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Zhou P, Yu X, Song T, Hou X. Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. PLoS One 2024; 19:e0296926. [PMID: 38547138 PMCID: PMC10977718 DOI: 10.1371/journal.pone.0296926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/22/2023] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To systematically evaluate the safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder (ADHD). METHODS Randomized controlled trials and prospective studies on antioxidant therapy in children and adolescents with ADHD were searched in PubMed, Embase, and Cochrane Library from the inception of databases to November 12, 2022. Two investigators independently screened the literature, extracted data, and evaluated the quality of the included studies. Network meta-analysis (PROSPERO registration number CRD 42023382824) was carried out by using R Studio 4.2.1. RESULTS 48 studies involving 12 antioxidant drugs (resveratrol, pycnogenol, omega-3, omega-6, quercetin, phosphatidylserine, almond, vitamin D, zinc, folic acid, ginkgo biloba, Acetyl-L-carnitine) were finally included, with 3,650 patients. Network meta-analysis showed that omega-6 (0.18), vitamin D (0.19), and quercetin (0.24) were the top three safest drugs according to SUCRA. The omega-3 (SUCRA 0.35), pycnogenol (SUCRA 0.36), and vitamin D (SUCRA 0.27) were the most effective in improving attention, hyperactivity, and total score of Conners' parent rating scale (CPRS), respectively. In terms of improving attention, hyperactivity, and total score of Conners' teacher rating scale (CTRS), pycnogenol (SUCRA 0.32), phosphatidylserine+omega-3 (SUCRA 0.26), and zinc (SUCRA 0.34) were the most effective, respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Parent, the optimal agents were phosphatidylserine (SUCRA 0.39), resveratrol+MPH (SUCRA 0.24), and phosphatidylserine (SUCRA 0.34), respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Teacher, pycnogenol (SUCRA 0.32), vitamin D (SUCRA 0.31) and vitamin D (SUCRA 0.18) were the optimal agents, respectively. The response rate of omega-3+6 was the highest in CGI (SUCRA 0.95) and CPT (SUCRA 0.42). CONCLUSION The rankings of safety and efficacy of the 12 antioxidants vary. Due to the low methodological quality of the included studies, the probability ranking cannot fully explain the clinical efficacy, and the results need to be interpreted with caution. More high-quality studies are still needed to verify our findings.
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Affiliation(s)
- Peike Zhou
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xiaohui Yu
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Tao Song
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xiaoli Hou
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
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Byrne MK, Cook R, Murta JCD, Bressington D, Meyer BJ. Dietary Intakes of Long-Chain Polyunsaturated Fatty Acids and Impulsivity: Comparing Non-Restricted, Vegetarian, and Vegan Diets. Nutrients 2024; 16:875. [PMID: 38542786 PMCID: PMC10975088 DOI: 10.3390/nu16060875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Research suggests a link between deficiencies in omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and impulsivity among psychiatric populations. However, this association is less evident in non-clinical populations. As omega-3 LCPUFAs are predominantly sourced through fish consumption, non-fish dieters may be more vulnerable to higher impulsivity. METHODS This cross-sectional observational study explored the association between lower intakes of omega-3 LCPUFA food sources and higher self-reported measures of impulsivity among healthy adults consuming non-restricted, vegetarian, and vegan diets. RESULTS The results from the validated Food Frequency Questionnaire showed significantly lower estimated omega-3 LCPUFA intakes among vegans and vegetarians when compared with people consuming non-restricted diets. Furthermore, although all groups scored within the normal range of impulsivity measures, vegans scored comparatively higher. Vegans also scored significantly higher in impulsivity control relating to attention than those consuming non-restricted diets. CONCLUSIONS The significantly lower omega-3 LCPUFA dietary intakes in the vegan diets were associated with higher scores in the second-order attentional aspect of self-reported impulsiveness.
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Affiliation(s)
- Mitchell K. Byrne
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Rebecca Cook
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Janina C. D. Murta
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai 50200, Thailand
| | - Barbara J. Meyer
- School of Medical, Indigenous and Health Sciences, Lipid Research Centre, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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Li K, Song X, Li H, Kuang X, Liu S, Liu R, Li D. Mussel oil is superior to fish oil in preventing atherosclerosis of ApoE -/- mice. Front Nutr 2024; 11:1326421. [PMID: 38410635 PMCID: PMC10894946 DOI: 10.3389/fnut.2024.1326421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives The present study aimed to explore the preventive effect of mussel oil (MO) on atherosclerosis and the potential mechanism in apolipoprotein E-null (ApoE-/-) mice. Methods ApoE-/- mice were fed with a high-fat and high-cholesterol chow and given corn oil (CO), fish oil (FO), MO, or aspirin (ASP, dissolved in CO) by gavage for 12 weeks. The total n-3 polyunsaturated fatty acids (PUFAs) in MO (51.01%) and FO (46.82%) were comparable (mainly C22:6n-3 and C20:5n-3). Wild-type mice were fed with a normal chow and given equivalent CO as health control (CON). Results Compared with the CON group, obvious atherosclerotic plaque appeared at aorta and aortic sinus in the CO group. Compared with the CO group, MO but not FO had a significantly smaller atherosclerotic plaque area in the aorta. The aortic atherosclerotic plaque area was comparable in the MO, CON, and ASP groups. The MO group had a significantly smaller atherosclerotic plaque area, lower lipid deposition, lower contents of smooth muscle cell (SMC), and slightly lower contents of macrophage at the aortic sinus than the FO group. Serum concentrations of IL-1β, NF-κB, and VCAM-1 were comparable in the MO and FO groups and were significantly lower than the CO group. Compared with the CO group, the MO group but not FO group had significantly lower aortic protein levels of p65NF-κB, p38MAPK, and VCAM-1. The aortic protein levels of p-p65NF-κB and p-p38MAPK were significantly lower in the MO group than the FO group. Conclusion In conclusion, MO is more potent than FO in preventing atherosclerosis, and the possible mechanism may be by downregulating p38MAPK/NF-κB signaling pathway, decreasing VCAM-1 and macrophage, and inhibiting proliferation and migration of SMC.
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Affiliation(s)
- Kelei Li
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Xiaolei Song
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Huiying Li
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Xiaotong Kuang
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Shiyi Liu
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Run Liu
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Duo Li
- Institute of Nutrition and Health, Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
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Sherzai D, Moness R, Sherzai S, Sherzai A. A Systematic Review of Omega-3 Fatty Acid Consumption and Cognitive Outcomes in Neurodevelopment. Am J Lifestyle Med 2023; 17:649-685. [PMID: 37711355 PMCID: PMC10498982 DOI: 10.1177/15598276221116052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION This systematic review addresses the effects of n-3 long-chain polyunsaturated fatty acids consumption on human neurodevelopment. It evaluates articles published between 2000 and 2022 investigating the cognitive outcomes during the period of neurodevelopment: from fetal development to adolescence. For the purpose of this review the terms LC PUFA and omega-3 fatty acid will be used interchangeably. METHOD Data were sourced from several major databases including PubMed (MEDLINE), Web of Science, and ProQuest Central. Randomized controlled trials (RCTs), nonrandomized controlled trials, prospective or retrospective cohort studies, and observational studies investigating the effects of omega-3 fatty acid consumption from dietary supplements, multiple-nutrient supplement, or food questionnaire on neurodevelopment were considered. Study population was separated in three developmental phases: (1) in-utero, (2) lactation/infancy, and (3) childhood/adolescence. Each article was evaluated for several key factors such as study type, type/dosage of PUFAs, number of subjects, length of intervention, participant age range, population characteristics, outcome measure (both primary/cognitive and secondary/other), results, conclusion, and confounding variables/limitations. RESULTS A total of 88 articles were included in the review, 69 RCTs and 19 longitudinal or observational studies. The results indicate equivocal effect of intervention, with some short-term benefits observed in the areas of visual attention, working memory, executive function, and communication. Omega-3 supplement might have a short-term positive impact on neurodevelopment in all three phases. Supplementation is recommended throughout life, rather than only during the earliest developmental stage.
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Affiliation(s)
- Dean Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Roman Moness
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Sophia Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Ayesha Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
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Lomiwes D, Barnes M, Shaw O, Ngametua N, Sawyer G, Burr N, Hedderley D, Kanon A, Bear T, Carroll A, Bentley-Hewitt K, Tian HS, Miller MR. The Efficacy of New Zealand Greenshell™ Mussel Powder Supplementation in Supporting Muscle Recovery Following Eccentric Exercise-Induced Muscle Damage in Healthy, Untrained Adult Males. Nutrients 2023; 15:nu15102316. [PMID: 37242198 DOI: 10.3390/nu15102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Unaccustomed eccentric exercise results in muscle damage limiting physical performance for several days. This study investigated if Greenshell™ mussel (GSM) powder consumption expedited muscle recovery from eccentric exercise-induced muscle damage (EIMD). Methods: Twenty untrained adult men were recruited into a double-blind, placebo-controlled, cross-over study and were randomly assigned to receive the GSM powder or placebo treatment first. Participants consumed their allocated intervention for four weeks then completed a bench-stepping exercise that induced muscle damage to the eccentrically exercised leg. Muscle function, soreness and biomarkers of muscle damage, oxidative stress and inflammation were measured before exercise, immediately after exercise and 24, 48 and 72 h post exercise. GSM powder promoted muscle function recovery, significantly improving (p < 0.05) isometric and concentric peak torque at 48 h and 72 h post exercise, respectively. Participants on the GSM treatment had faster dissipation of soreness, with significant treatment × time interactions for affective (p = 0.007) and Visual Analogue Scale-assessed pain (p = 0.018). At 72 h, plasma creatine kinase concentrations in the GSM group were lower (p < 0.05) compared with the placebo group. This study provides evidence for GSM powder being effective in supporting muscle recovery from EIMD.
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Affiliation(s)
- Dominic Lomiwes
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Matthew Barnes
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North 4410, New Zealand
| | - Odette Shaw
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Nayer Ngametua
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Greg Sawyer
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Natalie Burr
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Alexander Kanon
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Tracey Bear
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Andrew Carroll
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Kerry Bentley-Hewitt
- The New Zealand Institute for Plant and Food Research Limited, Nutrition and Health Group, Food Innovation, Palmerston North 4410, New Zealand
| | - Hong Sabrina Tian
- School of Food and Advanced Technology, Massey University, Auckland 0632, New Zealand
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Gillies D, Leach MJ, Perez Algorta G. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev 2023; 4:CD007986. [PMID: 37058600 PMCID: PMC10103546 DOI: 10.1002/14651858.cd007986.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age-inappropriate levels of inattention, hyperactivity, and impulsivity, and is associated with long-term social, academic, and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Research has shown that children and adolescents with ADHD have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega-3 PUFA. These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. This review is an update of a previously published Cochrane Review. Overall, there was little evidence that PUFA supplementation improved symptoms of ADHD in children and adolescents. OBJECTIVES To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents. SEARCH METHODS We searched 13 databases and two trials registers up to October 2021. We also checked the reference lists of relevant studies and reviews for additional references. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared PUFA with placebo or PUFA plus alternative therapy (medication, behavioural therapy, or psychotherapy) with the same alternative therapy alone in children and adolescents (aged 18 years and under) diagnosed with ADHD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was severity or improvement of ADHD symptoms. Our secondary outcomes were severity or incidence of behavioural problems; quality of life; severity or incidence of depressive symptoms; severity or incidence of anxiety symptoms; side effects; loss to follow-up; and cost. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 37 trials with more than 2374 participants, of which 24 trials were new to this update. Five trials (seven reports) used a cross-over design, while the remaining 32 trials (52 reports) used a parallel design. Seven trials were conducted in Iran, four each in the USA and Israel, and two each in Australia, Canada, New Zealand, Sweden, and the UK. Single studies were conducted in Brazil, France, Germany, India, Italy, Japan, Mexico, the Netherlands, Singapore, Spain, Sri Lanka, and Taiwan. Of the 36 trials that compared a PUFA to placebo, 19 used an omega-3 PUFA, six used a combined omega-3/omega-6 supplement, and two used an omega-6 PUFA. The nine remaining trials were included in the comparison of PUFA to placebo, but also had the same co-intervention in the PUFA and placebo groups. Of these, four trials compared a combination of omega-3 PUFA plus methylphenidate to methylphenidate. One trial each compared omega-3 PUFA plus atomoxetine to atomoxetine; omega-3 PUFA plus physical training to physical training; and an omega-3 or omega-6 supplement plus methylphenidate to methylphenidate; and two trials compared omega-3 PUFA plus dietary supplement to dietary supplement. Supplements were given for a period of between two weeks and six months. Although we found low-certainty evidence that PUFA compared to placebo may improve ADHD symptoms in the medium term (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.47 to 2.60; 3 studies, 191 participants), there was high-certainty evidence that PUFA had no effect on parent-rated total ADHD symptoms compared to placebo in the medium term (standardised mean difference (SMD) -0.08, 95% CI -0.24 to 0.07; 16 studies, 1166 participants). There was also high-certainty evidence that parent-rated inattention (medium-term: SMD -0.01, 95% CI -0.20 to 0.17; 12 studies, 960 participants) and hyperactivity/impulsivity (medium-term: SMD 0.09, 95% CI -0.04 to 0.23; 10 studies, 869 participants) scores were no different compared to placebo. There was moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups (RR 1.02, 95% CI 0.69 to 1.52; 8 studies, 591 participants). There was also moderate-certainty evidence that medium-term loss to follow-up was likely similar between groups (RR 1.03, 95% CI 0.77 to 1.37; 13 studies, 1121 participants). AUTHORS' CONCLUSIONS Although we found low-certainty evidence that children and adolescents receiving PUFA may be more likely to improve compared to those receiving placebo, there was high-certainty evidence that PUFA had no effect on total parent-rated ADHD symptoms. There was also high-certainty evidence that inattention and hyperactivity/impulsivity did not differ between PUFA and placebo groups. We found moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups. There was also moderate-certainty evidence that follow-up was similar between groups. It is important that future research addresses the current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, and short follow-up times.
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Affiliation(s)
- Donna Gillies
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Matthew J Leach
- School of Nursing & Midwifery, University of South Australia, Adelaide, Australia
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Fatty acids and evolving roles of their proteins in neurological, cardiovascular disorders and cancers. Prog Lipid Res 2021; 83:101116. [PMID: 34293403 DOI: 10.1016/j.plipres.2021.101116] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/04/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023]
Abstract
The dysregulation of fat metabolism is involved in various disorders, including neurodegenerative, cardiovascular, and cancers. The uptake of long-chain fatty acids (LCFAs) with 14 or more carbons plays a pivotal role in cellular metabolic homeostasis. Therefore, the uptake and metabolism of LCFAs must constantly be in tune with the cellular, metabolic, and structural requirements of cells. Many metabolic diseases are thought to be driven by the abnormal flow of fatty acids either from the dietary origin and/or released from adipose stores. Cellular uptake and intracellular trafficking of fatty acids are facilitated ubiquitously with unique combinations of fatty acid transport proteins and cytoplasmic fatty acid-binding proteins in every tissue. Extensive data are emerging on the defective transporters and metabolism of LCFAs and their clinical implications. Uptake and metabolism of LCFAs are crucial for the brain's functional development and cardiovascular health and maintenance. In addition, data suggest fatty acid metabolic transporter can normalize activated inflammatory response by reprogramming lipid metabolism in cancers. Here we review the current understanding of how LCFAs and their proteins contribute to the pathophysiology of three crucial diseases and the mechanisms involved in the processes.
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Basak S, Mallick R, Banerjee A, Pathak S, Duttaroy AK. Maternal Supply of Both Arachidonic and Docosahexaenoic Acids Is Required for Optimal Neurodevelopment. Nutrients 2021; 13:2061. [PMID: 34208549 PMCID: PMC8234848 DOI: 10.3390/nu13062061] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
During the last trimester of gestation and for the first 18 months after birth, both docosahexaenoic acid,22:6n-3 (DHA) and arachidonic acid,20:4n-6 (ARA) are preferentially deposited within the cerebral cortex at a rapid rate. Although the structural and functional roles of DHA in brain development are well investigated, similar roles of ARA are not well documented. The mode of action of these two fatty acids and their derivatives at different structural-functional roles and their levels in the gene expression and signaling pathways of the brain have been continuously emanating. In addition to DHA, the importance of ARA has been much discussed in recent years for fetal and postnatal brain development and the maternal supply of ARA and DHA. These fatty acids are also involved in various brain developmental processes; however, their mechanistic cross talks are not clearly known yet. This review describes the importance of ARA, in addition to DHA, in supporting the optimal brain development and growth and functional roles in the brain.
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Affiliation(s)
- Sanjay Basak
- Molecular Biology Division, ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad 500 007, India;
| | - Rahul Mallick
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210 Kuopio, Finland;
| | - Antara Banerjee
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603 103, India; (A.B.); (S.P.)
| | - Surajit Pathak
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Chennai 603 103, India; (A.B.); (S.P.)
| | - Asim K. Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
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Händel MN, Rohde JF, Rimestad ML, Bandak E, Birkefoss K, Tendal B, Lemcke S, Callesen HE. 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. Nutrients 2021; 13:1226. [PMID: 33917727 PMCID: PMC8068201 DOI: 10.3390/nu13041226] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Mina Nicole Händel
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark; (J.F.R.); (E.B.)
- The Danish Health Authority, 2300 Copenhagen, Denmark; (K.B.); (B.T.); (H.E.C.)
| | - Jeanett Friis Rohde
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark; (J.F.R.); (E.B.)
- The Danish Health Authority, 2300 Copenhagen, Denmark; (K.B.); (B.T.); (H.E.C.)
| | | | - Elisabeth Bandak
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark; (J.F.R.); (E.B.)
- The Danish Health Authority, 2300 Copenhagen, Denmark; (K.B.); (B.T.); (H.E.C.)
| | - Kirsten Birkefoss
- The Danish Health Authority, 2300 Copenhagen, Denmark; (K.B.); (B.T.); (H.E.C.)
| | - Britta Tendal
- The Danish Health Authority, 2300 Copenhagen, Denmark; (K.B.); (B.T.); (H.E.C.)
| | - Sanne Lemcke
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, 8200 Aarhus N, Denmark;
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Martinat M, Rossitto M, Di Miceli M, Layé S. Perinatal Dietary Polyunsaturated Fatty Acids in Brain Development, Role in Neurodevelopmental Disorders. Nutrients 2021; 13:1185. [PMID: 33918517 PMCID: PMC8065891 DOI: 10.3390/nu13041185] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/26/2022] Open
Abstract
n-3 and n-6 polyunsaturated fatty acids (PUFAs) are essential fatty acids that are provided by dietary intake. Growing evidence suggests that n-3 and n-6 PUFAs are paramount for brain functions. They constitute crucial elements of cellular membranes, especially in the brain. They are the precursors of several metabolites with different effects on inflammation and neuron outgrowth. Overall, long-chain PUFAs accumulate in the offspring brain during the embryonic and post-natal periods. In this review, we discuss how they accumulate in the developing brain, considering the maternal dietary supply, the polymorphisms of genes involved in their metabolism, and the differences linked to gender. We also report the mechanisms linking their bioavailability in the developing brain, their transfer from the mother to the embryo through the placenta, and their role in brain development. In addition, data on the potential role of altered bioavailability of long-chain n-3 PUFAs in the etiologies of neurodevelopmental diseases, such as autism, attention deficit and hyperactivity disorder, and schizophrenia, are reviewed.
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Arakaki FH, Xerfan EMS, Galduróz JCF, Tufik S, Andersen ML. Could PCSO-524® be a potential adjuvant treatment to sleep therapy in the management of depression? Psychiatry Res 2021; 295:113590. [PMID: 33276268 DOI: 10.1016/j.psychres.2020.113590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Sleep is essential in neural system homeostasis due to its regulation of the immunological system and inflammatory cytokines. Poor sleep quality can induce a pro-inflammatory state and aggravate depressive symptoms. Depression has been linked with high levels of peripheral and central pro-inflammatory markers. In this context, we highlight a possible role for PCSO-524®, a nutritional supplement extracted from the New Zealand green lipped mussel that has already been shown to have anti-inflammatory effects, as an adjuvant treatment for depression alongside sleep therapy. Although there are not as yet any studies on its use in treating depression, it has been demonstrated to be a promising treatment in another condition that has been linked with inflammation, attention deficit/hyperactivity disorder, and in some other neurodegenerative disorders. Therefore, PCSO-524®, associated with good sleep quality, could be an option to reinforce depression management.
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Affiliation(s)
- Felipe H Arakaki
- Departamento de Psicobiologia - Universidade Federal de Sao Paulo (UNIFESP), Brazil
| | - Ellen M S Xerfan
- Programa de Pós-Graduação em Medicina Translacional - Universidade Federal de Sao Paulo (UNIFESP), Brazil
| | | | - Sergio Tufik
- Departamento de Psicobiologia - Universidade Federal de Sao Paulo (UNIFESP), Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia - Universidade Federal de Sao Paulo (UNIFESP), Brazil.
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12
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van der Wurff IS, Meyer BJ, de Groot RH. Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition in Children and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose of DHA and EPA. Nutrients 2020; 12:E3115. [PMID: 33053843 PMCID: PMC7599612 DOI: 10.3390/nu12103115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in the cardiovascular field is effective if a certain Omega-3 index (O3I) is achieved or the daily n-3 LCPUFA dose is high enough. Whether this applies to studies on cognition in children and adolescents is unclear. The aims of the current review were to investigate whether: (1) a certain O3I level and (2) a minimum daily n-3 LCPUFA dose are required to improve cognition in 4-25 year olds. Web of Science and PubMed were searched. Inclusion criteria: placebo controlled randomized controlled trial; participants 4-25 years; supplementation with docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA); assessing cognition; in English and ≥10 participants per treatment arm. Thirty-three studies were included, 21 in typically developing participants, 12 in those with a disorder. A positive effect on cognitive measures was more likely in studies with an increase in O3I to >6%. Half of the studies in typically developing children with daily supplementation dose ≥450 mg DHA + EPA showed improved cognition. For children with a disorder no cut-off value was found. In conclusion, daily supplementation of ≥450 mg DHA + EPA per day and an increase in the O3I to >6% makes it more likely to show efficacy on cognition in children and adolescents.
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Affiliation(s)
- Inge S.M. van der Wurff
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
| | - Barbara J. Meyer
- School of Medicine, Lipid Research Centre, Molecular Horizons, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Renate H.M. de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 Maastricht, The Netherlands
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13
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Darcey VL, Serafine KM. Omega-3 Fatty Acids and Vulnerability to Addiction: Reviewing Preclinical and Clinical Evidence. Curr Pharm Des 2020; 26:2385-2401. [DOI: 10.2174/1381612826666200429094158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/06/2020] [Indexed: 01/05/2023]
Abstract
Omega-3 (N3) fatty acids are dietary nutrients that are essential for human health. Arguably, one of their most critical contributions to health is their involvement in the structure and function of the nervous system. N3 fatty acids accumulate in neuronal membranes through young adulthood, becoming particularly enriched in a brain region known to be the locus of cognitive control of behavior-the prefrontal cortex (PFC). The PFC undergoes a surge in development during adolescence, coinciding with a life stage when dietary quality and intake of N3 fatty acids tend to be suboptimal. Such low intake may impact neurodevelopment and normative development of cognitive functions suggested to be protective for the risk of subsequent substance and alcohol use disorders (UD). While multiple genetic and environmental factors contribute to risk for and resilience to substance and alcohol use disorders, mounting evidence suggests that dietary patterns early in life may also modulate cognitive and behavioral factors thought to elevate UD risk (e.g., impulsivity and reward sensitivity). This review aims to summarize the literature on dietary N3 fatty acids during childhood and adolescence and risk of executive/ cognitive or behavioral dysfunction, which may contribute to the risk of subsequent UD. We begin with a review of the effects of N3 fatty acids in the brain at the molecular to cellular levels–providing the biochemical mechanisms ostensibly supporting observed beneficial effects. We continue with a review of cognitive, behavioral and neurodevelopmental features thought to predict early substance and alcohol use in humans. This is followed by a review of the preclinical literature, largely demonstrating that dietary manipulation of N3 fatty acids contributes to behavioral changes that impact drug sensitivity. Finally, a review of the available evidence in human literature, suggesting an association between dietary N3 fatty and neurodevelopmental profiles associated with risk of adverse outcomes including UD. We conclude with a brief summary and call to action for additional research to extend the current understanding of the impact of dietary N3 fatty acids and the risk of drug and alcohol UD.
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Affiliation(s)
- Valerie L. Darcey
- Georgetown University, Interdisciplinary Program in Neuroscience, Washington DC, United States
| | - Katherine M. Serafine
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, United States
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14
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Omega-3 and its domain-specific effects on cognitive test performance in youths: A meta-analysis. Neurosci Biobehav Rev 2020; 112:420-436. [DOI: 10.1016/j.neubiorev.2020.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022]
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Zhang L, Liu H, Kuang L, Meng H, Zhou X. Omega-3 fatty acids for the treatment of depressive disorders in children and adolescents: a meta-analysis of randomized placebo-controlled trials. Child Adolesc Psychiatry Ment Health 2019; 13:36. [PMID: 31534476 PMCID: PMC6744624 DOI: 10.1186/s13034-019-0296-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To investigate the efficacy and safety of omega-3 fatty acids (O3FA) in treating depressive disorders in children and adolescents. METHOD We conducted a comprehensive search in electronic databases and hand-searched articles included for relevant studies. We included randomized controlled trials which studied on O3FA for treatment of children and adolescents with depression. The standard mean differences (SMDs) and the odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by a random-effects model. The primary outcomes were end-point depressive symptoms scores (efficacy) and all-cause discontinuation (safety). The secondary outcome of response rate was also assessed. Subgroup analyses were performed by age, severity of depression and dosage. Risk of bias assessment was performed based on the Jadad score and the Cochrane Collaboration's risk-of-bias method. RESULTS A total of four studies with 153 participants were included. In terms of efficacy, there was no significant difference of end-point depressive symptoms scores between O3FA and placebo (SMD = - 0.12, 95% CI - 0.53 to 0.30, P = 0.58; I 2= 30%). In terms of safety, the all-cause discontinuation showed no statistical significance between O3FA and placebo (OR = 1.3, 95% CI 0.58 to 2.93, P = 0.53; I 2= 0%). The response rate of O3FA was also not significant better than that of placebo (OR = 1.57, 95% CI 0.26 to 9.39, P = 0.62; I 2= 71%). Besides, there were also no significant differences in those subgroup analyses outcomes. The risk of bias of included trials were not high. CONCLUSIONS Only considering the limited evidence of O3FA in the acute treatment of major depressive disorder, it did not seem to offer a clear advantage for children and adolescents.
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Affiliation(s)
- Li Zhang
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huan Liu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Huaqing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
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Biochemical and cognitive effects of docosahexaenoic acid differ in a developmental and SorLA dependent manner. Behav Brain Res 2018; 348:90-100. [PMID: 29660442 DOI: 10.1016/j.bbr.2018.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/23/2022]
Abstract
Beneficial effects of omega-3 fatty acid intake on cognition are under debate as some studies show beneficial effects while others show no effects of omega-3 supplementation. These inconsistencies may be a result of inter-individual response variations, potentially caused by gene and diet interactions. SorLA is a multifunctional receptor involved in ligand trafficking including lipoprotein lipase and amyloid precursor protein. Decreased SorLA levels have been correlated to Alzheimer's disease, and omega-3 fatty acid supplementation is known to increase SorLA expression in neuronal cell lines and mouse models. We therefore addressed potential correlations between Sorl1 and dietary omega-3 in SorLA deficient mice (Sorl1-/-) and controls exposed to diets supplemented with or deprived of omega-3 during their entire development and lifespan (lifelong) or solely from the time of weaning (post weaning). Observed diet-induced effects were only evident when exposed to lifelong omega-3 supplementation or deprivation as opposed to post weaning exposure only. Lifelong exposure to omega-3 supplementation resulted in impaired spatial learning in Sorl1-/- mice. The vitamin C antioxidant capacity in the brains of Sorl1-/- mice was reduced, but reduced glutathione and vitamin E levels were increased, leaving the overall antioxidant capacity of the brain inconclusive. No gross morphological differences of hippocampal neurons were found to account for the altered behavior. We found a significant adverse effect in cognitive performance by combining SorLA deficiency with lifelong exposure to omega-3. Our results stress the need for investigations of the underlying molecular mechanisms to clarify the precise circumstances under which omega-3 supplementation may be beneficial.
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Healy-Stoffel M, Levant B. N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2018; 17:216-232. [PMID: 29651972 PMCID: PMC6563911 DOI: 10.2174/1871527317666180412153612] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/01/2017] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & OBJECTIVE A number of neuropsychiatric disorders, including Parkinson's disease, schizophrenia, attention deficit hyperactivity disorder, and, to some extent, depression, involve dysregulation of the brain dopamine systems. The etiology of these diseases is multifactorial, involving genetic and environmental factors. Evidence suggests that inadequate levels of n-3 (omega- 3) polyunsaturated fatty acids (PUFA) in the brain may represent a risk factor for these disorders. These fatty acids, which are derived from the diet, are a major component of neuronal membranes and are of particular importance in brain development and function. Low levels of n-3 PUFAs in the brain affect the brain dopamine systems and, when combined with appropriate genetic and other factors, increase the risk of developing these disorders and/or the severity of the disease. This article reviews the neurobiology of n-3 PUFAs and their effects on dopaminergic function. CONCLUSION Clinical studies supporting their role in the etiologies of diseases involving the brain dopamine systems and the potential of n-3 PUFAs in the treatment of these disorders are discussed.
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Affiliation(s)
| | - Beth Levant
- Department of Pharmacology, Toxicology, and Therapeutics and the Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS, USA
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Agostoni C, Nobile M, Ciappolino V, Delvecchio G, Tesei A, Turolo S, Crippa A, Mazzocchi A, Altamura CA, Brambilla P. The Role of Omega-3 Fatty Acids in Developmental Psychopathology: A Systematic Review on Early Psychosis, Autism, and ADHD. Int J Mol Sci 2017; 18:E2608. [PMID: 29207548 PMCID: PMC5751211 DOI: 10.3390/ijms18122608] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 12/24/2022] Open
Abstract
In this systematic review, we will consider and debate studies that have explored the effects of ω-3 polyunsaturated fatty acids (PUFAs) in three major, and somehow related, developmental psychiatric disorders: Autism, Attention Deficit and Hyperactivity disorder and Psychosis. The impact of ω-3 PUFAs on clinical symptoms and, if possible, brain trajectory in children and adolescents suffering from these illnesses will be reviewed and discussed, considering the biological plausibility of the effects of omega-3 fatty acids, together with their potential perspectives in the field. Heterogeneity in study designs will be discussed in the light of differences in results and interpretation of studies carried out so far.
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Affiliation(s)
- Carlo Agostoni
- Pediatric Intermediate Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
- SIGENP (Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition), via Libero Temolo 4 (Torre U8), 20126 Milan, Italy.
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, via Don Luigi Monza 20, Bosisio Parini, 23842 Lecco, Italy.
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Alessandra Tesei
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, via Don Luigi Monza 20, Bosisio Parini, 23842 Lecco, Italy.
| | - Stefano Turolo
- Pediatric Nephrology & Dialysis, Milano Fondazione IRCCS Cà Grande Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Alessandro Crippa
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, via Don Luigi Monza 20, Bosisio Parini, 23842 Lecco, Italy.
| | - Alessandra Mazzocchi
- Pediatric Intermediate Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Carlo A Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy.
- Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, 77021 TX, USA.
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Kean JD, Downey LA, Stough C. Systematic Overview of Bacopa monnieri (L.) Wettst. Dominant Poly-Herbal Formulas in Children and Adolescents. MEDICINES (BASEL, SWITZERLAND) 2017; 4:medicines4040086. [PMID: 29165401 PMCID: PMC5750610 DOI: 10.3390/medicines4040086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/07/2023]
Abstract
Background: The Ayurvedic medicinal system employs a holistic approach to health, utilising the synergistic properties of organic resources. Research into the Ayurvedic herb Bacopa monnieri (L.) Wettst. (B.monnieri) has reported improvements in cognitive outcomes in child and adult populations. The aim of current review is to systematically assess and critically summarize clinical trials investigating B.monnieri-dominant poly-herbal formulas and their effects on the cognition, memory, learning, and behaviour in children and adolescents. Methods: Key word searches were performed using PubMed, Scopus, Cochrane Library, DHARA, and CINAHL for publications meeting inclusion criteria up to November 2017. There were no restrictions in study design. Effect sizes were calculated for all significant findings to allow for direct comparisons, and each study was evaluated on design quality. Cognitive and behavioural outcomes were grouped into validated constructs for cross-study comparison. Results: Nine trials met inclusion criteria. Five studies reported sufficient data for effect size analysis with most improvements reported in behavioural outcomes. True cognitive abilities and behavioural constructs were reviewed in six studies, with visual perception, impulsivity, and attention demonstrating the greatest improvements. The veracity of the evidence for the formulations reviewed is weakened by inconsistent statistical design and under-reporting of safety and tolerability data (44%). Conclusions: The current review extends research supporting B.monnieri as a cognitive enhancer and provides modest evidence for the use of B.monnieri in poly-herbal preparations for improving cognitive and behavioural outcomes in child and adolescent populations. Greater emphasis on statistical vigour and the reporting of tolerability data are essential for future trials to adequately document poly-herbal treatment efficacy.
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Affiliation(s)
- James D Kean
- Centre for Human Psychopharmacology, Swinburne University, Melbourne 3122, Australia.
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne 3122, Australia.
- Institute for Breathing and Sleep, Austin Hospital, Melbourne 3084, Australia.
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University, Melbourne 3122, Australia.
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A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents. Nutrients 2017; 9:nu9050474. [PMID: 28489030 PMCID: PMC5452204 DOI: 10.3390/nu9050474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The influence of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation on health outcomes has been studied extensively with randomized controlled trials (RCT). In many research fields, difficulties with recruitment, adherence and high drop-out rates have been reported. However, what is unknown is how common these problems are in n-3 LCPUFA supplementation studies in children and adolescents. Therefore, this paper will review n-3 LCPUFA supplementation studies in children and adolescents with regard to recruitment, adherence and drop-out rates. METHODS The Web of Science, PubMed and Ovid databases were searched for papers reporting on RCT supplementing children and adolescents (2-18 years) with a form of n-3 LCPUFA (or placebo) for at least four weeks. As a proxy for abiding to CONSORT guidelines, we noted whether manuscripts provided a flow-chart and provided dates defining the period of recruitment and follow-up. RESULTS Ninety manuscripts (reporting on 75 studies) met the inclusion criteria. The majority of the studies did not abide by the CONSORT guidelines: 55% did not provide a flow-chart, while 70% did not provide dates. The majority of studies provided minimal details about the recruitment process. Only 25 of the 75 studies reported an adherence rate which was on average 85%. Sixty-five of the 75 studies included drop-out rates which were on average 17%. CONCLUSION Less than half of the included studies abided by the CONSORT guidelines (45% included a flow chart, while 30% reported dates). Problems with recruitment and drop-out seem to be common in n-3 LCPUFA supplementation trials in children and adolescents. However, reporting about recruitment, adherence and dropout rates was very heterogeneous and minimal in the included studies. Some techniques to improve recruitment, adherence and dropout rates were identified from the literature, however these techniques may need to be tailored to n-3 LCPUFA supplementation studies in children and adolescents.
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