Omega 3 Fatty Acids and Children with Autism: Consumption and Supplementation in Community Settings

Background:  Omega 3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid (DHA+EPA), are commonly used nutritional supplements for children with autism spectrum disorders (ASD).  It is unknown whether children with ASD who may be selective eaters meet their daily requirement for DHA+EPA from naturally occurring and/or fortified food sources, whether adequate or excessive amounts are provided through supplementation, or whether nutritional supplementation in community use reflects doses used in treatment trials examining symptoms including inattention and repetitive behaviors.

Objectives:  To quantify reported intake of DHA+EPA from both diet and nutritional supplementation in a community sample of children with ASD and examine the demographic and behavioral characteristics of children who are/are not given DHA+EPA supplementation.

Methods:  Autism Speaks Autism Treatment Network participants from 5 sites (n=286, 14% female) recorded 3 day diet records for food and supplements.  Total  intake was quantified using Nutrient Data for System © for EPA+ DHA and supplement manufacturer data.  Analyses included T tests or Wilcoxon rank sum tests for continuous data and Fisher’s exact tests for categorical data.

Results:  Only 1 of the 286 participants (a nonsupplement user) met the daily requirement for DHA+EPA from diet alone.  The major dietary sources of omega 3 intake in most children were eggs and chicken.  Supplement users (n=43) were similar in age and IQ to nonsupplement users, but more likely to be female (p=0.029) with college educated mothers (p=0.02). The groups did not differ in DHA+EPA consumption from diet alone. Of supplement users, 7% met and 65% exceeded dietary requirements. Supplement users had lower scores on the Child Behavior Checklist for externalizing behaviors (mean 56.6 + 9.6 vs 60.6 + 11.2; p=0.038), on the Children’s Sleep Habits Questionnaire (42.3 + 9 vs 45.4 + 9.3; p=0.028) and on the Repetitive Behavior Scale-Revised (26.2 + 17.3 vs 37.5 + 22.2; p<0.001). Doses used in clinical trials, greater than 1000 mg/d, were consumed by 28% of participants given supplements. 

Conclusions:  Children with ASD are deficit in their intake of Omega 3 Fatty acids from diet alone.  Supplementation in the community is typically at a lower dose than the doses evaluated in clinical trials. This unadjusted, cross sectional data cannot determine whether the association of increased DHA+EPA intake with less externalizing behavior, better sleep scores and less repetitive behaviors is related to supplementation or whether children with lower scores are more likely to receive supplements. Future clinical trials might evaluate the impact of a range of doses.

Acknowledgement: This project was supported by the Health Resources and Services Administration (HRSA) , U.S. Department of Health and Human Services (HHS) under cooperative agreement UA3 MC11054 – Autism Intervention Research Network on Physical Health. Content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This work was conducted through the Autism Speaks Autism Treatment Network serving as the Autism Intervention Research Network on Physical Health. Support was also from CTSI UL1 TR000042.