Food and Behaviour Research

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17 April 2007 - Omega-3 for child behaviour and learning - The Facts and the Hype

by Alex Richardson

FAB RESEARCH COMMENT:

A massive amount of media 'hype' surrounds the whole issue of whether fatty acids (mainly the omega-3 from fish oils) can help child behaviour and learning.

As the first person to carry out controlled trials in this area, I am all too well aware how grossly the mass media (fed by press releases from the companies who sell the supplements) can twist the facts to promote their own interests (i.e. to make money).

Sadly, the huge amount of misleading information has made many people very sceptical - particularly those in the medical profession, but also many other professionals, parents and policymakers.

Today's newspapers will be full of more 'miracle stories' following the publication of results from a new trial of 'fatty acids for ADHD symptoms'. These will be scorned by the sceptics as yet more examples of overly-simplistic thinking (i.e. 'Pill solves complex social problems') - and those who rush to buy supplements will be derided as fools easily parted from their money. (For the supplement used in this particular trial, this might be a justifiable claim given its high price compared with many others. But that's how they can afford all the advertising.)

As usual - the real truth is more complicated. But company press releases do drive most mass media stories. So here is the press release that triggered many of today's news stories - followed by some commentary on what the results of the study really indicated, for those who actually care.

And you can read the scientific abstract for yourself - along with some reported comments from the lead author and the Food Standards Agency - at ******

Subject: PRESS CONFERENCE ON OMEGA-3 FISH OIL RESEARCH

PRESS CONFERENCE

NEW PUBLISHED TRIAL BOLSTERS EVIDENCE THAT OMEGA-3 FISH OIL CAN BENEFIT CHILDREN WITH ADHD SYMPTOMS

Results from the largest, clinical-based omega-3 and omega-6 trial of its kind are to be presented today, bolstering a growing body of
evidence worthy of review by the Foods Standard Agency on the question of whether all school children should be given omega-3 supplements.

A double blind, randomised, placebo-controlled trial conducted by The University of South Australia and the Commonwealth Scientific Industrial Research Organisation of Human Nutrition, has shown significant improvements amongst 132 children aged 7-12yrs with
Attention Deficit Hyperactivity Disorder symptoms.

You are invited to hear Dr Natalie Sinn, PhD, Lead Researcher from The University of Australia present these fascinating results for the first time and have an opportunity to participate in a questions and answers session.

Tuesday 17th April 2007
10.30 Registration
11.00 Keynote presentation by Dr Natalie Sinn
11.45 Q&A session
12.30 Optional buffet lunch

RSVP to (** company contact details**)
Spaces are limited and must be reserved

Now let's look at this more closely

The content seems simple enough. "Come to a free lunch and be given your news story."

And there are some brilliant hook lines:

  • 'whether all school children should be given omega-3 supplements' Wonderfully controversial. Can popping pills really improve behaviour and learning in all school children?
  • 'A double blind, randomised, placebo-controlled trial'. Sounds very scientific. Surely the results must be credible?
  • 'The largest, clinical-based omega-3 and omega-6 trial of its kind. Hold on - is this clinics or schools we're talking about?
  • 132 children aged 7-12yrs with Attention Deficit Hyperactivity Disorder symptoms. Well, not drug-trial numbers, but respectable. The thing is - how many actually made it to the end of the study? Results were given for just 104. Do the drop-outs matter? Read on...

For those without access to the full paper, some important points worth knowing are:

  • The children in this study were selected for extreme scores on parent ratings of their behaviour and learning problems Their scores fell within the top 3% of the population on ADHD-type symptoms, as rated by their parents. This does NOT allow any generalisations to other groups such as children with less extreme difficulties, or children formally diagnosed with ADHD.

  • Crucially, The results reported are Not from 'Intention -to-Treat (ITT) analyses. In other words - the many children who dropped out were excluded from the analyses. This does not conform to the CONSORT guidelines for the reporting of randomised controlled trials, as endorsed by all leading scientific and medical journals, and required for the official evaluation of medical treatments such as drugs.

  • Teacher's ratings of the children's ADHD symptoms showed no significant effects of treatment This makes it rather difficult to see why schools or education authorities (i.e. the taxpayer) should spend money on these supplements, surely? Let alone for ALL schoolchildren?

So what CAN we conclude? As usual, the truth is rather less exciting than the headlines.

  • This is a worthwhile study, which appears to have been sensibly conducted and reported - at least by the researchers involved.

  • Crucially, it DID include a placebo control group - unlike most of the hyped-up 'non-studies' that the mass media and some companies (notably this one) are so fond of reporting.

  • It's a shame that the analyses were not reported on an Intention-To-Treat basis. The large number of dropouts suggests that such analyses would not have shown any benefits - but that wouldn't make the study worthless.

  • These results partially replicate (albeit less strongly) some of the findings from existing studies of children with behavioural and/or learning difficulties. To show benefits for even a subset of children from nutritional treatments is a useful step forward. (Apparently around 40-50% of children in this study showed marked improvements compared those receiving placebo treatment). It is also possible that by using different nutrient formulations or dosages, and/or outcome measures that may be more sensitive, better results could be obtained.

These were essentially the kind of comments attributed to the lead researcher in this study, Natalie Sinn of Adelaide University. She also emphasised how many important questions still need to be addressed by further research.

That's what we still need - not yet more hype.