Efficacy and Safety of Polyunsaturated Fatty Acids Supplementation in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

Based on epidemiological and animal studies, the rationale for using polyunsaturated fatty acids (PUFAs) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) seems promising. Here, the objective was to systematically identify and critically assess the evidence from clinical trials. The primary outcome was ADHD core symptoms. The secondary outcomes were behavioral difficulties, quality of life, and side effects. We performed a systematic search in Medline, Embase, Cinahl, PsycInfo, and the Cochrane Library up to June 2020. The overall certainty of evidence was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). We identified 31 relevant randomized controlled trials including 1755 patients. The results showed no effect on ADHD core symptoms rated by parents (k = 23; SMD: −0.17; 95% CI: −0.32, −0.02) or teachers (k = 10; SMD: −0.06; 95% CI: −0.31, 0.19). There was no effect on behavioral difficulties, rated by parents (k = 7; SMD: −0.02; 95% CI: −0.17, 0.14) or teachers (k = 5; SMD: −0.04; 95% CI: −0.35, 0.26). There was no effect on quality of life (SMD: 0.01; 95% CI: −0.29, 0.31). PUFA did not increase the occurrence of side effects. For now, there seems to be no benefit of PUFA in ADHD treatment; however, the certainty of evidence is questionable, and thus no conclusive guidance can be made. The protocol is registered in PROSPERO ID: CRD42020158453.

Eating Patterns and Dietary Interventions in ADHD: A Narrative Review

“…n -3 PUFA supplementation showed efficacy in improving omission and commission errors, but not memory and information processing, in children with ADHD. On the other hand, Händel et al [ 74 ], in their 2021 systematic review and meta-analysis, with a total of 31 relevant RCTs including 1755 patients, found that PUFA supplementation showed no effect on ADHD core symptoms rated by parents (k = 23; SMD: −0.17; 95% CI: −0.32, −0.02) or teachers (k = 10; SMD: −0.06; 95% CI: −0.31, 0.19). There was no effect on behavioral difficulties rated by parents (k = 7; SMD: −0.02; 95% CI: −0.17, 0.14) or teachers (k = 5; SMD: −0.04; 95% CI: −0.35, 0.26), and there was no effect on quality of life (SMD: 0.01; 95% CI: −0.29, 0.31).…”

Role of Nutrition and Diet on Healthy Mental State

“…The systematic review of Händel et al was centered around assessing the contribution of using polyunsaturated fatty acids (PUFAs, concretely omega 3 and omega 6) in the treatment plans of ADHD children and adolescents, obtained from randomized clinical trials [9]. Based on a substantial body of evidence, this review concluded that the benefits of PUFAs were not clear on core symptoms of ADHD reported by parents and teachers, neither were they clear on other behavioral measures nor on quality of life measures.…”

Usefulness of Cochrane Reviews in Clinical Guideline Development—A Survey of 585 Recommendations

“…The methodology used in the Danish Health Authority guideline development has previously been described [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. In short, the methodology is based on the recommendations for conducting systematic reviews and meta-analyses from the Cochrane Handbook for systematic reviews [ 8 ].…”