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. 2016 Spring;25(2):87-96.
Epub 2016 May 1.

Omega-6 to Omega-3 Fatty Acid Ratio in Patients with ADHD: A Meta-Analysis

Laura LaChance  1 , Kwame McKenzie  2 , Valerie H Taylor  3 , Simone N Vigod  3
Affiliations

Omega-6 to Omega-3 Fatty Acid Ratio in Patients with ADHD: A Meta-Analysis

Laura LaChance et al. J Can Acad Child Adolesc Psychiatry. 2016 Spring.

Abstract
in English, French

Objective: Omega-3 and omega-6 fatty acids have been shown to be deficient in individuals with attention deficit/hyperactivity disorder compared to controls (Hawkey & Nigg, 2014). Clinical trials of omega-3 and omega-6 supplements as treatment for ADHD have demonstrated minimal efficacy (Bloch & Qawasmi, 2011; Gillies, Sinn, Lad, Leach, & Ross, 2011; Hawkey & Nigg, 2014; Puri & Martins, 2014; Sonuga-Barke et al., 2013). Existing trials have analyzed omega-3 and omega-6 separately although the tissue ratio of these fatty acids (n6/n3) may be more important than absolute levels of either. The objective of this study was to determine the relationship between blood n6/n3 and arachidonic acid to eicosapentaenoic acid (AA/EPA), to ADHD symptoms.

Method: A systematic literature review identified original articles measuring blood n6/n3 or AA/EPA ratio in children and youth with ADHD, compared to controls without ADHD. Three databases were searched. Blood n6/n3, and AA/EPA ratios were compared between individuals with ADHD and controls. Results were pooled across studies using quantitative synthesis.

Results: Five articles met inclusion criteria for the meta-analysis. The pooled mean difference between patients with ADHD and controls was 1.97 (0.90-3.04) for n6/n3 (n=5 studies, I(2) 83%) and 8.25 (5.94-10.56) for AA/EPA (n=3 studies, I(2) 0%).

Conclusions: Children and youth with ADHD have elevated ratios of both blood n6/n3 and AA/EPA fatty acids compared to controls. Thus an elevated n6/n3, and more specifically AA/EPA, ratio may represent the underlying disturbance in essential fatty acid levels in patients with ADHD. These findings have implications for the development of future interventions using essential fatty acids to treat ADHD, and for the use of these ratios as biomarkers for titrating and monitoring ADHD treatment with essential fatty acids.

Objectif: Les acides gras omega-3 et omega-6 se sont révélés être déficients chez les personnes souffrant du trouble de déficit de l’attention avec hyperactivité (TDAH) comparativement aux sujets témoins (Hawkey et Nigg, 2014). Les essais cliniques sur les suppléments d’omega-3 et d’omega-6 comme traitement du TDAH ont démontré une efficacité minimale (Bloch et Qawasmi, 2011; Gillies, Sinn, Lad, Leach, et Ross, 2011; Hawkey et Nigg, 2014; Puri et Martins, 2014; Sonuga-Barke et al., 2013). Les essais existants ont analysé les omega-3 et omega-6 séparément, bien que le ratio tissulaire de ces acides gras (n-6/n-3) puisse être plus important que les niveaux absolus de chacun. L’objectif de cette étude était de déterminer la relation entre le n-6/n-3 sanguin et le ratio acide arachidonique sur acide eicosapentaénoïque (AA/EPA), et les symptômes du TDAH.

Méthode: Une revue systématique de la littérature a identifié les articles originaux mesurant le n-6/n-3 sanguin ou le ratio AA/EPA chez les enfants et les adolescents souffrant du TDAH, comparativement aux sujets témoins sans TDAH. Trois bases de données ont été recherchées. Le n-6/n-3 sanguin et les ratios AA/EPA ont été comparés entre les personnes souffrant du TDAH et les sujets témoins. Les résultats ont été totalisés entre les études à l’aide d’une synthèse quantitative.

Résultats: Cinq articles satisfaisaient aux critères d’inclusion de la méta-analyse. La différence moyenne totalisée entre les patients souffrant de TDAH et les sujets témoins était de 1,97 (0,90–3,04) pour n-6/n-3 (n = 5 études, I2 83 %) et de 8,25 (5,94–10,56) pour AA/EPA (n = 3 études, I2 0 %).

Conclusions: Les enfants et les adolescents souffrant du TDAH ont des ratios élevés tant du n-6/n-3 sanguin que des acides gras AA/EPA, comparativement aux sujets témoins. Donc, un ratio n-6/n-3 élevé, et plus spécifiquement le ratio AA/EPA, peuvent représenter la perturbation sous-jacente des niveaux d’acides gras essentiels chez les patients souffrant de TDAH. Ces résultats ont des implications pour le développement de futures interventions utilisant des acides gras essentiels pour traiter le TDAH, et pour l’utilisation de ces ratios comme biomarqueurs pour titrer et surveiller le traitement du TDAH avec les acides gras essentiels.

Keywords: attention deficit/hyperactivity disorder; omega-3 fatty acids; omega-6 fatty acids.

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Figures

Figure 1.
Figure 1.
Flow chart of the literature search and meta-analysis From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097 For more information, visit www.prisma-statement.org.
Figure 2.
Figure 2.
Blood omega-6 to omega-3 ratio in patients with ADHD vs. control subjects
Figure 3.
Figure 3.
Blood arachidonic acid (AA) to eicosapentaenoic acid (EPA) ratio in patients with ADHD vs. control subjects
Figure 4.
Figure 4.
Funnel Plot for n6/n3
See this image and copyright information in PMC

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