitive function measured by the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition (WPPSI-III) and fine-motor coordination measured by the 9-Hole Peg Test (9-HPT) at pre- and post-intervention. Biological samples (blood, urine, hair), and questionnaires to the caregivers were included at both time points. Linear mixed effect models with a random intercept for kindergarten were used to analyze changes from pre- to post-intervention in the primary outcome variables.

Results: There were 218 children included in the trial (105 in the fish, and 113 in the meat group). The children consumed a mean (standard deviation) of 2070 (978) g fish or 2675 (850) g meat from the study meals (p < 0.0001). The fish group had a significant increase of red blood cell n-3 LC-PUFAs. The intervention had no effect on the WPPSI-III scores (mean change total raw score; fish group 17.7, 95% confidence interval (CI) 14.8-20.7 vs meat group 17.8, 95% CI 15.0-20.6, p = 0.97) in the main analyses. In the sub-analyses, adjusting for dietary compliance, the fish group showed a higher improvement on total raw score (20.4, 95% CI 17.5-23.3) compared to the meat group (15.2, 95% CI 12.4-18.0, p = 0.0060); docosahexaenoic acid mediated this effect.

Conclusions: There was no beneficial effect of fatty fish compared to meat on cognitive functioning in the preschool children. When considering dietary compliance, we found a beneficial effect of fatty fish on cognitive scores.

Trial registration: ClinicalTrials.gov, NCT02331667 December 17, 2014.

Keywords: 9-Hole Peg Test; Cognitive function; Docosahexaenoic acid; Eicosapentaenoic acid; Fatty fish; Omega-3 index; Preschoolers; Vitamin D; Wechsler Preschool and Primary Scale of Intelligence.

Conflict of interest statement

Ethics approval and consent to participate

The trial has approval from the Regional Committees for Medical and Health Research Ethics North (2014/1396) and is registered in Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart showing the study population
Fig. 2
Fig. 2
Scatter plots of changes in the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition (WPPSI-III) from pre- to post-intervention vs amount fish (blue)/meat (red) consumed in kilograms (kg) (dietary compliance). The estimated regression line from an adjusted mixed effect model including the interaction between intervention and compliance, together with regression coefficient (β) and a 95% confidence interval are presented. Panel a shows WPPSI-III Total raw score, b Verbal raw score, c Performance raw score, and d Processing speed raw score

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