{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T20:53:44Z","timestamp":1790974424904,"version":"4.1.0"},"reference-count":151,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The first 1000 days of life, from conception to 2 years of age, represent a critical window during which nutrition can exert long-lasting effects on neurodevelopment, immune maturation, and susceptibility to prematurity-related morbidity. Docosahexaenoic acid (DHA) is a key structural n-3 long-chain polyunsaturated fatty acid of the brain and retina, characterized by rapid fetal accretion during the third trimester. Methods: We conducted a narrative review of studies published from March 2015 up to December 2025, including randomized controlled trials, follow-up studies, and systematic reviews\/meta-analyses about DHA supplementation during pregnancy, lactation, infancy and early childhood, and its role on development. Results: Across the first 1000 days, DHA supplementation improves biochemical DHA status, particularly in populations with low baseline levels (moderate to high level of evidence), while clinical outcomes remain heterogeneous. During pregnancy, some benefits in specific cognitive and behavioral domains have been demonstrated, whereas effects on global cognition and long-term behavior are frequently null (moderate evidence). Visual outcomes appear favorable, with improvements in visual acuity (moderate evidence). In preterm infants, enteral DHA\u2014often combined with arachidonic acid (ARA)\u2014is feasible and well tolerated. DHA may reduce inflammatory markers and necrotizing enterocolitis risk when in equilibrium with ARA (low to moderate evidence), while no evidence supports the link between DHA and reduced risk of bronchopulmonary dysplasia and retinopathy of prematurity (moderate evidence). Neurodevelopmental outcomes are mixed: neuroimaging studies suggest enhanced white matter maturation with DHA + ARA, whereas most trials show no clear benefit regarding standardized developmental scores (moderate evidence). Conclusions: DHA is biologically essential during the first 1000 days, but its clinical impact depends on timing, dose, baseline status, and prematurity-related context. The balance between DHA and ARA, rather than DHA supplementation alone, emerges as a key determinant of clinical efficacy, supporting a shift toward precision-based nutritional strategies in early life.<\/jats:p>","DOI":"10.3390\/nu18081178","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:48:07Z","timestamp":1775720887000},"page":"1178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["DHA: Nutritional Programming During the First 1000 Days of Life"],"prefix":"10.3390","volume":"18","author":[{"given":"Laura Maria","family":"Sollena","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Carta","sequence":"additional","affiliation":[{"name":"Neonatology and Neonatal Intensive Care Unit, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0376-7468","authenticated-orcid":false,"given":"Vincenzo","family":"Insinga","sequence":"additional","affiliation":[{"name":"Neonatology and Neonatal Intensive Care Unit, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Gabriele","sequence":"additional","affiliation":[{"name":"Neonatology and Neonatal Intensive Care Unit, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Notarbartolo","sequence":"additional","affiliation":[{"name":"Neonatology and Neonatal Intensive Care Unit, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costanza","family":"Sortino","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9576-1635","authenticated-orcid":false,"given":"Mario","family":"Giuffr\u00e8","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"},{"name":"Neonatology and Neonatal Intensive Care Unit, University Hospital Policlinico \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s13679-024-00554-3","article-title":"Potential Micronutrient Deficiencies in the First 1000 Days of Life: The Pediatrician on the Side of the Weakest","volume":"13","author":"Panzeri","year":"2024","journal-title":"Curr. Obes. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Weiser, M.J., Butt, C.M., and Mohajeri, M.H. (2016). Docosahexaenoic Acid and Cognition throughout the Lifespan. Nutrients, 8.","DOI":"10.3390\/nu8020099"},{"key":"ref_3","unstructured":"Sinclair, A.J. (2019). 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