Data from seven clinical trials involving over 500 children and adolescents indicated that omega-3s were associated with improvements in clinical symptoms of ADHD, while data from three clinical trials involving over 200 children and adolescents indicated a positive impact on cognitive measures associated with attention.
“[W]e provide strong evidence supporting a role for n3-PUFAs deficiency in ADHD, and for advocating n-3 PUFAs supplementation as a clinically relevant intervention in this group, especially if guided by a biomarker-based personalization approach,” wrote the authors, led by Jane Pei-Chen Chang from King’s College London, in Neuropsychopharmacology.
Boosting EPA/DHA intakes
Commenting independently on the meta-analysis, Harry Rice, PhD, VP of regulatory & scientific affairs for the Global Organization for EPA and DHA Omega-3s (GOED): “In the past, I've been lukewarm on whether or not increasing EPA/DHA intake benefits children with ADHD. Results from this meta-analysis put me a little closer to believing.
“Minimally, given the low side effect profile of omega-3s versus the drugs of choice to treat ADHD, I would highly recommend first increasing intake of EPA/DHA. This is particularly true if a child doesn't eat at least two servings of fatty fish a week or doesn't take an omega-3 supplement on a regular basis.”
The new meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used established scientific literature databases to identify appropriate studies for inclusion.
Data from seven randomized controlled trials (RCTs) with 534 young people indicated that that omega-s3 supplementation significantly improved inattention and hyperactivity symptoms, according to parental reports.
Additional analysis revealed that the improvements in hyperactivity were only observed when doses of EPA (eicosapentaenoic acid) of 500 mg/day or more were used.
Interesting, the researchers did not find improvements in hyperactivity and inattention when they looked at teacher’s reports, unlike what was reported by parents.
Omega-3 supplements were associated with improvements in select measures of cognitive performance, said the researchers.
“N-3 PUFAs are crucial for optimal neurotransmitter function: for example, incorporating more EPA and DHA in the cell membrane can increase cholesterol efflux, modulate lipid raft clustering and disruption, and affect the function of the dopamine transporter (DAT), which in turn may affect attention and executive function by regulating synaptic dopamine levels,” wrote the researchers.
Data from case-control studies were also collected to assess if omega-3 levels were also associated with ADHD, with results indicating that children and adolescents with ADHD had lower levels of EPA, DHA (docosahexaenoic acid),and total omega-3s.
“In the context of ‘personalised medicine’, it is tempting to speculate that a subpopulation of youth with ADHD and with low levels of n-3 PUFAs may respond better to n-3 PUFAs supplementation, but there are no studies to date attempting this stratification approach,” wrote the researchers. “However, we have [previously] shown that individuals at genetic risk of developing depression in the context of the immune challenge, interferon-alpha (IFN-alpha), have lower levels of RBCs n3-PUFAs, and that n-3 PUFAs supplementation prevents the onset of IFN-alpha-induced depression, arguably by replenishing the endogenously low anti-inflammatory PUFAs in the ‘at risk’ individuals.”
“Moreover, a recent study by Rapaport [Mol Psychiatry, 2016, Vol. 21, pp. 71–79] has stratified patients with major depressive disorder into a ‘high’ and a ‘low’ inflammation group, and shown that the ‘high inflammation’ group has a better responses to EPA [...] Therefore, stratification of ADHD children by n-3 PUFAs levels or by immune biomarkers could be one approach to optimise the therapeutic effects of n-3 PUFAs supplementation.”
Published online ahead of print, doi: 10.1038/npp.2017.160
“Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies”
Authors: P-C. Chang et al.