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Eur J Nutr. 2016 Oct;55(7):2199-207. doi: 10.1007/s00394-015-1030-y. Epub 2015 Sep 7.

Fatty acid composition in breastfeeding and school performance in children aged 12 years.

Author information

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508GA, Utrecht, The Netherlands.
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Health Sciences, Faculty of Earth and Life Sciences, and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.
Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, and Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508GA, Utrecht, The Netherlands.



Breastfeeding has been associated with improved cognition. It remains unclear whether long-chain polyunsaturated fatty acids (LC-PUFAs) play a role in this association. We assessed the association between LC-PUFA concentrations in infant feeding and school performance at age 12.


Within a population-based birth cohort, we compared school performance of 277 non-breastfed children and 157 children who had fatty acid composition of their mothers' breast milk measured. Two indicators of school performance were: (1) the score on a standardized achievement test and (2) the teacher's advice regarding a child's potential performance level in secondary education. Linear regression and multinomial logistic regression analyses were performed to assess the independent association between LC-PUFA content of breast milk and school performance.


Girls, who received breast milk with a relative high content (above the median) of docosahexaenoic acid (DHA), had a higher Cito-test score (β = 2.96 points, 95 % CI 0.24; 5.69) than non-breastfed girls. Among the breastfed girls, each percentage point of higher content of total n-3 LC-PUFA (β = 4.55, 95 % CI 0.43; 8.66) and DHA (β = 7.09, 95 % CI 0.9; 13.3) was associated with a higher Cito-test score. The association between LC-PUFA content and teacher school advice showed a similar pattern. There was no association between LC-PUFA content and school performance in boys.


Although a large part of the association between infant milk feeding and cognition seems to be explained by sociodemographic and lifestyle-related factors, a relative high content of n-3 PUFAs, especially DHA, in breast milk is associated with better school performance in 12-year-old girls but not in boys.


Birth cohort; Breastfeeding; Fatty acid composition; School performance

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Conflict of interest statement

The authors declare that they have no conflict of interest. Ethics statement The study protocol was approved by the medical ethics committees of the participating institutes and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All parents gave written informed consent.

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