Children born during earlier days were underweight or overweight, tall or short and fair or dark. It was rare that a child was born with defects. But now, we perform multiple scans on the pregnant mom to check on the health of the fetus due to fear of multiple health problems that crop up these days. Children born preterm are at an increased risk of autism spectrum disorder (ASD) with earlier deliveries garnering increased risks. Almost 5% of kids with a birth weight <2000 grams and 8% of those born <26 weeks of gestation are at a higher risk of ASD. ASDs are neurodevelopmental pathologies impairing social competencies and patterns of behaviour. Diagnosis is made purely based on observing the behaviour of the child and can be confirmed with any two of the following symptoms occurring repeatedly-repetitive patterns of behaviour, interest and activities, and lingering difficulties in social communication and interaction. Though we do come up with various proposals behind the occurrence of this condition none of them can justify the cause of the disorder on their own. It is widely accepted that both genetic and environmental factors contribute to the development of ASD but studies show that only 30% cases are clearly linked to these causes leaving the rest to assumption.
Worldwide, 0.76%-1.46% individuals suffer from ASD and over the past couple of decades the rates are steadily increasing for reasons unknown-some quote improved awareness in diagnostic criteria while some others propose changes in environmental factors to be potential contributors for this increase in rates. Despite advances in medicine and science we don’t have a proper curative treatment for ASD, a disorder that’s currently increasing at rapid rates. This has invoked many families (almost 28%) to rely on complementary and alternative medicine (CAM) to treat patients with ASD despite the long-standing fact that there is no scientific proof for this except in the case of melatonin. There have been many proposed diets, ingredients and foods that benefit kids with ASD but all of them without much proofs. Omega-3 fatty acids are one among these used by more than 28% kids with the disorder despite sufficient evidence to back up its benefits. Omega-3 fatty acids are polyunsaturated fatty acids (PUFA) found in three main types in the human diet-ALA (alpha-linolenic acid), DHA (docosahexaenoic acid), and EPA (eicosapentaenoic acid). DHA and EPA are found in seafood, while ALA is found in nut and plant oils. DHA and EPA can be synthesized from ALA by the human body but none of them can be synthesized from scratch. PUFAs have always occupied limelight when it comes to psychiatric diseases and evidences do show that PUFA deficiency is linked to neurodevelopmental problems such as schizophrenia, ASD and bipolar disorder.
PUFA has an anti-inflammatory effect which has been proposed to be helpful in brain function but because they cannot be synthesized by the human body it can cause an imbalance in PUFA levels which might be one of the reasons why we see increasing number of ASD cases nowadays. Omega-6 and omega-3 fatty acids are the two main PUFAs whose consumption must be 1:1 to 4:1. But the lifestyle and dietary habits presently lead to increased intake of omega-6 fatty acids once again increasing the risk of psychiatric diseases. All these make one thing clear-omega-3 and omega-6 fatty acids might hold a bigger role in affecting psychiatric conditions in individuals when taken in the right quantities.
Systematic Review of Clinical Studies Reporting Effective Treatment of Omega-3 Fatty Acids
There have been studies reporting poor concentration of omega-3 fatty acids in kids with ASD compared to controls and also in those with schizophrenia and ADHD. Yet another recent study supported the positive effects of fatty acids on treating people with depression. A group of researchers conducted a systematic review to research on all prior clinical studies that reported effective treatment of this fatty acid on kids with ASD. Databases such as MEDLINE and EMBASE were searched using key terminologies and various exclusion criteria to pick the appropriate studies that would suit the needs of the researchers. The team used letters to provide consent whether or not the fatty acids could be used to treat patients with ASD. A or B was used to denote that treatment should be provided to patients, C grade indicates that treatment should not be offered routinely and D grade shows that treatment should never be given. Though the database came up with 143 articles only 6 of them satisfied the inclusion criteria. Of this, only 1 was a randomized control trial which included 13 children with autism who were either assigned to 1.5 grams of omega-3 fatty acids or a placebo for 6 weeks. The aberrant-behavior checklist which included items such as hyperactivity and sensitivity showed improvements in the group consuming fatty acids but none of them were statistically significant.
4 studies were uncontrolled and open-label ones that had kids or adults with autism as participants. A study was done by Politi et al. done on 19 adults with a mean age of 29 suffering from severe autism, moderate to greater mental retardation and maladaptive behaviors. They were given 0.93 grams of fatty acid (DHA+EPA) and a vitamin supplement (5 mg of vitamin E daily). There was no improvement seen in any of the problematic behaviours while there was improvement in both severity and frequency of symptoms in the post-treatment period. Meguid et al. treated 30 children with autism for over 3 months using both omega-3 and omega-6 fatty acids and vitamin E. While 20 of the 30 kids showed improvement in the Childhood Autism Rating Scale there was no mean change observed in the group of 30 children. Another study by Patrick et al. on 22 kids given a daily capsule of omega-3 acids for 3 months showed that there was a significant increase in subscale assessments of basic language and learning skills from day 0 to 90. Bell et al. who studied 9 kids with Autism or Asperger’s were given one of two different omega-3 fatty acids of varying doses for 6 months. Though specific values did not show tremendous improvement there was an overall improvement in general health and other measures.
Another study on an 11-year-old boy with autism right from age 2.5 suffering from anxiety and agitation showed that supplementing fish oils at 3g/day proved that there was complete elimination of anxiety and agitation after 1 week and the improvements were stable after 8 months of follow-up.
The different study results show that there is insufficient evidence backing the benefits of omega-3 fatty acids on treating autism.
Omega-3 & Omega-6 Fatty Acids & Effects on Kids with Autism
A study conducted for knowing the effects of both omega-3 and omega-6 fatty acids on kids with autism included 565 children with attention deficit hyperactivity disorder (ADHD, n=401), ASD (85) or controls (n=79) aged between 3 and 17 years. Those with ASD were younger than those with ADHD or the controls. All kids and parents underwent a series of tests and questionnaires that included: The tests of variables of attention (TOVA) version 7 that analysed attention and impulsivity, The Australian Twin Brother Rating Scale (ATBRS) which rated 20 items on a scale of 0-3 where 0 means not at all and 3 means very much/very often and, Childhood Autism Rating Scale (CARS) that comprises of 15 scales measuring various things such as anxiety reaction, verbal communication, activity level, etc. and fatty acid analysis.
Results showed that kids with ADHD and ASD had lower erythrocyte DHA, lower EPA, lower AA, higher AA/EPA and lower n-3/n-6 ratio than controls. Kids with ASD had lower DHA, EPA and AA and higher n-3/n-6 ratio than kids with ADHD. Kids with ADHD and ASD had lower levels of n-3 PUFAs EPA and DHA. Such lower levels of DHA, EPA and n-3/n-6 ratio and higher AA/EPA ratio was linked to greater severity of symptoms. DHA levels in the study reported 2.28% for kids with ADHD, .85% for ASD and 4.72% for controls. It was evident that lower DHA levels showed poorer reading and greater ADHD-type behaviour. Another study by Brigandi et al. showed that DHA levels were 1.4% in the erythrocyte membranes in kids with autism compared to 1.76% in controls. This shows that a value of 0.85% in the ASD group is very low.
There is an improvement in reading and ADHD-type symptoms observed in kids who do not have ADHD when treated with EPA plus DHA or DHA. There are various studies showing marked improvements in kids with ADHD when they were given a supplement containing a 3/1 ratio of EPA/DHA showing that EPA has stronger effects than DHA. A study by Milte et al. on kids supplemented with high DHA, EPA or omega-6 showed that increased EPA or DHA was linked to improved cognition and behaviour and this association was strongest for DHA. The DOLAB study that supplemented school children with poor reading performance with DHA showed improvement in parent-rated ADHD-type symptoms and reading performance too.
Omega Supplementation in Toddlers
Preterm infants are at a higher risk of ASD and finding the effectiveness of omega-3 and 6 fatty acids could help kids. A pilot trial and a full-scale trial supplementation was done on toddlers born preterm and showing ASD symptoms.
Preemie Tots Trial: This is a randomized, placebo-controlled trial which included children aged between 18 and 38 months born ≤29 weeks of gestation. Those children who tool FA supplements, fatty fish or growth-promoting beverages with DHA ≥2 times/week were excluded apart from enforcing several other exclusion criteria. Parents of potentially eligible kids were asked to complete a questionnaire containing screening tools to assess early ASD symptoms which contained the Pervasive Developmental Disorder Screening Test II, Stage II (PDDST-II), the Brief Infant Toddler Social and Emotional Assessment (BITSEA) and another one from Ages and Stages Questionnaire-social emotional for assessing joint attention. All the kids were assigned to one of the two color coded groups (2 treatment and 2 placebo). The treatment group underwent 90 days of daily oral FA supplementation with lemon-oil-flavoured fish and borage oil and the placebo group was assigned to a daily intake of canola oil.
All the 31 participants selected after imposing various exclusion criteria were born at a mean of 27 weeks of gestation, were at a mean of 27 months old at enrolment and were males comparatively. Their mean PDDST-II score was 6 and the cut-off for evaluation for ASD ≥5. Almost 74% of the participants scored in this range. At the end of the 3-month study parents reported improvement on the behaviour-rating scale in both treatment and placebo group. The treatment group showed greater improvement on the BITSEA ASD scale than the placebo group. The study team continued to observe the participants and by Jan 2017 all the kids were around 70 months old and 12 of them received a diagnosis for ASD (2 in the treatment group and 3 in the placebo group had diagnosis, 4 in the treatment group and 3 in the placebo group had symptoms noted). There was an increase in the concentration of EPA, DHA and total n-3 fatty acids. The treatment group experienced larger increase in erythrocyte EPA and DHA with decrease in LA, AA and docosapentaenoic acid (DPA) and the placebo group experienced no notable changes in FA concentrations.
Omega-3 Fatty Acids for Autism Spectrum Disorder: A Systematic Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710498/
Omega-3 & Omega-6 Polyunsaturated Fatty Acid Levels & Correlation with Symptoms in Children with Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder & Typically Developing Controls: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156432
Omega-3 and Omega-6 Fatty Acid Supplementation May Reduce Autism Symptoms Based on Parent Report in Preterm Toddlers: https://academic.oup.com/jn/article/148/2/227/4913038
Supplementation of Omega-3 Fatty Acids May Improve Hyperactivity, Lethargy & Stereotype in Children with Autism Spectrum Disorder : A Meta-analysis of Randomized Control Trials: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634395/
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