Abstract
Omega-3 long chain polyunsaturated fatty acid supplementation (n-3 LCPUFA) for treatment of Autism Spectrum Disorder (ASD) is popular. The results of previous systematic reviews and meta-analyses of n-3 LCPUFA supplementation on ASD outcomes were inconclusive. Two meta-analyses were conducted; meta-analysis 1 compared blood levels of LCPUFA and their ratios arachidonic acid (ARA) to docosahexaenoic acid (DHA), ARA to eicosapentaenoic acid (EPA), or total n-6 to total n-3 LCPUFA in ASD to those of typically developing individuals (with no neurodevelopmental disorders), and meta-analysis 2 compared the effects of n-3 LCPUFA supplementation to placebo on symptoms of ASD. Case-control studies and randomised controlled trials (RCTs) were identified searching electronic databases up to May, 2016. Mean differences were pooled and analysed using inverse variance models. Heterogeneity was assessed using I2 statistic. Fifteen case-control studies (n = 1193) were reviewed. Compared with typically developed, ASD populations had lower DHA (−2.14 [95% CI −3.22 to −1.07]; p < 0.0001; I2 = 97%), EPA (−0.72 [95% CI −1.25 to −0.18]; p = 0.008; I2 = 88%), and ARA (−0.83 [95% CI, −1.48 to −0.17]; p = 0.01; I2 = 96%) and higher total n-6 LCPUFA to n-3 LCPUFA ratio (0.42 [95% CI 0.06 to 0.78]; p = 0.02; I2 = 74%). Four RCTs were included in meta-analysis 2 (n = 107). Compared with placebo, n-3 LCPUFA improved social interaction (−1.96 [95% CI −3.5 to −0.34]; p = 0.02; I2 = 0) and repetitive and restricted interests and behaviours (−1.08 [95% CI −2.17 to −0.01]; p = 0.05; I2 = 0). Populations with ASD have lower n-3 LCPUFA status and n-3 LCPUFA supplementation can potentially improve some ASD symptoms. Further research with large sample size and adequate study duration is warranted to confirm the efficacy of n-3 LCPUFA.
Highlights
The prevalence of Autism Spectrum Disorder (ASD) has dramatically increased over the past few years
Are amongst the most reported fatty acids of n-3 LCPUFAs and n-6 LCPUFAs categories, respectively, and have been shown to be more biologically active in the brain and been linked to neurodevelopment disorders, we focused on these fatty acids as well as the ratio of arachidonic acid (ARA) to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the ratio of n-6 LCPUFA to n-3 LCPUFA [41,42]
Future observational studies of n-3 LCPUFA in children with ASD are encouraged while including a uniform biomarker and reporting method, collecting dietary intake of both n-3 and n-6 LCPUFA, and matching cases and controls on potential modulating attributes
Summary
The prevalence of Autism Spectrum Disorder (ASD) has dramatically increased over the past few years. While previous prevalence studies of ASD identified less than 10 in 10,000 individuals [1], recent estimates suggest rates of 90 to 250 in 10,000 individuals [2,3,4,5]. Nutrients 2017, 9, 155 disorder that appears during the first years of life [6]. Children with ASD frequently experience behaviour problems and medical conditions, including inflammation, oxidative stress, and autoimmune disorders [7,8,9,10,11,12], and altered brain structure and function (in a subset of individuals) [13,14].
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