PEDIATRIC NEWS UPDATES Updates from April 2007

Apr. 14 - Omega-3's ADHD Benefit Claims Boosted By Clinical Trial
Omega-3 supplementation led to significant improvements of children with learning and behavioral problems, adding important data to this high profile subject.

A number of studies have reported similar results and this led to calls by some for omega-3 supplementation of school children. Indeed, the UK's Food Standards Agency (FSA) last year reviewed the science in this field but ultimately decided against such measures, stating the evidence was insufficient. In many cases these studies were said to lack quality in research methodology and reporting, and failed to account for confounders.

But studies like the randomized, double-blind, placebo-controlled trial published in the Journal of Developmental & Behavioral Pediatrics could lead to a rethink in this stance.

Lead author of the new study Nathalie Sinn told NutraIngredients.com that while omega-3 fatty acids appear critical for healthy brain development and health, efficacy in enhancing the learning and behavior of children in the general population had not been investigated in a clinical trial.

"Between one in five and one in 10 children suffer learning and behavior problems and these can cause significant problems for these children, their learning, parents, teachers and schools, and can persist into adulthood," she said.

"Therefore I would deem any consideration of this research and indeed any research that demonstrates possible benefits for learning in school children with improved nutrition and diet by policy makers to be a positive step."

The new study from the University of South Australia recruited 132 kids with ADHD aged 7 to 12 for the randomized, placebo-controlled, double-blind intervention study. One hundred and four children completed the trial.

For the first 15 weeks of study, the kids were given daily supplements of either polyunsaturated fatty acids (omega-3 and omega-6, 3000 milligrams per day), PUFAs plus multivitamins and minerals, or placebo capsules (palm oil).

After 15 weeks all the groups crossed-over to the PUFA plus multivitamins and minerals supplement.

The supplement, provided by Equazen Nutraceuticals, was derived from high-EPA marine fish oil and virgin evening primrose oil (GLA). The eyeq capsules formulation contained Eicosapentaenoic acid (EPA), Docosahexaenoic acid (DHA), GLA, and vitamin E.

Parents were asked to rate their child's condition after 15 and 30 weeks with the 14 ADHD scales of the Conner's Parent Rating Scales. After 15 weeks of eyeq supplements, improvements were recorded in half of these scales.

After 30 weeks (placebo group switching to eyeq supplements) the parental ratings of behavior improved significantly in nine out of 14 scales.

No significant improvements were recorded in the Conners Teacher Ratings Scale, but the researchers state that parental ratings are considered more accurate for identifying ADHD in children than teachers.

"The present study is the largest PUFA trial to date with children falling in the clinical ADHD range on Conners Index. The result supports those of other studies that have found improvements in developmental problems symptomatic of ADHD with PUFA supplementation," wrote Sinn.

"These results have significant implications for children with ADHD-related symptoms, parents, and clinicians."

Dr. Sinn said that many questions remain unanswered. "This work needs to be replicated in other scientifically controlled trials in populations of children with different constellations of symptoms and other developmental disorders that overlap with ADHD," she told this website.

"We need more understanding about biological mechanisms, degree of relative PUFA deficiency and which children are most likely to respond, and also the relative importance of the omega-3 fatty acids EPA and DHA, and the inclusion of omega-6 fatty acid GLA, in the supplement that has received successful outcomes in the UK and Adelaide trials."

She added that a new trial would be starting this year to continue this work, with the taking of blood and urine samples to gain more understanding of fatty acid and biological metabolic profiles of responders versus non-responders, extending neuropsychological assessments to gain more understanding of cognitive and learning benefits, and comparing EPA with DHA.

"This will be a 12-month 3-way crossover trial, from which we hope to release baseline data of fatty acid profiles by the end of this year and final results of the intervention in 2009," she said.

Source: Journal of Developmental & Behavioural Pediatrics
Volume 28, Pages 82-91
"Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD"
Authors: N. Sinn, J. Bryan

Dr. Jim's Comments: "We've been recommending Omega-3 supplements for many years now for anyone that doesn't eat fish three times per week. It's great to see a study like this because it helps convince parents that diet is just as important as a prescription when dealing with ADD/ADHD."

Apr 30 - Tooth Decay in Young Children is On the Rise in the US

Tooth decay in young children's baby teeth is on the rise, a worrying trend that signals the preschool crowd is eating too much sugar, according to the largest government study of the nation's dental health in more than 25 years.

The study also noted a drop in the proportion of non-elderly adults who have visited a dentist in the past year - a possible indicator of declining dental insurance.

But there was some good news: Older children have fewer cavities and adults have less periodontal disease than in the past, and more of the elderly are retaining their teeth.

"Overall, we can say that most Americans are noticing an improvement in their oral health," said the study's lead author, Dr. Bruce Dye of the National Center for Health Statistics.

Experts are concerned about the prevalence of cavities in baby teeth of children ages 2 to 5. It increased to 28 percent in 1999-2004, from 24 percent in 1988-1994, according to the report.

Tooth decay in young children had been decreasing for 40 years. Some studies have suggested the trend might have ended, but the new report contains the first statistically significant proof the trend has reversed, dental experts said.

One reason is that parents are giving their children more processed snack foods than in the past, and more bottled water or other drinks instead of fluoridated tap water, Dye said.

"They're relying more on fruit snacks, juice boxes, candy and soda" for the sustenance of preschoolers, he said.

Others experts agree diet is at least part of the explanation for the rising cavity rates.

"The same things contributing to the obesity epidemic can also contribute to tooth decay," said Dr. Gary Rozier, a dentist who teaches public health policy at the University of North Carolina.

Inadequate dental care may also play a role. Cavities in young children can form very quickly, and parents should begin bringing their children to the dentist at age 1, said Dr. Joel Berg, chairman of the University of Washington's Department of Pediatric Dentistry.

Parents also must help their young children brush properly. "Preschoolers don't have the dexterity to really clean their teeth," Berg said.

Baby teeth naturally fall out as children age, but dentists say untreated decay can spread and is too dangerous to go untreated.

Rotten baby teeth are treated with fillings or - if the decay is extensive - extraction. But baby teeth fill certain spaces in the mouth, so their early removal may lead to crowding when adult teeth come in.

The study is based on an annual federal survey of about 5,000 people. It includes detailed in-person health interviews, and medical and dental examinations by health care professionals.

The study averaged the findings from surveys done in 1988-1994 and compared them with the average results from surveys done in 1999-2004.

The results were reported at a meeting of the American Association for Public Health Dentistry in Denver.

Experts were heartened that the study found that cavities in permanent teeth decreased to 21 percent of children in 1999-2004, from 25 percent in 1988-1994.

That may be at least partly due to the growing prevalence of dental sealants, a plastic coating applied to teeth that protects against decay.

In the most recent set of surveys, about 38 percent of children and teens ages 12 to 19 had dental sealants.

Some of the other findings:

• Among senior citizens ages 65 and older, the percentage with complete tooth loss dropped to 27 percent, from 34 percent.
• Moderate and severe gum disease in adults ages 20 to 64 dropped to 5 percent, from 10 percent. Gum disease dropped to 17 percent, from 27 percent, in seniors.
• Tooth decay in the permanent teeth of children ages 6 to 11 dropped to 21 percent, from 25 percent. Tooth decay in youths ages 12 to 19 dropped to 59 percent, from 68 percent.
• The percentage of adults who said they'd been to a dentist in the previous year dropped to 60 percent, from 66 percent.