BACKGROUND: 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. OBJECTIVE: To update and assess relationships between seafood consumption during childhood and adolescence and neurocognitive development. METHODS: Three electronic databases were searched up to Sept 2024 to update a previous search from 2000-2019. Articles were included if associations were assessed between seafood during childhood and adolescence and neurocognitive development outcomes (cognitive development, behavior, movement/physical development, language/communication development, depression, anxiety, ADHD, and autism spectrum disorder). All articles were screened at title, abstract, and full-text levels by two independent analysts. Data were extracted, quality checked by a second analyst, and synthesized narratively by two 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 GRADE. RESULTS: Eighteen articles from 5 short-term (12-16 weeks) randomized controlled trials (RCTs) conducted in Northern Europe and 9 prospective cohort studies (PCSs) 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 years old (GRADE: low). This conclusion was informed by 5 short-term RCTs in which children aged 10 months to 15 years were provided fatty fish vs meat, poultry, or fish oil supplements. These RCTs were largely supported by results from 5 longer-term PCS. Evidence was inconsistent for behavior outcomes and was lacking for other outcomes. CONCLUSIONS: Seafood consumption within current recommended intake amounts consumed mainly as fatty fish likely improves cognitive development outcomes in children and adolescents. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: PROSPERO: CRD42023432844. STATEMENT OF SIGNIFICANCE: Consuming seafood within current recommended intake amounts as mainly fatty fish likely improves cognitive development outcomes in children and adolescents. Seafood intake for all individuals in the US, including children and adolescents, is below current recommendations, thus increasing intake may support better developmental outcomes.