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
What this study found
PUFA supplementation did not provide a clinically meaningful benefit for ADHD symptoms or related outcomes overall. Parent-rated core symptoms showed a small improvement (SMD -0.17, 95% CI -0.32 to -0.02; k = 23), but teacher-rated symptoms were not improved (SMD -0.06, 95% CI -0.31 to 0.19; k = 10). Behavioral difficulties were null for both parent ratings (SMD -0.02, 95% CI -0.17 to 0.14; k = 7) and teacher ratings (SMD -0.04, 95% CI -0.35 to 0.26; k = 5), and quality of life was unchanged (SMD 0.01, 95% CI -0.29 to 0.31). Adverse effects were not substantially increased, including…
- Study & population
- Systematic review and meta-analysis of 24 clinical trials in children and adolescents aged 6 to 18 years with ADHD diagnosed by ICD-10 or DSM criteria.
- Intervention
- Polyunsaturated fatty acid supplementation, including omega-3 and/or omega-6 formulations, was evaluated in children and adolescents with ADHD.
- Key limitation
- Certainty of evidence was low to very low because of risk of bias and imprecision.
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Open PDFOriginal 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.