Effects of Unsaturated Fatty Acids in Attention Deficit Hyperactivity Disorder-Juniper Publishers

                                                           Juniper Publishers
Long-chain polyunsaturated fatty acids (PUFA) in the blood, especially omega-3 fatty acids, have been repeatedly associated with various behavioral disorders, including ADHD, but the relationship has not yet been fully established. On the other hand, treatment of low omega 3 and PUFA levels with nutritional supplements in children with neurodevelopment disorder such as ADHD, dyslexia and dyspraxia are thought to improve disease symptoms. This review presents a summary of effects of unsaturated fatty acids in attention deficit hyperactivity disorder
Keywords: ADHD; Unsaturated Fatty Acids; Omega 3; Omega 6

Introduction

Nutritional status and eating behaviors of children with ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is defined as a neurodevelopmental disorder that reflect the persistence of ADHD symptoms such as inattention, overactivity, and impulsivity across lifespan [1]. ADHD was associated with greater severity of global eating disorder pathology, restraint, eating, shape, and weight concerns. Several mechanisms explain the reason of ADHD on eating patterns. According to a recent study (2018), children with ADHD may lose control more while eating and may consume more calories than healthy subjects. In addition, children diagnosed with ADHD may eat more food even if they are satiated compared to healthy subjects [2]. Faster eating in children with ADHD, inability to focus on hunger-satiety cycles, and inability to perceive body stimuli may lead to impaired eating-feeding patterns
As ADHD is a common diagnosis all over the world, experts and families are turning to different methods of treatment which have also associated with nutritional status. These methods are increasing and sometimes cause controversy due to the fact that there are some methods which are not proven yet. Although the approach to the treatment of ADHD with fatty acid supplementation is a frequently studied topic, there is a lack of a comprehensive literature review.

Unsaturated fatty acids in attention deficit hyperactivity disorder

Long-chain polyunsaturated fatty acids (PUFA) in the blood, especially omega-3 fatty acids, have been repeatedly associated with various behavioral disorders, including ADHD, but the relationship has not yet been fully established. On the other hand, treatment of low omega 3 and PUFA levels with nutritional supplements in children with neurodevelopment disorder such as ADHD, dyslexia and dyspraxia are thought to improve disease symptoms [3]. Furthermore, no significant adverse effects have been associated with this treatment model. In addition, some studies suggest possible beneficial outcomes in case of co-morbid conditions such as epilepsy [4].
According to a study, the ratio of omega-3 fatty acids was lower in plasma phospholipids and erythrocytes in ADHD group than in control group, whereas saturated fatty acid ratios were higher in ADHD group than in control group. While saturated fat intake was 30% higher in ADHD group, intake of all other nutrients was not different [5]. Studies have shown that omega-3 levels are lower in people with ADHD compared to their unaffected counterparts, but the reasons for this are not fully known [6].
In a study examining lipid and lipoprotein profiles, plasma triacylglycerols and phospholipids were lower and free cholesterol, HDL and apo-AI were higher in ADHD patients than controls. When compared to controls, total saturated fatty acid ratio was higher and PUFA levels were lower in ADHD patients. Therefore, this resulted in a significant reduction in the ratio of PUFA/saturated fats. It has been reported that lipid peroxidation is reduced (decreased plasma malondialdehyde values, increased G-tocopherol concentrations) in ADHD patients. The results of the study reveal that there are significant changes in lipid and lipoprotein profile and oxidant antioxidant status of ADHD patients [7]. These data indicate that essential fatty acid profiles of children with ADHD are abnormal, and this abnormality is not due to food intake.
Omega-3 fatty acid contains Elkosapentaenoic acid (EPA) and decosahegzaenoic acid (DHA). DHA omega-3 fatty acid accounts for more than 90% of omega-3 fats in the brain. Recent reviews show that EPA has more clinical efficacy. However, both EPA and DHA are expected to be important, based on methodological considerations of the included studies, the majority of studies to date, and different mechanisms of action [6].
High-dose EPA/DHA supplementation can improve behavior in children with ADHD. In a randomized controlled trial [8], children with ADHD showed increased EPA, decreased omega 6 fatty acid, and clinical improvement as a result of 0.5g of EPA supplementation for 15 weeks. Alternatively, there is a multifaceted complex interaction between further deterioration in executive functions, eating-appetite problems, eating problems, obesity, nutritional status, attachment and family relations problems and ADHD symptoms
According to a study, omega-3 fatty acid supplementation was found to have a small but significant effect on the improvement of ADHD symptoms, and the dose of eicosapentaenoic acid in food supplements was significantly correlated with supplementation efficacy. Omega-3 fatty acid supplementation was particularly effective in treating ADHD with higher doses of eicosapentaenoic acid [9]. Also, a recent meta-analysis shows that PUFAs supplementation monotherapy improves clinical symptoms and cognitive performances if these youths have a deficiency in n-3 PUFAs levels [10].

Controversial Studies

A recent Systematic Review [11] concluded that the majority of data showed no benefit of PUFA supplementation, although there were some limited data that did show an improvement with combined omega-3 and omega-6 supplementation. But they explained this conclusion via small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, short follow-up times and other methodological weaknesses. However, a recent meta-analysis of 24 studies with ADHD reported by Cooper et al showed that did not show improvements in any of the cognitive performance measures [12].

New Perspective

In this literature review, we emphasize the need for additional and more extensive clinical studies, but we concluded that omega-3 fatty acid supplementation is useful in the treatment of ADHD. It is thought that it will be beneficial to analyze the effects of food supplements by comparing them with different food supplements in the planning of treatment. In addition, ADHD, which adversely affects the quality of life, is important in terms of developing developmental problems from childhood to adulthood, using early diagnosis and effective treatment methods. Children and families should be properly informed during the treatment process. In order to raise the awareness of the families about nutrition and food supplements, programs can be included in social media channels, visual media and television where the studies on PUFA are explained and their effects are evaluated. The effectiveness of PUFA is thought to increase the use of food supplements to support pharmacological interventions, affect the course of treatment

Conclusion

This review gives an introduction to recent findings on the clinical efficacy of PUFAs in ADHD. Studies, Systematic reviews and meta-analyses of randomized controlled trials (RCTs) assessing outcomes of supplementation with PUFAs have shown inconsistent results. But literature provides further evidence of the beneficial effect of supplementation with PUFA in the treatment of ADHD. Future research should further explore abnormal fatty acid metabolism in ADHD.
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