Supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in children with autism spectrum disorders: a meta-analysis of randomized controlled trials

Figures & data

Figure 1 Flowchart of the selection strategy for the current meta-analysis.

Table 1 Summary of characteristics of studies in current meta-analysis

Study	Criteria	Diagnosis	Comparison	N	Duration (weeks)	Gender (% female)	Age (years)	Drug free	Outcome	Country
Mankad et al (2015)^Citation40	DSM-IV	Autistic disorder Asperger	Omega 3 (1.5 g/day) Placebo	18 19	24	27.0	3.9 3.5	Yes	BASC-2 CGI-I	Canada
Bent et al (2014)^Citation41	N/A	ASD	Omega 3 (1.3 g/day) Placebo	29 28	6	12.3	7.2	No	ABC SRS CGI-I	USA
Voigt et al (2014)^Citation42	DSM-IV	Autistic disorder	Omega 3 (200 mg/day) Placebo	24 24	24	17.0	5.8 6.5	Yes	ABC BASC CGI-I	USA
Yui et al (2012)^Citation25	DSM-IV	Autistic disorder Asperger Language disorder	Omega 3 (1.44 g/day) Placebo	7 6	16	7.7	14.6	No	ABC SRS	Japan
Bent et al (2011)^Citation43	DSM-IV	ASD	Omega 3 (1.3 g/day) Placebo	14 13	12	11.1	5.8	N/A	ABC SRS BASC CGI-I	USA
Amminger et al (2007)^Citation44	DSM-IV	Autistic disorder	Omega 3 (1.5 g/day) placebo	7 5	6	0.0	10.5 12.1	N/A	ABC	Austria

Abbreviations: ABC, Aberrant Behavior Checklist; ASD, autism spectrum disorder; BASC, Behavior Assessment System for Children; CGI-I, Clinical Global Impression – Improvement; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; N/A, not available; SRS, Social Responsiveness Scale.

Figure 2 Meta-analysis of difference of primary outcome, in aspects of (A) changes of ABC, (B) clinical improvement, and (C) changes of SRS total scores, in ASD children treated with omega 3 and placebo.

Notes: (A) The treatment effect is significantly better by omega 3 than by placebo in subscales of lethargy (P=0.018) and stereotypy (P=0.032), trend of better response by omega 3 than by placebo in hyperactivity (P=0.064), but no any significance between omega 3 and placebo in inappropriate speech (P=0.366) or irritability (P=0.931). (B) There was no any significant difference of clinical improvement between children with ASD receiving omega 3 and those receiving placebo (P=0.569). (C) There was trend of better response by placebo than by omega 3 in changes of SRS total scores (P=0.066).
Abbreviations: ABC, Aberrant Behavior Checklist; ASD, autism spectrum disorder; CGI-I, Clinical Global Impression – Improvement; CI, confidence interval; SRS, Social Responsiveness Scale.

Figure 3 Meta-analysis of difference of (A) dropout rate and (B) rate of discontinuation from study due to side effect in ASD children treated with omega 3 and placebo.

Notes: (A) There was no any significant difference between the dropout rate in ASD children receiving omega 3 and those receiving placebo (P=0.795). (B) There was no any significant difference between the rate of discontinuation from study due to side effect between ASD children receiving omega 3 and those receiving placebo (P=0.707).
Abbreviations: ASD, autism spectrum disorder; CI, confidence interval.

Table 2 Summary of clinical features of participants in included studies

Characteristics	Mankad et al (2015)^Citation40		Bent et al (2014)^Citation41		Voigt et al (2014)^Citation42		Yui et al (2012)^Citation25		Bent et al (2011)^Citation43		Amminger et al (2007)^Citation44
Treatment type	Omega 3	Control	Omega 3	Control	Omega 3	Control	Omega 3	Control	Omega 3	Control	Omega 3	Control
Number of participants	18	19	29	28	24	24	7	6	14	12	7	5
Mean age (years)	3.9	3.5	7.2		5.8	6.5	14.6		5.8		10.5	12.1
Female (%)	27.0		12.3		17.0		7.7		11.1		0.0
Criteria	DSM-IV		Parent reported		DSM-IV		DSM-IV		DSM-IV		DSM-IV
Diagnosis (inclusion criteria)	Autistic disorder Asperger		ASD		Autistic disorder (CRS >30)		Autistic disorder Asperger Language disorder (ABC withdrawal >10)		ASD (CGI-S >4)		Autistic disorder (ABC irritability >17)
Physical condition	Excluded		Excluded		Not excluded		Excluded		Excluded		Excluded
Psychiatric disorder	Excluded		Not excluded		Not excluded		Excluded		Not excluded		Excluded
Drug free	+		−		+		−		N/A		N/A
Duration (weeks)	24		6		24		16		12		6
ADOS
Total	28.4	15.0
ABC
Hyperactivity			20.0	28.1			18.3	20.3	16.8	20.3	33.3	24.6
Irritability			20.0	16.8			12.8	12.7	10.1	12.0	29.3	26.4
Stereotypy			8.0	5.4			7.6	8.0	2.8	6.0	14.4	7.8
Lethargy			12.2	8.8			26.7	30.0	7.7	8.3	24.4	25.6
Inappropriate speech			7.0	5.8			7.3	4.5	3.3	5.2	8.3	9.0
SRS
Total			89.7	88.3					76.9	79.0
Awareness			79.5	78.9			14.6	17.3
Cognition			84.8	83.1			24.9	25.2
Communication			84.9	83.8			46.9	51.3
Motivation			76.1	75.9			22.7	25.3
Autistic mannerisms			94.7	92.5			23.9	22.5
BASC
Social skill					26.5	30.3
Country	Canada		USA		USA		Japan		USA		Austria

Note: Data presentation: mean.

Abbreviations: ABC, Aberrant Behavior Checklist; ADOS, Autism Diagnostic Observation Schedule; ASD, autism spectrum disorder; BASC, Behavior Assessment System for Children; CGI-S, Clinical Global Impression – Severity; CRS, The Childhood Autism Rating Scale; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; N/A, not available; SRS, Social Responsiveness Scale.

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