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Huang X, Jiménez-Moleón JJ, Lindholm B, Cederholm T, Arnlöv J, Risérus U, Sjögren P, Carrero JJ. Mediterranean diet, kidney function, and mortality in men with CKD. Clin J Am Soc Nephrol 2013; 8:1548-55. [PMID: 23744002 PMCID: PMC3805069 DOI: 10.2215/cjn.01780213] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/30/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Adherence to a Mediterranean diet may link to a better preserved kidney function in the community as well as a favorable cardiometabolic profile and reduced mortality risk in individuals with manifest CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Dietary habits were determined by 7-day dietary records in a population-based cohort of 1110 Swedish men (age 70 years) from 1991 to 1995, 506 of whom were considered to have CKD because of a GFR<60 ml/min per 1.73 m(2). A Mediterranean Diet Score was calculated, and participants were categorized as having low, medium, or high adherence. Adequate dietary reporters were identified with Goldberg cutoffs (n=597). Deaths were registered during a median follow-up of 9.9 years. RESULTS Compared with low adherents, medium and high adherents were 23% and 42% less likely to have CKD, respectively (adjusted odds ratio [95% confidence interval]=0.77 [0.57 to 1.05] and 0.58 [0.38 to 0.87], respectively, P for trend=0.04). Among those individuals with CKD, phosphate intake and net endogenous acid production were progressively lower across increasing adherence groups. No differences were observed regarding other cardiometabolic risk factors across adherence groups. As many as 168 (33%) CKD individuals died during follow-up. Compared with low adherents, proportional hazards regression associated medium and high adherents to a 25% and 23% lower mortality risk, respectively (adjusted hazard ratio [95% confidence interval]=0.75 [0.52 to 1.06] and 0.77 [0.44 to 1.36], respectively, P for trend=0.10). Sensitivity analyses showed significant and stronger associations when only adequate dietary reporters were considered. CONCLUSIONS Adherence to a Mediterranean dietary pattern is associated with lower likelihood of CKD in elderly men. A greater adherence to this diet independently predicted survival in those patients with manifest CKD. Clinical trials are warranted to test the hypothesis that following such a diet could improve outcomes (independent of other healthy lifestyles) in CKD patients.
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Affiliation(s)
- Xiaoyan Huang
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Stockholm, Sweden.
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Guida B, Cataldi M, Maresca ID, Germanò R, Trio R, Nastasi AM, Federico S, Memoli A, Apicella L, Memoli B, Sabbatini M. Dietary intake as a link between obesity, systemic inflammation, and the assumption of multiple cardiovascular and antidiabetic drugs in renal transplant recipients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:363728. [PMID: 23984354 PMCID: PMC3745927 DOI: 10.1155/2013/363728] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Abstract
We evaluated dietary intake and nutritional-inflammation status in ninety-six renal transplant recipients, 7.2 ± 5.0 years after transplantation. Patients were classified as normoweight (NW), overweight (OW), and obese (OB), if their body mass index was between 18.5 and 24.9, 25.0 and 29.9, and ≥ 30 kg/m(2), respectively. Food composition tables were used to estimate nutrient intakes. The values obtained were compared with those recommended in current nutritional guidelines. 52% of the patients were NW, 29% were OW, and 19% were OB. Total energy, fat, and dietary n-6 PUFAs intake was higher in OB than in NW. IL-6 and hs-CRP were higher in OB than in NW. The prevalence of multidrug regimen was higher in OB. In all patients, total energy, protein, saturated fatty acids, and sodium intake were higher than guideline recommendations. On the contrary, the intake of unsaturated and n-6 and n-3 polyunsaturated fatty acids and fiber was lower than recommended. In conclusion, the prevalence of obesity was high in our patients, and it was associated with inflammation and the assumption of multiple cardiovascular and antidiabetic drugs. Dietary intake did not meet nutritional recommendations in all patients, especially in obese ones, highlighting the need of a long-term nutritional support in renal transplant recipients.
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Affiliation(s)
- Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, University Federico II of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
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Lee CC, Adler AI. Recent findings on the effects of marine-derived n-3 polyunsaturated fatty acids on urinary albumin excretion and renal function. Curr Atheroscler Rep 2013; 14:535-41. [PMID: 22886495 DOI: 10.1007/s11883-012-0279-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Albuminuria (this includes microalbuminuria and macroalbuminuria) and reduced glomerular filtration rate are present not only in high-risk populations, but also in the general population. These manifestations of renal disease are associated with an increased risk of cardiovascular disease and may reflect subclinical vascular disease. Long-chain n-3 polyunsaturated fatty acids have been vigorously studied for their potential cardioprotective effects. These fatty acids reduce the levels of serum lipids, blood pressure, inflammation, and endothelial dysfunction, all of which are associated with albuminuria and renal impairment; therefore, marine-derived n-3 fatty acids may potentially play a role in their prevention. This report reviews the recent findings relating marine-derived n-3 fatty acids to urinary albumin excretion and renal function and their risk factors. Although some evidence suggests that marine-derived n-3 fatty acids are associated with a lower incidence of albuminuria in diabetes, there is inadequate evidence supporting their role in glomerular filtration.
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Affiliation(s)
- C Christine Lee
- Department of Nutritional Sciences, University of Toronto, 150 College Street, Room 147C, Toronto, ON M5S 3E2, Canada.
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Huang X, Sjögren P, Cederholm T, Ärnlöv J, Lindholm B, Risérus U, Carrero JJ. Serum and adipose tissue fatty acid composition as biomarkers of habitual dietary fat intake in elderly men with chronic kidney disease. Nephrol Dial Transplant 2012; 29:128-36. [PMID: 23229929 DOI: 10.1093/ndt/gfs478] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fatty acid (FA) composition in serum cholesterol esters (CE) and adipose tissue (AT) reflect the long-term FA intake in the general population. Because both dietary intake and FA biomarkers associate with renal function, our aim was to identify which CE and AT FAs are useful biomarkers of habitual FA intake in individuals with chronic kidney disease (CKD). METHODS Cross-sectional analysis was performed in 506 men (aged 70 years) with a glomerular filtration rate (GFR) of <60 mL/min per 1.73 m(2) from the Uppsala Longitudinal Study of Adult Men cohort. Dietary habits were evaluated with a 7-day dietary record. FA compositions in CE and AT were analyzed by gas-liquid chromatography in two random subsamples of 248 and 318 individuals, respectively. RESULTS Both CE and AT linoleic acid and docosahexaenoic acid (DHA) were strongly associated with their corresponding intake, after adjustments for non-dietary factors. The proportions of eicosapentaenoic acid (EPA) and palmitic acid in CE and AT moderately correlated with dietary intake, whereas correlations of other FAs were weaker or absent. Proportions of EPA and DHA in CE and AT were positively associated with the total energy-adjusted fish intake. Results were confirmed in adequate reporters as identified by the Goldberg cutoff method. These relationships held constant, regardless of a GFR above or below 45 mL/min per 1.73 m(2) or the prevalence of microalbuminuria. CONCLUSIONS Proportions of EPA, DHA, palmitic and linoleic acid in serum CE and AT are good indicators of their dietary intake in men with CKD. They can be considered valid biomarkers for epidemiological studies and assessment of compliance.
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Affiliation(s)
- Xiaoyan Huang
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
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Fish Oil Supplementation Reduces Cachexia and Tumor Growth While Improving Renal Function in Tumor-Bearing Rats. Lipids 2012; 47:1031-41. [DOI: 10.1007/s11745-012-3715-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
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Castro-González I, Maafs-Rodríguez A, Silencio-Barrita J, Galindo-Gómez C, Pérez-Gil F. Evaluation of the possible inclusion of certain fish species in chronic kidney disease diets based on their adverse and beneficial nutrient ratios. Int J Food Sci Nutr 2012; 64:82-8. [DOI: 10.3109/09637486.2012.700921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Patterson E, Wall R, Fitzgerald GF, Ross RP, Stanton C. Health implications of high dietary omega-6 polyunsaturated Fatty acids. J Nutr Metab 2012; 2012:539426. [PMID: 22570770 PMCID: PMC3335257 DOI: 10.1155/2012/539426] [Citation(s) in RCA: 505] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/17/2011] [Accepted: 11/20/2011] [Indexed: 12/17/2022] Open
Abstract
Omega-6 (n-6) polyunsaturated fatty acids (PUFA) (e.g., arachidonic acid (AA)) and omega-3 (n-3) PUFA (e.g., eicosapentaenoic acid (EPA)) are precursors to potent lipid mediator signalling molecules, termed "eicosanoids," which have important roles in the regulation of inflammation. In general, eicosanoids derived from n-6 PUFA are proinflammatory while eicosanoids derived from n-3 PUFA are anti-inflammatory. Dietary changes over the past few decades in the intake of n-6 and n-3 PUFA show striking increases in the (n-6) to (n-3) ratio (~15 : 1), which are associated with greater metabolism of the n-6 PUFA compared with n-3 PUFA. Coinciding with this increase in the ratio of (n-6) : (n-3) PUFA are increases in chronic inflammatory diseases such as nonalcoholic fatty liver disease (NAFLD), cardiovascular disease, obesity, inflammatory bowel disease (IBD), rheumatoid arthritis, and Alzheimer's disease (AD). By increasing the ratio of (n-3) : (n-6) PUFA in the Western diet, reductions may be achieved in the incidence of these chronic inflammatory diseases.
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Affiliation(s)
- E. Patterson
- Alimentary Pharmabiotic Centre, Biosciences Institute, County Cork, Ireland
- Teagasc Food Research Centre, Biosciences Department, Moorepark, Fermoy, County Cork, Ireland
| | - R. Wall
- Alimentary Pharmabiotic Centre, Biosciences Institute, County Cork, Ireland
- Teagasc Food Research Centre, Biosciences Department, Moorepark, Fermoy, County Cork, Ireland
| | - G. F. Fitzgerald
- Alimentary Pharmabiotic Centre, Biosciences Institute, County Cork, Ireland
- Department of Microbiology, University College Cork, County Cork, Ireland
| | - R. P. Ross
- Alimentary Pharmabiotic Centre, Biosciences Institute, County Cork, Ireland
- Teagasc Food Research Centre, Biosciences Department, Moorepark, Fermoy, County Cork, Ireland
| | - C. Stanton
- Alimentary Pharmabiotic Centre, Biosciences Institute, County Cork, Ireland
- Teagasc Food Research Centre, Biosciences Department, Moorepark, Fermoy, County Cork, Ireland
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Block R, Kakinami L, Liebman S, Shearer GC, Kramer H, Tsai M. Cis-vaccenic acid and the Framingham risk score predict chronic kidney disease: the multi-ethnic study of atherosclerosis (MESA). Prostaglandins Leukot Essent Fatty Acids 2012; 86:175-82. [PMID: 22417701 PMCID: PMC3340522 DOI: 10.1016/j.plefa.2012.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 02/26/2012] [Accepted: 02/27/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Data on the associations of fatty acids with chronic kidney disease (CKD) are sparse. MATERIALS AND METHODS We performed a cross-sectional study of 2792 men and women from the MESA cohort of African-American, Caucasian, Chinese and Hispanic adults without known cardiovascular disease. Plasma phospholipid fatty acid proportions were associated with estimated glomerular filtration rate (eGFR) and the albumin/creatinine ratio. RESULTS Cis-vaccenic acid (18:1n-7), adjusted for other fatty acids using multivariate logistic regression (CI: 1.0-1.4), and step-wise logistic regression (CI: 1.02-1.42), was positively associated with reduced eGFR. The Framingham Risk Score, when adjusting for fatty acid proportions and demographic factors, was positively associated with CKD as measured by the eGFR and the albumin/creatinine ratio. DISCUSSION AND CONCLUSIONS Plasma phospholipid proportions of the 18 carbon monounsaturated cis-vaccenic acid {18:1n-7}) and the Framingham Risk Score are associated with kidney function. The potential role of 18:1n-7 in the development of CKD warrants further investigation.
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Affiliation(s)
- Robert Block
- Department of Community and Preventive Medicine, Division of Epidemiology, the University of Rochester School of Medicine, Rochester, NY 14642, USA.
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Calderon Artero P, Champagne C, Garigen S, Mousa S, Block R. Fish oil metabolites: translating promising findings from bench to bedside to reduce cardiovascular disease. JOURNAL OF GLYCOMICS & LIPIDOMICS 2012; 2:1000106. [PMID: 22708071 PMCID: PMC3372925 DOI: 10.4172/2153-0637.1000104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiovascular disease is an inflammatory process and the leading cause of death in the United States. Novel omega-3 derived potent lipid mediators, termed resolvins and protectins, have been identified as major pathophysiologic players in the resolution phase of the inflammatory response. Potent lipid mediators offer tremendous metabolic and pathophysiologic insights in regard to the risk and treatment of cardiovascular disease. In this review, resolvins and protectins are described and analyzed as accelerators of discovery via their potential role as biomarkers for research and clinical decision making in cardiovascular disease. Specific barriers relating to biomarker validation, laboratory methods, and improvement of risk models are introduced and discussed. Potential therapeutic impacts in cardiovascular disease are also mentioned with special consideration for cost-saving implications with respect to dietary fish oil as an alternative to resolvin and protectin treatment. Given the high tolerability of fish oil supplements and previously described benefits of omega-3 fatty acid intake in cardiovascular disease, we conclude that resolvins and protectins are set to soon take center stage as future biomarkers and well-tolerated therapies for cardiovascular disease.
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Affiliation(s)
- P Calderon Artero
- University of Rochester Medical School and Department of Community and Preventive Medicine, the University of Rochester School of Medicine and Dentistry, Rochester, New York
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60
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Burnett BP, Levy RM. 5-Lipoxygenase metabolic contributions to NSAID-induced organ toxicity. Adv Ther 2012; 29:79-98. [PMID: 22351432 DOI: 10.1007/s12325-011-0100-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Indexed: 01/01/2023]
Abstract
Cyclooxygenase (COX)-1, COX-2, and 5-lipoxygenase (5-LOX) enzymes produce effectors of pain and inflammation in osteoarthritis (OA) and many other diseases. All three enzymes play a key role in the metabolism of arachidonic acid (AA) to inflammatory fatty acids, which contribute to the deterioration of cartilage. AA is derived from both phospholipase A(2) (PLA(2)) conversion of cell membrane phospholipids and dietary consumption of omega-6 fatty acids. Nonsteroidal antiinflammatory drugs (NSAIDs) inhibit the COX enzymes, but show no anti-5-LOX activity to prevent the formation of leukotrienes (LTs). Cysteinyl LTs, such as LTC(4), LTD(4), LTE(4), and leukoattractive LTB(4) accumulate in several organs of mammals in response to NSAID consumption. Elevated 5-LOX-mediated AA metabolism may contribute to the side-effect profile observed for NSAIDs in OA. Current therapeutics under development, so-called "dual inhibitors" of COX and 5-LOX, show improved side-effect profiles and may represent a new option in the management of OA.
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Affiliation(s)
- Bruce P Burnett
- Department of Medical Education and Scientific Affairs, Primus Pharmaceuticals, Inc., Scottsdale, Arizona, USA.
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61
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Consumption of long-chain n-3 PUFA, α-linolenic acid and fish is associated with the prevalence of chronic kidney disease. Br J Nutr 2011; 105:1361-8. [PMID: 21255476 DOI: 10.1017/s0007114510005040] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to the anti-inflammatory properties of PUFA, it has been suggested that they may protect against kidney damage in adults. However, relatively few epidemiological studies have examined this hypothesis in human subjects. We investigated the association between dietary intakes of PUFA (n-3, n-6 and α-linolenic acid), fish and the prevalence of chronic kidney disease (CKD). A total of 2600 Blue Mountains Eye Study (1997-9) participants aged ≥ 50 years were analysed. Dietary data were collected using a semi-quantitative FFQ, and PUFA and fish intakes were calculated. Baseline biochemistry including serum creatinine was measured. Moderate CKD was defined as an estimated glomerular filtration rate of < 60 ml/min per 1·73 m2. Participants in the highest quartile of long-chain n-3 PUFA intake had a significantly reduced likelihood of having CKD compared with those in the lowest quartile of intake (multivariable-adjusted OR 0·69, 95 % CI 0·49, 0·99). α-Linolenic acid intake was positively associated with CKD (OR, per standard deviation increase in α-linolenic acid, 1·18, 95 % CI 1·05, 1·32). Total n-3 PUFA or total n-6 PUFA were not significantly associated with CKD. The highest compared with the lowest quartile of fish consumption was associated with a reduced likelihood of CKD (OR 0·68, 95 % CI 0·48, 0·97; P for trend = 0·02). The present study shows that an increased dietary intake of long-chain n-3 PUFA and fish reduces the prevalence of CKD. Hence, a diet rich in n-3 PUFA and fish could have a role in maintaining healthy kidney function, in addition to roles of these nutrients in the prevention and modulation of other diseases.
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Lauretani F, Maggio M, Pizzarelli F, Michelassi S, Ruggiero C, Ceda GP, Bandinelli S, Ferrucci L. Omega-3 and renal function in older adults. Curr Pharm Des 2010; 15:4149-56. [PMID: 20041816 DOI: 10.2174/138161209789909719] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic kidney disease (CKD) is a major public health problem and can result in end-stage renal disease with need for dialysis or transplantation. In Europe up to 12% of the adult population had some renal impairment, while in the United States the end stage of CKD has increased dramatically from 209.000 in 1991 to 472.000 in 2004. Diabetes and hypertension are major causes of kidney pathology. Infection, particularly ascending infection, is more common with increasing age, as both immune function declines and associated pathology predisposing to infection, such as obstructive uropathy, becomes more common. Most pathological changes in the kidney appear to be initiated by oxidative stress, followed by an inflammatory reaction. Oxidative stress results from an imbalance between free radicals and their detoxification by endogenous and exogenous scavengers, including polyunsaturated fatty acids (PUFA). Recent studies showed that PUFA supplementation slowed the rate of loss of renal function in patients with IgA nephropathy. Then, studies of omega-3 supplementation in dialysis patients describe salutary effects on triglyceride levels and dialysis access patency. We examined the relationship between total plasma PUFA levels and change in creatinine clearance over a three-year follow-up in the older persons enrolled in the InCHIANTI study, a population-based epidemiology study conducted in Tuscany, Italy. This study showed that older adults with low total plasma PUFA levels have a greater decline in creatinine clearance over three years of follow-up. These findings suggest that a higher dietary intake of PUFA may be protective against progression to chronic kidney disease.
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Affiliation(s)
- F Lauretani
- Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy.
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Tziomalos K, Ganotakis ES, Gazi IF, Nair DR, Mikhailidis DP. Kidney function and estimated vascular risk in patients with primary dyslipidemia. Open Cardiovasc Med J 2009; 3:57-68. [PMID: 19572030 PMCID: PMC2703830 DOI: 10.2174/1874192400903010057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 01/30/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation. Aim: To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia. Methods: Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation. Results: In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined. Conclusions: Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.
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Affiliation(s)
- Konstantinos Tziomalos
- Department of Clinical Biochemistry (Vascular Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Miller ER, Juraschek SP, Appel LJ, Madala M, Anderson CAM, Bleys J, Guallar E. The effect of n-3 long-chain polyunsaturated fatty acid supplementation on urine protein excretion and kidney function: meta-analysis of clinical trials. Am J Clin Nutr 2009; 89:1937-45. [PMID: 19403630 PMCID: PMC3148029 DOI: 10.3945/ajcn.2008.26867] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic kidney disease is a major worldwide problem. Although epidemiologic and experimental studies suggest that n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation may prevent or slow the progression of kidney disease, evidence from clinical trials is inconsistent. OBJECTIVE The objective was to combine evidence from controlled clinical trials to assess the effect of n-3 LCPUFA supplementation on the change in urine protein excretion (UPE) and on glomerular filtration rate (GFR). DESIGN We performed a meta-analysis of clinical trials that tested the effect of n-3 LCPUFA supplementation on UPE, a marker of kidney damage, and on GFR, a marker of kidney function. A random-effects model was used to pool SD effect size (Cohen's d) across studies. RESULTS Seventeen trials with 626 participants were included in the meta-analysis. Most trials focused on patients with a single underlying diagnosis: IgA nephropathy (n = 5), diabetes (n = 7), or lupus nephritis (n = 1). The dose of n-3 LCPUFAs ranged from 0.7 to 5.1 g/d, and the median follow-up was 9 mo. In the pooled analysis, there was a greater reduction in UPE in the n-3 LCPUFA group than in the control group: Cohen's d for all trials was -0.19 (95% CI: -0.34, -0.04; P = 0.01). In a patient with 1 g UPE/d , this corresponds to a reduction of 190 mg/d. Effects on GFR were reported in 12 trials. The decline in GFR was slower in the n-3 LCPUFA group than in the control group, but this effect was not significant (0.11; 95% CI: -0.07, 0.29; P = 0.24). CONCLUSIONS In our meta-analysis, use of n-3 LCPUFA supplements reduced UPE but not the decline in GFR. However, small numbers of participants in trials, different methods of assessing proteinuria and GFR, and inconsistent data reporting limit the strength of these conclusions. Large, high-quality trials with clinical outcomes are warranted.
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Affiliation(s)
- Edgar R Miller
- Johns Hopkins School of Medicine, the Johns Hopkins Bloomberg School of Public Health, and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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Anderson S, Halter JB, Hazzard WR, Himmelfarb J, Horne FM, Kaysen GA, Kusek JW, Nayfield SG, Schmader K, Tian Y, Ashworth JR, Clayton CP, Parker RP, Tarver ED, Woolard NF, High KP. Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults. J Am Soc Nephrol 2009; 20:1199-209. [DOI: 10.1681/asn.2008080860] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Omega-3 fatty acids: how can they be used in secondary prevention? Curr Atheroscler Rep 2009; 10:510-7. [PMID: 18937899 DOI: 10.1007/s11883-008-0079-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Omega-3 fatty acids (FAs) are divided into long-chain fatty acids (eicosapentaenoic acid and docosahexaenoic acid ), which are found in fatty fish, and intermediate-chain FAs (alpha-linolenic acid), which are found in vegetable oils. Omega-3 FAs favorably modulate a variety of vascular risk factors and also exert antiarrhythmic effects. Epidemiologic data suggest that increased consumption of marine omega-3 FAs is associated with reduced coronary heart disease (CHD) mortality. Randomized controlled studies also show that supplementation with EPA and DHA reduces CHD risk, primarily in the secondary prevention setting. Data are more limited on the efficacy of marine omega-3 FAs for the primary prevention of CHD and on the role of alpha-linolenic acid. Increased intake of EPA and DHA represents a valuable tool for vascular disease prevention and should be recommended in all patients with CHD.
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Affiliation(s)
- Konstantinos Tziomalos
- Second Propedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, 63 Solonos Street, Thessaloniki, 54248, Greece.
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Garman JH, Mulroney S, Manigrasso M, Flynn E, Maric C. Omega-3 fatty acid rich diet prevents diabetic renal disease. Am J Physiol Renal Physiol 2008; 296:F306-16. [PMID: 19052104 DOI: 10.1152/ajprenal.90326.2008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFA) show beneficial effects in cardiovascular disease, IgA, and diabetic nephropathy; however, the mechanisms underlying these benefits are unknown. The study was performed in male Sprague-Dawley rats randomly divided into four treatment groups: nondiabetic (ND), streptozotocin-induced diabetic (D), diabetic and fed a high n-3 PUFA diet (D+canola), and diabetic and fed a high n-6 (omega-6) PUFA diet (D+corn). Study treatments were carried out for 30 wk. D+canola significantly decreased diabetes-associated increases in urine albumin excretion (ND 17.8 +/- 6.4; D 97.3 +/- 9.4; D+canola 8.3 +/- 2.2 mg/day); systolic blood pressure (ND 153 +/- 9; D 198 +/- 7; D+canola 162 +/- 9 mmHg); glomerulosclerosis (ND 0.6 +/- 0.2; D 1.8 +/- 0.2; D+canola 0.8 +/- 0.1 AU); and tubulointerstitial fibrosis in the renal cortex (ND 1.2 +/- 0.2; D 2.0 +/- 0.2; D+canola 1.1 +/- 0.1) and the inner stripe of the outer medulla (ND 1.0 +/- 0.2; D 2.1 +/- 0.2; D+canola 1.1 +/- 0.2 AU). D+corn also exerted renoprotection, but not to the same degree as D+canola (urine albumin excretion, 33.8 +/- 6.1 mg/day; systolic blood pressure, D+corn 177 +/- 6 mmHg; glomerulosclerosis, D+corn 1.2 +/- 0.3 AU; cortical tubulointerstitial fibrosis, D+corn 1.6 +/- 0.1 AU; medullary tubulointerstitial fibrosis, D+corn 1.5 +/- 0.1 AU). In addition, D+canola attenuated D-associated increase in collagen type I and type IV, IL-6, MCP-1, transforming growth factor-beta, and CD68 expression. These observations indicate a beneficial effect of high dietary intake of n-3 PUFA in reducing diabetic renal disease.
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Affiliation(s)
- Joseph H Garman
- Dept. of Physiology and Biophysics, Univ. of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216, USA
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Cohen BE, Garg SK, Ali S, Harris WS, Whooley MA. Red blood cell docosahexaenoic acid and eicosapentaenoic acid concentrations are positively associated with socioeconomic status in patients with established coronary artery disease: data from the Heart and Soul Study. J Nutr 2008; 138:1135-40. [PMID: 18492846 PMCID: PMC2675885 DOI: 10.1093/jn/138.6.1135] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.
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Affiliation(s)
- Beth E. Cohen
- Department of Veterans Affairs Medical Center, San Francisco, CA 94121;, Division of General Internal Medicine, University of California, San Francisco, CA 94143;,To whom correspondence should be addressed. E-mail:
| | - Sachin K. Garg
- Emory University School of Medicine, Atlanta, GA 30322 and
| | - Sadia Ali
- Department of Veterans Affairs Medical Center, San Francisco, CA 94121
| | - William S. Harris
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 50175
| | - Mary A. Whooley
- Department of Veterans Affairs Medical Center, San Francisco, CA 94121;, Division of General Internal Medicine, University of California, San Francisco, CA 94143
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