The FINS-TEENS randomized trial looked into how the ingestion of fatty fish impacted adolescents’ nutrition as well as their ability to concentrate.
Background
Small changes in what one eats may have the power to affect mental abilities in humans, even in industrialized countries with ample food sources. Most research has looked into the significance of nutrition during early childhood when the brain is most active and at a higher risk of harm due to lacking proper nutrition. Even though we still have a lot to learn, it is clear that during the teenage years the brain is still developing, and there is not much knowledge about nutrition’s impact on mental capability in teenagers from normal schools.
The accumulating proof shows that a sufficient amount of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFAs) is necessary for the proper progress and activity of the brain. It is reasonable to think that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have a role to play since they are essential parts of neural cell membranes. The brain is influenced by the alteration of membrane fluidity, insulating of nerve cells (myelination), and sending of chemical signals (neurotransmission). Furthermore, people in Europe are eating too much of the n-6 kind of fatty acids, which could create an inequity between the n-6 and n-3 PUFAs inside their bodies. No randomized controlled trials have been able to demonstrate that supplementation with n-3 PUFA affects cognition in individuals who do not have a diagnosed mental health condition. In healthy adolescents, the results were not clear, and two separate randomized controlled trials found no advantage of adding DHA on its own or with EPA to cognitive performance in students.
Young people who eat fish have been proven to do better in school and on cognitive tests. An experiment using a randomized controlled trial determined that reading ability improved after a school meal plan that included fish being served roughly once a week. Fattier types of fish such as mackerel, herring, and salmon are the key dietary sources of n-3 LCPUFAs, but they also have other vital micronutrients for the brain, like vitamin D, iodine, and vitamin B12. The diet of Norwegian adolescents contains little fish. It is sensible to speculate that having more fatty fish in one’s diet might be more advantageous than consuming meat and even taking n-3 LCPUFAs supplements. We are unaware of any randomized controlled trials that have previously studied the direct effect of consuming fish on the mental ability of teenagers.
The purpose of this randomized controlled trial was to determine if consuming fatty fish three times a week for 12 weeks would change the attention span of adolescents, aged 14 to 15, when compared to similar meals that had meat and/or supplements containing long-chain polyunsaturated fatty acids.
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Methods
Study design and ethics
An investigation, called FINS-TEENS, was performed in eight lower secondary schools situated in Bergen, Norway during the period of February to May of 2015. A three-part study employed a randomized controlled trial (RCT) format to look into the mental responsiveness resulting from feeding teens from normal schools dishes that have fatty fish or food choices with either meat/cheese or fish oil supplements.
The experiment followed the guidelines outlined in the agreement of Helsinki. Permission was granted from the Norwegian Data Protection Official for Research (project number: 41030) for ethical conduct. All participants and their parent/caregiver provided written permission before the trial began, and participants had the option to leave the trial without needing to explain their decision.
Subjects and randomization
Adolescents in the 9th grade of the participating schools who had fluency in both spoken and written Norwegian were included in the study. All 9th grade students were given an invite to take part in the research. The participants who were not eligible for this study were those who reported an allergy or intolerance to the food or supplements being used. The random allocation was performed individually stratified by sex. Two researchers (with one of them blinded) chose to put each enrolled boy and girl into either the fish, the meat, or the supplement group randomly. The researchers and participants were aware of which treatment conditions were used in the current study, but the d2 test of attention was rated without knowing which treatment they had taken part in.
The sustenance and vitamins were provided to students during their standard lunch period (typically between 11am and 12pm) while they were at school. The participants ate together in their respective classrooms. The participants’ regular school lunch was replaced by fish and meat dishes, while the individuals in the supplement group ate their customary lunch as well as took the supplements. The individuals involved got the food or health supplements three times weekly over a period of 12 weeks. In Norway, school lunches generally consist of a homemade sandwich, with either medium dark or dark bread or crispbread filled with meat, cheese, or liverwurst paste, and a piece of fruit or vegetable.
The catering service cooked both the seafood dishes and the meat-based options. Meals in the fish group consisted of salmon, mackerel, and herring, whereas the meat group meals had chicken, turkey, beef, lamb, and cheese. Upon request, only food that adheres to halal standards was served, and no pork was included. The meals had the same ingredients other than meat or fish, and they included vegetables and/or salad, usually wheat-based pastas, focaccia bread, baguettes, or tortillas, and sometimes a dressing. For the gluten-sensitive participants, we had gluten-free items available upon request, however those with celiac disease had to opt out of the trial since it was not practical for us to guarantee completely gluten-free meals. The n-3 LCPUFAs of the supplementation and fish group were equalized with the help of a reference of 90 g fish per serving, and seven capsules were given to each serving. The capsules of Nycoplus® Omega-3, sold at a public pharmacy, had 500 mg of fish oil in each, of which 158 mg was EPA, 105 mg was DHA and 13 mg was DPA (docosapentaenoic acid). On average, each portion of the food weighed 230 g and the fish group meals contained 2.1 micrograms per 100 g of vitamin D, 4.9 micrograms per 100 g of iodine, 152.3 milligrams per 100 g of EPA, 262.3 milligrams per 100 g of DHA, and 39.9 milligrams per 100 g of DPA. The food items in the animal-based foods group had, on average, less than 1 microgram of vitamin D per 100 grams, 2.6 micrograms of iodine per 100 grams, 3.2 milligrams of eicosapentaenoic acid per 100 grams, 5 milligrams of docosahexaenoic acid per 100 grams, and 6 milligrams of docosapentaenoic acid per 100 grams.
Every participant in the trial was monitored to make sure they followed their diets as prescribed. They tallied the remaining capsules and visually estimated how much fish/meat had been devoured by utilizing a range from 0 to 4; ‘0’ signifying ‘none consumed’, ‘1’ representing ‘1/4 consumed’, ‘2’ meaning ‘2/4 consumed’, ‘3’ signifying ‘3/4 consumed’, and ‘4’ corresponding to ‘all consumed’.
Results
Study population
Out of the 785 pupils who were studying in the ninth grade when enrollments were taking place, 481 (or 61%) consented to join in. Three people took out themselves from the study on the day of commencing the test before it was randomly assigned. Thus, 478 participants were randomly allocated to intervention groups. Forty-seven people dropped out of the study and ceased taking part in the intervention, with 22 of them being in the fish group, 11 of them in the meat group, and 14 of them in the supplement group. The caregivers filled out 370 questionnaires out of the total, which accounted for 78% of them.
The average age of the participants was 14.6 years with a standard deviation of 0.3, and an average BMI of 19.8kg/m2 with a standard deviation of 2.9. The majority of participants in the study were natives, meaning that the individual and both of their parents were both born in Norway. The average omega-3 index for the members was 5.8 and the range was 1.3%. In addition, 95% of the people in the study had an index that was 8% or less. 92%, 10%, and 40% of individuals had levels of s-25(OH)D, s-ferritin and UIC that were below the required amount. The average amount of fish eaten for dinner each week was said to be 1.5 times, including 1 serving of fatty fish. 18% of people take omega-3 supplements daily, while 53% never take them. No distinctions were observed at the start of the study between the groups that had the intervention in terms of their characteristics, nourishment, or dietary habits.
On average, each individual partaking in the intervention was given thirty meals, with the amount varying by up to six meals.
Discussion
The outcome of this trial involving teenage students indicated that a three-month-long diet that used supplements or fish dinners consisting of long-chain polyunsaturated fatty acids enriched with DHA resulted in increased red blood cell concentrations and a greater omega-3 index than diets with meat dishes. No recognizable distinctions between the groups were seen in the alteration of s-25(OH)D, s-ferritin, or UIC levels from the beginning to the end of the intervention. No link was observed between changes in nutrition-related measurements and attention capability, but the cross-sectional analysis indicated a connection between the participant’s healthy eating rating and speed of processing (TN) at the start of the study, as well as between reported intake of fatty fish (salmon, mackerel and herring) and TN at the commencement. 54% of the participants had insufficient levels of S-25(OH)D, 10% had inadequate levels of S-ferritin, and 40% had inadequate UIC levels.
The omega-3 index in this group of adolescents was typically 5.8%, which is a bit larger than the 4.9% average for 1300 Australian youths. In our sample, 5% of people had an omega-3 index below 4%, which was higher than the 0.4% of people in the Australian sample. Meanwhile, only 5% of our sample had an omega-3 index of more than 8%, in contrast to the 15.6% of people in the Australian sample. The rise in omega-3 indices of 0.6% in the fish consumers and 1.6% in the supplement users is relatively similar to what Stonehouse et al. observed; they discovered a 0.8%-1.8% uptick among individuals who ate salmon (providing 710 mg/d EPA + DHA) or used salmon oil supplements (at doses of 210-600 mg/d EPA + DHA) for a span of 8 weeks. This research had a slightly larger percentage of teenagers with a lack of vitamin D compared to the amount of European adolescents in the HELENA study. This could be attributed to the beginning of the experiment taking place during the month of February, which would normally be the time of year when levels of vitamin D reach their peak in places located as far north as Bergen, Norway (60.4°N). This lack of sun exposure from the ultraviolet B radiation plays a role in the deficiency. The average increase in the fish group of 5.3 nmol/L is comparable to the findings of a meta-analysis on randomized controlled trials in adults (over 18 years old); the average increase of fish participants relative to the placebo group was 4.4 nmol/L, and it increases to 6.8 nmol/L when only fatty fish was taken into account. A majority of white meat was offered to the meat eaters, which may account for the reduced amount of s-ferritin levels for this set, despite the fact that there were no distinctions seen between the respective groups. We didn’t take into account the development of puberty, however it is unlikely that the beginning of the menstrual cycle could have had an impact on s-ferritin levels in the period of time of 12 weeks. The average UIC among the adolescents observed in this sampling was 111.8 μg/L, exceeding the World Health Organisation’s threshold for adequate iodine concentration among populations. The number of Icelandic adolescent girls (ranging in age from 16 to 20) tested was 112, and the median of their levels was 200 μg/L, which is much higher than the amount in the text. It is possible that Iceland has a history of having high amounts of iodine in its diet from its avid consumption of fish and milk. The present trial results that demonstrate a large percentage of UICs below 100 μg/L are worrisome, and this could be due to the fact that families rarely employ iodized salt and the Norwegian food industry does not make use of it at all. It is likely that no adjustment in UIC was seen in the fish group from prior to afterward treatment because we selected fatty seafood, when typically lean seafood holds a greater amount of iodine.
If all the participants in this clinical trial had adhered to a 100 percent dietary regimen, they would have consumed three helpings of fatty fish meals each week, providing a mean dosage of roughly 1050 mg of EPA (eicosapentaenoic acid) and 1800 mg of DHA (docosahexaenoic acid) each week. This means that the average dose over seven days is 150 milligrams of EPA and 257 milligrams of DHA. This dosage is less than the amount used in other trials with similar supplements. It is, however, slightly greater than the European Food Safety Authority’s suggested daily intake of 250 mg of EPA and DHA combined. The fish group had low dietary compliance, which means they got a smaller dose of whatever they were eating. That could explain why those who took supplements had a bigger increase in DHA and omega-3 than those in the fish group.
Conclusions
To finish, it appears that the consumption of n-3 supplements and meals containing fat fish led to an increase in red blood cell (RBC) drinking of DHA and the levels of omega-3 index were increased more than meals containing meat. It is possible that the greater increase in these levels from the n-3 supplements may be linked to differences in adhering to the diet. No links between any of the food components measured and the results of the d2 task of concentration were discovered. At the beginning, results indicated that there were not enough s-25(OH)D and UIC, as well as below standard levels of EPA + DHA in red blood cells in several participants when measured against the criteria for adults. It is uncertain what the long-term effects of the inadequate nutritional situation in these teenagers could be, but it is a matter of serious concern and should be further investigated in later research.
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