Effect of fish oil supplementation in pregnancy on bone, lean, and fat mass at six years: randomised clinical trial

OBJECTIVE: To examine the effect of supplementation with n-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) in pregnancy on anthropometry and body composition in offspring. DESIGN: Double blinded, randomised controlled trial. SETTING: Copenhagen Prospective Studies on Asthma in Childhood(2010) cohort. PARTICIPANTS: 736 pregnant women and their offspring. INTERVENTION: n-3 LCPUFA (fish oil) or control (olive oil) daily from pregnancy week 24 until one week after birth. MAIN OUTCOME MEASURES: Height/length, weight, head, and waist measurements and body composition from dual energy x ray absorptiometry (all pre-specified secondary endpoints of the n-3 LCPUFA trial; the primary outcome for the trial was persistent wheeze/asthma). RESULTS: The mean body mass index (BMI) z score was increased between age 0 and 6 years in the fish oil supplementation group compared with the control group (0.14 (95% confidence interval 0.04 to 0.23); P=0.006). At 6 years, supplementation was associated with a higher BMI z score (0.19 (0.06 to 0.32); P=0.004), a higher weight/height (3.48 (0.38 to 6.57) g/cm; P=0.03), and a larger waist circumference (0.6 (0.0 to 1.2) cm; P=0.04) but not a higher proportion of obese children, using International Obesity Task Force grades. The dual energy x ray absorptiometry scan at age 6 years showed a higher total mass (395.4 (86.6 to 704.3) g; P=0.01) in the supplementation versus the control group, explained by a higher lean mass (280.7 (98.9 to 462.4) g; P=0.002), a higher bone mineral content (10.3 (2.3 to 18.1) g; P=0.01), and a non-significantly higher fat mass (116.3 (−92.9 to 325.5) g; P=0.28), but no differences were seen in total body fat or lean mass percentage. CONCLUSION: Fish oil supplementation from the 24th week of pregnancy led to a higher BMI in the offspring from 0 to 6 years of age but not an increased risk of obesity at age 6. The body composition at age 6 years in children given fish oil supplementation was characterised by a proportional increase in lean, bone, and fat mass suggesting a general growth stimulating effect of n-3 LCPUFA. TRIAL REGISTRATION: Clinicaltrials.gov NCT00798226