A case series on the potential effect of omega-3-fatty acid supplementation on 24-h heart rate variability and its circadian variation in children with attention deficit (hyperactivity) disorder

  • Reiner Buchhorn
  • Julian Koenig
  • Marc N. Jarczok
  • Hanna Eichholz
  • Christian Willaschek
  • Julian F. Thayer
  • Michael Kaess
Short Communication


Attention deficit disorder with and without hyperactivity (ADHD) in children is associated with decreased 24-h heart rate variability (HRV). Previous research has shown that supplementation of omega-3-fatty acid increases HRV. Here, we aimed to investigate whether the supplementation of omega-3-fatty acids would increase 24-h HRV in an uncontrolled case series of children with ADHD. HRV was recorded in 18 children and adolescents (age 13.35 ± 2.8 years) before and after omega-3 supplementation. Preliminary results indicate that omega-3 supplementation in children with AD(H)D may reduce mean heart rate and increase its variability. Future studies would do well to implement randomized, placebo-controlled designs with greater methodological rigor.


Heart rate variability ADHD Vagal activity Circadian variation Omega-3 



JK and MNJ are supported by a Physician-Scientist-Fellowship provided by the Medical Faculty of Heidelberg University.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest, real or perceived, to declare.


  1. Bos DJ, Oranje B, Veerhoek ES, Van Diepen RM, Weusten JM, Demmelmair H et al (2015) Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol 40:2298–2306CrossRefGoogle Scholar
  2. Buchhorn R, Christian W (2014) Ventricular arrhythmias in children with attention deficit disorder—a symptom of autonomic imbalance? Cardiol Young 24:120–125CrossRefPubMedGoogle Scholar
  3. Buchhorn R, Conzelmann A, Willaschek C, Störk D, Taurines R, Renner TJ (2012) Heart rate variability and methylphenidate in children with ADHD. Atten Deficit Hyperact Disord 4:85–91CrossRefGoogle Scholar
  4. Carney RM, Freedland KE, Stein PK, Steinmeyer BC, Harris WS, Rubin EH et al (2010) Effect of omega-3 fatty acids on heart rate variability in depressed patients with coronary heart disease. Psychosom Med 72:748–754CrossRefPubMedPubMedCentralGoogle Scholar
  5. Chang J-C, Su K-P, Mondelli V, Pariante CM (2017) Omega-3 polyunsaturated fatty acids in youths with attention deficit hyperactivity disorder (ADHD): a systematic review and meta-analysis of clinical trials and biological studies. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. doi: 10.1038/npp.2017.160 Google Scholar
  6. Christensen JH (2011) Omega-3 polyunsaturated fatty acids and heart rate variability. Front Physiol. doi: 10.3389/fphys.2011.00084 PubMedPubMedCentralGoogle Scholar
  7. Cooper RE, Tye C, Kuntsi J, Vassos E, Asherson P (2015) Omega-3 polyunsaturated fatty acid supplementation and cognition: a systematic review and meta-analysis. J Psychopharmacol 29:753–763CrossRefPubMedGoogle Scholar
  8. Cooper RE, Tye C, Kuntsi J, Vassos E, Asherson P (2016) The effect of omega-3 polyunsaturated fatty acid supplementation on emotional dysregulation, oppositional behaviour and conduct problems in ADHD: a systematic review and meta-analysis. J Affect Disord 190:474–482CrossRefPubMedGoogle Scholar
  9. Dalsgaard S, Kvist AP, Leckman JF, Nielsen HS, Simonsen M (2014) Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study. J Child Adolesc Psychopharmacol 24:302–310CrossRefPubMedPubMedCentralGoogle Scholar
  10. Farah BQ, Barros MVG, Balagopal B, Ritti-Dias RM (2014) Heart rate variability and cardiovascular risk factors in adolescent boys. J Pediatr 165:945–950CrossRefPubMedGoogle Scholar
  11. Gow RV, Hibbeln JR, Parletta N (2015) Current evidence and future directions for research with omega-3 fatty acids and attention deficit hyperactivity disorder. Curr Opin Clin Nutr Metab Care 18:133–138CrossRefPubMedGoogle Scholar
  12. Hawkey E, Nigg JT (2014) Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clin Psychol Rev 34:496–505CrossRefPubMedPubMedCentralGoogle Scholar
  13. Koenig J, Rash JA, Kemp AH, Buchhorn R, Thayer JF, Kaess M (2017) Resting state vagal tone in attention deficit (hyperactivity) disorder: a meta-analysis. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry 18:256–267CrossRefGoogle Scholar
  14. London B, Albert C, Anderson ME, Giles WR, Wagoner DRV, Balk E et al (2007) Omega-3 fatty acids and cardiac arrhythmias: prior studies and recommendations for future research. Circulation 116:e320–e335CrossRefPubMedGoogle Scholar
  15. Messamore E, McNamara RK (2016) Detection and treatment of omega-3 fatty acid deficiency in psychiatric practice: rationale and implementation. Lipids Health Dis. doi: 10.1186/s12944-016-0196-5 PubMedPubMedCentralGoogle Scholar
  16. Mick E, McManus DD, Goldberg RJ (2013) Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol 23:534–541CrossRefGoogle Scholar
  17. Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ (2013) Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PLoS ONE 8:e66697CrossRefPubMedPubMedCentralGoogle Scholar
  18. Neylon A, Canniffe C, Anand S, Kreatsoulas C, Blake GJ, Sugrue D, McGorrian C (2013) A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis 55:574–581CrossRefPubMedGoogle Scholar
  19. O’Keefe JH Jr, Abuissa H, Sastre A, Steinhaus DM, Harris WS (2006) Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am J Cardiol 97:1127–1130CrossRefPubMedGoogle Scholar
  20. Romieu I, Téllez-Rojo MM, Lazo M, Manzano-Patiño A, Cortez-Lugo M, Julien P et al (2005) Omega-3 fatty acid prevents heart rate variability reductions associated with particulate matter. Am J Respir Crit Care Med 172:1534–1540CrossRefPubMedGoogle Scholar
  21. Simopoulos AP (2008) The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med Maywood NJ 233:674–688CrossRefGoogle Scholar
  22. Sinn N, Milte C, Howe PRC (2010) Oiling the brain: a review of randomized controlled trials of omega-3 fatty acids in psychopathology across the lifespan. Nutrients 2:128–170CrossRefPubMedPubMedCentralGoogle Scholar
  23. Sinn N, Milte CM, Street SJ, Buckley JD, Coates AM, Petkov J, Howe PRC (2012) Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial. Br J Nutr 107:1682–1693CrossRefPubMedGoogle Scholar
  24. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93:1043–1065CrossRefGoogle Scholar
  25. Thayer JF, Yamamoto SS, Brosschot JF (2010) The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 141:122–131CrossRefPubMedGoogle Scholar
  26. Triedman JK, Alexander ME (2010) Needle in a haystack. Circulation 121:1283–1285CrossRefPubMedGoogle Scholar
  27. Vrijkotte TGM, van den Born B-JH, Hoekstra CMCA, Gademan MGJ, van Eijsden M, de Rooij SR, Twickler MTB (2015) Cardiac autonomic nervous system activation and metabolic profile in young children: the ABCD study. PLoS ONE 10:e0138302CrossRefPubMedPubMedCentralGoogle Scholar
  28. Widenhorn-Müller K, Schwanda S, Scholz E, Spitzer M, Bode H (2014) Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. Prostaglandins Leukot Essent Fatty Acids 91:49–60CrossRefPubMedGoogle Scholar
  29. Wulsin LR, Horn PS, Perry JL, Massaro J, D’Agostino R (2015): Autonomic imbalance as a predictor of metabolic risks, cardiovascular disease, diabetes, and mortality autonomic imbalance predicts CVD, DM, mortality. J Clin Endocrinol Metab. jc20144123Google Scholar

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Reiner Buchhorn
    • 1
  • Julian Koenig
    • 2
  • Marc N. Jarczok
    • 3
  • Hanna Eichholz
    • 1
  • Christian Willaschek
    • 1
  • Julian F. Thayer
    • 4
  • Michael Kaess
    • 2
    • 5
  1. 1.Department of Paediatrics, Klinik für Kinder- und JugendmedizinCaritas KrankenhausBad MergentheimGermany
  2. 2.Section for Translational Psychobiology in Child and Adolescents Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial MedicineHeidelberg UniversityHeidelbergGermany
  3. 3.Institute of Medical Psychology, Center for Psychosocial MedicineHeidelberg UniversityHeidelbergGermany
  4. 4.Department of PsychologyThe Ohio State UniversityColumbusUSA
  5. 5.Clinic for Child and Adolescent PsychiatryUniversity Hospital HeidelbergHeidelbergGermany

Personalised recommendations