The effect of omega-3 fatty acids on aggression: A meta-analysis

Omega-3 supplementation reduces aggressive behavior: A meta-analytic review of randomized controlled trials

There is increasing interest in the use of omega-3 supplements to reduce aggressive behavior. This meta-analysis summarizes findings from 28 RCTs (randomized controlled trials) on omega-3 supplementation to reduce aggression, yielding 35 independent samples with a total of 3,918 participants. Three analyses were conducted where the unit of analysis was independent samples, independent studies, and independent laboratories. Significant effect sizes were observed for all three analyses (g = .16, .20, .28 respectively), averaging .22, in the direction of omega-3 supplementation reducing aggression. There was no evidence of publication bias, and sensitivity analyses confirmed findings. Moderator analyses were largely non-significant, indicating that beneficial effects are obtained across age, gender, recruitment sample, diagnoses, treatment duration, and dosage. Omega-3 also reduced both reactive and proactive forms of aggression, particularly with respect to self-reports (g = .27 and .20 respectively). It is concluded that there is now sufficient evidence to begin to implement omega-3 supplementation to reduce aggression in children and adults - irrespective of whether the setting is the community, the clinic, or the criminal justice system.

PROTOCOL: The efficacy of nutritional interventions in reducing childhood/youth aggressive and antisocial behavior: A systematic review and meta-analysis

This is a protocol for a Campbell systematic review of intervention effectiveness. The goal of this systematic review is to answer the following questions based on the available empirical evidence: Are there nutritional interventions (dietary manipulation, fortification or supplementation) that can reduce excessive aggression towards others in children/youth? If yes, how strong is their effect and is there a difference among the three intervention types? Are there nutritional interventions that can reduce antisocial behaviors in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce non-violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? What implementation barriers and solutions to these exist in relation to the above nutritional interventions in children/youth?

Nutraceuticals in Psychiatric Disorders: A Systematic Review

Correct nutrition and diet are directly correlated with mental health, functions of the immune system, and gut microbiota composition. Diets with a high content of some nutrients, such as fibers, phytochemicals, and short-chain fatty acids (omega-3 fatty acids), seem to have an anti-inflammatory and protective action on the nervous system. Among nutraceuticals, supplementation of probiotics and omega-3 fatty acids plays a role in improving symptoms of several mental disorders. In this review, we collect data on the efficacy of nutraceuticals in patients with schizophrenia, autism spectrum disorders, major depression, bipolar disorder, and personality disorders. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out the direction for future research.

Homicide or Happiness: Did Folate Fortification and Public Health Campaigns Influence Homicide Rates and the Great American Crime Decline?

The last several years have witnessed a remarkable growth in research directed at nutrition and behavior, with increased interest in the field of nutritional criminology. It is becoming clear that dietary patterns and specific nutrients play an important role in cognition and behavior, including those related to aggression, violence, and antisocial activity. Included in this expanding knowledge base is the recognition that folate, through multiple pathways, including enzymatic reactions and gut microbiome ecology, plays a critical role in central nervous system functioning. These mechanistic advances allow for a retrospective analysis of a topic that remains unexplained-the sudden and unpredicted drop in homicide and other violent crime rates in the United States and other nations in the 1990s. Here, we revisit this marked reduction in homicide rates through the lens of the coincident public health campaign (and subsequent mandatory fortification) to increase folic acid intake. Based on objectively measured blood folate levels through the National Health and Nutrition Examination Surveys, there is little doubt that tissue folate witnessed a dramatic rise at the national level from 1988 through 2000. Drawing from accumulated and emerging research on the neurobehavioral aspects of folate, it is our contention that this relatively sudden and massive increase in tissue folate levels may have contributed to reductions in violent crime in the United States.

Dietary Intakes of Long-Chain Polyunsaturated Fatty Acids and Impulsivity: Comparing Non-Restricted, Vegetarian, and Vegan Diets

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.

Nutritional factors associated with aggression

Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.

Complementary and Integrative Treatments of Aggressiveness/Emotion Dysregulation: Associated with Disruptive Disorders and Disruptive Mood Dysregulation Disorder

Youth with emotional dysregulation (ED) and irritability/aggression, common in disruptive disorders (frequently comorbid with attention-deficit/hyperactivity disorder), are underserved by conventional treatments. Anger dysregulation is usually the core feature of ED. Complementary and integrative Medicine (CIM) treatments for youth with disruptive disorders and ED are reviewed. Broad-spectrum micronutrient supplementation has a medium effect and is supported by two double-blind randomized controlled trials using similar formulations. Other CIM treatments supported by controlled data but needing further research, include omega-3 fatty acid supplementation, music therapy, martial arts, restricting exposure to media violence, decreasing sleep deprivation, and increased exposure to green-blue spaces.

Omega-3 fatty acid intake during pregnancy and risk of infant maltreatment: a nationwide birth cohort - the Japan Environment and Children's Study

BACKGROUND

Intake of omega-3 polyunsaturated fatty acids (PUFAs) has favorable effects, including reducing violent and aggressive behaviors, but its association with infant maltreatment is unknown. We therefore tested the hypothesis that maternal intake of omega-3 PUFAs is associated with a lower risk of infant maltreatment.

METHODS

Participants were 92 191 mothers involved in the ongoing Japan Environment and Children's Study. Omega-3 PUFA intake during pregnancy was measured using a food frequency questionnaire. Infant maltreatment was assessed using a self-reported questionnaire administered at 1 and 6 months postpartum.

RESULTS

Analysis using the lowest quintile of intake as a reference revealed that the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cases of 'hitting' decreased as quintiles increased, with values for the second to fifth quintiles of 0.93 (95% CI 0.77-1.13), 0.79 (95% CI 0.64-0.97), 0.78 (95% CI 0.64-0.96), and 0.72 (95% CI 0.59-0.89), respectively. Adjusted ORs (95% CIs) for 'shaking very hard' at 6 months were 0.87 (0.73-1.04), 0.81 (0.67-0.97), 0.73 (0.61-0.89), and 0.78 (0.65-0.94), respectively. Adjusted ORs for 'leaving alone at home' for the second to fifth quintiles were 0.92 (0.87-0.98), 0.91 (0.86-0.97), 0.94 (0.88-0.99), and 0.85 (0.80-0.90), respectively.

CONCLUSIONS

Higher maternal intake of omega-3 PUFAs during pregnancy was associated with fewer cases of hitting and violent shaking and leaving the child alone at home, implying a lower risk of infant maltreatment. Our results indicate the potential applicability of omega-3 PUFAs in reducing infant maltreatment.

Dietary interventions, the gut microbiome, and aggressive behavior: Review of research evidence and potential next steps

Research in biosocial criminology and other related disciplines has established links between nutrition and aggressive behavior. In addition to observational studies, randomized trials of nutritional supplements like vitamins, omega-3 fatty acids, and folic acid provide evidence of the dietary impact on aggression. However, the exact mechanism of the diet-aggression link is not well understood. The current article proposes that the gut microbiome plays an important role in the process, with the microbiota-gut-brain axis serving as such a mediating mechanism between diet and behavior. Based on animal and human studies, this review synthesizes a wide array of research across several academic fields: from the effects of dietary interventions on aggression, to the results of microbiota transplantation on socioemotional and behavioral outcomes, to the connections between early adversity, stress, microbiome, and aggression. Possibilities for integrating the microbiotic perspective with the more traditional, sociologically oriented theories in criminology are discussed, using social disorganization and self-control theories as examples. To extend the existing lines of research further, the article considers harnessing the experimental potential of noninvasive and low-cost dietary interventions to help establish the causal impact of the gut microbiome on aggressive behavior, while adhering to the high ethical standards and modern research requirements. Implications of this research for criminal justice policy and practice are essential: not only can it help determine whether the improved gut microbiome functioning moderates aggressive and violent behavior but also provide ways to prevent and reduce such behavior, alone or in combination with other crime prevention programs.

Dietary Fatty Acid Composition Impacts the Fatty Acid Profiles of Different Regions of the Bovine Brain

Fatty acid composition across functional brain regions was determined in bovine brains collected from cattle that were provided supplements of calcium salts containing either palm or fish oil. The Angus cattle were divided into two groups, with one group offered the supplement of calcium salts of palm oil and the other offered the calcium salts of fish oil (n = 5 females and n = 5 males/supplement) for 220 days. These supplements to the basal forage diet were provided ad libitum as a suspension in dried molasses. The fish oil exclusively provided eicosapentaenoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3). The functional regions were dissected from the entire brains following commercial harvest. While the cattle provided diets supplemented with the calcium salts of palm oil had increased (p < 0.01) liver concentrations of C18:1 n-9, C18:2 n-6, and arachidonic acid, the fish-oil-supplemented cattle had greater (p < 0.01) concentrations of liver EPA, DHA, and C18:3 n-3. In the brain, DHA was the most abundant polyunsaturated fatty acid. In the amygdala, pons, frontal lobe, internal capsule, and sensory cortex, DHA concentrations were greater (p < 0.05) in the brains of the cattle fed fish oil. Differences among the supplements were small, indicating that brain DHA content is resistant to dietary change. Arachidonic acid and C22:4 n-6 concentrations were greater across the regions for the palm-oil-supplemented cattle. EPA and C22:5 n-3 concentrations were low, but they were greater across the regions for the cattle fed fish oil. The effects of sex were inconsistent. The fatty acid profiles of the brain regions differed by diet, but they were similar to the contents reported for other species.

Environmental Influences on the Behavioural and Emotional Outcomes of Children: A Network Analysis

Background: Intellectual developmental disorders are a serious source of health morbidity with negative consequences for adults as well as children. However, there is limited evidence on the environmental, trace element, behavioural, and emotional outcomes in children. Here, we investigated whether there is any association between child behaviour and emotional outcomes and micronutrients using network analysis. Methods: A cross-sectional study was conducted in 9-year-old children within a Pacific Island Families study birth cohort. Elemental concentration was determined in children’s toenails after acid digestion and analysed using inductively coupled plasma mass spectrometry. We used network analysis to identify closely associated trace elements and tested the directions and strength of these trace elements. MANCOVA were used to identify the significant associations between individual elements and the behavioural/emotional function of the children using the children behaviour checklist (CBCL). At the final step, quantile regression analysis was used to assess and quantify the identified associations between CBCL function scores and manganese, adjusted by sex, ethnicity, and standardized BMI. Results: Three major nutrient networks were identified. In the Mn network, Mn was strongly positively associated with Al (0.63) and Fe (r = 0.65) and moderately associated with Pb (r = 0.45) and Sb (r = 0.42). Al was also strongly associated with Fe (r = 0.9). Children in the second or third clinical group, with an elevated externalized CBCL score, had a much higher mean and median level of Mn as compared to the normal range group. The aggression score was significantly associated with Mn concentration and sex. Higher Mn concentrations were associated with a higher aggression score. A 1 ug/g unit increase in Mn was associated with a 2.44-fold increase (95% confidence interval: 1.55–4.21) in aggression score, and boys had higher median aggression score than girls (difference: 1.7, 95% CI: 0.9–2.8). Attention and rule breaking scores were both significantly associated with Mn concentration. Higher Mn concentrations were associated with higher attention behaviour problem and rule breaking scores. A 1 ug/g unit increase in Mn was found to be associated with a 1.80-fold increase (95% confidence interval: 1.37–2.82) in attention score, and a 1.46-fold increase (95% confidence interval: 1.01–1.74) in the rule breaking score. Thought score was not significantly associated with Mn concentration (p = 0.13) but was significantly lower in boys (p = 0.004). Conclusions: Exceeding Mn levels is potentially toxic and has been identified to be associated with worse externalized children’s behavioural health and emotional well-being. Future studies are necessary to find the exposure paths so that advice shall be provided to family and care providers in public health and environmental protection.

Male intake of omega-3 fatty acids and risk of intimate partner violence perpetration: a nationwide birth cohort - the Japan Environment and Children's Study

AIMS

Intake of omega-3 polyunsaturated fatty acids (PUFAs) has favourable effects on reducing aggressive and violent behaviours, but its association with perpetration of intimate partner violence (IPV) is not known. We aimed to determine the association between male intake of omega-3 PUFAs and risk of IPV perpetration.

METHODS

Participants were male-female pairs in the Japan Environment and Children's Study, in which first pregnant women and then their partners were enrolled (analytic sample: n = 48 065). Male intake of omega-3 PUFAs during the past year (preconception to mid/late pregnancy) was determined using a food frequency questionnaire. IPV (physical violence and emotional abuse) during pregnancy was measured using a self-reported questionnaire completed by pregnant women in mid/late pregnancy. Generalised additive mixed-model analysis was used to examine the non-linear association between energy-adjusted male omega-3 PUFA intake and the adjusted prevalence of male IPV perpetration.

RESULTS

A sharply decreasing regression curve was plotted for physical violence, with prevalence starting at 1.35% at the lowest intake level and decreasing to a minimum value of 0.76% at intake of 2.20 g/day (71.7th percentile). However, prevalence largely remained flat from there onward, with the upper limit of the error range not reaching the initial lower limit of the error range until intake exceeded 5.21 g/day (99.77th percentile). For emotional abuse, on the other hand, there was a distorted U- or V-shaped regression curve that rose slightly after reaching a minimum. The prevalence declined from 17.69% initially, reached a minimum at 12.44% at 2.13 g/day (68.3th percentile), and then rose slightly. The lower limit of the error range reached the minimum upper limit at 4.17 g/day (99.1th percentile), and the upper limit finally reached the maximum lower limit value at 4.56 g/day (99.5th percentile).

CONCLUSIONS

In this nationwide birth cohort study, higher male intake of omega-3 PUFAs was associated with lower risk of physical violence and emotional abuse perpetration except for extremely high intake. Our results indicate the potential applicability of omega-3 PUFAs in reducing aggressive and violent behaviours in IPV.Trial registration: UMIN000030786.

Review on Selected Aggression Causes and the Role of Neurocognitive Science in the Diagnosis

Simple Summary

Aggression in dogs is often a reason for abandonment and/or euthanasia. Recently, knowledge about aggression has been subjected to more detailed analysis. In recent years, it has been studied in terms of factors affecting it, such as diet (especially nutritional supplements) and physiology (endocrine system). In addition, recently, new methods of brain research, such as neurocognitive research, have appeared, which enable a significant increase in knowledge about dog behavior, including aggression.

Abstract

Aggression as a behavior is not always desirable, often ends in abandonment and/or euthanasia. However, it is possible to prevent the occurrence of unwanted aggression in domestic dogs. Aggression is not a fully understood phenomenon. In recent years, many studies have focused on the influence of diet and physiology (including the endocrine system) on the emergence of behavioral disorders. In particular, the emphasis was put on nutritional additives such as fatty acids, amino acids, and probiotics. In addition, the possibility of using neurocognition in the observation of abnormal behavior in dogs has also been discussed, which may allow for a more detailed determination of the basis of aggressive behavior in dogs. In this review, the concepts related to aggression and its potential causes have been gathered. In addition, the possible influence of diet and hormones on aggression in dogs has been discussed, as well as the application of neurocognition in the possibility of its diagnosis.

Flaxseed oil as omega-3 polyunsaturated fatty acid source modulates cortisol concentrations and social dominance in male and female guinea pigs

Flaxseed oil is an excellent source of the essential omega-3 polyunsaturated fatty acid (PUFA) alpha-linolenic acid (ALA). Omega-3 PUFAs are important neuronal components and can counteract aggressive, depressive, and anxiety-like behavior, reduce glucocorticoid (e.g. cortisol) concentrations under chronic stress but also increase acute glucocorticoid responses. As glucocorticoids per se and glucocorticoid responsiveness can modulate the establishment of dominance hierarchies, we investigated if flaxseed oil high in ALA can promote social dominance through effects on glucocorticoid concentrations. Two male and two female groups of domestic guinea pigs (n = 9 per group) were maintained on a control or a 5% (w/w) flaxseed oil diet for four weeks. Social behaviors, hierarchy indices, locomotion, and saliva cortisol concentrations were determined during basal group housing conditions and stressful social confrontations with unfamiliar individuals of the other groups. Flaxseed groups had increased basal cortisol concentrations and showed no cortisol increase during social confrontations. Cortisol concentrations in control groups significantly increased during social confrontations. Such higher cortisol responses positively affected individual hierarchy indices in control males. However, flaxseed males became dominant irrespective of cortisol concentrations. In females, the opposite was detected, namely a higher dominant status in control compared to flaxseed females. Open-field- and dark-light-tests for anxiety-like behavior revealed no pronounced differences, but flaxseed males showed the highest locomotor activity. Flaxseed oil as an ALA source sex-specifically promoted social dominance irrespective of cortisol concentrations and responses. The underlying neuronal mechanisms remain to be determined, but a sex-specific energetic advantage may have accounted for this effect.

Irritability, Anger, and Aggression in the Context of Pediatric Bipolar Disorder

Irritability, anger, and aggression, although not specific for pediatric bipolar disorder (BD), can be a common finding and an important source of distress and impairment in these patients. Over the past 2 decades the diagnostic significance of irritability in pediatric BD has been highly debated. Beyond the debate of its diagnostic significance, the clinical importance of irritability, anger, and aggression in youth with BD has been well established. In this review, the authors discuss evaluation and management strategies of irritability, anger, and aggression in youth with BD.

The relationship between history of dietary nutrients intakes and incidence of aggressive behavior in adolescent girls: A case-control study

BACKGROUND & AIMS

Aggressive behavior (AB) progress to a major concern among adolescents. The present study is designed to assess possible association between dietary intake of macronutrient, some micronutrient, cholesterol, and antioxidants with AB in adolescent girls, from age 9-13 years old.

MATERIALS AND METHODS

In the case-control study, a total 212 primary school girls between 9 and 13 years of age were divided into two groups (106 with AB and 106 healthy) base on aggression score of the Buss-Perry questionnaire. A 147-item food frequency questionnaire (FFQ) was used to evaluate nutritional intake of subjects. Independent t-test and Mann-Whitney test was used to compare quantitative variables between the two groups according to the normality of data distribution. Chi-square test was used to compare categorical variables between case and control groups. Logistic regression models were used to assess possible association of nutrients intake with AB.

RESULTS

The consumption of more simple carbohydrate [odds ratios (OR): 14.53, confidence interval (CI): (13.23, 17.56)] total fat [OR: 13.31, CI: (8.50, 16.47)], SFAs [OR: 11.831, CI: (8.94, 15.36)], TFAs [OR: 9.10, CI: (6.87, 10.12)], and caffeine [OR: 16.26, CI: (14.53, 17.88)] significantly increase the occurrence of aggressive behaviors. Conversely, intake of fiber [OR: 0.997, CI: (0.012, 0.999)], W3 [OR: 0.991, CI: (0.040, 0.999)], and vitamin K [OR: 0.994, CI: (0.990, 0.999)] were marginal associated with reduced odds of AB.

CONCLUSIONS

The intake of caffeine, simple carbohydrate, total fat, SFAs, TFAs, could increase the occurrence of AB.

Nutritional supplementation in the treatment of violent and aggressive behavior: A systematic review

Aggression in correctional and psychiatric settings is relatively common and has a negative effect on physical and mental health both among inmates/clients and staff, as well as organizational-level functioning. The aim of the present study was to critically review the evidence on the effectiveness of nutritional supplements in reducing aggression and violence to contribute to a better understanding of options available for managing aggressive behaviors in adults. The EMBASE, MEDLINE, PsycINFO, Cochrane Library, and PubMed databases were searched for effectiveness studies published in English anytime up until March 2020. Study quality was assessed using the Mixed Methods Appraisal Tool. Altogether, 14 studies met inclusion criteria; 2 investigated micronutrients, 10 examined macronutrients, while further 2 examined a combination of micro and macronutrients. Out of the 14 studies, 5 reported a beneficial effect of nutritional supplementation (omega-3 fatty acids, vitamins/minerals, S-adenosyl-l-methionine, or tryptophan). Five studies did not report a significant beneficial effect of nutritional supplementation (omega-3 fatty acids, folic acid, tryptophan, broad range supplement containing vitamins and fatty acids, and fatty acids in augmentation with valproic acid), while four studies reported mixed effects (on l-tryptophan, broad-range micronutrient formula, folic acid, and omega-3 fatty acids). The results overall indicated that research in this area is in its infancy: very few studies examined the same composition of nutritional supplementation and when they did so the results were contradictory. The methodological shortcoming of existing studies and directions for future research are discussed to facilitate high-quality research in this evolving area of nutritional psychiatry.

Role of Callous and Unemotional (CU) Traits on the Development of Youth with Behavioral Disorders: A Systematic Review

Numerous studies have shown that youth with behavioral disorders (BD) present an increased risk for developing severe and persistent antisocial behaviors in adulthood. Retrospective research notes that not all children and adolescents follow a negative trajectory and explains this heterogeneity in particular by the severity of CU traits. Our study examines how these traits affect the functioning of children and adolescents with BD. Method: A systematic literature review conducted through various databases and using different keywords made it possible to analyze 52 studies published from 2015 to 2020 that measured the bidirectional effects of CU traits on the functioning of young. Results: Out of the 52 studies, 47 analyzed links between CU traits and neurobiological or mental health, 20 examined family and school contexts, eight focused on social adjustment, 10 on social interactions and 19 measured links with cognitive functioning, especially executive functions. Conclusion: Consistent with previous recommendations in the field, our findings emphasize the importance of assessing the presence of UC traits in early childhood to prevent the emergence of comorbid disorders and to target multimodal (early) interventions to influence the life trajectories of youth with high CU traits.

Importance of EPA and DHA Blood Levels in Brain Structure and Function

Brain structure and function depend on a constant and sufficient supply with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) by blood. Blood levels of EPA and DHA reflect dietary intake and other variables and are preferably assessed as percentage in erythrocytes with a well-documented and standardized analytical method (HS-Omega-3 Index^®). Every human being has an Omega-3 Index between 2 and 20%, with an optimum of 8–11%. Compared to an optimal Omega-3 Index, a lower Omega-3 Index was associated with increased risk for total mortality and ischemic stroke, reduced brain volume, impaired cognition, accelerated progression to dementia, psychiatric diseases, compromises of complex brain functions, and other brain issues in epidemiologic studies. Most intervention trials, and their meta-analyses considered EPA and DHA as drugs with good bioavailability, a design tending to produce meaningful results in populations characterized by low baseline blood levels (e.g., in major depression), but otherwise responsible for many neutral results and substantial confusion. When trial results were evaluated using blood levels of EPA and DHA measured, effects were larger than comparing EPA and DHA to placebo groups, and paralleled epidemiologic findings. This indicates future trial design, and suggests a targeted use EPA and DHA, based on the Omega-3 Index.

Infection threat shapes our social instincts

We social animals must balance the need to avoid infections with the need to interact with conspecifics. To that end we have evolved, alongside our physiological immune system, a suite of behaviors devised to deal with potentially contagious individuals. Focusing mostly on humans, the current review describes the design and biological innards of this behavioral immune system, laying out how infection threat shapes sociality and sociality shapes infection threat. The paper shows how the danger of contagion is detected and posted to the brain; how it affects individuals’ mate choice and sex life; why it strengthens ties within groups but severs those between them, leading to hostility toward anyone who looks, smells, or behaves unusually; and how it permeates the foundation of our moral and political views. This system was already in place when agriculture and animal domestication set off a massive increase in our population density, personal connections, and interaction with other species, amplifying enormously the spread of disease. Alas, pandemics such as COVID-19 not only are a disaster for public health, but, by rousing millions of behavioral immune systems, could prove a threat to harmonious cohabitation too.

Relationships between inflammatory markers and suicide risk status in major depression

Pro-inflammatory status has been implicated in depression and suicidal behaviors. Polyunsaturated fatty acids (PUFAs) and cytokines, two types of inflammatory biomarkers, have been associated with suicide, independent of depression severity. How these biomarkers relate to each other is less clear. We measured plasma phospholipid levels of arachidonic acid (AA%), docosahexaenoic acid (DHA%), and eicosapentaenoic acid (EPA%) as a percentage of total phospholipids, as well as serum interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α), in 80 patients with major depressive disorder (MDD) and 24 healthy controls (HC). Individual PUFA and cytokine species were compared using ANOVA across four suicide risk-stratified groups: 1) highest-risk, recent (within 5 years) suicide attempters (n = 20); 2) high-risk, severe current suicidal ideators (having intent or plan) with no recent attempt history (n = 22); 3) low-risk, current non-ideators who were also lifetime non-attempters (n = 38); and 4) HC (n = 24). None of the participants were enrolled following an acute suicide attempt. Of biomarkers studied, only DHA% (p = 0.012) and IL-1β (p = 0.002) differed between groups. In post-hoc testing, DHA% was lower in attempters than ideators (p = 0.018) or MDD non-ideators (trend level, p = 0.073). IL-1β was lowest in attempters, differentiating them from ideators (p = 0.009) and HC (p = 0.004). Recent suicide attempt, one of the most powerful predictors of suicide risk, was also most closely tied to inflammatory indices in this study. Low DHA% as an indicator of suicide risk is consistent with previous reports; however, lower IL-1β was unexpected and may relate to acuity/chronicity of inflammation. There is a need for prospective studies of immune status with respect to suicidal behaviors.

Omega-3 supplementation, child antisocial behavior, and psychopathic personality: a randomized, double-blind, placebo-controlled, stratified, parallel group trial

While some RCTs have observed efficacy for omega-3 supplementation in reducing antisocial behavior, the role of psychopathic personality and gender in moderating treatment outcome has not been examined. This study examines whether omega-3 supplementation reduces antisocial behavior, and whether any treatment effects are a function of gender and psychopathy. Three hundred and twenty-four schoolchildren with a mean age of 11.9 years were randomized into 3 groups: omega-3 (N = 108), placebo (N = 110), and no-treatment controls (N = 106). Parent and child reports of child antisocial and aggressive behavior and psychopathic-like personality were collected at 0 months (baseline), 6 months (end of treatment), and 12 months (6 months post-treatment). A group × time × gender interaction (p = .016) indicated that only females in the omega-3 group showed a significant reduction in antisocial behavior 6 months post-treatment compared to baseline (d = .35), whereas the females in the two control groups showed no change over time. A group x time x psychopathy interaction (p < .006) was also observed, with psychopathic personality levels moderating treatment outcome. Children in the omega-3 group with high (but not low) psychopathic-like personality showed significant improvements in child-reported antisocial behavior at the end of treatment (d = .19) Results suggest that omega-3 supplementation may be helpful in reducing childhood antisocial and aggressive behavior in females, and those with psychopathic-like personalities.

Efficacy of Polyunsaturated Fatty Acids (PUFAs) on Impulsive Behaviours and Aggressiveness in Psychiatric Disorders

It is the focus of increasing interest to investigate the effects of long-chain n-3 and long-chain n-6 polyunsaturated fatty acids (LC n-3 PUFAs; LC n-6 PUFAs) on psychiatric symptoms in a transdiagnostic perspective. There is some evidence that low levels of LC n-3 PUFAs and a higher ratio of LC n-6 to LC n-3 PUFAs in plasma and blood cells are associated with aggressive and impulsive behaviours. Therefore, implementation of LC n-3 PUFAs may produce positive effects on hostility, aggression, and impulsivity in both psychiatric and non-psychiatric samples across different stages of life. A possible mechanism of action of LC n-3 PUFAs in conditions characterized by a high level of impulsivity and aggression is due to the effect of these compounds on the serotonin system and membrane stability. Studies that evaluated the effects of LC n-3 PUFAs on impulsivity and aggressiveness indicated that addition of rather low doses of these agents to antipsychotic treatment might reduce agitation and violent behaviours in psychosis, attention deficit hyperactivity disorder, personality disorders, and impulsive control and conduct disorders. The present review is aimed at examining and discussing available data from recent trials on this topic.

Dietary fatty acids modulate cortisol concentrations and social dominance during social confrontations in adolescent male guinea pigs

The hypothalamic-pituitary-adrenal (HPA)-axis and related glucocorticoid concentrations regulate physiology and behavior, which can be modulated by nutritional conditions, particularly by the dietary fatty acid composition. Omega-3 polyunsaturated fatty acids (PUFAs) have been shown to promote hypothalamic-pituitary-adrenal (HPA)-axis functions, whereas saturated fatty acids (SFAs) in general produce adverse effects and even increase baseline glucocorticoid concentrations. Glucocorticoids (e.g. cortisol) were further documented to modulate the establishment of dominance relationships, while the involvement of dietary fatty acids remains understudied. This study focused on different effects of PUFAs and SFAs on cortisol concentrations and social dominance in male guinea pigs. Three groups of animals were maintained on diets high in PUFAs (10 % w/w walnut oil), SFAs (10 % w/w coconut fat), or on an untreated control diet starting already prenatally. During adolescence, at an age of 60, 90, and 120 days, each individual's saliva cortisol concentrations and hierarchy index (calculated by initiated and received agonistic behavior) were measured during basal group housing conditions and stressful social confrontations with unfamiliar individuals of the other groups. SFA males showed highest baseline cortisol concentrations, lowest cortisol responses to social confrontations, and became subdominant. PUFA and control males showed significant cortisol responses. However, while control males became dominant during social confrontations, the hierarchy index in PUFA males decreased with age. Individual hierarchy indices during consecutive social confrontations revealed a high consistency. The findings presented here indicate that dietary fatty acids differently affect HPA-axis functions and social dominance but the underlying mechanisms remain to be determined.

The Effect of Dietary Supplementation on Aggressive Behaviour in Australian Adult Male Prisoners: A Feasibility and Pilot Study for a Randomised, Double Blind Placebo Controlled Trial

This study aimed to assess the feasibility of conducting a nutrition trial in adult male prisoners. Adult male prisoners were recruited for a 16-week randomised control trial comparing the effect of ingestion of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) and multivitamin supplements versus placebo on aggressive behaviour. The baseline and post-intervention assessments from the participant blood samples were the erythrocyte n-3 LCPUFA levels as well as measures of aggressive behaviour determined through institutional records of misconduct (IRM), the Inmate Behaviour Observation Scale (IBOS), and questionnaires. A total of 136 adult male prisoners consented to the study with a retention rate of 60%, and 93% of blood samples were successfully collected. The IRM and IBOS scores were collected for 100% of participants, whilst 82–97% of participants completed the questionnaires. From the baseline data, the Odds Ratio shows that prisoners are 4.3 times more likely to have an IBOS >2 if they are below the 6% cut off on the omega-3 index. Both groups improved across all outcome measures and, at the current sample size, no significant differences were seen between them. A power calculation suggests a total sample size of 600 participants is required to detect the effects of this dietary supplementation, and that this supplementation study is feasible in a Correctional Centre. Important criteria for the exclusion and consideration of logistics and compliance are presented.

Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology

The usefulness of polyunsaturated fatty acids on inflammatory, cardiovascular, and the nervous system was studied in the last decades, but the mechanisms underlying their benefic properties are still partially unknown. These agents seem to express their action on the membrane phospholipid composition and permeability and modulation of second messenger cascades. In psychiatry, the efficacy and tolerability of omega-3 fatty acids were investigated in several psychiatric disorders, including major depression, bipolar disorder, personality disorders, high-risk conditions to develop psychosis, attention-deficit hyperactivity disorder, and autism spectrum disorders. Initial findings in this field are promising, and some relevant questions need to be addressed. In particular, the effects of these agents on the main symptom dimensions have to be investigated in a trans-diagnostic perspective. The present systematic review is aimed to examine the available data on the efficacy of omega-3 fatty acids on domains of psychotic symptoms, affective symptoms, impulsivity, and aggressiveness, and harmful behaviors, and suicide risk.

Effects of dietary fatty acids on the social life of male Guinea pigs from adolescence to adulthood

Dietary intake of polyunsaturated fatty acids (PUFAs) or saturated fatty acids (SFAs) differently modulates neurophysiological and behavioral functions in response to altered hypothalamic-pituitary-adrenal (HPA)-axis activity and an individual's development. In this context, an individual's social environment, including social interactions and social hierarchies, is closely related to hormone concentrations and possibly interacts with dietary fatty acid effects. We investigated if dietary supplementation with walnut oil (high in PUFAs) and coconut fat (high in SFAs), compared to a control group, affects body mass gain, cortisol and testosterone concentrations, plasma fatty acids, and social behavior in male domestic guinea pigs from adolescence to adulthood. For analyses of cortisol and testosterone concentrations, social interactions were included as covariates in order to consider effects of social behavior on hormone concentrations. Our results revealed that SFAs increased escalated conflicts like fights and stimulated cortisol and testosterone concentrations, which limited body mass gain and first-year survival. PUFAs did not remarkably affect social behavior and hormone concentrations, but enabled the strongest body mass gain, which probably resulted from an energetic advantage. Neither sociopositive nor agonistic behaviors explained age-specific differences in hormone concentrations between groups. However, a high number of subdominant individuals and lower testosterone concentrations were related to increased cortisol concentrations in adult PUFA males. Our findings demonstrate the importance of dietary fatty acids regarding behavioral and endocrine developmental processes and adaptations to the social environment by modulating HPA-axis function and body homeostasis.

Dysregulation of amino acids and lipids metabolism in schizophrenia with violence

BACKGROUND

Many studies have related biochemical characteristics to violence and have reported schizophrenia could elevated the risk of violent behaviour. However, the metabolic characteristics of schizophrenia patients with violence (V.SC) are unclear.

METHODS

To explore the metabolic characteristics of schizophrenia with violence and to identify potential biomarkers, untargeted metabolomics was performed by using gas chromatography time-of-flight mass spectrometry to analyse the plasma metabolites of fifty-three V.SC and twenty-four schizophrenia patients without violence (NV.SC). Multivariate and univariate analyses were performed to identify differential metabolites and biomarkers. Violence was assessed by the MacArthur Violence Assessment Study method. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale.

RESULTS

Multivariate analysis was unable to distinguish V.SC from NV.SC. Glycerolipid metabolism and phenylalanine, tyrosine and tryptophan biosynthesis were the differential metabolic pathways between V.SC and NV.SC. We confirmed ten metabolites and five metabolites as metabolic biomarkers of V.SC by random forest and support vector machine analysis, respectively. The biomarker panel, including the ratio of L-asparagine to L-aspartic acid, vanillylmandelic acid and glutaric acid, yielded an area under the receiver operating characteristic curve of 0.808.

CONCLUSIONS

This study gives a holistic view of the metabolic phenotype of schizophrenia with violence which is characterized by the dysregulation of lipids and amino acids. These results might provide information for the aetiological understanding and management of violence in schizophrenia; however, this is a preliminary metabolomics study about schizophrenia with violence, which needs to be repeated in future studies.

Frequently overlooked realistic moral bioenhancement interventions

Many supporters of 'moral bioenhancement' (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants-the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE.

Polyunsaturated Fatty Acids: What is Their Role in Treatment of Psychiatric Disorders?

In the central nervous system omega-3 fatty acids modulate cell signaling and affect dopaminergic and serotonergic pathways. On this basis, a new application for omega-3 fatty acids has been proposed, concerning the treatment of several psychiatric disorders. The present article is an update of a previous systematic review and is aimed to provide a complete report of data published in the period between 1980 and 2019 on efficacy and tolerability of omega-3 fatty acids in psychiatric disorders. In July 2019, an electronic search on PUBMED, Medline and PsychINFO of all RCTs, systematic reviews and meta-analyses on omega-3 fatty acids and psychiatric disorders without any filter or MESH restriction was performed. After eligibility processes, the final number of records included in this review was 126. One hundred and two of these studies were RCTs, while 24 were reviews and meta-analyses. The role of omega-3 fatty acids was studied in schizophrenia, major depression, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, eating disorders, substance use disorder and borderline personality disorder. The main evidence of the efficacy of omega-3 fatty acids has been obtained in treating depressive symptoms in patients with major depression and, to a lesser degree, bipolar depression. Some efficacy was also found in early phases of schizophrenia in addition to antipsychotic treatment, but not in the chronic phases of psychosis. Small beneficial effects of omega-3 fatty acids were observed in ADHD and positive results were reported in a few trials on core symptoms of borderline personality disorder. For other psychiatric disorders results are inconsistent.

Omega-3 (ω-3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial

BACKGROUND

While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline.

METHODS

In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7-16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome.

RESULTS

Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31.

CONCLUSIONS

Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.

Fatty Fish Intake and the Effect on Mental Health and Sleep in Preschool Children in FINS-KIDS, a Randomized Controlled Trial

Mental health and sleep problems are prevalent in children during preschool years. The aim of the current study was to investigate if increased intake of fatty fish compared with meat improves mental health and sleep in four- to six-year-old children. The children (n = 232) in the two-armed randomized controlled trial, Fish Intervention Studies-KIDS (FINS-KIDS), were randomly assigned to lunch meals with fatty fish (herring/mackerel) or meat (chicken/lamb/beef) three times a week for 16 weeks. The fish and meat were weighed before and after the meals to record the exact consumption in grams (dietary compliance). Mental health problems were assessed by the strengths and difficulties questionnaire (SDQ) and sleep by parent report pre- and post-intervention. There was no significant statistical difference between changes in mental health and sleep for the fish eating group compared with the meat eating group, neither in the crude analysis nor after adjusting for intake of fish or meat (dietary compliance).

Reductions of intimate partner violence resulting from supplementing children with omega-3 fatty acids: A randomized, double-blind, placebo-controlled, stratified, parallel-group trial

Omega-3 supplementation has been found to reduce externalizing behavior in children. Reciprocal models of parent-child behavior suggest that improving child behavior could lead to improvements in parent behavior, however no study has examined whether omega-3 supplementation in children could reduce intimate partner violence or child maltreatment by their adult caregivers. In this randomized, double-blind, placebo-controlled, stratified, parallel group trial, a community sample of children were randomized to receive either a fruit drink containing 1 gm of omega-3 fats (Smartfish Recharge; Omega-3 group, n = 100) or the same fruit drink without omega-3's (Placebo group, n = 100). Child participants, adult caregivers, and research staff were blinded to group assignment. Adult caregivers reported inter-partner and child-directed physical assault and psychological aggression at baseline, 6 months (end of treatment) and 12 months (6 months post-treatment) using the Conflicts Tactics Scale. Caregivers of children in the omega-3 group reported long-term reductions in psychological aggression in a group × time interaction. Improvements in adult psychological aggression were correlated with improvements in child externalizing behavior scores. No differences were reported for child maltreatment. This study is the first to show that omega-3 supplementation in children can reduce inter-partner psychological aggression among adult caregivers not receiving supplements. Findings suggest that improving child behavior through omega-3 supplementation could have long-term benefits to the family system as a whole.

The association of omega-3 fatty acid levels with personality and cognitive reactivity

OBJECTIVE

Low omega (n)-3 polyunsaturated fatty acid (PUFA) levels have been found in patients with various major psychiatric disorders. This study aims to identify whether psychological vulnerabilities (personality and cognitive reactivity) underlying these psychiatric conditions are also associated with n-3 PUFA blood levels.

METHODS

Data was used from 2912 subjects (mean age 41.9 years, 66.4% female) from the Netherlands Study of Depression and Anxiety (NESDA). Five personality dimensions (NEO Five Factor Inventory) and cognitive reactivity measures (Leiden Index of Depression Sensitivity-Revised and Anxiety Sensitivity Index) were assessed. Plasma n-3 PUFA and docosahexaenoic acid (DHA) levels (as ratios against total fatty acids; mmol%) were assessed using a nuclear magnetic resonance platform.

RESULTS

Low n-3 PUFA and DHA levels were associated with high neuroticism (Standardized beta (Beta) = -0.045, 95% Confidence Interval (CI) = -0.079 to -0.010, p = 0.011; Beta = -0.058, 95%CI = -0.093 to -0.022, p = 0.001), low extraversion (Beta = 0.065, 95%CI = 0.031 to 0.099, p < 0.001; Beta = 0.074, 95%CI = 0.039 to 0.109, p < 0.001) and low conscientiousness (Beta = 0.060, 95%CI = 0.027 to 0.093, p < 0.001; Beta = 0.074, 95%CI = 0.039 to 0.108, p < 0.001). Low n-3 PUFA and DHA levels were related to high hopelessness/suicidality (Beta = -0.059, 95%CI = -0.096 to -0.023, p = 0.001; Beta = -0.078, 95%CI = -0.116 to -0.041, p < 0.001), but not with other cognitive reactivity measures. Directions of associations were generally consistent in subjects with and without a current depressive disorder.

CONCLUSION

Low n-3 PUFA and DHA levels are associated with personality (high neuroticism, low extraversion and low conscientiousness) and cognitive reactivity (high hopelessness/suicidality). Effect sizes were rather small, but in line with previous research on personality and chronic diseases. Future research should examine which lifestyle and/or biological pathways underlie these associations.

Omega-3 Supplementation as a Dietary Intervention to Reduce Aggressive and Antisocial Behavior

PURPOSE OF REVIEW

Although there is an increasing body of literature on the relationship between omega-3 fatty acids and aggressive/antisocial behavior, evidence to date suggests that there are mixed findings on the efficacy of omega-3 supplementation as a dietary intervention to reduce such behaviors. This article describes the current state of the research regarding omega-3 supplementation and aggressive/antisocial behavior from intervention studies, with an emphasis on randomized controlled trials.

RECENT FINDINGS

The current evidence base indicates a small effect size (approximately d = .20) for the efficacy of increased omega-3 intake in reducing aggressive and antisocial behavior in children and adults. How precisely omega-3 supplementation results in such behavioral improvement is an open question, although upregulation of dysfunctional prefrontal regions is one candidate mediator. Directions for further research include understanding the more basic mechanisms that may underlie any intervention effects, delineating dose-response relationships, ascertaining optimal treatment duration and composition, conducting follow-ups post-treatment, and testing the provisional hypothesis that more impulsive, reactive forms of aggression may be particularly amenable to omega-3 supplementation.

Omega-3 supplements reduce self-reported physical aggression in healthy adults

There is emerging evidence that Omega-3 polyunsaturated fatty acids (PUFA) supplements can decrease aggression. However, experimental studies with adults from non-specific populations are scarce. We hypothesized that Omega-3 supplements would decrease self-reported aggression among non-clinical participants. In a double-blind randomized trial, two groups of participants (N = 194) aged 18-45 from the general population followed a 6-weeks treatment with 638mg docosahexaenoic acid (DHA) and 772mg eicosapentaenoic acid (EPA) per day or the equivalent quantity of copra oil (placebo). Self-reported aggressiveness was measured at baseline and after the 6-week treatment period. Findings showed that Omega-3 supplements significantly decreased self-reported aggressiveness at the end of the 6-week period (d = 0.31). In conclusion, this experiment indicates that Omega-3 administration has beneficial effects in reducing aggression among the general population.

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents

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.

Analysis using national databases reveals a positive association between dietary polyunsaturated fatty acids with TV watching and diabetes in European females

In recent years, dietary polyunsaturated fatty acids (PUFA) have increased in parallel to sedentary behavior and diabetes across the world. To test any putative association between dietary PUFA and sedentary behavior or diabetes in females, we obtained country-specific, cross-sectional data on sedentary activity and diabetes prevalence from European Cardiovascular Statistics 2012. Age and gender-specific, nutritional data from each country were obtained from nutritional surveys as well. Socioeconomic (GDP), physical environment (urbanization index) and climatic confounders were accounted for each country. Upon analysis, we found a strong, positive association between sedentary lifestyle in 11-yr old girls (> = 2 hours of TV/ weekday) and dietary PUFA across 21 European countries. Further, a weak association of dietary PUFA and a strong relationship of per-capita GDP was established with elevated fasting blood glucose [(> = 7.0 mmol/L; or on medication] among 25+ year old adult females across 23 countries in Europe. In summary, we present novel ecological evidence that dietary PUFA is strongly associated with sedentary behavior among pre-teen girls and weakly associated with diabetes among adult women across Europe. In the latter group, per-capita GDP was a significant predictor for diabetes as well. Therefore, we recommend that prospective randomized controlled trials (RCTs) be implemented to evaluate if ubiquitous presence of dietary PUFA and low socioeconomic status are possible confounders when intervening to treat/prevent sedentary lifestyle or diabetes in female subjects in Western nations.