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

Mina Nicole Händel,Kirsten Birkefoss,Jeanett Friis Rohde,Britta Tendal,Sanne Lemcke,Elisabeth Bandak,Marie Louise Rimestad,Henriette Edemann Callesen

doi:10.3390/nu13041226

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.

Highlights

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents, which may persist into adulthood
Established methods recommended by the Cochrane Collaboration [16] and according to the principles described in the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) [17] approach were used to conduct this systematic review and meta-analysis
The results showed no clinically relevant effect was found on the primary outcome parent-rated ADHD core symptoms (SMD: −0.17; 95% confidence interval (CI): −0.32, −0.02) (Figure 3), corresponding to a mean difference on the Parent ADHD

Summary

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents, which may persist into adulthood. A meta-analysis of 102 prevalence studies found that the worldwide prevalence estimate for ADHD among children and adolescents under the age of 18 years is 3.4% (CI 95% 2.6–4.5) [1]. ADHD is characterized by three core symptoms, namely, inattention, hyperactivity, and impulsivity. The symptoms must be present in different settings and be both impairing and age inappropriate. Long-term studies have revealed that a diagnosis of ADHD is associated with lower educational achievements and significant higher prevalence of, e.g., injury, substance abuse, unemployment, and delinquency [3,4,5,6,7,8]

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Conclusion