The effects of docosahexaenoic acid-rich fish oil on behavior, school attendance rate and malaria infection in school children--a double-blind, randomized, placebo-controlled trial in Lampung, Indonesia.

BACKGROUND There are only a very limited number of reports of intervention studies on the effects of fish oil on behavior in normal school children. OBJECTIVE To observe the effects of fish oil on behavior and school attendance rates in school children. DESIGN Fourth to sixth graders (mostly 9-12 years of age) of an elementary school in Lampung Province, Indonesia, were randomly divided into either a docosahexaenoic acid (DHA) group (n=116) or a control group (n=117) in a double-blind manner. The subjects in the DHA group took 6 fish oil capsules per day (0.65 g DHA and 0.10 g eicosapentaenoic acid (EPA)/day) for 3 months. Controls took soybean oil capsules. Two questionnaires were administered and blood was taken at the start and end of the study. Two questionnaires were administered at the start and end of the study: Hostility-Aggression Questionnaire for Children (HAQ-C) and Barratt Impulsiveness Scale, version 11 (BIS-11), for measurement of aggression and impulsivity, respectively. Attendance was recorded during the study period. OUTCOMES The concentrations of DHA and EPA in the phospholipid fraction in red blood cells were significantly increased in the DHA group. Behavior checked with HAQ-C or BIS-11 did not show any differences between groups. However, the odds ratio of inability to attend school regularly during the study period was 0.40 (95%CI: 0.23-0.71) in the DHA group compared with controls (p=0.002). CONCLUSIONS DHA-rich fish oil may improve the school attendance rate of children in Lampung, Indonesia.