Omega-3 for Children and Adolescents: Supplements with 450 mg of EPA and DHA and the Omega-3 Index of 6% improve cognitive performance

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

This is stated by a new review of the scientific literature published in the journal Nutrients, conducted by scientists from 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-3s on a variety 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 neuron growth and membrane fluidity, blood-brain barrier integrity, and inflammation. The role in brain development and function has stimulated many studies to understand the relationship between polyunsaturated fatty acids and cognitive abilities in children and adolescents, with often conflicting results. Indeed, while some research has shown a positive effect of supplementation, others have found neutral effects. However, review studies have always been heterogeneous, investigating the effects of different omega-3 supplement doses and compositions that varied considerably between studies. Therefore, it remains to be understood whether omega-3 supplements can positively influence neurological abilities and whether their effectiveness correlates with the dose used or the circulating level of these fatty acids, a parameter which can be represented by the Omega-3 Index. The Omega-3 Index is defined as the sum of EPA and DHA in red blood cells and is based on a standardized analytical method. An index range between 8-11% is associated with the lowest risk of mortality in coronary artery disease and, based on this scientific evidence, some researchers have suggested this range could also be important for determining effects on mental health. According to some research, the result of omega-3 supplementation on some abilities such as long-term memory is evident only with doses of at least 400 mg of DHA and EPA.

Is an Omega-3 Index of 6% the threshold value for mental abilities? 

Taking into account the results related to the Omega-3 Index range on cardiovascular health, a literature review was undertaken to investigate whether the daily dose of DHA and EPA plays a role in the effect of supplementation on cognitive abilities. The new review of omega-3 supplement studies analyzed effects in children, adolescents, and young adults up to 25 years old—the age when brain development occurs. The results revealed that positive cognitive effects of supplements can be demonstrated if the Omega-3 Index, after treatment, increases to at least 6%. Furthermore, there is some evidence that a dose of at least 450 mg of DHA and EPA per day may lead to improved cognitive performance in developing children and adolescents.

Some of the analyzed studies also included children with attention deficit hyperactivity disorder (ADHD), but no improvements in these symptoms were observed after treatment with supplements. Commenting independently on the study results, Harry Rice, Vice President of the EPA and DHA Organization (GOED), stated that in this review the authors addressed an important knowledge gap on the cognitive effects of omega-3 supplementation in a very important demographic group.

According to Rice, further research and evidence are needed not only on the existence of a beneficial effect of omega-3s on children’s mental health but also on the dependence of this effect on an omega-3 “threshold” value and a minimum intake of EPA and DHA. The authors of the research suggest that there may be large interindividual differences in response to omega-3 supplementation. For this reason, blood levels of omega-3 should be measured at the beginning and end of studies to reach reasonable conclusions.

Some study details 

To conduct a systematic literature review, scientific publications on the subject were searched on specific websites up to July 3, 2019. The researchers identified 33 publications to include in the review: all investigated the effects of administering either a placebo or EPA and DHA supplements, including participants aged 4 to 25 years. In total, 33 studies were selected, of which 21 included typically developing children and adolescents, while 12 focused on children and adolescents with cognitive difficulties, particularly attention deficit hyperactivity disorder (ADHD). The study durations ranged from four to 52 weeks.

The role of personalized supplementation under further study 

According to the research results, it is likely that the positive effects of omega-3 supplementation can be demonstrated only if the Omega-3 Index reaches a value of at least 6%. Moreover, half of the studies involving growing children found that a daily dose of at least 450 mg of DHA + EPA is able to promote cognitive improvements. Future research on omega-3 supplementation will need to include measurements of blood EPA and DHA levels to determine a more precise target for cognitive function, as has been done for cardiovascular health. Considering the large interpersonal variability in response to EPA and DHA supplements, it is desirable that future studies use a personalized approach regarding the dose employed.

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