Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials
Open accessAbstract
Interest in the value of Omega—3 (n—3) fatty acid supplementation for treatment of ADHD remains high. No prior meta-analysis has examined whether ADHD is associated with alterations in blood lipid levels and meta-analyses of supplementation have reached conflicting conclusions. Methods We report two new meta-analyses. Study 1 examined blood levels of Omega—3 fatty acids in relation to ADHD. Study 2 examined a larger sample of randomized intervention trials than previously reported. Results Study 1 included 9 studies (n = 586) and found lower overall blood levels of n—3 in individuals with ADHD versus controls (g = 0.42, 95% CI = 0.26–0.59; p < .001). Study 2 included 16 studies (n = 1408) and found that n—3 supplementation improved ADHD composite symptoms; using the best available rating and reporter (g = 0.26, 95% CI = 0.15–0.37; p < .001). Supplementation showed reliable effects on hyperactivity by parent and teacher report, but reliable effects for inattention only by parent report. Conclusions Omega—3 levels are reduced in children with ADHD. Dietary supplementation appears to create modest improvements in symptoms. There is sufficient evidence to consider Omega—3 fatty acids as a possible supplement to established therapies. However it remains unclear whether such intervention should be confined to children with below normal blood levels.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Blood omega-3 PUFA levels are moderately lower in ADHD youths than in non-ADHD youths.
“A meta-analysis of nine studies and 586 people found moderately lower overall blood levels of omega-3 PUFAs in ADHD than non-ADHD youth”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Hawkey and Nigg, 2014
Omega-3 fatty acid supplementation was associated with small-to-medium improvements in ADHD symptoms in three meta-analyses.
“Omega-3 fatty acid supplementation was associated with small-to-medium improvements in ADHD symptoms in three meta-analyses (ten studies with 699 participants, 16 studies with 1,408 participants, 7 studies with 534 participants) (Bloch and Qawasmi, 2011; Chang et al., 2018; Hawkey and Nigg, 2014).”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Hawkey and Nigg, 2014
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Assessing heterogeneity in meta-analysis: Q statistic or I² index?
Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F., & Botella, J. (2006) · Psychological Methods · doi:10.1037/1082-989x.11.2.193 · Cited by 4,256 · see citing works
Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., Stevenson, J., Danckaerts, M., van der Oord, S., Döpfner, M., et al. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12070991 · Cited by 1,167 · see citing works
Healthy intakes of n−3 and n–6 fatty acids: estimations considering worldwide diversity
Hibbeln, J. R., Nieminen, L. R. G., Blasbalg, T. L., Riggs, J. A., & Lands, W. E. M. (2006) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.6.1483s · Cited by 538 · see citing works
Janssen, C. I. F., & Kiliaan, A. J. (2013) · Progress in Lipid Research · doi:10.1016/j.plipres.2013.10.002 · Cited by 515 · see citing works
Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder
Stevens, L., Zentall, S., Deck, J., Abate, M., Watkins, B. A., Lipp, S., & Burgess, J. R. (1995) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/62.4.761 · Cited by 445 · see citing works
Bloch, M. H., & Qawasmi, A. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.06.008 · Cited by 417 · see citing works
Richardson, A. J., & Puri, B. K. (2002) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/s0278-5846(01)00254-8 · Cited by 379 · see citing works
Banaschewski, T., Coghill, D., Santosh, P., Zuddas, A., Asherson, P., Buitelaar, J., Danckaerts, M., Döpfner, M., Faraone, S. V., Rothenberger, A., et al. (2006) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-006-0549-0 · Cited by 375 · see citing works
Voigt, R. G., Llorente, A. M., Jensen, C. L., Fraley, J. K., Berretta, M. C., & Heird, W. C. (2001) · The Journal of Pediatrics · doi:10.1067/mpd.2001.116050 · Cited by 365 · see citing works
EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors
Stevens, L., Zhang, W., Peck, L. W., Kuczek, T., Grevstad, N., Mahon, A. K., Zentall, S. S., Arnold, L. E., & Burgess, J. R. (2003) · Lipids · doi:10.1007/s11745-006-1155-0 · Cited by 337 · see citing works
Schuchardt, J. P., Huß, M., Stauss‐Grabo, M., & Hahn, A. (2009) · European Journal of Pediatrics · doi:10.1007/s00431-009-1035-8 · Cited by 295 · see citing works
Hirayama, S., Hamazaki, T., & TERASAWA, K. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601830 · Cited by 288 · see citing works
Parletta, N., & Bryan, J. (2007) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/01.dbp.0000267558.88457.a5 · Cited by 262 · see citing works
Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.10.015 · Cited by 260 · see citing works
Self-citationMeasured gene-by-environment interaction in relation to attention-deficit/hyperactivity disorder
Nigg, J., Nikolas, M., & Burt, S. A. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.01.025 · Cited by 259 · see citing works
Omega-3 fatty acids in boys with behavior, learning, and health problems
Stevens, L. (1996) · Physiology & Behavior · doi:10.1016/0031-9384(95)02207-4 · Cited by 258 · see citing works
Infant Feeding and Childhood Cognition at Ages 3 and 7 Years
Belfort, M. B., Rifas‐Shiman, S. L., KLEINMAN, K. P., Guthrie, L., Bellinger, D. C., Taveras, E. M., Gillman, M. W., & Oken, E. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.455 · Cited by 244 · see citing works
The Diet Factor in Attention-Deficit/Hyperactivity Disorder
Millichap, J. G., & Yee, M. M. (2012) · PEDIATRICS · doi:10.1542/peds.2011-2199 · Cited by 224 · see citing works
Artificial Food Colors and Attention-Deficit/Hyperactivity Symptoms: Conclusions to Dye for
Arnold, L., Lofthouse, N., & Hurt, E. A. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0133-x · Cited by 218 · see citing works
Why and How Meet n-3 PUFA Dietary Recommendations?
Molendi‐Coste, O., Legry, V., & Leclercq, I. A. (2010) · Gastroenterology Research and Practice · doi:10.1155/2011/364040 · Cited by 204 · see citing works
Omega-3 fatty acid status in attention-deficit/hyperactivity disorder
Antalis, C. J., Stevens, L. J., Campbell, M. L., Pazdro, R., Ericson, K. L., & Burgess, J. R. (2006) · Prostaglandins Leukotrienes and Essential Fatty Acids · doi:10.1016/j.plefa.2006.07.004 · Cited by 200 · see citing works
Johnson, M., Östlund, S., Fransson, G., Kadesjö, B., & Gillberg, C. (2009) · Journal of Attention Disorders · doi:10.1177/1087054708316261 · Cited by 198 · see citing works
Chen, J., Hsu, S.-F., Hsu, C.-D., Hwang, L.-H., & Yang, S. (2004) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2004.01.008 · Cited by 186 · see citing works
Sex-specific differences in essential fatty acid metabolism
Décsi, T., & Kennedy, K. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.000893 · Cited by 170 · see citing works
Richardson, A. J., Burton, J., Sewell, R. P., Spreckelsen, T. F., & Montgomery, P. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043909 · Cited by 169 · see citing works
Vaisman, N., Kaysar, N., Zaruk-Adasha, Y., Pelled, D., Brichon, G., Zwingelstein, G., & Bodennec, J. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.5.1170 · Cited by 160 · see citing works
Gillies, D. M., Sinn, J. K. H., Lad, S. S., Leach, M., & Ross, M. J. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007986.pub2 · Cited by 160 · see citing works
Colter, A. L., Cutler, C., & Meckling, K. A. (2008) · Nutrition Journal · doi:10.1186/1475-2891-7-8 · Cited by 152 · see citing works
Drane, D. L., & Logemann, J. A. (2000) · Paediatric and Perinatal Epidemiology · doi:10.1046/j.1365-3016.2000.00301.x · Cited by 152 · see citing works
Sorgi, P., Hallowell, E. M., Hutchins, H., & Sears, B. (2007) · Nutrition Journal · doi:10.1186/1475-2891-6-16 · Cited by 140 · see citing works
The effects of essential fatty acid supplementation by efamol in hyperactive children
Aman, M. G., Mitchell, E. A., & Turbott, S. H. (1987) · Research on Child and Adolescent Psychopathology · doi:10.1007/bf00916467 · Cited by 136 · see citing works
Milte, C. M., Parletta, N., Buckley, J. D., Coates, A. M., Young, R. M., & Howe, P. R. C. (2012) · Nutrition · doi:10.1016/j.nut.2011.12.009 · Cited by 135 · see citing works
Joshi, K. S., Lad, S. S., Kale, M., Patwardhan, B., Mahadik, S. P., Patni, B., Chaudhary, A., Bhave, S. A., & Pandit, A. (2005) · Prostaglandins Leukotrienes and Essential Fatty Acids · doi:10.1016/j.plefa.2005.10.001 · Cited by 125 · see citing works
Arnold, L. E., Kleykamp, D., Votolato, N. A., Taylor, W. A., Kontras, S. B., & Tobin, K. (1989) · Biological Psychiatry · doi:10.1016/0006-3223(89)90167-4 · Cited by 118 · see citing works
Stevenson, J., Sonuga-Barke, E. J. S., McCann, D., Grimshaw, K. E. C., Parker, K. M., Rose-Zerilli, M. J. J., Holloway, J. W., & Warner, J. O. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09101529 · Cited by 113 · see citing works
Young, G. S., Maharaj, N. J., & Conquer, J. A. (2004) · Lipids · doi:10.1007/s11745-004-1209-3 · Cited by 112 · see citing works
Stevenson, J., Buitelaar, J., Cortese, S., Ferrin, M., Konofal, E., Lecendreux, M., Simonoff, E., Wong, I. C. K., & Sonuga‐Barke, E. (2014) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12215 · Cited by 106 · see citing works
Itomura, M., Hamazaki, K., Sawazaki, S., Kobayashi, M., TERASAWA, K., Watanabe, S., & Hamazaki, T. (2005) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2004.10.009 · Cited by 99 · see citing works
Manor, I., Magen, A., Keidar, D., Rosen, S., Tasker, H., Cohen, T., Richter, Y., Zaaroor-Regev, D., Manor, Y., & Weizman, A. (2012) · European psychiatry · doi:10.1016/j.eurpsy.2011.05.004 · Cited by 98 · see citing works
Bélanger, S., Vanasse, M., Spahis, S., Sylvestre, M., Lippé, S., L'heureux, F., Ghadirian, P., Vanasse, C., & Levy, E. (2009) · Paediatrics & child health · doi:10.1093/pch/14.2.89 · Cited by 94 · see citing works
Germano, M., Meleleo, D., Montorfano, G., Adorni, L., Negroni, M., Berra, B., & Rizzo, A. M. (2007) · Nutritional Neuroscience · doi:10.1080/10284150601153801 · Cited by 81 · see citing works
Perera, H., Jeewandara, K. C., Seneviratne, S., & Guruge, C. (2012) · Journal of Child Neurology · doi:10.1177/0883073811435243 · Cited by 69 · see citing works
Raz, R., Carasso, R. L., & Yehuda, S. (2009) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2008.070 · Cited by 67 · see citing works
Dietary Omega-3 Fatty Acids Modulate Large-Scale Systems Organization in the Rhesus Macaque Brain
Grayson, D. S., Kroenke, C. D., Neuringer, M., & Fair, D. A. (2014) · Journal of Neuroscience · doi:10.1523/jneurosci.3038-13.2014 · Cited by 67 · see citing works
Kohlboeck, G., Glaser, C., Tiesler, C. M. T., Demmelmair, H., Standl, M., Romanos, M., Koletzko, B. V., Lehmann, I., & Heinrich, J. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.015800 · Cited by 60 · see citing works
Milte, C. M., Parletta, N., & Howe, P. R. C. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2009.00229.x · Cited by 50 · see citing works
Kirby, A., Woodward, A. J., Jackson, S., Wang, Y., & Crawford, M. A. (2010) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2010.01.015 · Cited by 45 · see citing works
Gow, R. V., Matsudaira, T., Taylor, E. A., Rubia, K., Crawford, M. A., Ghebremeskel, K., Ibrahimovic, A., Vallée‐Tourangeau, F., Williams, L. M., & Sumich, A. L. (2009) · Prostaglandins Leukotrienes and Essential Fatty Acids · doi:10.1016/j.plefa.2008.12.007 · Cited by 25 · see citing works
Project DyAdd: Fatty acids in adult dyslexia, ADHD, and their comorbid combination
Laasonen, M. R., Hokkanen, L., Leppämäki, S., Tani, P., & Erkkilä, A. T. (2009) · Prostaglandins Leukotrienes and Essential Fatty Acids · doi:10.1016/j.plefa.2009.04.005 · Cited by 23 · see citing works
Brue, A. W., Oakland, T., & Evans, R. (2001) · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Brue AW Oakland TD Evans RA The use of a dietary supplement combination and an essential fatty acid as an alternative and complementary treatment for children with attention-deficit/hyperactivity disorder The Scientific Review of Alternative Medicine 2001 5 4 187 194
Cited by
Sorted by citations
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., et al. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.022 · Cited by 1,545 · see citing works
“1408 participants, 7 studies with 534 participants) (Bloch and Qawasmi, 2011; Chang et al., 2018; Hawkey and Nigg, 2014).”
InfluentialSelf-citationNeuroinflammation as a risk factor for attention deficit hyperactivity disorder
Dunn, G. A., Nigg, J. T., & Sullivan, E. L. (2019) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2019.05.005 · Cited by 299 · see citing works
Self-citationKim, J. H., Kim, J. Y., Lee, J., Jeong, G. H., Lee, E., Lee, S., Lee, K. H., Kronbichler, A., Stubbs, B., Solmi, M., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30312-6 · Cited by 258 · see citing works
Adams, J., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E., Mitchell, J., Ingram, J., Hellmers, R., Laake, D., et al. (2018) · Nutrients · doi:10.3390/nu10030369 · Cited by 267 · see citing works
Chang, J. P.-C., Su, K.-P., Mondelli, V., & Pariante, C. M. (2018) · Neuropsychopharmacology · doi:10.1038/npp.2017.160 · Cited by 248 · see citing works
Firth, J., Teasdale, S. B., Allott, K., Siskind, D., Marx, W., Cotter, J., Veronese, N., Schuch, F., Smith, L., Solmi, M., et al. (2019) · World Psychiatry · doi:10.1002/wps.20672 · Cited by 214 · see citing works
Importance of EPA and DHA Blood Levels in Brain Structure and Function
von Schacky, C. (2021) · Nutrients · doi:10.3390/nu13041074 · Cited by 174 · see citing works
Cenit, M. C., Nuevo, I. C., Codoñer-Franch, P., Dinan, T. G., & Sanz, Y. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-0969-z · Cited by 163 · see citing works
The Mediterranean Diet and ADHD in Children and Adolescents
Ríos-Hernández, A., Alda, J. A., Farran-Codina, A., Ferreira-García, E., & Izquierdo-Pulido, M. (2017) · PEDIATRICS · doi:10.1542/peds.2016-2027 · Cited by 160 · see citing works
Pelsser, L. M., Frankena, K., Toorman, J., & Rodrigues Pereira, R. (2017) · PLOS ONE · doi:10.1371/journal.pone.0169277 · Cited by 145 · see citing works
Healy-Stoffel, M., & Levant, B. (2018) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527317666180412153612 · Cited by 133 · see citing works
Working memory and organizational skills problems in <scp>ADHD</scp>
Kofler, M. J., Sarver, D. E., Harmon, S. L., Moltisanti, A., Aduen, P. A., Soto, E. F., & Ferretti, N. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12773 · Cited by 125 · see citing works
Farsad-Naeimi, A., Asjodi, F., Omidian, M., Askari, M., Nouri, M., Pizarro, A. B., & Daneshzad, E. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102512 · Cited by 99 · see citing works
Restriction and Elimination Diets in ADHD Treatment
Nigg, J. T., & Holton, K. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.010 · Cited by 60 · see citing works
Self-citationLewis, N., Villani, A., & Lagopoulos, J. (2025) · Neuroscience · doi:10.1016/j.neuroscience.2025.01.031 · Cited by 25 · see citing works
Wang, Z., Zhu, H., Chen, L., Gan, C., Min, W., Xiao, J., Zou, Z., & He, Y. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241264660 · Cited by 4 · see citing works
- Authors
- Hawkey, E., & Nigg, J. T.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Nigg, Joel T.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 34
- Issue
- 6
- Pages
- 496-505
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC4321799
- OpenAlex
- W1986174305
- Semantic Scholar
- 9b20b26842557903ae106b5510f32038ef9474af
- Cited by
- 160
- References
- 51
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 14 · 2023: 6 · 2022: 16 · 2021: 12 · 2020: 12 · 2019: 15 · 2018: 15 · 2017: 21 · 2016: 18 · 2015: 9 · 2014: 3
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- OHSU internal institutional funds
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- omega-3 fatty acids, attention deficit hyperactivity disorder, serum lipids, hyperactivity, inattention, children, dietary supplementation, parent and teacher ratings
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Humans, Fatty Acids, Omega-3
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
