Editorial

Omega-3 Long-Chain Polyunsaturated Fatty Acids in Older Children

To compare risk factors of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) to age/sex-matched controls with particular attention to family history, parental age and nutrition.

31 ASD and 81 ADHD patients were compared to 612 age/sex-matched controls by reviewing charts for parental age, sibling order, gestational age, and early feeding, and by parental interview for early feeding and family history of psychopathology on affected patients and 139 of those controls.

Parental age affected ASD and ADHD females but not males. First-born males were at increased risk for both disorders even though their siblings had older parents and their parents were not more likely to stop having children. Breastfeeding in the absence of parental psychopathology reduced ADHD risk, but breastfeeding of first-born males by older mothers with psychopathology was a risk for ASD. Breastfeeding was only a risk for ADHD if the mother had psychopathology. Parent emigration from a place of high fish consumption was a significant ASD risk factor.

ADHD and ASD share risk factors due to shared genetic and nutritional interactions, likely revolving around deficiencies of omega-3 fatty acids (n3FAs) during brain development. Fatty acid metabolism genes are important in that process. The 4:1 male to female ratio for both disorders results from hormonally driven fat metabolism differences. Risk factors for both disorders including maternal smoking, prematurity, and gestational diabetes may also be attributed to their effect on n3FA supplies. Breastfeeding can be a risk factor when the mother’s genes and/or age affect her milk quality. Parental age and gene defects may affect female more than male offspring. Childbirth with adequate spacing and breastfeeding can override maternal age and protect subsequent offspring. Genetic variations in fat metabolism can be influenced by cultural/geographic diet, causing deficiencies in offspring with migration-influenced diet changes. Interaction of n3FA deficient diets, delayed child-bearing, and breastfeeding by mothers with psychopathology may be important factors in the rising incidence of ASD and ADHD in recent decades. Partial prevention through diet and supplements may be possible.

El ácido docosahexaenoico (DHA) es un ácido graso poliinsaturado de la serie n-3, al que se atribuyen múltiples funciones que están todavía en estudio. En prematuros y neonatos se ha puesto de manifiesto su influencia sobre el desarrollo visual y neurológico; sin embargo, están en estudio los efectos sobre determinadas enfermedades crónicas neurológicas, inflamatorias o metabólicas. Los requerimientos de DHA no están determinados, aunque los aportes deben basarse en imitar la composición de la lactancia materna y, en niños mayores y mujeres gestantes y/o lactantes, asegurar la ingesta de pescado azul al menos 2 veces por semana. Es fundamental reconocer la necesidad de suplementos de este ácido graso en algunas enfermedades con dietas restringidas o alteraciones metabólicas que ocasionen un déficit, pero también conocer las evidencias científicas sobre los efectos que produce en diferentes situaciones. Esta revisión actualiza la información existente, con el fin de proponer un aporte adecuado de DHA en diversas edades y patologías.

Docosahexaenoic acid (DHA) is a n-3 polyunsaturated fatty acid with multiple functions, although these are still under study. The development of visual and neurological functions have been demonstrated in premature infants and neonates, however, its effects are still being studied in certain chronic neurological diseases, and inflammatory and metabolic disorders. The DHA requirements are not fixed but recommendations must be based on an intake similar to the composition of breastfeeding, and in older children and during pregnancy and lactation, to ensure consumption of oily fish at least twice a week. It is essential to recognise the need for supplementation of this fatty acid in some diseases that require restricted diet, and in metabolic alterations resulting in a deficiency, but also know the scientific evidence on the effects produced in different situations. This review updates this information to propose an adequate intake of DHA at different ages and in different diseases.