Seafood and Neurocognitive Development in Children: A Systematic Review

Seafood is a source of essential nutrients to support neurocognitive development of children and adolescents, but there are concerns about contaminant exposure. Assessing seafood as a food group, rather than a source of nutrients or contaminants, can inform future dietary guidance. This study aimed to update and assess relationships between seafood consumption during childhood and adolescence and neurocognitive development. Three electronic databases were searched until September 2024 to update a previous search from 2000 to 2019. Articles were included if associations were assessed between seafood intake during childhood and adolescence and neurocognitive development outcomes (cognitive development, social-emotional and behavioral development, movement/physical development, language/communication development, depression, anxiety, attention-deficit/hyperactivity disorder, and autism spectrum disorder). All articles were screened at title, abstract, and full-text levels by 2 independent analysts. Data were extracted by 1 analyst, quality checked by a second analyst, and synthesized narratively by 2 analysts independently, considering direction, magnitude, and statistical significance of results for each outcome; discrepancies were resolved via discussion. Risk of bias was assessed using ROBINS-E and ROB 2.0. Certainty of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eighteen articles from 5 short-term (12-16 wk) RCTs conducted in Northern Europe and 9 prospective cohort studies conducted in various countries were included. The evidence suggested a relationship between higher seafood consumption and improved cognitive development outcomes for children and adolescents aged 0-18 y old (GRADE: low). This conclusion was informed by 5 short-term RCTs in which children aged 10 mo to 15 y were provided fatty fish compared with meat, poultry, or fish oil supplements. These RCTs were largely supported by results from 5 longer-term prospective cohort studies. Evidence was inconsistent for social-emotional and behavioral development outcomes and was lacking for other outcomes. Seafood consumption within current recommended intake amounts consumed mainly as fatty fish likely improves cognitive development outcomes in children and adolescents. This review was registered at PROSPERO as CRD42023432844.