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Polyunsaturated fatty acids
supplementation can improve specific
language impairment in preschool children:
a pilot study
Dalia G. Yasseen
1
, Nermien E. Waly
2
and Khaled O. Abdulghani
3*
Abstract
Background: Speech and language are one of the higher cognitive brain functions. Language delay is one of the
major concerns of child health in Egypt. Speech therapy is the standard management in language delay.
Objective: We aimed to investigate the potential role of dietary supplementation with polyunsaturated fatty acids
(PUFAs) in improving specific language impairment.
Subjects and methods: A total of 220 children (ages 3–4) were included in this study at the Phonetics Department,
Helwan School of Medicine, Egypt, during the period from 2015 to 2018. Children received comprehensive
neurological examination and intelligence quotient (IQ) test to exclude the other causes of language delay. Language
evaluation was performed using the Arabic language test. They either received family counseling, speech therapy (45
min; 3 times a week for 16 weeks), and PUFA supplementation 500 mg twice daily (group A) or only counseling and
speech therapy (group B). Language quotient (LQ) was calculated before and after treatment.
Results: Our results show that LQ significantly improved in group A compared with group B (p<0.004).
Conclusion: Dietary supplementation with PUFA has a beneficial role in the management of specific language
impairment along with speech therapy.
Keywords: PUFA, Language impairment, Preschool children
Introduction
Speech and language are one of the higher cognitive brain
functions [1]. There is a great socioeconomic impact for
cognitive disability. In fact, this impact has exceeded the
impact of both cancer and cardiovascular diseases [2,3].
Language delay is one of the major concerns of parents in
Egypt as it may leads to learning and social disabilities.
Cognition refers to several higher neurological functions
as memory, learning, language, and comprehension [4].
Speech and language acquisition starts at the first 3 years of
life. During this period, the human brain is maturing, which
makes it the most critical period for developing language
skills. Several factors pose a risk of language and cognitive
delays via the impairments of brain development [1,5]. Nu-
tritional deficiencies are among those risk factors especially
in developing countries [6]. Among those deficiencies are
polyunsaturated fatty acids (PUFAs) deficiencies. Growing
evidence indicates the impact of deficiency in dietary intake
of omega-3 PUFAs to human mental and neurological dis-
orders [7].
Omega-3 PUFA is a family of polyunsaturated fatty
acids that is predominantly found in fish oils. The most
important fatty acids in human physiology contained in
the fish oil supplement are the long chain members of the
omega-3 family, known as α-linolenic acid, eicosapenta-
enoic acid (EPA), and docosahexaenoic acid (DHA). These
major fatty acids are known as n-3 PUFAs [8]. Omega-3
PUFA was found to possess cardio-, hepato-, and neuro-
protective properties [9–11]. The availability of omega-3
PUFAs in diet has decreased during the last decades.
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
* Correspondence: Khaled.abdulghani@med.helwan.edu.eg
3
Departemnt of Neurology and Psychiatry, Helwan University School of
Medicine, Cairo, Egypt
Full list of author information is available at the end of the article
The Egyptian Journal of Neurology
,
Psychiatry and Neurosurgery
Yasseen et al. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
(2020) 56:20
https://doi.org/10.1186/s41983-020-0158-8
Dietary supplies of these fatty acids are not able to fulfill
the needs of the nervous system proper development. A
shortage of these fatty acids during the pre- and postnatal
periods usually results from the shortage of maternally
provided PUFAs in the placenta and breast milk [2,12].
Despite lacking statistics, a study has shown deceased
PUFAs levels in the blood of autistic Egyptian children
[13]. Moreover, the cost of enough omega-3-rich foods is
beyond the financial capabilities of average Egyptian fam-
ilies; therefore, they are not a part of traditional Egyptian
regular food.
Cognition, as a brain function, has been greatly studied
in relation to omega-3 PUFA. Deficiency of omega-3
PUFA has a serious impact on cognitive brain develop-
ment, while its dietary supplementation may be benefi-
cial [2–5,14]. Several clinical studies have shown that
nutritional deficiencies of n-3 PUFAs/omega 3 are asso-
ciated with autism and attention deficit hyperkinetic dis-
order (ADHD), and their supplementations was often
useful in such cases [15].
The role of n-3 PUFAs in the brain function is not well
understood. A study reported that n-3 PUFAs regulate
membrane fluidity and consequently neuronal functions
[16]. The n-3 PUFAs are important in the regulation of
many biochemical functions as neurotransmitter release,
uptake, and receptor functions in the central nervous sys-
tem [17]. On the other hand, postnatal DHA status has
been found to correlate with neurodevelopment [18]. De-
ficiencies of n-3 PUFA lead to loss of DHA from the brain
causing memory loss, learning disabilities, and impaired
visual acuity [19]. The aim of this study was to evaluate
the potential role of dietary supplementation with n-3
PUFAs in managing specific language impairment in chil-
dren at Helwan University Hospital.
Subjects and methods
This is a randomized case-control study, included a total of
220 children whose parents were seeking medical advice for
delayed language development at Phonetic Unit, Helwan
University Hospital from September 2015 to January 2018.
All children have normal hearing sensitivity and nor-
mal intelligence (IQ score ≥90) based on the Stanford-
Binet Intelligence Scale, Arabic version [20]. None of
them had any history of cognitive or neurological im-
pairments nor any psychological or behavioral disorders.
All children were subjected to the protocol of language
assessment [21]. It starts with the parent’s interview;
commenting on (a) complaint and analysis of symptoms;
(b) age, birth order, parent’s job, degree of education,
parental consanguinity, and similar condition in the fam-
ily; (c) developmental history (prenatal, neonatal, and
postnatal); (d) developmental milestones; and (e) past
history of early childhood illness.
After the parent’s interview, all children were sub-
jected to (a) general and neurological examination, (b)
vocal tract examination, (c) psychometric evaluation
using Arabic version Stanford-Binet Intelligence Scale
[20], and (d) language evaluation by a valid and reliable
test for the evaluation of language development using
language testing of Arabic-speaking children [21]. For
each child, the total language quotient was calculated.
Patients were randomly assigned to two equal groups.
Group A patients received family counseling, speech
therapy sessions (45 min; 3 times a week, for 16 weeks),
and omega-3 fatty acid 500 mg twice daily commercial
supplements for kids with DHA and EPA. Group B pa-
tients only received family counseling and speech ther-
apy sessions (45 min; 3 times a week, for 16 weeks).
Family counseling: The parents were informed about
the nature of the problem and how to stimulate lan-
guage development by using all possible surrounding ac-
tivities done in the presence of the child or done by the
child to comment in simple statements. They were ad-
vised to avoid commands, frequent questions, and direct
corrections, and to be directed to enhance the cognitive
and social abilities, which will facilitate the development
of linguistic abilities.
Statistical analysis
The data collected and analyzed by the computer pro-
gram SPSS, version 21 (IBM, Chicago, USA). The data
expressed as mean, standard deviation, and percentage.
We used the ANOVA test to determine the significance
for numeric variable. Student’sttest was used for the
comparison of parametric data between the independent
groups. The level of statistical significance (pvalue) was
set at 0.05.
Table 1 Gender distribution in study groups
Sex Group A
n(%)
Group B
n(%)
pvalue
Male 91 (82.7%) 94 (85.5 %) 0.58
Female 19 (17.3%) 16 (14.5 %)
Table 2 Age distribution in among study groups
Age Group A Group B pvalue
Range (years) 3–43–4 0.86
Mean ± SD (months) 36.409 ± 3.49 36.492 ± 3.36
Table 3 Language quotients in study groups prior to
intervention
Language quotient Group A Group B pvalue
Mean ± SD 71.99 ± 9.75 69 ± 8.49 0.076
Yasseen et al. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery (2020) 56:20 Page 2 of 4
Results
The included were 185 males and 35 females, whose ages
ranged between 3 and 4 years. Age and gender distribution
are comparable in our study groups. Tables 1and 2show
the age distribution between both groups. There was no
statistically significant difference in both age and gender
among our study groups (p= 0.58). Also, there was no sta-
tistically significant difference in language quotient be-
tween both groups (p= 0.076) as shown in Table 3.
On the other hand, there was a statistically significant
improvement in language quotient following interven-
tion in both groups (p< 0.0001). This improvement was
statistically higher in group A compared with group B as
shown in Table 4.
Discussion
Language development delay is one of the major con-
cerns of parents in our society and worldwide that may
lead to learning and social disabilities. Early diagnosis/
intervention is critical for future health benefits [22]. To
our knowledge, this is the first study to describe this ef-
fect in language development in Egypt. Our study results
show that the use of omega-3 PUFAs is beneficial in
children diagnosed with specific language impairment.
This comes in agreement with other studies that de-
scribed the beneficial effects of PUFAs in neuronal de-
velopment and maturation [4,13,15].
A total of 220 children were included in this study, with
185 males and 35 females whose ages ranged between 3
and 4 years. The gender distribution in our study sample
was 84% males and 16% females. This percentage is simi-
lar to another Egyptian study that showed increased
prevalence of cognitive delays and disorders in boys. The
study showed that 73.5% children diagnosed with develop-
mental delays were boys while 26.5% were girls [22].
Speech therapy and family counseling is usually the
standard management of these cases. In our study, this
approach has improved the language quotient in chil-
dren significantly (Tables 3and 4). This result agrees
with previous studies that found the positive effect of
speech therapy in cases of language delay in children
[23]. However, this effectiveness was debatable in other
studies depending on target group, cause of delay, and
child’s age [24–26].
When we tested the effectiveness of omega-3 supple-
mentation along with speech therapy, the language quo-
tient of tested children (group A) significantly improved
compared with children who received speech therapy
only (group B). Although data is limited, this result
comes in agreement with another study that found the
beneficial effects of dietary supplementation of PUFAs in
various cognitive developmental disorders [13]. More-
over, Strain and colleagues, in 2012, found that pre- and
postnatal PUFA improved psychomotor performance
and communication in children [27].
Conclusion
Polyunsaturated fatty acids supplementation has a benefi-
cial effect in children with specific language impairment.
Along with standard speech therapy, we recommend the
prenatal and postnatal supplementation of diet with n-3
PUFAs to prevent speech delay. Further larger studies are
needed to confirm these results.
Abbreviations
ADHD: Attention deficit hyperkinetic disorder; DHA: Docosahexaenoic acid;
EPA: Eicosapentaenoic acid; IQ: Intelligence quotient; LQ: Language quotient;
PUFA: Polyunsaturated fatty acids
Acknowledgements
None
Authors’contributions
DY and NW made substantial contributions to the conception and design of
the study; DY performed the acquisition of data; DY, NW, and KA
participated in the analysis and interpretation of data; NW and KA have been
involved in drafting the manuscript or revising it critically for important
intellectual content. All authors agreed to be accountable for all aspects of
the work in ensuring that questions related to the accuracy or integrity of
any part of the work are appropriately investigated and resolved. All authors
read and approved the final manuscript.
Funding
None
Availability of data and materials
The datasets generated and analyzed during the current study are not
publicly available due to institutional limitations, yet they are available from
the corresponding author on reasonable request.
Ethics approval and consent to participate
This study was approved by the ethical committee of Helwan University
School of Medicine on the 10th of September 2015. All parent or legal
guardian of patients provided an informed written consent prior to
participating in any study-related activities.
Consent for publication
Not applicable
Competing interests
The authors declare that they have no competing interests.
Table 4 Comparison of pre- and post-intervention language quotient in both groups
Language
quotient
Group A Group B pvalue
Pre-intervention Post-intervention Pre-intervention Post-intervention
Mean ± SD 71.99 ± 9.75 79.61 ± 10.08 69 ± 8.49 75.77 ± 8.74 0.004
pvalue < 0.0001 < 0.0001
Yasseen et al. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery (2020) 56:20 Page 3 of 4
Author details
1
Department of Phonetics and Communication, Helwan University School of
Medicine, Cairo, Egypt.
2
Department of Physiology, Helwan University School
of Medicine, Cairo, Egypt.
3
Departemnt of Neurology and Psychiatry, Helwan
University School of Medicine, Cairo, Egypt.
Received: 5 August 2019 Accepted: 30 January 2020
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