Food and Behaviour Research

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EFA Supplementation in Children with Inattention, Hyperactivity, and Other Disruptive Behaviours

Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR. (2003) Lipids 38 1007-21 

Web URL: View this and related abstracts via PubMed here

Abstract:

This pilot study evaluated the effects of supplementation with PUFA on blood FA composition and behaviour in children with Attention-Deficit/Hyperactivity Disorder (AD/HD)- like symptoms also reporting thirst and skin problems.

Fifty children were randomised to treatment groups receiving either a PUFA supplement providing a daily dose of 480 mg DHA, 80mg EPA, 40mg arachidonic acid (AA), 96mg GLA, and 24mg alpha-tocopherol acetate, or an olive oil placebo for 4 months of double-blind parallel treatment.

Supplementation with the PUFA led to a substantial increase in the proportions of EPA, DHA and alpha-tocopherol in the plasma phospholipids and red blood cell (RBC) total lipids, but an increase was noted in the plasma phospholipids proportions of 18:3n-3 with olive oil as well. Significant improvements in multiple outcomes (as rated by parents) were noted in both groups, but a clear benefit from PUFA supplementation for all behaviours characteristic of AD/HD was not observed. For most outcomes, improvement in the PUFA group was consistently nominally better than that of the olive oil group, but the treatment difference was significant, by secondary intent-to-treat analysis, on only 2 out of 16 outcome measures: conduct problems rated by parents (-42.7 vs –9.9 %, n=47, p=0.05), and attention symptoms rated by teachers (-14.8 vs +3.4 %, n=47, p=0.03).

PUFA supplementation led to a greater number of participants showing improvement in oppositional defiant behaviour from a clinical to a non-clinical range compared with olive oil supplementation (8 out of 12 vs 3 out of 11, n=33, p=0.02). Also, significant correlations were observed when comparing the magnitude of change between increasing proportions of EPA in the RBC and decreasing disruptive behaviour as assessed by the Abbreviated Symptom Questionnaire (ASQ) for parents (r = -0.38, n=31, p < 0.05), and for EPA and DHA in the RBC and teachers’ Disruptive Behaviour Disorders (DBD) rating scale for Attention (r = -0.49, n=24, p < 0.05). Interestingly, significant correlations were observed between the magnitude of increase in alpha-tocopherol concentrations in the RBC and a decrease in scores for all four subscales of the teachers’ DBD (Hyperactivity, r= -0.45; Attention, r = -0.60; Conduct, r=- 0.41; Oppositional/Defiant Disorder, r = -0.54; n=24, p < 0.05) as well as the ASQ for teachers (r = -0.51, n=24, p < 0.05).

Thus, the results of this pilot study suggest the need for further research with both n-3 fatty acids and vitamin E in children with behavioural disorders.

FAB RESEARCH COMMENT:

John Burgess, Laura Stevens and colleagues at Purdue University were among the first to provide good evidence of blood fatty acid abnormalities as well as physical signs of fatty acid deficiency in ADHD. See:


This paper gives the results of their long-awaited study of fatty acid treatment in children with ADHD-type difficulties. Here, although blood fatty acid measures still differed at the pre-treatment baseline between these ADHD-type children and controls, they did so in a much more complex - if not paradoxical - manner than in earlier studies. Deficiencies of key fatty acids in plasma were combined with an apparent excess of the same fatty acids in red cell membranes. (NB: this discrepancy might indicate a metabolic problem, as all of the ADHD-type children had also been selected for certain physical signs - such as excessive thirst and dry skin - that are classically associated with essential fatty acid deficiencies.)

Results of the treatment trial showed a only a slight advantage for the fatty acid supplement (which contained fish oil, evening primrose oil and Vitamin E, providing mainly omega-3 but some omega-6 fatty acids). The group differences were significant only for parent-rated behaviour problems and teacher-rated attentional difficulties.

A complicating factor, however, was that the olive oil placebo appeared to produce some similar biochemical changes to those found with the active supplement. Furthermore, biochemical changes in both groups were related to behavioural improvements, so the authors seem justified in their conclusions that these issues now need further study.