Omega 3 Fatty Acids

Prepared by Francisca Soto-Aguilar Bralic. MD, Ms Nutrition, Ms Global Public Health

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Omega-3 fatty acids are essential polyunsaturated fats that play a crucial role in the development of the brain, eyes, and nervous system. They are also vital for maintaining cardiovascular health and reducing inflammation. Omega-3s are found mainly in fatty fish, flaxseeds, chia seeds, hemp seeds and walnuts. The types of Omega-3s found in these sources are different, and long-chain Omega-3s such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the diet are found only in animal sources. Many children may not consume sufficient amounts of omega-3s through their diet, so supplementation with fish or microalgae oils may be important in some cases. This guideline provides recommendations for omega-3 supplementation in children, based on U.S. dietary recommendations and current research.

Recommended Dietary Intakes (RDI) for Omega-3 Fatty Acids in Children

The Institute of Medicine (IOM)—now known as the National Academy of Medicine (NAM)-has set Adequate Intakes (AI) for omega-3 fatty acids, specifically alpha-linolenic acid (ALA), which is the essential omega-3 fatty acid found in plant sources:

Note: Adequate Intake (AI) is the recommended intake for nutrients based on observed or experimentally determined estimates of intake by a group of healthy people. For vegetarian and vegan people, who’s omega-3 intake is based on short-chain fatty acids only (ALA), experts recommend to increase the RDI.

Omega-3 Supplementation Recommendations by Age

Infants (0-12 months)

Rationale: Omega-3 fatty acids, particularly DHA, are essential for brain and retinal development in infants. Since breast milk is a natural source of DHA, exclusively breastfed infants typically receive adequate omega-3s. However, in cases where breastfeeding is not possible or if the mother has a low omega-3 intake, infant formula enriched with DHA is recommended.

Recommendation:

• Breastfed infants: Asses mother’s omega-3 intake. Continue breastfeeding, as it can provide omega-3s, particularly DHA.
• Formula-fed infants: Ensure the formula is DHA-enriched.
• Supplementation: Given that many people do not consume a diet rich in omega-3s, the process of ALA conversion may not keep up with the increased DHA requirements at this critical stage for brain and eyes development, so a supplement of 0.5 grams of DHA + EPA per day is recommended. This supplement can be made of micro algae or fish oils.

Summary: infants and their mothers (if breastfed) should be assessed and advised in their intake of omega-3 fatty acids, and supplementation at this stage is recommended, with micro algae oils or fish oils containing 0,5 grams of DHA+EPA.

Toddlers (1-3 years)

Rationale: The rapid development of the brain and nervous system continues in this age group, with DHA playing a key role in cognitive and visual development. This is also a period when dietary habits may limit omega-3 intake.

Recommendation:

Diet: Omega-3s can be obtained from a combination of food sources like fatty fish (e.g., salmon, mackerel), flaxseeds, chia seeds, hemp seeds and walnuts. These plant-sources should be milled before offering them to toddlers, for a better absorption and to avoid obstruction of the airway.

• Fatty fish: 2-3 servings per week
• Milled flaxseeds: 1/4-1/2 tablespoon per day
• Milled chia seeds: 1/4-1/2 tablespoon per day
• Milled hemp seeds: 1 tablespoon per day
• Walnuts: 5-10 grams per day

Supplementation: Given that most people do not consume a diet rich in omega-3s, the process of ALA conversion may not keep up with the increased DHA requirements at this critical stage for brain and eyes development, so a supplement of 0.5 grams of DHA + EPA per day is recommended. This supplement can be made of micro algae or fish oils.

Summary: toddler’s caretakers should be assessed and advised in their intake of omega-3 fatty acids through foods, but on top of that a supplementation at this stage is recommended, with micro algae oils or fish oils containing 0,5 grams of DHA+EPA.

Children (4-8 years)

Rationale: At this age, children need omega-3s for optimal brain function, cognitive development, and eye health. The majority of children in this age group may not be consuming sufficient omega-3s from their diet, so assessment and medical advice is important.

Recommendation:

Diet: Encourage regular and varied consumption of omega-3-rich foods, such as milled flaxseeds, milled chia seeds, milled hep seeds, walnuts and fatty fish (for children that consume them).

Supplementation: If omega-3-rich foods are not consistently included in the diet, supplementation with plant-based omega-3 oils (micro algae oil) or fish oil is recommended

Summary: children’s caretakers should be assessed and advised in their intake of omega-3 fatty acids through foods, and supplementation at this stage can be recommended when these foods are not sufficiently included in their diets.

Children (9-13 years)

Rationale: The brain continues to develop throughout childhood, and adequate omega-3 intake is essential for improving cognitive function, focus, and memory. Omega-3 fatty acids also support cardiovascular health as children approach adolescence.

Recommendation:

Diet: Encourage regular and varied consumption of omega-3-rich foods, such as milled flaxseeds, milled chia seeds, milled hep seeds, walnuts and fatty fish (for children that consume them).

Supplementation: If omega-3-rich foods are not consistently included in the diet, supplementation with plant-based omega-3 oils (micro algae oil) or fish oil is recommended.

Summary: children’s caretakers should be assessed and advised in their intake of omega-3 fatty acids through foods, and supplementation at this stage can be recommended when these foods are not sufficiently included in their diets.

Adolescents (14-18 years)

Rationale: Omega-3 fatty acids remain important during adolescence for brain function, particularly for learning, memory, and mood regulation. Omega-3s also support cardiovascular health as cholesterol and blood pressure can begin to show early signs of change.

Recommendation:

Diet: Encourage regular and varied consumption of omega-3-rich foods, such as milled flaxseeds, milled chia seeds, milled hep seeds, walnuts and fatty fish (for children that consume them).

Supplementation: If omega-3-rich foods are not consistently included in the diet, supplementation with plant-based omega-3 oils (micro algae oil) or fish oil is recommended.

Summary: adolescent’s should be assessed and advised in their intake of omega-3 fatty acids through foods, and supplementation at this stage can be recommended when these foods are not sufficiently included in their diets.

Special Populations at Risk for Omega-3 Deficiency

Certain children are at a higher risk for omega-3 deficiency and may require supplementation:

• Children on Vegetarian or Vegan Diets and children that do not consume fatty fish and seafoods regularly: These children may not consume enough EPA and DHA from their diet and should be advised to include regularly plant-sources of omega-3 fatty acids, and considered for supplementation with micro algae oil when needed.
• Children with Food Allergies: Those with fish allergies or sensitivities may not be able to obtain omega-3s from traditional fish sources and can benefit from a regular consumption of plant-sources and/or algae-based supplements.
• Children with Malabsorption Conditions: Conditions like cystic fibrosis, celiac disease, and Crohn’s disease can impair fat absorption, including omega-3s, and may require supplementation in higher doses.
• Children with Developmental Disorders: Children with ADHD or other developmental delays may benefit from omega-3 supplementation, as studies suggest that DHA and EPA support cognitive function and behavior, but these conditions do need further studies.

Safety and Monitoring

• Toxicity: Omega-3 fatty acids are generally considered safe when taken in appropriate amounts. However, excessive intake (e.g., >3 g/day) may increase the risk of bleeding or interfere with immune function. Omega-3 supplementation should be monitored for potential side effects, especially at high doses.
• Upper Intake Levels: The U.S. Institute of Medicine has not set upper intake levels for omega-3s, but exceeding 3 grams per day may lead to adverse effects, especially in children with clotting disorders or those taking anticoagulant medications.
• Monitoring: While omega-3 deficiency is rare, regular assessment of dietary habits and supplementation adherence is important. For children on restricted diets or those receiving supplementation, periodic blood tests can assess omega-3 status, although this is generally not required in healthy children.

References

1. Institute of Medicine. 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490.
2. Baroni L, Goggi S, Battaglino R, Berveglieri M, Fasan I, Filippin D, Griffith P, Rizzo G, Tomasini C, Tosatti MA, Battino MA. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. Nutrients. 2018 Dec 20;11(1):5. doi: 10.3390/nu11010005. PMID: 30577451; PMCID: PMC6356233.
3. Saunders, A. V., Davis, B. C., & Garg, M. L. (2013). Omega-3 polyunsaturated fatty acids and vegetarian diets. The Medical journal of Australia, 199(S4), S22-S26. https://doi.org/10.5694/mja11.11507

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