This project examines whether inadequate dietary intakes of omega-3 essential fatty acids increases the risk for pathological behaviors associated with alcoholism, specifically depression, aggression and suicide. Randomized, placebo controlled clinical interventional trials are currently being conducted in adult populations among aggressive alcoholics, women with depression during pregnancy and suicide attempters. These studies have been stimulated by the discovery of large differences in the prevalence rates of several psychiatric disorders when comparing populations with high or low measure of seafood consumption and from examinations of omega-3 fatty acid tissue concentrations in epidemiological studies. Nutritional inadequacies during early development may leave residual neuropsychiatric deficits which contribute to an increased predisposition toward psychiatric disorders in adulthood. Developmental outcome studies are discussed below. In our ongoing clinical trial of aggressive alcoholics, the key questions are to assess if treatment with 2.8 g/d of omega-3 fatty acids will reduce 1) aggressive behaviors, 2) improve neurochemical measures of serotonergic function 3) improve cardiovascular measures thought to be associated with depressive and violent behaviors. This protocol has been actively recruiting subjects and has achieved a 100% tracking of data. Preliminary results are not available until completion when the blind is broken. In collaboration with Laure-Budens Branchey, M.D. we found that low plasma levels of DHA and AA predicted relapse among cocaine and alcohol dependent subjects over the course of two years. We have consulted on a successfully funded R0-1 grant to determine if supplementation with omega-3 fatty acids will actually reduce relapse in a randomized, controlled trial. Mothers can become depleted of omega-3 essential fatty acids during pregnancy when their dietary intake is inadequate. Dietary deficiencies may increase the risk of depressive symptoms for the mothers. 1) Preliminary data is available from an open trial of omega-3 fatty acids among women with depression during pregnancy currently being conducted in collaboration with Marlene Freeman, MD at the University of Arizona. Depressive symptoms were reduced an average of 43.5 % during 8 weeks of treatment. These findings are significant as they offer a treatment for depression during pregnancy that is no only non toxic, but has additional health benefits to pregnant women and their babies. These findings are being followed up with a randomized, controlled trial. These results of these interventional trials were predicted from data from an epidemiological study of the dietary intake of omega-3 fatty acids during pregnancy among nearly 14,000 women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). In a clear dose response relationship, deficient intakes were associated with nearly a doubling of the risk of depressive symptoms (EPDS >12) at 32 weeks gestation (p<1.4 X 10 -17) and 18 weeks gestation and at both 8 weeks and 8 months postpartum. Findings were robust after rigorous examination of potential confounding factors. Deficient intake of omega-3 essential fatty acids during early development may also have adverse residual effects on the behaviors of children. 1) In collaboration with the ALSPAC study, we found that deficient intake of omega-3 fatty acids during pregnancy were related to a doubling of the risk of adverse behavioral disorders among children at both 3.5 and 7 years of age. A dose response relationship predicted such parameters as increased risk of conduct disorders: fighting, lying, stealing, disobedience, which are well recognized risk factors for future sociopathic and criminal behaviors. These data are still being evaluated to determine the contribution of other variables such as socioeconomic status. We have collaborated in the submission of an R0-1 grant to prospectively capture initial drinking behavior of these children as they enter adolescence. These data can be evaluated to determine if inadequate intake during pregnancy or early childhood is a risk factor for future substance abuse. If this is identified as a risk factor, prevention studies can be planned. Since early neurodevelopmental insults have been identified as an increased risk for schizophrenia, we have examined two populations in which both plasma, obtained at birth, and 40 year clinical follow up data were available. In the first study, low plasma concentrations of essential fatty acids were unrelated to the risk of developing psychosis. Data from the second study are currently being evaluated. In a prior cross-national analysis we found higher rates of homicide mortality were correlated to lower rates of seafood consumption. In order to further refine this finding we utilized the observation that the omega-6 fatty acids from seed oils compete with omega-3 fatty acids for tissue deposition. We found that from 1950 to 2000, the increasing rates of homicide mortality were closely correlated with increasing availability omega-6 fatty acids in the food supply, in the USA, the United Kingdom, Australia and Canada. This association is also are consistent with observational and interventional data for violence and hostility published by other investigators. 2) In collaboration with Dr. Carlos Iribarren, we examined the dietary intake of omega-3 fatty acids and behavioral correlates among the 4,000 subjects in the CARDIA trial. We found that among all categories of subjects, including white men, white women, black men and black women, lower intake of DHA and other omega-3 fatty acids predicted a doubling of the risk of reporting clinically significant measures of hostility. These findings were robust after evaluation of confounding factors. 3) In an interventional trial conducted in collaboration with Dr. Muldoon at the University of Pittsburgh, subjects with hypercholesterolemia were given either Simvistatin, (a cholesterol lowering drug) or a placebo for 8 weeks. We quantified changes in mood, cognition and plasma concentrations of essential fatty acids. Treatment with Simvistatin lowered total fatty acid concentrations, but spared DHA and AA. The relationship between the sparing of these essential fatty acids and improvements or decrements in mood and cognition are still under examination. 4) We co-authored a now funded R0-1 to conduct a randomized trial of omega-3 fatty acids to reduce aggression among Thai school children. Reduction of the duration of cold and influenza infections will also be assessed and this project is currently underway.
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