Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan (Liu, Lin).
Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan (Wu).
J Clin Psychiatry. 2023 Aug 30;84(5):22r14772. doi: 10.4088/JCP.22r14772.
Previous studies have shown conflicting results for the effectiveness of omega-3 polyunsaturated fatty acids (PUFAs) in improving attention-deficit/hyperactivity disorder (ADHD) symptoms. This inconsistency may be due to differences in dosage, composition, and treatment duration. The current meta-analysis aims to address this inconsistency by improving subtype analyses and focusing on heterogeneity in treatment duration, omega-3 PUFA composition, and eicosapentaenoic acid (EPA) dose. We searched PubMed, EMBASE, PsycINFO, and Cochrane Library for randomized controlled trials of omega-3 PUFAs for ADHD, without publication year or language limitations, up to November 27, 2022. The primary outcome was the improvement of ADHD core symptoms. Subgroup analyses were conducted based on the formula, dosages, and composition ratios of omega-3 PUFAs. To ensure methodological quality, the Cochrane Risk-of-Bias Tool 1.0 was utilized to assess the risk of bias for each study included in the analysis. The pooled data were then analyzed using the random-effect meta-analysis, and the inverse variance method was employed. The outcomes of interest were extracted using a data extraction form developed for this study. Twenty-two studies with 1,789 participants were included in the analysis. Overall, omega-3 PUFAs did not significantly improve ADHD core symptoms compared to placebo (standardized mean difference [SMD]: -0.16; 95% CI, -0.34 to 0.01; = .07). However, in the subgroup of studies with a treatment duration of at least 4 months, omega-3 PUFAs were significantly more effective than placebo (SMD: -0.35; 95% CI,-0.61 to -0.09; = .007). Neither high eicosapentaenoic acid (EPA) dosage nor high EPA/docosahexaenoic acid (DHA) ratio was found to improve ADHD symptoms. Our findings indicate that omega-3 PUFAs did not improve ADHD core symptoms, but long-term supplementation may have potential benefits. The main limitation of the study was the moderate heterogeneity and small sample sizes in subgroup analyses and the lack of dietary pattern information.
先前的研究对于 ω-3 多不饱和脂肪酸（PUFAs）改善注意缺陷/多动障碍（ADHD）症状的有效性结果存在矛盾。这种不一致可能是由于剂量、组成和治疗持续时间的差异造成的。本项荟萃分析旨在通过改善亚组分析并关注治疗持续时间、ω-3 PUFAs 组成和二十碳五烯酸（EPA）剂量的异质性来解决这一不一致性。我们在 PubMed、EMBASE、PsycINFO 和 Cochrane Library 中检索了关于 ω-3 PUFAs 治疗 ADHD 的随机对照试验，没有发表年份或语言限制，截至 2022 年 11 月 27 日。主要结局是 ADHD 核心症状的改善。根据 ω-3 PUFAs 的配方、剂量和组成比进行了亚组分析。为了确保方法学质量，使用 Cochrane 偏倚风险工具 1.0 对纳入分析的每项研究的偏倚风险进行了评估。然后使用随机效应荟萃分析对汇总数据进行分析，并采用方差倒数法。使用为这项研究制定的数据提取表提取了感兴趣的结果。纳入了 22 项研究，共 1789 名参与者。总体而言，与安慰剂相比，ω-3 PUFAs 并没有显著改善 ADHD 核心症状（标准化均数差 [SMD]：-0.16；95%CI：-0.34 至 0.01； = .07）。然而，在治疗持续时间至少为 4 个月的亚组研究中，ω-3 PUFAs 明显比安慰剂更有效（SMD：-0.35；95%CI：-0.61 至 -0.09； = .007）。高 EPA 剂量或高 EPA/二十二碳六烯酸（DHA）比值均未发现可改善 ADHD 症状。我们的研究结果表明，ω-3 PUFAs 并未改善 ADHD 核心症状，但长期补充可能有潜在的益处。研究的主要局限性是亚组分析中的异质性和样本量较小以及缺乏饮食模式信息。
