Study: Dietary Supplementation With Fatty Acids...

Discussion in 'Healthful Living / Natural Treatments' started by Sheila, Jul 14, 2007.

  1. Sheila

    Sheila Moderator

    Interesting study.

    The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder
    Alexandra J. Richardson and Paul Montgomery
    Pediatrics 2005;115;1360-1366

    The following excerpts from:

    "ABSTRACT. Background. Developmental coordination
    disorder (Developmental Coordination Disorder (DCD)) affects 5% of school-aged children.
    In addition to the core deficits in motor function, this
    condition is associated commonly with difficulties in
    learning, behavior, and psychosocial adjustment that
    persist into adulthood. Mounting evidence suggests that
    a relative lack of certain polyunsaturated fatty acids may
    contribute to related neurodevelopmental and psychiatric
    disorders such as dyslexia and attention-deficit/hyperactivity
    disorder. Given the current lack of effective,
    evidence-based treatment options for Developmental Coordination Disorder (DCD), the use of
    fatty acid supplements merits investigation....

    To our knowledge, this is the first randomized,
    controlled trial of this kind among children with
    Developmental Coordination Disorder (DCD). Our hypothesis was that treatment for 3
    months with a fatty acid supplement would lead to
    significant improvements over placebo, as assessed
    with changes in motor skills, reading and spelling
    ages, and teacher ratings of behavioral and learning
    difficulties usually associated with ADHD.

    Results showed no effect of treatment on motor
    skills but significant improvements in reading, spelling,
    and behavior for active treatment versus placebo
    during 3 months of treatment in parallel groups.

    After a 1-way treatment crossover (placebo to active),
    similar changes were seen in the placebo crossover
    group, whereas children continuing with active
    treatment maintained or improved their progress.
    This study involved 117 children, between 5 and
    12 years of age, from mainstream schools in 1 United
    Kingdom county, all of whom met Developmental Coordination Disorder (DCD) criteria but
    were otherwise normal and not receiving any other
    treatment for their specific learning difficulties. Although
    it seems unlikely that these children would
    differ significantly from general population samples
    in other developed countries, generalizability to
    other age groups and cultures cannot be assumed.

    The low rate of dropout and high rate of compliance
    with treatment indicated that the researchers and
    teaching staff members provided very strong motivation,
    which might not be the case in other circumstances.
    No adverse events were reported, and the
    high compliance rate also suggests good acceptability
    of fatty acid supplements.

    The improvements in literacy skills and behavior
    found here are consistent with other reports of benefits
    from fatty acid supplementation among children
    selected for dyslexia or ADHD,5,6 but it is noteworthy
    that no group effect of treatment on motor
    skills was apparent. The similarity in the effect sizes
    for ADHD-related symptoms between this Developmental Coordination Disorder (DCD)
    sample and one selected with standard criteria for
    dyslexia5 suggests that these results may be more
    widely generalizable. Although the focus of this investigation
    was Developmental Coordination Disorder (DCD), the high level of comorbidity
    typically found between these conditions and the
    heterogeneity within each of them suggest that a
    symptom-based approach may be more fruitful than
    an exclusive focus on current diagnostic categories.
    In this kind of population, delays in literacy development
    usually increase over time, indicating the
    value of early intervention. Children in the placebo
    group fell even more behind with spelling during the
    0- to 3-month parallel-group phase, although they
    did show average progress in reading. In contrast,
    children receiving active treatment made 3 times the
    expected normal gain in reading age and twice the
    normal gain in spelling age, bringing their average
    scores toward normative values. In the follow-up
    phase, they continued to make improvements above
    what would be expected for chronologic age.

    With global measures of teacher-rated behavior,
    children receiving active treatment improved by
    0.5 SD in the 0- to 3-month parallel-group phase,
    with some additional improvements in the follow-up
    phase. In the placebo group, no changes were observed
    until the children crossed over to active treatment.

    The first-line treatment for ADHD symptoms
    in most developed countries is methylphenidate, for
    which a recent meta-analysis21 found an overall effect
    size of 0.78 with the Conners’ index but little or
    no evidence of durability beyond 4 weeks of treatment.
    By comparison, in this study the effect sizes
    with this measure were 0.55 for the first 3 months
    and 0.70 over 6 months for children receiving fatty
    acid treatment throughout.

    The problems faced by this kind of population are
    enduring. Follow-up studies indicate that, without
    specific intervention, children with Developmental Coordination Disorder (DCD) and ADHD
    at 7 years of age have unusually poor academic,
    social, and health outcomes in adolescence and
    young adulthood.13,22,23 Studies with older populations
    are therefore required, in addition to replication
    of the current findings. Although our data suggest
    that continuing treatment from 3 to 6 months
    may produce additional benefits, issues of both durability
    and maintenance of treatment effects also
    require attention in future studies.

    The optimal dosage and combination of fatty acids
    are at present unknown. An -3/-6 ratio of 4:1 was
    selected for this study on the basis of previous work
    indicating benefits in dyslexia and ADHD,5,6 although
    in this case the marine oil contained a higher
    eicosapentaenoic acid/docosahexaenoic acid ratio.
    Additional studies are needed to establish both the
    optimal composition of fatty acid treatments and
    dose-response relationships.

    This study was a pragmatic one designed to investigate
    the efficacy of fatty acid treatment and can
    therefore shed no light on the possible mechanisms
    at work. The findings do suggest, however, that fatty
    acid supplements of this type may be a safe, tolerable,
    effective treatment for improving academic
    progress and behavior among children with Developmental Coordination Disorder (DCD)."