Supplement omega-3 based on weight

Older, larger children using omega-3 fatty acid supplements as therapy for mood disorders-as well as those taking the supplement for general brain and heart health-may need more of the essential nutrient than smaller children, leading researchers to call for new studies into weight-appropriate dosing.

The study,¹ led by researchers at The Ohio State University, Columbus, piggybacked on a general study evaluating the therapeutic effects of omega-3 fatty acids in mood disorders. Researchers analyzed omega-3 supplementation in 64 children aged 7 to 14 years with mood disorders. Those given supplements during the study were given 4 capsules containing 2000 mg of omega-3 daily compared with a placebo group.

When researchers compared fatty acid uptake to overall body weight and body mass index (BMI), they found that the more a child weighed, the less amounts of 2 key omega-3 fatty acids were in the child’s blood. The higher the BMI, the lower the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

The revelation highlights the need for weight-appropriate dosing of supplements and medication, according to the research team. In addition to mental health benefits, omega-3 supplements also have been shown to lower blood pressure and increase good cholesterol in children aged 8 to 15 years, but most studies on the benefits of omega-3 have been focused on adults or infants and small children.

More: Beware nutritional supplements for kids

L. Eugene Arnold, MD, MEd, professor emeritus of psychiatry at The Ohio State University, led the study and says the only thing that is truly certain right now is that more research is needed to find the optimal dosing for omega-3 supplements. “One of the things that this study highlights is that we really don’t know the best dose for omega-3 fatty acids,” Arnold says.

There’s evidence that omega-3 fatty acids have a small but significant and beneficial effect on patients with attention-deficit/hyperactivity disorder (ADHD). There is also limited research to support a benefit of omega-3 fatty acids for patients with mood disorders, particular depression and bipolar disorder, he says.

Although a “balanced diet” should, in theory, provide adequate amounts of these nutrients, to benefit from omega-3s naturally one would have to have a diet rich in grass-fattened game and livestock, as well as ocean fish. Eating a traditional Western diet, with farm-raised meat or fish, doesn’t offer the same benefit-balanced or not.

“How many kids eat a balanced diet and how many have the access to the grass-fattened game and livestock and the wild ocean fish and so forth?” Arnold notes. “In order to achieve the same results as a balanced diet, it’s necessary for some supplements.”

Farm-raised animals, even fish, are grain fed, which introduces omega-6 fatty acids to the body. The brain needs fatty acids to perform, and whereas omega-3 fatty acids are ideal because they provide direct sources of DHA and EPA, omega-6 can work but is not optimal.

NEXT: Looking to supplements to improve intake

“If the DHA and EPA are not available, the brain will use omega-6 to substitute and it will work, but it’s like running a high-performance engine on low-octane gas. So it will run, but not optimally,” Arnold says.

Fish oil supplements will work, but fish is ideal because of the protein, with the caveat that fish also may be contaminated with mercury. Mercury is an important consideration when buying supplements, he adds, recommending supplements that are labeled to say the mercury and heavy metals have been eliminated or that they are US Pharmacopeial Convention (USP) grade.

The study is not intended to change clinical practice, Arnold says, but was an offshoot of a larger study called the “Omega-3 and Therapy Study for Childhood Bipolar Disorder–Not Otherwise Specified (OATS),” a clinical trial of psychoeducation and psychotherapy and omega-3 fatty acids for mood disorders in children and adolescents.

To truly understand the best dosing and determine a recommendation for clinical practice, more studies are needed.

Arnold says his team is working to secure funding for follow-up studies to delve into the question of optimal dosing, and the best ratio of EPA to DHA. In the meantime, supplements would benefit healthy children, but would be particularly useful as a therapeutic intervention for children with mood disorders. “[For] any child that [pediatricians] are prescribing a drug to for some emotional or mental problem, whether depression or ADHD, they should also be prescribing omega-3 fatty acids,” he says.

Studies have been published using as little as a gram of fish oil for ADHD and depression in children and are showing good results, and other studies using larger amounts also show good results, Arnold notes.

Next: Factoring the metabolic X syndrome

“This particular study suggests that it’s possible to get too much of a good thing, and maybe less is more,” he says. “The kids with the larger body mass had better effect from the omega-3 fatty acids even though the increase in their blood level was less.”

This could be in part because the older/larger children had larger bodies to disperse the dose, but also because the omega-3s may have been sequestered into the adipose tissue of the larger/older children. Age also may play a role in the metabolism and/or storage of omega-3 fatty acids, but more research is needed to say for certain, Arnold says.

“We need to have studies of relative doses to find the optimal dose. In the meantime, I would say a gram a day is good for you and it’s not too much. Two grams is tolerable and safe,” Arnold says.

REFERENCE

1. Christian LM, Young AS, Mitchell AM, Belury MA, Gracious BL, Arnold LE, Fristad MA. Body weight affects omega-3 polyunsaturated fatty acid (PUFA) accumulation in youth following supplementation in post-hoc analyses of a randomized controlled trial. PLoS One. 2017;12(4):e0173087.