Omega-3 for children and adolescents: supplements with 450 mg EPA and DHA and 6% Omega-3 Index improve cognitive performance

Omega-3 supplements can improve cognitive abilities in children and young people, but only when blood omega-3 levels reach a certain threshold. Specifically, a daily supplementation of at least 450 milligrams of EPA and DHA, and achieving an Omega-3 Index of at least 6 percent, would be required to achieve significant results on cognitive processes in young people aged 4 to 25 years.

This is according to a new review of the scientific literature published in the journal Nutrients, and carried out by scientists at several universities in the Netherlands.

Cognitive processes in developmental age: the role of the Omega-3 Index

Numerous studies have investigated the influence of omega-3 on a range of functions such as cardiovascular health, depression, ADHD, autism spectrum disorder, pregnancy outcomes, and cognitive development. The omega-3s EPA, DHA, and AA are involved in brain development processes, including the growth of neurons and the fluidity of their membranes, the integrity of the blood-brain barrier, and inflammation. The role in brain development and functioning has stimulated a large number of studies to understand the relationship between polyunsaturated fatty acids and cognitive abilities in children and adolescents, with often mixed results. Although, in fact some research has shown a positive effect of supplementation, others have found neutral effects. However, review studies have always been mixed, investigating the action of different doses of omega-3 supplements and with the composition varying widely from one research to another. Therefore, it remains to be understood whether omega-3 supplements can positively influence neurological abilities and whether their efficacy can be related to the dose used or the circulating level of these fatty acids, a parameter that can be represented by theOmega-3 Index TheOmega-3 Index or Omega-3 Index is defined as the sum of EPA and DHA in red blood cells, and is based on a standardized analytical method. A range of this Index between 8-11% is associated with the lowest risk of mortality in coronary heart disease, and based on this scientific evidence, some researchers have suggested that this range of values might also be important in establishing mental health effects. According to some research, the result of omega-3 supplementation on certain abilities such as long-term memory is evident only with a dose of at least 400 mg of DHA and EPA. 

Is a 6% Omega-3 Index the threshold value for mental ability? 

Taking into account the findings regarding the range of Omega-3 Index on cardiovascular health, a review of the scientific literature was undertaken with the aim of investigating whether the daily dose of DHA and EPA played a role in the action of supplementation on cognitive abilities. The new review of studies on omega-3 supplements analyzed the effects in children, adolescents, and young people up to age 25; the age at which the brain develops. The results revealed that the positive cognitive effects of supplements can be demonstrated if the Omega-3 Index, after the treatment period increases to at least 6% . In addition, there seems to be some evidence that a dosage of at least 450 mg of DHA and EPA per day can lead to improved cognitive performance in developing children and young people. 

Some of the studies reviewed had also included boys with hyperactivity disorder, but no improvement was observed on these symptoms after treatment with the supplements. Commenting independently on the results of the study, Harry Rice, vice president of the Organization for EPA and DHA (Goed), said that in this review the authors addressed an important gap in knowledge about the cognitive effects of omega-3 supplementation in a very important demographic. 

Also according to Rice, further research and evidence is needed not only of the existence of a beneficial mental health effect of omega-3 in children, but also of the dependence of this on a "threshold" value of omega-3 and a minimum intake of EPA and DHA. For the authors of the research there could be large interindividual differences in response to omega-3 supplementation. For this reason, blood levels of omega-3 must be measured, at the beginning and end of the study in order to reach reasonable conclusions. 

Some details of the study 

To conduct a systematic literature review, specific websites were searched for scientific publications on the topic under consideration through July 3, 2019. The researchers identified 33 publications for inclusion in the review: all investigated the effects of administering a placebo or EPA and DHA supplements, and had included participants aged 4 to 25 years. In the end, 33 studies were selected, of which 21 had included children and adolescents with typical development, while in 12 papers the focus was on children and adolescents with cognitive problems, particularly attention deficit hyperactivity disorder (ADHD). The duration of the studies ranged from four weeks to 52 weeks. 

The role of personalized supplementation under consideration in further studies 

According to the research results, it is likely that the positive effects of omega-3 supplementation can only be demonstrated if the Omega-3 Index reaches a value corresponding to at least 6 percent. In addition, half of the studies with growing children found that a daily dose of at least 450 mg of DHA + EPA is able to promote cognitive improvements. It will be necessary for future investigations of omega-3 supplementation to include measurement of blood levels of EPA and DHA in order to determine a more precise target for cognitive functioning, as happened with that available for cardiovascular health. Given the large interpersonal difference in response to the use of EPA and DHA supplements, it is desirable that future studies use a personalized approach regarding the dose used. 

Source: Van der Wur et al. 2020 "Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition inChildren and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose ofDHA and EPA." Nutrients 12 (10), 3115