Patient Presentation
A 10-year-old female came to clinic for her health maintenance examination. She was doing well physically and had many friends socially. She was having problems at school in reading where she was getting additional help and was making some progress. However she still remained behind her classmates. Her teachers and parents did not describe problems in other areas including executive function or attention. The family history revealed that her father had some reading problems as a child. The pertinent physical exam showed a smiley female with growth parameters in the 50-75%. Her examination was normal.
The diagnosis of a healthy female with a reading disability was made. The mother asked about supplementing with fish oil as her friend used it for her child who had some developmental problems. The pediatrician said that she didn’t know a lot about using it, but a quick review of the National Institutes of Health Complimentary and Alternative Medicine website showed that while there was not data to support its use for learning problems, fish oils had few side effects. “I guess that you could use them, but you could also use the money for something else too,” she said. “I do recommend that you continue to work with the teachers and follow her closely. She may need more help than she is getting now but you will only know that by working with the teachers,” she counseled.
Discussion
Fats and fatty acids are essential for good human health.
Saturated fats have hydrogen pairs linked to each carbon on the carbon backbone. They are solid or semi-solid at room temperature. Common examples are butter, lard, or hardened vegetable shortening. They are linked to higher cholesterol and triglycerides and only a small amount of them are recommended to be consumed in the diet.
Unsaturated fats have one or more hydrogen atoms missing from the carbon backbone. They are liquid at room temperature.
- Monounsaturated fatty acids have one hydrogen pair that is missing from the carbon backbone. They are liquid at room temperature but start to become solid when placed into the refrigerator. Common examples are Canola oil, olive oil, peanut oil and avocados.
They lower total and LDL cholesterol and increase HDL cholesterol. - Polyunsaturated fatty acids (PUFAs) have two or more hydrogen pairs that are missing from the carbon backbone. They are liquid at room temperature and when cooled. Common examples are corn oil, soybean oil, and the seeds and oil made from safflower, sesame, and sunflower seeds.
They lower total and LDL cholesterol but also lower HDL production. - Omega-3 fatty acids are a type of polyunsaturated fats derived from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). They are commonly found in fatty fish such as mackerel, albacore tuna, sardines, salmon, herring, anchovies, sardines and lake trout. They can also be found in Canola oil, soybean oil, flaxseed oil, and walnuts. They are also a component of human breast milk.
Omega-3 fatty acids lower total cholesterol and triglycerides.
Learning Point
Omega-3s have been shown to decrease cardiovascular disease including heart attack, arrhythmias, stroke and sudden cardiac death. Omega-3s help to regulate the immune system and they have been shown to “…decrease inflammation and be useful in the treatment of rheumatoid arthritis, [inflammatory bowel disease], and psoriasis.” Some studies support a benefit also in Alzheimer disease and depression. Omega-3s also help fetal brain development and have been added to infant formulas since 2002 to be more like breastmilk.
Current data does not support Omega-3 supplementation for improved cognition, inhibition, attention, memory, reading, reaction times, and autism spectrum disorder. Even in infant formula trials, the end-point that is measured appears to affect the outcome, and the authors concluded that “[a]vailable data are currently inadequate to conclude that [Omega-3]supplementation has a clinically meaningful beneficial effect upon neurological development.”
Fatty fish also have higher levels of mercury and toxins (especially polychorinated biphenyls and dioxin) and therefore the pros and cons of fatty fish must be balanced, and two servings of fatty fish (3-4 ounces/serving) are recommended weekly that is broiled or baked. Frying is not recommended. High levels of mercury are found in shark, swordfish, king mackerel, and tile fish (also called golden snapper or golden bass) but low levels are found in anchovies, catfish, sardines, salmon, pollock, clams, oysters and shrimp. The fish listed as having high levels of mercury are not recommended to be consumed during pregnancy, breastfeeding and for young children. Supplements of fish oil or Omega-3s have not shown to have the same benefit for cardiac disease as eating the fish itself.
Questions for Further Discussion
1. What approach to complimentary and alternative medicine to you take when discussing it with patients?
2. What sources of information for complimentary and alternative medicine do you recommend to patients?
Related Cases
- Disease: Dietary Fats | Dietary Supplements | Heart Diseases | Learning Disorders
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: General Pediatrics | Nutrition / Dietetics | Preventive Medicine and Health Maintenance | School
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Dietary Supplements and Learning Disorders.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
University of Illinois Extension. What are Polyunsaturated and Monounsaturated Fats?
Available from the Internet at http://extension.illinois.edu/diabetes2/subsection.cfm?SubSectionID=46 (rev. 6/2014, cited 9/25/17).
National Center for Complimentary and Alternative Medicine. Omega-3 Supplements: In Depth.
Available from the Internet at https://nccih.nih.gov/health/omega3/introduction.htm (rev. 8/2015, cited 9/25/17).
Cooper RE, Tye C, Kuntsi J, Vassos E, Asherson P. Omega-3 polyunsaturated fatty acid supplementation and cognition: A systematic review and meta-analysis. J Psychopharmacol. 2015 Jul;29(7):753-63.
Sun H, Como PG, Downey LC, Murphy D, Ariagno RL, Rodriguez W. Infant formula and neurocognitive outcomes: impact of study end-point selection. J Perinatol. 2015 Oct;35(10):867-74.
Parian AM, Mullin GE. Fish Consumption and Health: The Yin and Yang. Nutr Clin Pract. 2016 Aug;31(4):562-5.
Gould JF, Treyvaud K, Yelland LN, Anderson PJ, Smithers LG, McPhee AJ, Makrides M. Seven-Year Follow-up of Children Born to Women in a Randomized Trial of Prenatal DHA Supplementation. JAMA. 2017 Mar 21;317(11):1173-1175.
Horvath A, Lukasik J, Szajewska H. Omega-3 Fatty Acid Supplementation Does Not Affect Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis. J Nutr. 2017 Mar;147(3):367-376.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa
Pediatric Education 