EvidenceBasedNursingResearchProjectPaper

Group3
RachelSullivan,KatieSylvia,JohnEstoesta,EmilyDowling,CarleyTaylor,AnnaChang

I.
TableofEvidence

II.
Synthesis

Introduction
Overthepastcentury,theongoingdebateandcontroversyonthebenefitsofcowsmilk,
whetherwholeorskimmilkhasbeenconstantlydebated.Itusedtobethoughtthatthedaily
consumptionofmilkwasabsolutelynecessarythroughoutchildhoodandevenadolescence.Then
itbecameanissuethatmanyweregainingtoomuchweightandtheissueofchildhoodobesity
becameprevalent.Milkhasbeensaidtohavemanypositivebenefitsforchildrenandeven
adults.Itishighincalcium,fats,andothernutrientsthatcanprovetobebeneficialinthe
developmentofstrongbones,andevenbraindevelopment.Althoughresearchisstillongoingon
thesubject,mostresearcherscanagreethatitisimportanttoconsumemilkasachild.
Inthepediatricpopulation,ithasbeenshownthatfatintakehasanimportantrolein
braindevelopment.Understandingthedifferentsourcesandroutesinwhichfatscanbe
introducedintothedietcanhelpoptimizegrowth.Also,determiningtheeffectsoffatsinthe
pediatricpopulationatcertainagescanencouragefamiliestoprovidesufficientnutritionto
fosteradequatebrainhealththatcatertospecificagesandtheirneeds.Supplementationofthese
fattyacidsduringpregnancyandtheintroductionofatleast2%milkintothepediatricdiethas
beenanimportantaspectofresearchandstudies.Manystudieshavebeendoneonthissubject
withresultsthatshouldbeofgreatinterestandimportancetoparentsoftoddlers.

StudyCommonalities
Withinthisresearch,12studieshavebeenselectedandexaminedinordertoprovide
insightintheeffectsoffatintakeonbraindevelopmentinthepediatricpopulation.Accordingto
Birch(2000)andSteer(2013),thesupplementationoffattyacidsreappositiveresultsandmay
preventlowerlevelsofcognitivedevelopmentwhenimplementedintothedietofnewborns.
AnotherclaimssimilarresultsbyexpressingthebenefitsofDHA,anomega3fattyacid,on
areasofcognitionorbehaviors(Kuratko,2013).Thesestudieshelpsupporttheuseofdietary
fatsinthepediatricpopulationtofosterproperneurocognitivehealthandcanencourageparents
orguardianstoimplementfatsintotheirchildsdiet.Althoughthesearticlesfocusontheimpact
offatsintopediatricdiets,otherarticlesfocusonthetypeofdairyproductsasasourceofdietary
fat.Withtheriseinobesityamongtoddlersandchildren,increasingfatintakecancausein
unnecessaryandpossiblyunhealthyweightgain.Studiesshowthatreducingfatintakefrom
wholemilkto2%ortoskimmilkcanpreventunhealthyweightgainwhilestillsupportcognitive
developmentandgrowthinchildren(Wosje,2010Scharf,2013Fox,2010)Allthreearticles
expresstheneedtoprovideadequatefatsintothediettomaintainbraindevelopmentwhile
addressingtheconcernforahealthyweightrangeinchildren.Understandingthepossible
ramificationsofwholemilkonchildrencanhelppreventincreasingnumbersofchildobesityto
encouragehealthyfatsupplementationforbraindevelopmentandahealthyweightinthe
pediatricpopulation.
StudyDifferences
Twoarticles(Ou,2015Kuratko,2013)defendthepositiveimpactfatscontributetothe
developingbrain,whileotherarticlesexpressthatsupplementationdoesnotaffectcognition.

Agostoni(2012)explainsthatdietaryfatsdonotaffectchildrennegativelyandposeslittleharm.
SimilarresultsareevidentinDelgadoNogueras(2016)studyexclaimingthatsupplementation
didnotprovetopassbothnegativeresultsorpositiveresultsindicatingthatfatshadlittleimpact
onbraindevelopment.
Oneofthearticlesthatshowsapositivecorrelationbetweenfattyacidsandbrain
development(Kuratko,2013)ismorefocusedonsupplementationduringpregnancyandhow
thataffectsbehaviorandcognitioninthepediatricpopulation.SupplementationofDHA
revealedbenefitsinoverhalfofthestudiesdone.Theotherarticle(Ou,2015)dealsmorewith
comparingwhetherthechildwasfedwithbreastmilkorcowsmilkformuladuringthefirstyear
oflifeandhowitaffectsthedevelopmentofgreymatterintheneuronsofthebrain.Thisyielded
resultsthatshowednoeffectonthevolumeofgreymatterhowever,whenstudiedinthechildat
8yearsofage,itshowedthatthedevelopmentandfunctionofgreymatterwasgreaterin
childrenthatweregivenbreastmilkcomparedtocowsmilkformula.Thisarticlehighlights
anotherdifferencebetweenmanyofthearticles:agethatchildrenwerestudied.Somestudies
weredonestillduringpregnancyandtheresultswerenotstudieduntilthechildwasbornorhad
grownafewyears.Othersweredonebyusingacertainmethodoffeedinginanewbornor
toddlerandfinaldataaresultswerenotgathereduntilthechildwastestedateightyearsofage.
Oneofthearticlesincludedinourresearch(Steer,2013)wasverymuchsointhemiddle
ofallthedata,withresultsthatremainedneutral.Inthisstudy,reducedlevelsoffattyacids
showedreducedstandardsofcognitivedevelopmentintheinfant,butdidnotshowasignificant
effectontheIQwhentestedatageeight.Althoughthescoreswereslightlyelevatedinthese

children,theresultswerenotfoundtobedrasticenoughtoaffecttheresearchbeingfavoredin
eitherdirection.
Wealsofoundarticlesthatcouldshowhowbroadofatopicfatintake,especiallyfrom
dairyproducts,hasproventobeinpediatrics.Wefoundinformationthatwasnotonlyconcerned
withhowfatintakecanaffectdevelopment,buthowabalanceisneededwhenconsideringwhat
amountistoomuchforachild.Wosje(2010)providedalternativestowholemilkbysuggesting
that2%milkcanbesubstitutedinachildsdietinordertoreduceoverallfatintakewithout
compromisinggrowthanddevelopment.
Youcanseeintheprevioustable,thatthereweremanydifferentpopulationsstudied,
includinginfants,children,adolescents,andmotherchildpairs.Also,somearticleswere
literaturereviewthatstudiedmanydifferentarticlesastheirresearch.Youcanseethatmany
differenttechniquesorinstrumentswereusedtomeasuredataaswell,includingscales,such
astheWechslerIntelligenceScaleforChildren(Steer,2013)andTheBayleyScalesofInfant
Development(Baym,2014)orphysicaltests,suchasbloodFAsor3Dimaging.
InconsistenciesorGapsAmongStudy

Whenconductingourresearch,wehadadifficulttimefindingstudiesthatconsistently
observedthesamepopulation.Weoriginallyintendedtofocusspecificallyonthetoddler
population,whichweweredefiningaschildrenaged15.Afterbeginningourresearch,we
realizedthatthelimitedamountofstudiesthathavebeenperformedonourtopicwerenot
lookingatthisagegroupfrequentlyenoughtodevelopthegeneralizationsthatweneeded.We
decidedtochangeourpopulationtothepediatricpopulationinordertoincludemoredataand
incorporatethemostrecentevidence.Therewerealsoalotofinconsistencieswhenitcameto

theaspectofdevelopmentthatthestudieswerelookingat.Wewantedtostudyhowdifferentfat
intakewouldimpactbraindevelopment.Therewerenotmanyarticlesthatfocusedjustonbrain
developmenttherewerealotthatreferencedschoolperformanceandmemorybutnotsolely
development.Thisleadsustobelievethatalthoughthisisahottopicrightnow,thereare
significantgapsandvariationsinthestudiesthatneedtobestudiedfurthertohelpimprove
validityoftheresultsandmakespecificrecommendations.
LimitationsoftheStudyandThreatstoValidity
Therearemanyuncontrollablefactorsthatcouldhaveaffectedthesestudies.Duetothe
subjectsofourstudies,itisdifficulttosingleoutonefactorthatcouldaffectbraingrowthand
development,andIQ.Thereareavarietyoffactorsthatcouldaffectdevelopmentbesides
nutritionsuchasnurture,experiences,andgenetics.Mostofthestudiesrecognizethesefactors
aslimitationstotheirresearchandreaffirmthevalidityoftheirinstrumentsassuccessfortheir
results.Severalfactors,however,serveasthreatstothevalidityofthestudy.Forexample,there
isntaconstantinstrumentthatisusedinthetestingprocess.Theseinstrumentsvariedfrom
supplementrichformulastowholemilkto2%milk.Aconsistencyfromtheinstrumentsutilized
inthestudyisimportanttopreventalternativeandlessthandesirableresultsfromsurfacingthat
ultimatelydoesnotcontributetothevalidityofthestudyitself.
III.

ImplicationsandRecommendationsforPractice
Educatehealthcarepersonnelandparents
Advocateforfatintakeasaninfantandtoswitchtolowornonfatmilkafterage5
Encouragetheintakeofhealthyfatsasatoddler

 Encourageandallowchildrentobeinvolvedintheirfoodchoicessotheycanbe
educatedanddeterminetheirlikesanddislikes.
Encourageparentstoreadtotheirchildrenonadailybasistohelpfosterbraingrowth.
RecommendOmega3supplementsforthemotherduringpregnancytoenhancebrain
development.
Researchtheintroductionofotherfatsandhowthosedifferintheinfluenceofbrain
developmentincomparisontocowsmilk.
Provideotherwaystoprovidethisproperintakeforthosewhocannotintakeordislike
dairyproducts.
Promotethecontinuationofbreastfeedingforaslongasthemotherdesires
IV.
References

Agostonia,C.&Carolib,M.(2012).Roleoffatsinthefirsttwoyearsoflifeasrelatedtolater
developmentofNCDs.Nutrition,MetabolismandCardiovascularDiseases,22(10),775780.
doi:10.1016/j.numecd.2012.05.004

Baym,C.L.,Khan,N.A.,Monti,J.M.,Raine,L.B.,Drolette,E.S.,Moore,D.R.,...Cohen,
N.J.(2014).Dietarylipidsaredifferentiallyassociatedwithhippocampaldependentrelational
memoryinprepubscentchildren.AmericanJournalofClinicalNutrition,99(5),10261033.

Birch,E.E.,Garfield,S.,Hoffman,D.R.,Uauy,R.,&Birch,D.G.(2000).Arandomized
controlledtrialofearlydietarysupplyoflongchainpolyunsaturatedfattyacidsandmental
developmentinterminfants.DevelopmentalMedicineandChildNeurology,42(3),174181.

DelgadoNoguera,M.F.(2015).Supplementationwithlongchainpolyunsaturatedfattyacids
(LCPUFA)tobreastfeedingmothersforimprovingchildgrowthanddevelopment.Cochrane
DatabaseofSystematicReviews(7),12.

Fox,M.K.,Condon,E.,Briefel,R.R.,Reidy,K.C.,&Deming,D.M.(2010).Research:Food
ConsumptionPatternsofYoungPreschoolers:AreTheyStartingOffontheRightPath?Journal
OfTheAmericanDieteticAssociation,110(Supplement),S52S59.doi:
10.1016/j.jada.2010.09.002


Griebler,U.,Bruckmller,M.U.,Kien,C.,Dieminger,B.,Meidlinger,B.,Seper,K.,et.al
Gartlehner,G.(2016).PublicHealthNutrition,19(2),29330715p.doi:
10.1017/S1368980015001354

Huffman,S.L.,Harika,R.K.,Eilander,A.,Osendarp,S.J.M.(2011).Essentialfats:howdothey
affectgrowthanddevelopmentofinfantsandyoungchildrenindevelopingcountries?A
literaturereview.Maternal&ChildNutrition,7,4465.doi:10.1111/j.17408709.2011.00356.x

Kuratko,C.,Barrett,E.,Nelson,E.,&Salem,N.(2013).Therelationshipofdocosahexaenoicacid
(DHA)withlearningandbehaviorinhealthychildren:areview.Nutrients,5(7),27772810.doi:
10.3390/nu5072777

Ou,X.,Andres,A.,Pivik,R.T.,Cleves,M.A.,Snow,J.H.,Ding,Z.,&Badger,T.M.(2015).
VoxelbasedmorphometryandfMRIrevealeddifferencesinbraingraymatterinbreastfedand
milkformulafedchildren.AmericanJournalofNeuroradiology,37(3).doi:10.3174/ajnr.A4593

Scharf,R.J.,Demmer,R.T.,&DeBoer,M.D.(2013).Longitudinalevaluationofmilktype
consumedandweightstatusinpreschoolers.ArchivesofDiseaseinChildhood,98(5),335340.
doi:10.1136/archdischild2012302941

Steer,C.D.,Lattka,E.,Koleltzko,B.,Golding,J.,&Hibbeln,J.R.(2013).Maternalfattyacidsin
pregnancy,FADSpolymorphisms,andchildintelligencequotientat8yofage.American
JournalofClinicalNutrition,98(6),15751582.doi:http://dx.doi.org/10.3945/ajcn.112.051524.

Wosje,K,S.,SpeckerB,L.,Giddens,J.(2010).Nodifferencesingrowthorbodycomposition
fromage12to24monthsbetweentoddlersconsuming2%milkandtoddlersconsumingwhole
milk.JournaloftheAmericanDieteticsAssociation,101(1),5356.doi:10.1016/S00028223
(01)000153