Carotenoid components have a role in maintaining eye and brain development in children, and deficiency from birth through early childhood may contribute to adverse outcomes related to skin health, metabolic function and vision.
To consolidate existing evidence on the benefits of carotenoids in improving visual and cognitive function outcomes in children, as well as identify knowledge gaps, a review was conducted by Western University of Health Sciences in California, US.
This review includes observational and interventional studies published up to January 2026.
The evidence indicates that dietary carotenoids, particularly lutein, zeaxanthin and β-carotene, are present in maternal serum, human milk, infant serum and in brain and retinal tissues.
On the other hand, benefits for retinal maturation, possible mitigation of myopic changes, and neuroprotective effects in certain retinal diseases are promising but not yet definitive.
“We found a paucity of carotenoid intervention and controlled trials for direct carotenoid exposure, and its relative effect on neurocognitive function and visual milestone development during early life,” the researchers wrote in Nutrients.
“Further long-term studies are required to define optimal carotenoid types, doses, timing (prenatal versus postnatal), and bioavailability strategies (human milk-mimicking formulations), to establish causality and safety thresholds for children, and to confirm whether early-life carotenoid exposure yields durable gains in vision and cognition.”
The researchers added that macular pigment optical density (MPOD), serum carotenoid levels and non-invasive skin measures serve as useful biomarkers for assessing carotenoid status. These are also associated with children’s visual and cognitive performance.
Importance of early exposure
The first six years of life are crucial for visual and cognitive development, and are linked to complex environmental exposure during the “critical developmental period”.
The levels of carotenoids vary under various conditions, such as disease states and premature infants. Other factors, including sources of carotenoids, sun exposure, co-intake of fats, and adiposity, also influence carotenoid levels in the body.
Carotenoid exposure in early life from maternal serum and human milk may be associated with cognitive function, as these carotenoids may act as the primary concentrated elements in brain tissues during their establishment and development.
As such, a longer duration of exclusive breastfeeding is linked to high skin carotenoid levels in later childhood, and the duration of breastfeeding had a significantly inverse association with body mass index.
“Future studies, focusing on the role of nutrition and cognitive activity exposure during critical developmental periods, may help in understanding the interrelationship of the eye and brain carotenoids and their influence on delays in developmental milestones,” the researchers wrote.
The role of carotenoids in visual milestone development has not been investigated with long-term controlled trials with nutrition and cognitive interventions.
Establishing this could lead to a better understanding of how carotenoids could contribute to changes in visual sensory function, along with anatomical maturation of the retina during early childhood.
Most studies assessing eye and brain biomarkers of development are conducted in the US, where carotenoid concentrations, particularly lutein and zeaxanthin, are at levels lower than in other countries. The study of these biomarkers in other regions or multi-ethnic groups is particularly essential.
Eyes on myopia
Between 80% and 90% of teenagers and young adults in countries like China, Japan, Singapore, South Korea and Taiwan are myopic.
Eyes with myopia have longer axial length, and its progression is significant in early developmental years. This could lead to maculopathy and increased risk of glaucoma.
In a randomized controlled trial in China, the benefits of lutein esters in children aged eight to 12 years were evaluated. Results showed that supplementation led to effective mitigation of sub-foveal and temporal choroidal thinning, which are known biomarkers of increased myopia.
In adults, MPOD showed a positive association with retinal thickness parameters, with notably lower levels in cases of pathological myopia.
Furthermore, MPOD appears to be a modifiable biomarker, as several studies also reported improvement in MPOD following lutein supplementation in individuals with high or pathological myopia.
These lutein and zeaxanthin intervention studies suggest that MPOD levels in children and adults can be improved with active lutein supplementation for three to six months in eyes with high myopia and those with large myopic pathological changes of the posterior segment.
Nevertheless, the researchers stated that despite growing evidence of possible benefits of carotenoids in preventing myopia and slowing its progression, more research is needed before it can become a form of adjunctive therapy.
Source: Nutrients. doi: doi.org/10.3390/nu18132147. “Associations Between Carotenoid Status, Visual Outcomes and Cognitive Metrics in Children: A Scoping Review”. Authors: Payal Sangani and Pinakin Gunvant Davey.
