Can Eating Fish Make Kids Smarter Archives - Health Tips From The Professor

How Much Omega-3s Do Children Need?

September 6, 2022 by Dr. Steve Chaney

What Does This Study Mean For Your Children?

Author: Dr. Stephen Chaney

It is back to school time again. If you have children, you are probably rushing around to make sure they are ready.

Backpack…Check.
Books…Check
School supplies…Check
Omega-3s…???

Every parent wants their child to do their best in school. But do they need omega-3s to do their best? I don’t need to tell you that question is controversial.

Some experts claim that omega-3 supplementation in children improves their cognition. [Note: Cognition is defined as the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. In layman’s terms that means your child’s ability to learn.]

Other experts point out that studies in this area disagree. Some studies support these claims. Others don’t. Because the studies disagree these experts conclude there is no good evidence to support omega-3 supplementation in children.

The authors of this study (ISM van der Wurff et al, Nutrients, 12: 3115, 2020) took a different approach. They asked why these studies disagreed. They hypothesized that previous studies disagreed because there is a minimal dose of omega-3s needed to achieve cognitive benefits in children. In short, they were asking how much omega-3s do children need.

They based their hypothesis on recent studies showing that a minimum dose of omega-3s is required to show heart health benefits in adults.

What Have We Learned From Studies on Omega-3s And Heart Health?

The breakthrough in omega-3/heart health studies came with the development of something called the omega-3 index. Simply put, omega-3s accumulate in our cell membranes. The omega-3 index is the percent omega-3s in red blood cell membranes and is a good measure of our omega-3 status.

Once investigators began measuring the omega-3 index in their studies and correlating it with heart health, it became clear that:

An omega-3 index of ≤4% correlated with a high risk of heart disease.

An omega-3 index of ≥8% correlated with a low risk of heart disease.

Most Americans have an omega-3 index in the 4-6% range.

Clinical studies in which participants’ omega-3 index started in the low range and increased to ~8% through supplementation generally showed a positive effect of omega-3s on reducing heart disease risk. [I say generally because there are other factors in study design that can obscure the effect of omega-3s.]

This is the model that the authors adopted for their study. They asked how much omega-3s do children need to show a positive effect of omega-3s on their cognition (ability to learn).

How Was The Study Done?

The authors included 21 studies in their analysis that met the following criteria:

All studies were placebo controlled randomized clinical trials.

The participants were 4-25 years old and had not been diagnosed with ADHD.

Supplementation was with the long-chain omega-3s DHA and/or EPA.

The trial assessed the effect of omega-3 supplementation on cognition.

I do not want to underestimate the difficulties the authors faced in their quest. The individual studies differed in:

The dose of omega-3s.

- The relative amount of DHA and EPA.

- Whether omega-3 index was measured. Only some of the studies measured fatty acid levels in the blood. The authors were able to calculate the omega-3 index in these studies.

How cognition (ability to learn) was measured.

The age of the children.

- 20 of the studies were done with children (4-12 years old) or late adolescents (20-25 years old).

- Only one study was done on early to middle adolescents (12-20 years old).

All these variables influence the outcome and could obscure the effect of omega-3s on cognition.

In short, determining the omega-3 dose-response for an effect on cognition was a monumental task. It was like searching for a needle in a haystack. These authors did a remarkable job.

How Much Omega-3s Do Children Need?

Here is what the scientists found when they analyzed the data:

60% of the studies in which an omega-3 index of ≥6% was achieved showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 20% of the studies that did not achieve an omega-3 index of 6%.

- That is a 3-fold difference in effectiveness once a threshold of 6% omega-3 index was reached.

50% of the studies in which a dose of ≥ 450 mg/day of DHA + EPA was used showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 25% of the studies that used <450 mg/day DHA + EPA.

- That is a 2-fold difference in effectiveness once a threshold of 450 mg/day DHA + EPA was given.

The authors concluded, “Daily supplementation of ≥450 mg/day DHA and/or EPA and an increase in the omega-3 index to >6% makes it more likely to show efficacy [of omega-3s] on cognition (ability to learn) in children and adolescents.”

What Does This Study Tell Us?

It is important to understand what this study does and does not tell us.

This study does not:

Prove that omega-3 supplementation can improve cognition (ability to learn) in children and adolescents.

Define optimal levels of DHA + EPA.

Tell us whether DHA, EPA, or a mixture is better.

It was not designed to do any of these things. It was designed to give us a roadmap for future studies. It tells us how to design studies that can provide definitive answers to these questions.

This study does:

Define a threshold dose of DHA + EPA for future studies (450 mg/day).

Tells us how to best use the omega-3 index in future studies. To obtain meaningful results:

- Participants should start with an omega-3 index of 4% or less.

- Participants should end with an omega-3 index of 6% or greater.

In my opinion, future studies would also be much more effective if scientists in this area of research could agree on a single set of cognitive measures to be used in all subsequent studies.

In short, this study provides critical information that can be used to design future studies that will be able to provide definitive conclusions about omega-3s and cognition in children.

What Does This Study Mean For Your Children?

As a parent or grandparent, you probably aren’t interested in optimizing the design of future clinical studies. You want answers now.

Blood tests for omega-3 index are available, but they are not widely used. And your insurance may not cover them.

So, for you the most important finding from this study is that 450 mg/day DHA + EPA appears to be the threshold for improving a child’s cognition (their ability to learn).

450 mg/day is not an excessive amount. The NIH defines adequate intakes for omega-3s as follows:

4-8 years: 800 mg/day
9-13 years: 1 gm/day for females, 1.2 gm/day for males
14-18 years: 1.1 gm/day for females and 1.6 gm/day for males.
With at least 10% of that coming from DHA + EPA

Other organizations around the world recommend between 100 mg/day and 500 mg/day DHA + EPA depending on the age and weight of the child and the organization.

Most children need supplementation to reach adequate omega-3 intake. The NIH estimates the average child only gets around 40 mg/day omega-3s from their diet. No matter which recommendation you follow, it is clear that most children are not getting the recommended amount of DHA + EPA in their diet.

Genetics.
Diet.
Environment.
The value placed on learning by parents and peers.

Supplementation is just one factor in your child’s ability to learn. But it is one you can easily control. . And if your child is like most, he or she is probably not getting enough omega-3s in their diet.

The Bottom Line

It is back to school time again. Every parent wants their child to do their best in school. But do they need omega-3s to do their best? I don’t need to tell you that question is controversial.

Some studies support these claims, but others don’t. Because the studies disagree some experts conclude there is no good evidence to support omega-3 supplementation in children.

The authors of a recent study took a different approach. They asked why these studies disagreed. They hypothesized that previous studies disagreed because there was a minimal dose of omega-3s needed to achieve cognitive benefits in children. They asked how much omega-3s children need.

They analyzed the data from 21 previous studies looking at the effect of omega-3 supplementation on cognition (ability to learn) in children and adolescents. Their analysis showed:

60% of the studies in which an omega-3 index of ≥6% was achieved showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 20% of the studies that did not achieve an omega-3 index of 6%.

- That is a 3-fold difference in effectiveness once a threshold of 6% omega-3 index was reached.

50% of the studies in which a dose of ≥ 450 mg/day of DHA + EPA was used showed a beneficial effect of omega-3 supplementation on cognition (ability to learn) compared to 25% of the studies that used <450 mg/day DHA + EPA.

- That is a 2-fold difference in effectiveness once a threshold dose of 450 mg/day DHA + EPA was given.

The authors concluded, “Daily supplementation of ≥450 mg/day DHA + EPA and an increase in the omega-3 index to >6% makes it more likely to show efficacy [of omega-3s] on cognition (ability to learn) in children and adolescents.”

For more details on the study and what it means for your children and grandchildren, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Can Eating Fish Make Kids Smarter?

September 3, 2019 by Dr. Steve Chaney

Will Omega-3s Turn Your Kid Into A Genius?

Author: Dr. Stephen Chaney

You have probably heard the old saying that fish is brain food. Is it true? Could eating fish make your kid(s) smarter?

It is certainly a plausible hypothesis. Many fish are good sources of long chain omega-3s (omega-3 fatty acids). Long chain omega-3s, particularly DHA, are an important part of the myelin sheath that coats our neurons.

We can think of the myelin sheath as analogous to the plastic coating on electrical wiring. The coating on electrical wires assures that the electrical signal gets from the beginning of the wire to the end without shorting out somewhere in the middle. The myelin sheath plays a similar role for our neurons.

A number of clinical studies suggest that adequate intake of fish and/or fish oil during pregnancy and the early stages of childhood is important for brain development. Other studies suggest that omega-3 supplementation may improve mental focus and reading skills in school-age children.

The current clinical study (J Liu et al, Scientific Reports, 7: 17961, 2017) looked at the effect of fish consumption in Chinese children aged 9-11 on their IQ score measured at age 12.

How Was The Study Done?

This study included 541 Chinese school children who were part of an ongoing prospective longitudinal study. [That is scientific jargon meaning that one variable (diet) was measured at the beginning of the study and correlated with a second variable (IQ) measured several years later.]

The children were asked to fill out a food frequency questionnaire at ages 9-11. Fish intake frequency was measured by asking the children: “How often do you consume fish in a typical month?” The children were required to choose from:

seldom (less than 2 times per month),
sometimes (2-3 times per month), and
often (at least once a week).

It was assumed that the children might not have known what kind of fish their mothers prepared, so they were not asked to identify the kind of fish they ate.

At the time the children were enrolled in the program the investigators collected data on 13 other variables which might influence IQ. These variables included:

Gender
Parent’s education.
Parent’s occupation.
Parent’s marital status.
Whether the child was breastfed or not.
Duration of breastfeeding.
Home location.
Siblings.
Breakfast consumption (previous research has suggested breakfast intake may influence cognition).

At age 12 the IQ of the children was assessed using the Chinese version of a standard IQ test. The IQ tests were administered independently by two trained investigators to minimize investigator bias.

Verbal IQ was assessed based on:
- Information Recall.
- Comprehension
- Arithmetic
- Vocabulary
- Recognition of Similarities.

Performance IQ was assessed based on:
- Picture Arrangement.
- Picture Completion.
- Object Assembly.
- Block Design.
- Coding
- Mazes
The Total IQ score was based on a combination of the Verbal and Performance scores.

The study measured the impact of fish consumption at ages 9-11 on IQ at age 12 and included statistical correction for other variables that might have influenced IQ.

Can Eating Fish Make Your Kids Smarter?

When the children who frequently consumed fish (≥once a week) were compared to children who seldom consumed fish (˂2 times a month), their IQ scores were:

75 points higher in verbal IQ.
79 points higher in performance IQ.
80 points higher in total IQ.

When the children who sometimes consumed fish (2-3 times a month) were compared to children who seldom consumed fish, their IQ scores were:

92 points higher in verbal IQ.
52 points higher in performance IQ.
31 points higher in total IQ.

These data are consistent with previous studies showing that both dietary fish and omega-3 intake are associated with improved cognitive and academic performance in school age children.

[Note: This study also suggested that fish consumption may improve sleep quality, and the improved sleep quality may influence IQ. This is a complex subject. As such, it is best discussed in a future issue of “Health Tips From the Professor”.]

What Are the Strengths And Weaknesses Of This Study?

Strengths: The strengths of the study were:

It was a relatively large study.
Fish consumption was measured 1-3 years earlier than IQ.
The association between fish consumption and IQ remained significant after adjusting for 13 other variables known to influence IQ.
There was a clear dose-response relationship between the three levels of fish consumption.
It is consistent with a number of other studies showing that fish/omega-3 intake improves cognitive performance in children.

Thus, the authors concluded: “We believe the findings cannot be easily attributed to chance and that, instead, they reflect a reliable relationship between early, frequent fish consumption and later, improved cognitive performance.”

Weaknesses: The weaknesses of the study were:

It did not ask what kinds of fish the children were eating. Some fish are much better sources of omega-3s than others, so it is not entirely accurate to attribute the higher IQ to omega-3 intake.
It did not assess the effect of “diet context” on the results. The Chinese diet is a primarily plant-based, low-fat diet. It is unclear whether eating fish once a week would have the same effect on IQ in the context of a typical American diet.
It is an “association study.” It simply measured the association between fish consumption and IQ. It does not prove cause and effect.

Finally, this is the first study to measure the correlation between fish consumption and IQ in this age group. Clearly, more experiments are needed to confirm these findings.

Will Omega-3s Turn Your Kid Into A Genius?

Who wouldn’t want their children or grandchildren to have higher IQs?

However, I wouldn’t read too much into a study like this.

Let me share some perspective by way of a personal story. When I was in grade school, every child was given an IQ test and an aptitude test (I scored very low on anything mechanical in the aptitude test, which my wife can attest to.)

We children, as might be expected, shared our IQ scores. However, the scores didn’t prove to be as meaningful as we initially expected.

There were some kids in my class who had much higher IQ scores. In fact, they ranked in the genius category. However, many of them did mediocre in school and had undistinguished careers. In contrast, some of the kids who scored lower on their IQ tests had spectacular careers in their chosen fields.

The moral of this story is, of course, that there is a lot more than IQ that goes into success in school and success in life. With IQ, like many other things, it is important to have enough, but more is not necessarily better.

However, this study is consistent with many other studies suggesting that omega-3s, especially DHA, are important for brain development, mental focus, and cognitive skills in children. Consequently, if you have a child or grandchild, you want to make sure that they are getting enough omega-3s in their diet.

How much is enough, you might ask? Recommendations range from 70 mg/day EPA+DHA for children ages 1-3 to 100-150 mg/day EPA+DHA for older children, with about 2/3 of that coming from DHA.

While that may not sound like much, a recent study of 10, 942 American children ages 1-11 found that only around 25% of them were getting the recommended amount of EPA+DHA from their diet. In fact, most American children only get around 20-40 mg of EPA+DHA from their diet.

Fish are the preferred source of EPA+DHA because they also provide a healthy protein source, something else your child may not be getting enough of. The best fish sources of omega-3s are mackerel, salmon, sea bass, and sardines.

Of course, if your child is one of the many children who are not fond of omega-3-rich fish, you may want to consider an omega-3 supplement, especially one rich in DHA.

The Bottom Line

A recent study analyzed the correlation between fish consumption and IQ in school aged children. The study found:

When the children who frequently consumed fish (≥once a week) were compared to children who seldom consumed fish (˂2 times a month), their IQ scores were:

75 points higher in verbal IQ.
79 points higher in performance IQ.
80 points higher in total IQ.

When the children who sometimes consumed fish (2-3 times a month) were compared to children who seldom consumed fish, their IQ scores were:

92 points higher in verbal IQ.
52 points higher in performance IQ.
31 points higher in total IQ.

These data are consistent with previous studies showing that both dietary fish and omega-3 intake are associated with improved cognitive and academic performance in school age children.

For more details on the study and perspective on what the study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.