Fatty Acid Supplementation in Toddlers Born Preterm and Attention and Autism Outcomes at 8–10 Years: Omega Tots Randomized Controlled Trial Long-Term Follow-Up

Abstract Purpose Children born preterm are at increased likelihood of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). We examined whether 6 months of daily dietary docosahexaenoic acid (DHA) + arachidonic acid (AA) supplementation at age 1-year reduced attention problems and likelihood of ADHD and ASD diagnoses in children born preterm. Methods In the Omega Tots randomized placebo-controlled trial, children born at <35 weeks’ gestation received daily DHA (200 mg) + AA (200 mg) or placebo (400 mg corn oil) at 10–16 months’ corrected age. This long-term follow-up assessed outcomes at 8.5–10.5 years. Outcomes included parent- and teacher-rated attention problems, performance on the Flanker Inhibitory Control and Attention Test (continuous performance task), and medical record diagnoses of ASD and ADHD. Mixed linear and log-binomial regression models estimated treatment effects. Subgroup analyses examined effects by sex, birthweight, family income, dietary omega-3 intake, and blood omega-3 status. Results At least 1 outcome measure was available for all 376 children eligible for follow-up. Flanker scores were higher (better) for the DHA+AA group (difference=3.02; 95% CI=0.01, 6.04), particularly among children with lower dietary omega-3 intake (difference=4.88; 95% CI=0.53, 9.23). DHA+AA was associated with fewer teacher-rated attention problems among children with birthweight>1500g (difference=-2.97; 95% CI=-5.38, -0.55). No group differences were found in likelihood of autism and ADHD diagnoses. Conclusions DHA+AA supplementation was associated with modest improvements in attention, particularly among specific subgroups, supporting further investigation of targeted, personalized nutrition approaches. There was no association between supplementation and likelihood of ADHD and autism. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT05191823