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Bhargava S, de la Puente-Secades S, Schurgers L, Jankowski J. Lipids and lipoproteins in cardiovascular diseases: a classification. Trends Endocrinol Metab 2022; 33:409-423. [PMID: 35370062 DOI: 10.1016/j.tem.2022.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022]
Abstract
Lipids and lipoproteins, their metabolism, and their transport are essential contributing factors of cardiovascular disease (CVD) as they regulate plasma cholesterol concentration, enhancing cholesterol uptake by macrophages, leading to foam cell formation and ultimately resulting in plaque formation and inflammation. However, lipids and lipoproteins have cardioprotective functions as well, such as preventing oxidation of proatherogenic molecules and downregulating inflammatory proteins.
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Affiliation(s)
- Shruti Bhargava
- Institute of Molecular Cardiovascular Research, Medical Faculty, RWTH Aachen University, Aachen, Germany; Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
| | - Sofia de la Puente-Secades
- Institute of Molecular Cardiovascular Research, Medical Faculty, RWTH Aachen University, Aachen, Germany; Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
| | - Leon Schurgers
- Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
| | - Joachim Jankowski
- Institute of Molecular Cardiovascular Research, Medical Faculty, RWTH Aachen University, Aachen, Germany; Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands.
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Guo N, Zhu Y, Tian D, Zhao Y, Zhang C, Mu C, Han C, Zhu R, Liu X. Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies. BMC Med 2022; 20:194. [PMID: 35606791 PMCID: PMC9128224 DOI: 10.1186/s12916-022-02381-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke is one of the major challenges for the global healthcare system, which makes it necessary to explore the relationship between various modifiable factors and stroke risk. Recently, numerous meta-analyses of prospective observational studies have reported that dietary factors played a key role in the occurrence of stroke. However, the conclusions of previous studies have remained controversial and unclear. Accordingly, we conducted an umbrella review synthesizing and recalculating available evidence to assess the certainty of the associations between dietary factors and stroke. METHODS Relevant meta-analyses examining the associations between dietary factors and stroke were searched in PubMed and Embase databases up to September 1, 2021. For each eligible meta-analysis, two independent reviewers appraised the methodologic quality using the AMSTAR 2 criteria and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals, heterogeneity between studies, and small-study effects. Moreover, we further assessed the associations between dietary factors and ischemic stroke as well as hemorrhagic stroke. Lastly, a set of pre-specified criteria was applied to qualitatively evaluate the epidemiological credibility of each dietary factor. RESULTS Overall, our umbrella review included 122 qualified meta-analyses for qualitative synthesis, involving 71 dietary factors related to food groups, foods, macronutrients, and micronutrients. Using the AMSTAR 2 criteria, 5 studies were assessed as high quality, 4 studies as moderate quality, and 113 studies as low or critically low quality. We identified 34 dietary factors associated with stroke occurrence, 25 dietary factors related to ischemic stroke, and 11 factors related to hemorrhagic stroke. Among them, high/moderate certainty epidemiological evidence demonstrated an inverse association between intake of fruits (RR: 0.90) and vegetables (RR: 0.92) and stroke incidence, but a detrimental association between red meat (RR: 1.12), especially processed red meat consumption (RR:1.17), and stroke incidence. Besides, the evidence of high/moderate certainty suggested that the intake of processed meat, fruits, coffee, tea, magnesium, and dietary fiber was associated with ischemic stroke risk, while consumption of tea, fruits, and vegetables was relevant to hemorrhagic stroke susceptibility. CONCLUSIONS Our study has reported that several dietary factors have a significant impact on stroke risk and offered a new insight into the relationship between dietary modification and stroke occurrence. Our results may provide an effective strategy for stroke prevention.
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Affiliation(s)
- Na Guo
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ying Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Dandan Tian
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yating Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chenguang Zhang
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Changqing Mu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chen Han
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ruixia Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Liu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China.
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Hira K, Ueno Y, Miyamoto N, Nakajima S, Kijima C, Hattori N. Association of blood eicosapentaenoic acid levels with intracerebral hemorrhage during the COVID-19 pandemic: preliminary experience from a single-center in Japan. BMC Neurol 2022; 22:128. [PMID: 35382754 PMCID: PMC8980204 DOI: 10.1186/s12883-022-02657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/30/2022] [Indexed: 01/08/2023] Open
Abstract
Background The COVID-19 pandemic has forced lockdowns and declarations of states of emergency, resulting in marked changes to daily life such as dietary habits in many countries. Though serum omega-3 polyunsaturated fatty acids levels have been shown to be useful markers for recurrent vascular events or worse prognosis in cardiovascular diseases and ischemic stroke, the relationship between serum omega-3 PUFA levels and the occurrence of intracerebral hemorrhage has essentially been unknown. We explored the association of serum omega-3 polyunsaturated fatty acids with intracerebral hemorrhage during the COVID-19 pandemic. Methods Participants comprised patients admitted to Juntendo University Hospital (Tokyo, Japan) with intracerebral hemorrhage between January 1, 2016 and April 30, 2020. Clinical characteristics including serum omega-3 polyunsaturated fatty acid levels were compared between patients developing intracerebral hemorrhage during the period from January 1, 2016 to February 29, 2020, and the subsequent COVID-19 pandemic period (March 1 to April 30, 2020). Clinical characteristics independently related to intracerebral hemorrhage during the COVID-19 pandemic were analyzed by comparing these two cohorts of intracerebral hemorrhage patients in different periods. Results A total of 103 patients (age, 67.0 ± 13.9 years; 67 males) with intracerebral hemorrhage were enrolled. Intracerebral hemorrhage developed in 91 patients before and 12 patients during the COVID-19 pandemic. Monthly averages of intracerebral hemorrhage patients admitted to our hospital during and before the COVID-19 pandemic were 6 and 1.82, respectively. Serum eicosapentaenoic acid levels were significantly lower in intracerebral hemorrhage patients during the COVID-19 pandemic than before (31.87 ± 12.93 μg/ml vs. 63.74 ± 43.29 μg/ml, p = 0.007). Multiple logistic regression analysis showed that, compared to before the COVID-19 pandemic, dyslipidemia (odds ratio 0.163, 95% confidence interval 0.031–0.852; p = 0.032) and eicosapentaenoic acid levels (odds ratio 0.947, 95% confidence interval 0.901–0.994; p = 0.029) were associated with intracerebral hemorrhage during the COVID-19 pandemic. Conclusions From our preliminary results, low eicosapentaenoic acid levels were linked with intracerebral hemorrhage during the COVID-19 pandemic. Low levels of eicosapentaenoic acid might be an endogenous surrogate marker for intracerebral hemorrhage during the COVID-19 pandemic.
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Affiliation(s)
- Kenichiro Hira
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Chikage Kijima
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Balasubramanian R, Hu J, Guasch-Ferre M, Li J, Sorond F, Zhao Y, Shutta KH, Salas-Salvado J, Hu F, Clish CB, Rexrode KM. Metabolomic Profiles Associated With Incident Ischemic Stroke. Neurology 2022; 98:e483-e492. [PMID: 34853177 PMCID: PMC8826464 DOI: 10.1212/wnl.0000000000013129] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Women have higher lifetime risk of stroke than men, and metabolic factors seem more strongly associated with stroke for women than men. However, few studies in either men or women have evaluated metabolomic profiles and incident stroke. METHODS We applied liquid chromatography-tandem mass spectrometry to measure 519 plasma metabolites in a discovery set of women in the Nurses' Health Study (NHS; 454 incident ischemic stroke cases, 454 controls) with validation in 2 independent, prospective cohorts: Prevención con Dieta Mediterránea (PREDIMED; 118 stroke cases, 791 controls) and Nurses' Health Study 2 (NHS2; 49 ischemic stroke cases, 49 controls). We applied logistic regression models with stroke as the outcome to adjust for multiple risk factors; the false discovery rate was controlled through the q value method. RESULTS Twenty-three metabolites were significantly associated with incident stroke in NHS after adjustment for traditional risk factors (q < 0.05). Of these, 14 metabolites were available in PREDIMED and 3 were significantly associated with incident stroke: methionine sulfoxide, N6-acetyllysine, and sucrose (q < 0.05). In NHS2, one of the 23 metabolites (glucuronate) was significantly associated with incident stroke (q < 0.05). For all 4 metabolites, higher levels were associated with increased risk. These 4 metabolites were used to create a stroke metabolite score (SMS) in the NHS and tested in PREDIMED. Per unit of standard deviation of SMS, the odds ratio for incident stroke was 4.12 (95% confidence interval [CI] 2.26-7.51) in PREDIMED, after adjustment for risk factors. In PREDIMED, the area under the receiver operating characteristic curve (AUC) for the model including SMS and traditional risk factors was 0.70 (95% CI 0.75-0.79) vs the AUC for the model including the traditional risk factors only of 0.65 (95% CI 0.70-0.75), corresponding to a 5% improvement in risk prediction with SMS (p < 0.005). DISCUSSION Metabolites associated with stroke included 2 amino acids, a carboxylic acid, and sucrose. A composite SMS including these metabolites was associated with ischemic stroke and showed improvement in risk prediction beyond traditional risk factors. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a SMS accurately predicts incident ischemic stroke risk.
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Affiliation(s)
- Raji Balasubramanian
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge.
| | - Jie Hu
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Marta Guasch-Ferre
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Jun Li
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Farzaneh Sorond
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Yibai Zhao
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Katherine H Shutta
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Jordi Salas-Salvado
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Frank Hu
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Clary B Clish
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Kathryn M Rexrode
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
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Toko H, Morita H, Katakura M, Hashimoto M, Ko T, Bujo S, Adachi Y, Ueda K, Murakami H, Ishizuka M, Guo J, Zhao C, Fujiwara T, Hara H, Takeda N, Takimoto E, Shido O, Harada M, Komuro I. Omega-3 fatty acid prevents the development of heart failure by changing fatty acid composition in the heart. Sci Rep 2020; 10:15553. [PMID: 32968201 PMCID: PMC7512019 DOI: 10.1038/s41598-020-72686-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022] Open
Abstract
Some clinical trials showed that omega-3 fatty acid (FA) reduced cardiovascular events, but it remains unknown whether omega-3 FA supplementation changes the composition of FAs and their metabolites in the heart and how the changes, if any, exert beneficial effects on cardiac structure and function. To clarify these issues, we supplied omega-3 FA to mice exposed to pressure overload, and examined cardiac structure and function by echocardiography and a proportion of FAs and their metabolites by gas chromatography and liquid chromatography-tandem mass spectrometry, respectively. Pressure overload induced cardiac hypertrophy and dysfunction, and reduced concentration of all FAs’ components and increased free form arachidonic acid and its metabolites, precursors of pro-inflammatory mediators in the heart. Omega-3 FA supplementation increased both total and free form of eicosapentaenoic acid, a precursor of pro-resolution mediators and reduced free form arachidonic acid in the heart. Omega-3 FA supplementation suppressed expressions of pro-inflammatory cytokines and the infiltration of inflammatory cells into the heart and ameliorated cardiac dysfunction and fibrosis. These results suggest that omega-3 FA-induced changes of FAs composition in the heart have beneficial effects on cardiac function via regulating inflammation.
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Affiliation(s)
- Haruhiro Toko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Advanced Translational Research and Medicine in Management of Pulmonary Hypertension, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masanori Katakura
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan.,Laboratory of Nutritional Physiology, Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan
| | - Michio Hashimoto
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan
| | - Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Adachi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazutaka Ueda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruka Murakami
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masato Ishizuka
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jiaxi Guo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chunxia Zhao
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takayuki Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hironori Hara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eiki Takimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Shido
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan
| | - Mutsuo Harada
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Advanced Clinical Science and Therapeutics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Platelet Responses in Cardiovascular Disease: Sex-Related Differences in Nutritional and Pharmacological Interventions. Cardiovasc Ther 2020; 2020:2342837. [PMID: 32547635 PMCID: PMC7273457 DOI: 10.1155/2020/2342837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVD) represent one of the biggest causes of death globally, and their prevalence, aetiology, and outcome are related to genetic, metabolic, and environmental factors, among which sex- and age-dependent differences may play a key role. Among CVD risk factors, platelet hyperactivity deserves particular mention, as it is involved in the pathophysiology of main cardiovascular events (including stroke, myocardial infarction, and peripheral vascular injury) and is closely related to sex/age differences. Several determinants (e.g., hormonal status and traditional cardiovascular risk factors), together with platelet-related factors (e.g., plasma membrane composition, receptor signaling, and platelet-derived microparticles) can elucidate sex-related disparity in platelet functionality and CVD onset and outcome, especially in relation to efficacy of current primary and secondary interventional strategies. Here, we examined the state of the art concerning sex differences in platelet biology and their relationship with specific cardiovascular events and responses to common antiplatelet therapies. Moreover, as healthy nutrition is widely recognized to play a key role in CVD, we also focused our attention on specific dietary components (especially polyunsaturated fatty acids and flavonoids) and patterns (such as Mediterranean diet), which also emerged to impact platelet functions in a sex-dependent manner. These results highlight that full understanding of gender-related differences will be useful for designing personalized strategies, in order to prevent and/or treat platelet-mediated vascular damage.
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Jain P, Suemoto CK, Rexrode K, Manson JE, Robins JM, Hernán MA, Danaei G. Hypothetical Lifestyle Strategies in Middle-Aged Women and the Long-Term Risk of Stroke. Stroke 2020; 51:1381-1387. [PMID: 32268852 PMCID: PMC7185054 DOI: 10.1161/strokeaha.119.026761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Supplemental Digital Content is available in the text. Long-term effect of lifestyle changes on stroke incidence has not been estimated in randomized trials. We used observational data to estimate the incidence of stroke under hypothetical lifestyle strategies in the NHS (Nurses’ Health Study).
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Affiliation(s)
- Priyanka Jain
- From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia K Suemoto
- Division of Geriatrics, University of São Paulo Medical School, Brazil (C.K.S.)
| | - Kathryn Rexrode
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.R., J.E.M.)
| | - JoAnn E Manson
- From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.R., J.E.M.)
| | - James M Robins
- From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Biostatistics (J.M.R., M.A.H.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Miguel A Hernán
- From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Biostatistics (J.M.R., M.A.H.), Harvard T.H. Chan School of Public Health, Boston, MA.,Harvard-MIT Division of Health Sciences and Technology, Boston, MA (M.A.H.)
| | - Goodarz Danaei
- From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Global Health and Population (G.D.), Harvard T.H. Chan School of Public Health, Boston, MA
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8
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2020; 3:CD003177. [PMID: 32114706 PMCID: PMC7049091 DOI: 10.1002/14651858.cd003177.pub5] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3)), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) may benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess the effects of increased intake of fish- and plant-based omega-3 fats for all-cause mortality, cardiovascular events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to February 2019, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to August 2019, with no language restrictions. We handsearched systematic review references and bibliographies and contacted trial authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation or advice to increase LCn3 or ALA intake, or both, versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 86 RCTs (162,796 participants) in this review update and found that 28 were at low summary risk of bias. Trials were of 12 to 88 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most trials assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5 g a day to more than 5 g a day (19 RCTs gave at least 3 g LCn3 daily). Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.93 to 1.01; 143,693 participants; 11,297 deaths in 45 RCTs; high-certainty evidence), cardiovascular mortality (RR 0.92, 95% CI 0.86 to 0.99; 117,837 participants; 5658 deaths in 29 RCTs; moderate-certainty evidence), cardiovascular events (RR 0.96, 95% CI 0.92 to 1.01; 140,482 participants; 17,619 people experienced events in 43 RCTs; high-certainty evidence), stroke (RR 1.02, 95% CI 0.94 to 1.12; 138,888 participants; 2850 strokes in 31 RCTs; moderate-certainty evidence) or arrhythmia (RR 0.99, 95% CI 0.92 to 1.06; 77,990 participants; 4586 people experienced arrhythmia in 30 RCTs; low-certainty evidence). Increasing LCn3 may slightly reduce coronary heart disease mortality (number needed to treat for an additional beneficial outcome (NNTB) 334, RR 0.90, 95% CI 0.81 to 1.00; 127,378 participants; 3598 coronary heart disease deaths in 24 RCTs, low-certainty evidence) and coronary heart disease events (NNTB 167, RR 0.91, 95% CI 0.85 to 0.97; 134,116 participants; 8791 people experienced coronary heart disease events in 32 RCTs, low-certainty evidence). Overall, effects did not differ by trial duration or LCn3 dose in pre-planned subgrouping or meta-regression. There is little evidence of effects of eating fish. Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20; 19,327 participants; 459 deaths in 5 RCTs, moderate-certainty evidence),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25; 18,619 participants; 219 cardiovascular deaths in 4 RCTs; moderate-certainty evidence), coronary heart disease mortality (RR 0.95, 95% CI 0.72 to 1.26; 18,353 participants; 193 coronary heart disease deaths in 3 RCTs; moderate-certainty evidence) and coronary heart disease events (RR 1.00, 95% CI 0.82 to 1.22; 19,061 participants; 397 coronary heart disease events in 4 RCTs; low-certainty evidence). However, increased ALA may slightly reduce risk of cardiovascular disease events (NNTB 500, RR 0.95, 95% CI 0.83 to 1.07; but RR 0.91, 95% CI 0.79 to 1.04 in RCTs at low summary risk of bias; 19,327 participants; 884 cardiovascular disease events in 5 RCTs; low-certainty evidence), and probably slightly reduces risk of arrhythmia (NNTB 91, RR 0.73, 95% CI 0.55 to 0.97; 4912 participants; 173 events in 2 RCTs; moderate-certainty evidence). Effects on stroke are unclear. Increasing LCn3 and ALA had little or no effect on serious adverse events, adiposity, lipids and blood pressure, except increasing LCn3 reduced triglycerides by ˜15% in a dose-dependent way (high-certainty evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and low-certainty evidence suggests that increasing LCn3 slightly reduces risk of coronary heart disease mortality and events, and reduces serum triglycerides (evidence mainly from supplement trials). Increasing ALA slightly reduces risk of cardiovascular events and arrhythmia.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Teesside UniversitySchool of Social Sciences, Humanities and LawMiddlesboroughUKTS1 3BA
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
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Abstract
The effect of dietary fats on cardiometabolic diseases, including cardiovascular diseases and type 2 diabetes mellitus, has generated tremendous interest. Many earlier investigations focused on total fat and conventional fat classes (such as saturated and unsaturated fats) and their influence on a limited number of risk factors. However, dietary fats comprise heterogeneous molecules with diverse structures, and growing research in the past two decades supports correspondingly complex health effects of individual dietary fats. Moreover, health effects of dietary fats might be modified by additional factors, such as accompanying nutrients and food-processing methods, emphasizing the importance of the food sources. Accordingly, the rapidly increasing scientific findings on dietary fats and cardiometabolic diseases have generated debate among scientists, caused confusion for the general public and present challenges for translation into dietary advice and policies. This Review summarizes the evidence on the effects of different dietary fats and their food sources on cell function and on risk factors and clinical events of cardiometabolic diseases. The aim is not to provide an exhaustive review but rather to focus on the most important evidence from randomized controlled trials and prospective cohort studies and to highlight current areas of controversy and the most relevant future research directions for understanding how to improve the prevention and management of cardiometabolic diseases through optimization of dietary fat intake.
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Ueno Y, Miyamoto N, Yamashiro K, Tanaka R, Hattori N. Omega-3 Polyunsaturated Fatty Acids and Stroke Burden. Int J Mol Sci 2019; 20:ijms20225549. [PMID: 31703271 PMCID: PMC6888676 DOI: 10.3390/ijms20225549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022] Open
Abstract
Stroke is a major leading cause of death and disability worldwide. N-3 polyunsaturated fatty acids (PUFAs) including eicosapentaenoic acid and docosahexaenoic acid have potent anti-inflammatory effects, reduce platelet aggregation, and regress atherosclerotic plaques. Since the discovery that the Greenland Eskimo population, whose diet is high in marine n-3 PUFAs, have a lower incidence of coronary heart disease than Western populations, numerous epidemiological studies to explore the associations of dietary intakes of fish and n-3 PUFAs with cardiovascular diseases, and large-scale clinical trials to identify the benefits of treatment with n-3 PUFAs have been conducted. In most of these studies the incidence and mortality of stroke were also evaluated mainly as secondary endpoints. Thus, a systematic literature review regarding the association of dietary intake of n-3 PUFAs with stroke in the epidemiological studies and the treatment effects of n-3 PUFAs in the clinical trials was conducted. Moreover, recent experimental studies were also reviewed to explore the molecular mechanisms of the neuroprotective effects of n-3 PUFAs after stroke.
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Affiliation(s)
- Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan; (N.M.); (K.Y.); (N.H.)
- Correspondence: ; Tel.: +81-3-3813-3111; Fax: +81-3-5800-0547
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan; (N.M.); (K.Y.); (N.H.)
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan; (N.M.); (K.Y.); (N.H.)
| | - Ryota Tanaka
- Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan; (N.M.); (K.Y.); (N.H.)
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11
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Overview of Meta-Analyses: The Impact of Dietary Lifestyle on Stroke Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193582. [PMID: 31557825 PMCID: PMC6801861 DOI: 10.3390/ijerph16193582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
A stroke is one of the most prevalent cardiovascular diseases worldwide, both in high-income countries and in medium and low-medium income countries. The World Health Organization's (WHO) report on non-communicable diseases (NCDs) indicates that the highest behavioral risk in NCDs is attributable to incorrect nutrition. The objective of our work is to present an overview of meta-analyses that have investigated the impact of different foods and/or drinks in relationship with the risk of stroke events (ischemic/hemorrhagic). The papers to be included in the overview were found in MEDLINE, EMBASE, Scopus, Clinicaltrials.gov, Web of Science, and Cochrane Library and were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart. Quality assessment were made according to the AMSTAR 2 scale. This overview shows that all primary studies came from countries with high income levels. This evidence shows that many countries are not represented. Therefore, different lifestyles, ethnic groups, potentially harmful or virtuous eating habits are not reported. It is important to underline how the choose of foods may help reduce the risk of cardiovascular diseases and stroke in particular.
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 11:CD003177. [PMID: 30521670 PMCID: PMC6517311 DOI: 10.1002/14651858.cd003177.pub4] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5g/d LCn3 to > 5 g/d (16 RCTs gave at least 3g/d LCn3).Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs) and ALA may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence with greater effects in trials at low summary risk of bias), and probably reduces risk of arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, except LCn3 reduced triglycerides by ˜15% in a dose-dependant way (high-quality evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event and arrhythmia risk.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Durham UniversityWolfson Research InstituteDurhamUKDH1 3LE
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Fai K AlAbdulghafoor
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 7:CD003177. [PMID: 30019766 PMCID: PMC6513557 DOI: 10.1002/14651858.cd003177.pub3] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet.Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Durham UniversityWolfson Research InstituteDurhamUKDH1 3LE
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Fai K AlAbdulghafoor
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
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Iacoviello L, Bonaccio M, Cairella G, Catani MV, Costanzo S, D'Elia L, Giacco R, Rendina D, Sabino P, Savini I, Strazzullo P. Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis 2018; 28:309-334. [PMID: 29482962 DOI: 10.1016/j.numecd.2017.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS To systematically review the latest evidence on established and emerging nutrition-related risk factors for incidence of and mortality from total, ischemic and haemorrhagic strokes. The present review was conducted in the framework of the work carried out through 2015 and 2016 for the preparation of the Italian Guidelines for the Prevention and Treatment of Stroke, 8th Edition, by ISO-SPREAD (Italian Stroke Organization and the Stroke Prevention and Educational Awareness Diffusion). METHODS AND RESULTS Systematic review of articles focused on primary prevention of stroke published between January 2013 to May 2016 through an extensive search of the literature using MEDLINE/PUBMED, EMBASE and the Cochrane Library. Articles were ranked according to the SIGN methodology while the GRADE system was used to establish the strength of recommendations. As a result of our literature search, we examined 87 meta-analyses overall (mainly of prospective studies), a few isolated more recent prospective studies not included in the meta-analyses, and a smaller number of available randomized controlled trials and case-control studies. Based on the analysis of the above articles, 36 Syntheses of the available evidence and 36 Recommendations were eventually prepared. The present document was developed by organizing the available evidence into three individual areas (nutrients, food groups and dietary patterns) to provide a systematic and user-friendly overview of the available evidence on the relationship between nutrition and primary prevention of stroke. Yet analysis of foods and food patterns allowed translating the information about nutrients in a tool more amenable to use in daily life also in the light of the argument that people eat foods rather than nutrients. CONCLUSIONS The present literature review and dietary recommendations provide healthcare professionals and all interested readers with a useful overview for the reduction of the risk of total, ischemic and haemorrhagic stroke through dietary modifications.
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Affiliation(s)
- L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100, Varese, Italy.
| | - M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - G Cairella
- Servizio Igiene Alimenti e Nutrizione, ASL Rome B, Italy
| | - M V Catani
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - S Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077, Pozzilli, IS, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - R Giacco
- Institute of Food Science, National Research Council, 83100, Avellino, Italy
| | - D Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - P Sabino
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy
| | - I Savini
- Department of Experimental Medicine & Surgery, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - P Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131, Naples, Italy.
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Stivala S, Savarese G, Camici GG, Lüscher TF, Wagner D, Reiner M, Martinod K, Beer J. Dietary omega-3 alpha-linolenic acid does not prevent venous thrombosis in mice. Thromb Haemost 2017; 113:177-84. [DOI: 10.1160/th14-03-0200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/13/2014] [Indexed: 01/17/2023]
Abstract
SummaryVenous thromboembolism (VTE) is a leading cause of cardiovascular death. Omega-3 fatty acids (n-3 FA) exhibit protective effects against cardiovascular disease. Others and our group have reported that the plant-derived n-3 FA alpha-linolenic acid (ALA) displays antiinflammatory, anticoagulant and antiplatelet effects, thereby reducing atherosclerosis and arterial thrombosis in mice fed a high ALA diet. Since procoagulant factors such as tissue factor and fibrin as well as platelets and leukocytes are crucially involved in the development of VTE, we investigated possible protective effects of dietary ALA on venous thrombus formation in a mouse model of stenosis- and furthermore, in a mouse model of endothelial injury-induced venous thrombosis. Four week old C57BL/6 mice underwent four weeks of high (7.3g%) or low ALA (0.03g%) treatment before being exposed to inferior vena cava (IVC) stenosis for 48 hours or laser injury of the endothelium of the internal jugular vein (IJV). Thrombus generation frequency, thrombus size and composition (IVC stenosis group) and time to thrombus formation (endothelial injury group) were assessed. In addition, plasma glycocalicin, a marker of platelet activation, platelet P-selectin and activated integrin expression as well as plasma thrombin generation was determined, but did not reveal any significant differences between he groups. Despite its protective properties against arterial thrombus formation, dietary ALA did not protect against venous thrombosis neither in the IVC stenosis nor the endothelial injury model, further indicating that the biological processes involved in arterial and venous thrombosis are different.
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Saber H, Yakoob MY, Shi P, Longstreth WT, Lemaitre RN, Siscovick D, Rexrode KM, Willett WC, Mozaffarian D. Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts. Stroke 2017; 48:2678-2685. [PMID: 28830976 DOI: 10.1161/strokeaha.117.018235] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke. METHODS We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis. RESULTS A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results. CONCLUSIONS In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid.
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Affiliation(s)
- Hamidreza Saber
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Mohammad Yawar Yakoob
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Peilin Shi
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - W T Longstreth
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Rozenn N Lemaitre
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - David Siscovick
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Kathryn M Rexrode
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Walter C Willett
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.)
| | - Dariush Mozaffarian
- From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Boston, MA (P.S., D.M.); Departments of Neurology and Epidemiology (W.T.L.) and Departments of Medicine and Epidemiology (R.N.L.), University of Washington, Seattle; New York Academy of Medicine (D.S.); and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.).
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Yang B, Ren XL, Huang H, Guo XJ, Ma AG, Li D. Circulating long-chain n-3 polyunsaturated fatty acid and incidence of stroke: a meta-analysis of prospective cohort studies. Oncotarget 2017; 8:83781-83791. [PMID: 29137382 PMCID: PMC5663554 DOI: 10.18632/oncotarget.19530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/12/2017] [Indexed: 01/29/2023] Open
Abstract
Background Circulating long-chain (LC) n-3 polyunsaturated fatty acid (PUFA) can provide objective measures that reflect both dietary consumption and relevant biological processes. Nevertheless, prospective cohort studies on circulating LC n-3 PUFA in relation to incidence of stroke have yielded inconsistent results. We therefore conducted a meta-analysis to quantitatively evaluate the association. Results A total of 2,836 stroke events occurred among 20,460 individuals aged 35–79 yr from 10 prospective cohort studies. Circulating LC n-3 PUFA was significantly associated with reduced risk of stroke (RR: 0.86; 95% CI: 0.76, 0.98; I2 = 0.00%), especially 22:5n-3 (RR: 0.74; 95% CI: 0.60, 0.92) and 22:6n-3 (RR: 0.78; 95% CI: 0.65, 0.94). The associations were more pronounced with ischemic stroke (RR: 0.81; 95% CI: 0.68, 0.96), but not with hemorrhagic stroke (RR: 0.95; 95% CI: 0.60, 1.49). A 1% increment of 22:5n-3 and 22:6n-3 proportions in circulating blood was associated with 25% (RR: 0.75; 95% CI: 0.64, 0.87) and 11% (RR: 0.89; 95% CI: 0.83, 0.95) reduced risk of stroke, respectively. Materials and Methods Pertinent studies were identified from Cochrane Library, PubMed and EMBASE database through June 2017. Multivariate-adjusted risk ratios (RRs) with 95% confidence interval (CI) for incident stroke when comparing the top with the bottom tertiles of baseline LC n-3 PUFA proportions in blood were pooled using a random-effect model. Conclusions Circulating LC n-3 PUFAs were linearly associated with reduced risk of stroke, especially 22:5n-3 and 22:6n-3. Such findings highlight the importance of circulating LC n-3 PUFA in the development of ischemic stroke.
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Affiliation(s)
- Bo Yang
- School of Public Health, Qingdao University, Qingdao, China.,Key Laboratory of Watershed Science and Health of Zhejiang Province, School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Li Ren
- The Laboratory of Animal Center, Wenzhou Medical University, Wenzhou, China
| | - Hong Huang
- Key Laboratory of Watershed Science and Health of Zhejiang Province, School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Juan Guo
- Key Laboratory of Watershed Science and Health of Zhejiang Province, School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Ai-Guo Ma
- School of Public Health, Qingdao University, Qingdao, China
| | - Duo Li
- School of Public Health, Qingdao University, Qingdao, China
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18
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Neuroprotective diets for stroke. Neurochem Int 2017; 107:4-10. [PMID: 28161467 DOI: 10.1016/j.neuint.2017.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
Stroke is one of the main causes of death and disability in the elderly. In the last few years, there has been increasing evidence that suggests the influence of the diet on the decrease of stroke risk. Probably, because of the presence of bioactive components with beneficial effects such as antioxidant or anti-inflammatory properties. This article reviews several dietary bioactive compounds from studies in models of cerebral ischemia that have obtained promising results decreasing cerebral damage. We propose that many of these compounds present in diet could be good candidates to test new neuroprotection approaches focused on reducing the damage and protecting the brain before stroke occurs.
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Wall-Medrano A, de la Rosa LA, Vázquez-Flores AA, Mercado-Mercado G, González-Arellanes R, López-Díaz JA, González-Córdova AF, González-Aguilar GA, Vallejo-Cordoba B, Molina-Corral FJ. Lipidomic and Antioxidant Response to Grape Seed, Corn and Coconut Oils in Healthy Wistar Rats. Nutrients 2017; 9:E82. [PMID: 28117688 PMCID: PMC5295126 DOI: 10.3390/nu9010082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
Specialty oils differ in fatty acid, phytosterol and antioxidant content, impacting their benefits for cardiovascular health. The lipid (fatty acid, phytosterol) and antioxidant (total phenolics, radical scavenging capacity) profiles of grapeseed (GSO), corn (CO) and coconut (CNO) oils and their physiological (triacylglycerides, total and HDL-cholesterol and antioxidant capacity (FRAP) in serum and fatty acid and phytosterol hepatic deposition) and genomic (HL, LCAT, ApoA-1 and SR-BP1 mRNA hepatic levels) responses after their sub-chronic intake (10% diet for 28 days) was examined in healthy albino rats. Fatty acid, phytosterol and antioxidant profiles differed between oils (p ≤ 0.01). Serum and hepatic triacylglycerides and total cholesterol increased (p ≤ 0.01); serum HDL-Cholesterol decreased (p < 0.05); but serum FRAP did not differ (p > 0.05) in CNO-fed rats as compared to CO or GSO groups. Hepatic phytosterol deposition was higher (+2.2 mg/g; p ≤ 0.001) in CO- than GSO-fed rats, but their fatty acid deposition was similar. All but ApoA-1 mRNA level increased in GSO-fed rats as compared to other groups (p ≤ 0.01). Hepatic fatty acid handling, but not antioxidant response, nor hepatic phytosterol deposition, could be related to a more efficient reverse-cholesterol transport in GSO-fed rats as compared to CO or CNO.
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Affiliation(s)
- Abraham Wall-Medrano
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - Laura A de la Rosa
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - Alma A Vázquez-Flores
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - Gilberto Mercado-Mercado
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - Rogelio González-Arellanes
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - José A López-Díaz
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del PRONAF y Estocolmo s/n, Ciudad Juárez 32310, Chihuahua, Mexico.
| | - Aarón F González-Córdova
- Centro de Investigación en Alimentación y Desarrollo, AC (Unidad Hermosillo), Coordinación de Tecnología de Alimentos de Origen Animal (DTAOA), Carretera a la Victoria km. 0.6, AP 1735, Hermosillo 83000, Sonora, Mexico.
| | - Gustavo A González-Aguilar
- Centro de Investigación en Alimentación y Desarrollo, AC (Unidad Hermosillo), Tecnología de Alimentos de Origen Vegetal (DTAOV), Carretera a la Victoria km. 0.6, AP 1735, Hermosillo 83000, Sonora, Mexico.
| | - Belinda Vallejo-Cordoba
- Centro de Investigación en Alimentación y Desarrollo, AC (Unidad Hermosillo), Coordinación de Tecnología de Alimentos de Origen Animal (DTAOA), Carretera a la Victoria km. 0.6, AP 1735, Hermosillo 83000, Sonora, Mexico.
| | - Francisco J Molina-Corral
- Centro de Investigación en Alimentación y Desarrollo, AC. (Unidad Cuauhtémoc), Laboratorio de Tecnología de Alimentos de Origen Vegetal y Toxicología, Ave. Río Conchos s/n, Parque Industrial, AP 781, Cuauhtémoc 31570, Chihuahua, Mexico.
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Relationship between changes in polyunsaturated fatty acids and aging-related arterial stiffness in overweight subjects 50 years or older over a 3-year period. J Clin Lipidol 2017; 11:185-194.e2. [DOI: 10.1016/j.jacl.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 12/31/2022]
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Rhee JJ, Kim E, Buring JE, Kurth T. Fish Consumption, Omega-3 Fatty Acids, and Risk of Cardiovascular Disease. Am J Prev Med 2017; 52:10-19. [PMID: 27646568 PMCID: PMC5167636 DOI: 10.1016/j.amepre.2016.07.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Data on omega-3 polyunsaturated fatty acids in relation to cardiovascular disease are limited in women. The aim of this study was to examine longitudinal relations of tuna and dark fish, α-linolenic acid, and marine omega-3 fatty acid intake with incident major cardiovascular disease in women. METHODS This was a prospective cohort study of U.S. women participating in the Women's Health Study from 1993 to 2014, during which the data were collected and analyzed. A total of 39,876 women who were aged ≥45 years and free of cardiovascular disease at baseline provided dietary data on food frequency questionnaires. Analyses used Cox proportional hazards models to evaluate the association between fish and energy-adjusted omega-3 polyunsaturated fatty acid intake and the risk of major cardiovascular disease, defined as a composite outcome of myocardial infarction, stroke, and cardiovascular death, in 38,392 women in the final analytic sample (96%). RESULTS During 713,559 person years of follow-up, 1,941 cases of incident major cardiovascular disease were confirmed. Tuna and dark fish intake was not associated with the risk of incident major cardiovascular disease (p-trend >0.05). Neither α-linolenic acid nor marine omega-3 fatty acid intake was associated with major cardiovascular disease or with individual cardiovascular outcomes (all p-trend >0.05). There was no effect modification by age, BMI, or baseline history of hypertension. CONCLUSIONS In this cohort of women without history of cardiovascular disease, intakes of tuna and dark fish, α-linolenic acid, and marine omega-3 fatty acids were not associated with risk of major cardiovascular disease.
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Affiliation(s)
- Jinnie J Rhee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
| | - Eunjung Kim
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tobias Kurth
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Berressem D, Koch K, Franke N, Klein J, Eckert GP. Intravenous Treatment with a Long-Chain Omega-3 Lipid Emulsion Provides Neuroprotection in a Murine Model of Ischemic Stroke - A Pilot Study. PLoS One 2016; 11:e0167329. [PMID: 27902774 PMCID: PMC5130273 DOI: 10.1371/journal.pone.0167329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/11/2016] [Indexed: 01/08/2023] Open
Abstract
Single long-chain omega-3 fatty acids (e.g. docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA)) are known for their neuroprotective properties associated with ischemic stroke. This pilot study aimed to test the effectiveness of an acute treatment with a long-chain omega-3 lipid emulsion (Omegaven 10%®, OGV) that contains fish oil (DHA 18 mg/ml; EPA 21 mg/ml) and α-tocopherol (0.2 mg/ml) in a transient middle cerebral artery occlusion (MCAO) model of ischemic stroke in mice. For this purpose, female CD-1 mice were anesthetized and subjected to 90 minutes of MCAO. To reflect a clinically relevant situation for an acute treatment, either after induction of stroke or after reperfusion, a single dose of OGV was injected intravenously into the tail vein (5 ml/kg b.w.). A neurological severity score was used to assess motor function and neurological outcome. Stroke-related parameters were determined 24 hours after MCAO. Microdialysis was used to collect samples from extracellular space of the striatum. Mitochondrial function was determined in isolated mitochondria or dissociated brain cells. Inflammation markers were measured in brain homogenate. According to control experiments, neuroprotective effects could be attributed to the long-chain omega-3 content of the emulsion. Intravenous injection of OGV reduced size and severity of stroke, restored mitochondrial function, and prevented excitotoxic glutamate release. Increases of pro-inflammatory markers (COX-2 and IL-6) were attenuated. Neurological severity scoring and neurochemical data demonstrated that acute OGV treatment shortly after induction of stroke was most efficient and able to improve short-term neurological outcome, reflecting the importance of an acute treatment to improve the outcome. Summarising, acute treatment of stroke with a single intravenous dose of OGV provided strong neuroprotective effects and was most effective when given immediately after onset of ischemia. As OGV is an approved fishoil emulsion for parenteral nutrition in humans, our results may provide first translational data for a possible early management of ischemic stroke with administration of OGV to prevent further brain damage.
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Affiliation(s)
- Dirk Berressem
- Goethe-University of Frankfurt, Department of Pharmacology, Germany
- * E-mail:
| | - Konrad Koch
- Goethe-University of Frankfurt, Department of Pharmacology, Germany
| | - Nicole Franke
- Goethe-University of Frankfurt, Department of Pharmacology, Germany
| | - Jochen Klein
- Goethe-University of Frankfurt, Department of Pharmacology, Germany
| | - Gunter P. Eckert
- Goethe-University of Frankfurt, Department of Pharmacology, Germany
- Justus-Liebig-University Giessen, Institute of Nutritional Sciences, Germany
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Kippler M, Larsson SC, Berglund M, Glynn A, Wolk A, Åkesson A. Associations of dietary polychlorinated biphenyls and long-chain omega-3 fatty acids with stroke risk. ENVIRONMENT INTERNATIONAL 2016; 94:706-711. [PMID: 27473885 DOI: 10.1016/j.envint.2016.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Little is known about joint exposure to polychlorinated biphenyls (PCBs) and long-chain omega-3 fatty acids [eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)], through fish consumption, on cerebrovascular disease risk. OBJECTIVE To explore associations of dietary PCB exposure and EPA-DHA intake with risk of different stroke subtypes. METHODS This was assessed in the prospective population-based Cohort of Swedish Men including 39,948, middle-aged and elderly men, who were free of cardiovascular disease and cancer at baseline in 1997. Validated estimates of dietary PCBs and EPA-DHA were obtained via a food frequency questionnaire. RESULTS During 12years of follow-up, 2286 and 474 incident cases of ischemic stroke and hemorrhagic stroke, respectively, were ascertained through register linkage. Dietary PCB exposure and EPA-DHA intake were associated with hemorrhagic stroke but not ischemic stroke. Men in the highest quartile of dietary PCB exposure (median 412ng/day) had a multivariable- and EPA-DHA-adjusted RR of hemorrhagic stroke of 2.77 [95% confidence interval (CI), 1.48-5.19] compared with men in the lowest quartile (median 128ng/day; p for trend <0.01). The corresponding RRs in men with and without hypertension were 5.45 (95% CI, 1.34-22.1) and 2.37 (95% CI 1.17-4.79), respectively. The multivariable- and PCB-adjusted RR of hemorrhagic stroke for the highest quartile of EPA-DHA intake (median 0.73g/day) versus the lowest quartile (median 0.18g/day) was 0.42 (95% CI, 0.22-0.79). CONCLUSION Dietary PCB exposure was associated with an increased risk of hemorrhagic stroke, whereas a protective association was observed for dietary EPA-DHA intake.
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Affiliation(s)
- Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE 171 77, Stockholm, Sweden.
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE 171 77, Stockholm, Sweden.
| | - Marika Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE 171 77, Stockholm, Sweden.
| | - Anders Glynn
- Department of Risk and Benefit Assessment, National Food Agency, Box 622, SE 751 26, Uppsala, Sweden.
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE 171 77, Stockholm, Sweden.
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE 171 77, Stockholm, Sweden.
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Del Brutto OH, Mera RM, Ha JE, Del Brutto VJ, Castillo PR, Zambrano M, Gillman J. Oily fish consumption is inversely correlated with cerebral microbleeds in community-dwelling older adults: results from the Atahualpa Project. Aging Clin Exp Res 2016; 28:737-43. [PMID: 26497828 DOI: 10.1007/s40520-015-0473-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oily fish is a major dietary source of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). These nutrients improve endothelial dysfunction, reduce β-amyloid induced damage of neurovascular units, and might prevent the occurrence of cerebral microbleeds. However, this relationship has not been investigated so far. AIM To evaluate the association between oily fish intake and cerebral microbleeds in a population of frequent fish consumers living in coastal Ecuador. METHODS Cerebral microbleeds were identified by gradient-echo MRI and oily fish consumption was calculated in community-dwellers aged ≥60 years enrolled in the Atahualpa Project. The association between cerebral microbleeds and fish servings was examined in regression models adjusted for relevant confounders. A predictive model was constructed using quintiles of fish servings to take into account the non-linearity in the relationship. RESULTS Out of 311 eligible individuals, 293 (94 %) were enrolled. Cerebral microbleeds were recognized in 37 (13 %) individuals. Mean fish consumption was 8.8 ± 5.4 servings per week (ω-3 PUFAs estimates: 10.2 ± 7.1 g). Multivariate analysis showed an inverse relationship between cerebral microbleeds and fish consumption (p < 0.001). Predictive margins of CMB were higher for individuals in the lowest (≤4.3) than for those in the highest (≥13.1) quintile of fish servings (17.4 vs 2.3 %, p < 0.001). CONCLUSIONS This study shows a lower cerebral microbleed presence among older adults eating large amounts of oily fish (13 servings per week, equivalent to about 15 g of ω-3 PUFAs). These high requirements can be more readily accomplished in other populations by taking fish oil preparations. Longitudinal studies are warranted to assess whether these interventions reduce incident cerebral microbleeds in high-risk individuals.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
- , Air Center 3542, PO Box 522970, Miami, FL, 33152-2970, USA.
| | | | - Jung-Eun Ha
- Langone Medical Center, New York University, New York, NY, USA
| | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Public Health Nutr 2016; 19:3327-3336. [PMID: 27338865 DOI: 10.1017/s136898001600152x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality. DESIGN Prospective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA. SETTING The primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infarction and all-cause mortality, based on cumulative average fish consumption ascertained at baseline. SUBJECTS Participants (n 16 479) were enrolled between 2003 and 2007, completed the self-administered Block98 FFQ and were free of CVD at baseline. RESULTS There were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week (v. <1 serving/month) were at a significantly increased risk of cardiovascular events (HR=1·63; 95 % CI 1·11, 2·40). Intake of non-fried fish was not associated with risk of incident CVD. There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality. CONCLUSIONS Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events. Given the increased intake of fried fish in the stroke belt and among African Americans, these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD.
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Leikin-Frenkel AI. Is there A Role for Alpha-Linolenic Acid in the Fetal Programming of Health? J Clin Med 2016; 5:jcm5040040. [PMID: 27023621 PMCID: PMC4850463 DOI: 10.3390/jcm5040040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 12/12/2022] Open
Abstract
The role of ω3 alpha linolenic acid (ALA) in the maternal diet during pregnancy and lactation, and its effect on the prevention of disease and programming of health in offspring, is largely unknown. Compared to ALA, ω3 docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids have been more widely researched due to their direct implication in fetal neural development. In this literature search we found that ALA, the essential ω3 fatty acid and metabolic precursor of DHA and EPA has been, paradoxically, almost unexplored. In light of new and evolving findings, this review proposes that ALA may have an intrinsic role, beyond the role as metabolic parent of DHA and EPA, during fetal development as a regulator of gene programming for the prevention of metabolic disease and promotion of health in offspring.
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Affiliation(s)
- Alicia I Leikin-Frenkel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
- Bert Strassburger Lipid Center, Sheba, Tel Hashomer, Ramat Gan 52621, Israel.
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Abstract
Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
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Affiliation(s)
- Dariush Mozaffarian
- From Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA.
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Wolfram G, Bechthold A, Boeing H, Ellinger S, Hauner H, Kroke A, Leschik-Bonnet E, Linseisen J, Lorkowski S, Schulze M, Stehle P, Dinter J. Evidence-Based Guideline of the German Nutrition Society: Fat Intake and Prevention of Selected Nutrition-Related Diseases. ANNALS OF NUTRITION AND METABOLISM 2015; 67:141-204. [PMID: 26414007 DOI: 10.1159/000437243] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As nutrition-related chronic diseases have become more and more frequent, the importance of dietary prevention has also increased. Dietary fat plays a major role in human nutrition, and modification of fat and/or fatty acid intake could have a preventive potential. The aim of the guideline of the German Nutrition Society (DGE) was to systematically evaluate the evidence for the prevention of the widespread diseases obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease (CHD), stroke, and cancer through the intake of fat or fatty acids. The main results can be summarized as follows: it was concluded with convincing evidence that a reduced intake of total and saturated fat as well as a larger intake of polyunsaturated fatty acids (PUFA) at the expense of saturated fatty acids (SFA) reduces the concentration of total and low-density lipoprotein cholesterol in plasma. Furthermore, there is convincing evidence that a high intake of trans fatty acids increases risk of dyslipoproteinaemia and that a high intake of long-chain polyunsaturated n-3 fatty acids reduces the triglyceride concentration in plasma. A high fat intake increases the risk of obesity with probable evidence when total energy intake is not controlled for (ad libitum diet). When energy intake is controlled for, there is probable evidence for no association between fat intake and risk of obesity. A larger intake of PUFA at the expense of SFA reduces risk of CHD with probable evidence. Furthermore, there is probable evidence that a high intake of long-chain polyunsaturated n-3 fatty acids reduces risk of hypertension and CHD. With probable evidence, a high trans fatty acid intake increases risk of CHD. The practical consequences for current dietary recommendations are described at the end of this article.
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BMI Affects the Relationship between Long Chain N-3 Polyunsaturated Fatty Acid Intake and Stroke Risk: a Meta-Analysis. Sci Rep 2015; 5:14161. [PMID: 26369699 PMCID: PMC4572932 DOI: 10.1038/srep14161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/17/2015] [Indexed: 01/11/2023] Open
Abstract
We performed a meta-analysis to clarify the relationship between long chain n-3 polyunsaturated fatty acid (PUFA) intake and stroke risk. Relevant studies were identified by searching online databases through May 2015. Log relative risks (RRs) of the highest versus the lowest for cohort studies were weighed by the inverse variance method to obtain pooled RRs. Fourteen prospective cohort studies including 514,483 individuals and 9,065 strokes were included. The pooled RR of overall stroke risk for long chain n-3 PUFA intake was 0.87 [95% confidence interval (CI), 0.79–0.95]. Stratification analysis showed that higher long chain n-3 PUFAs intake was associated with reduced fatal stroke risk (RR = 0.84; 95% CI, 0.73–0.97), reduced stroke risk for BMI < 24 (RR = 0.86; 95% CI, 0.75–0.98) and reduced stroke risk for females (RR = 0.81; 95% CI, 0.71–0.92), but was not associated with stroke risk for either BMI ≥ 24 or men. This meta-analysis reveals that higher long chain n-3 PUFA intake is inversely associated with risk of stroke morbidity and mortality with BMI and sex as key factors influencing this risk. Individuals should be encouraged to manage their body weight while increasing their intake of long chain n-3 PUFAs.
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Marventano S, Kolacz P, Castellano S, Galvano F, Buscemi S, Mistretta A, Grosso G. A review of recent evidence in human studies of n-3 and n-6 PUFA intake on cardiovascular disease, cancer, and depressive disorders: does the ratio really matter? Int J Food Sci Nutr 2015; 66:611-22. [PMID: 26307560 DOI: 10.3109/09637486.2015.1077790] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Polyunsaturated fatty acids (PUFAs) have been considered of great interest for human health due to their potential anti-inflammatory action that may protect from a number of chronic-degenerative diseases with an inflammatory pathogenesis. This review aimed to report the most updated evidence of both n-3 and n-6 PUFAs effect on cardiovascular disease, cancer, and depression in humans. Attention has been also paid to those studies exploring the effects of the ratio intake. Results from pooled analyses of human studies reported a general positive effect of n-3 PUFAs intake on all outcomes considered. In contrast, the role of n-6 PUFAs on human health needs to be better assessed in order to clearly identify which compound exerts beneficial/harmful effects. Only a limited number of clinical studies considered the n-3:n-6 PUFAs ratio, rather reporting contrasting results. A number of limitations when considering the ratio between these two families of PUFAs have risen.
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Affiliation(s)
- Stefano Marventano
- a Department of Medical, Surgical Sciences, and Advanced Technologies "G.F. Ingrassia", Section of Hygiene and Public Health , University of Catania , Catania , Italy
| | - Paulina Kolacz
- b Department of Human Nutrition , Jagiellonian University Medical College in Krakow , Krakow , Poland
| | - Sabrina Castellano
- c Department of Biomedical and Biotechnological Sciences, Section of Pharmacology and Biochemistry , University of Catania , Catania , Italy , and
| | - Fabio Galvano
- c Department of Biomedical and Biotechnological Sciences, Section of Pharmacology and Biochemistry , University of Catania , Catania , Italy , and
| | - Silvio Buscemi
- d Department of Internal Medicine , University of Palermo , Palermo , Italy
| | - Antonio Mistretta
- a Department of Medical, Surgical Sciences, and Advanced Technologies "G.F. Ingrassia", Section of Hygiene and Public Health , University of Catania , Catania , Italy
| | - Giuseppe Grosso
- a Department of Medical, Surgical Sciences, and Advanced Technologies "G.F. Ingrassia", Section of Hygiene and Public Health , University of Catania , Catania , Italy
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Abstract
Lifestyle modifications and environmental factors are important for stroke prevention and rehabilitation after stroke. The individual stroke risk may be modified by factors like physical activity, body weight and nutrition, special dietary supplements such as vitamins, smoking, consumption of tea, coffee and alcohol, psychological factors and by keeping a pet. The focus of this article lies on measures for stroke prevention. For certain topics, it also comments on factors that are important during rehabilitation after stroke.
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Affiliation(s)
- L M Gerischer
- Klinik und Hochschulambulanz für Neurologie, Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
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Weintraub HS. Overview of Prescription Omega-3 Fatty Acid Products for Hypertriglyceridemia. Postgrad Med 2015; 126:7-18. [DOI: 10.3810/pgm.2014.11.2828] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Early origins of chronic obstructive lung diseases across the life course. Eur J Epidemiol 2014; 29:871-85. [PMID: 25537319 DOI: 10.1007/s10654-014-9981-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/06/2014] [Indexed: 12/12/2022]
Abstract
Chronic obstructive lung diseases, like asthma and chronic obstructive pulmonary disease, have high prevalences and are a major public health concern. Chronic obstructive lung diseases have at least part of their origins in early life. Exposure to an adverse environment during critical periods in early life might lead to permanent developmental adaptations which results in impaired lung growth with smaller airways and lower lung volume, altered immunological responses and related inflammation, and subsequently to increased risks of chronic obstructive lung diseases throughout the life course. Various pathways leading from early life factors to respiratory health outcomes in later life have been studied, including fetal and early infant growth patterns, preterm birth, maternal obesity, diet and smoking, children's diet, allergen exposure and respiratory tract infections, and genetic susceptibility. Data on potential adverse factors in the embryonic and preconception period and respiratory health outcomes are scarce. Also, the underlying mechanisms how specific adverse exposures in the fetal and early postnatal period lead to chronic obstructive lung diseases in later life are not yet fully understood. Current studies suggest that interactions between early environmental exposures and genetic factors such as changes in DNA-methylation and RNA expression patterns may explain the early development of chronic obstructive lung diseases. New well-designed epidemiological studies are needed to identify specific critical periods and to elucidate the mechanisms underlying the development of chronic obstructive lung disease throughout the life course.
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The Generation R Study: Biobank update 2015. Eur J Epidemiol 2014; 29:911-27. [PMID: 25527369 DOI: 10.1007/s10654-014-9980-6] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/06/2014] [Indexed: 12/14/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. In total, 9,778 mothers were enrolled in the study. Data collection in children and their parents include questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, Magnetic Resonance Imaging and biological samples. Efforts have been conducted for collecting biological samples including blood, hair, faeces, nasal swabs, saliva and urine samples and generating genomics data on DNA, RNA and microbiome. In this paper, we give an update of the collection, processing and storage of these biological samples and available measures. Together with detailed phenotype measurements, these biological samples provide a unique resource for epidemiological studies focused on environmental exposures, genetic and genomic determinants and their interactions in relation to growth, health and development from fetal life onwards.
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Retrospective Case Series of Patients with Diabetes or Prediabetes Who Were Switched from Omega-3-Acid Ethyl Esters to Icosapent Ethyl. Cardiol Ther 2014; 4:83-93. [PMID: 25515964 PMCID: PMC4472650 DOI: 10.1007/s40119-014-0032-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction Patients with diabetes and prediabetes are at increased risk of dyslipidemia and cardiovascular disease. To reduce this risk, statins and additional therapies may be considered. Omega-3 fatty acids offer an option to reduce triglycerides (TG) and potentially improve other lipid parameters, although products that contain docosahexaenoic acid (DHA) may increase low-density lipoprotein cholesterol (LDL-C) while eicosapentaenoic acid (EPA) does not. Prescription formulations include omega-3-acid mixtures (combination of predominantly EPA and DHA), and icosapent ethyl (high-purity prescription form of EPA ethyl ester); prescription omega-3 products are indicated as an adjunct to diet to reduce TGs in adult patients with severe hypertriglyceridemia at a dose of 4 g/day. Methods This was a retrospective analysis of records from a private endocrinology practice of patients who received omega-3-acid ethyl esters (OM3EE) (4 g/day) and were subsequently switched to icosapent ethyl (IPE; 4 g/day) due to the potential of OM3EE to raise LDL-C and/or cause gastrointestinal upset. Patient records were analyzed for LDL-C, TG, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C measured before and after the switch to IPE. Results The records of ten patients met the criteria for this analysis and were included. All patients had taken OM3EE for ≥1 year prior to their last lipid measurement before switching to IPE, and all had been taking IPE for >3 months at the time of their subsequent lipid measurement. Nine of the ten patients were on concomitant statin therapy throughout. Reductions in LDL-C, TC, and non-HDL-C were observed in eight patients, reductions or no changes in TG were observed in eight patients, and increases or no changes in HDL-C were observed in eight patients. No gastrointestinal adverse events were observed. Conclusion In most patients with prediabetes or diabetes who switched from OM3EE to IPE, LDL-C and other lipid parameters improved. IPE was well tolerated.
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Wang A, Lin Y, Wu Y, Zhang D. Macronutrients intake and risk of Parkinson's disease: A meta-analysis. Geriatr Gerontol Int 2014; 15:606-16. [DOI: 10.1111/ggi.12321] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Aimin Wang
- Department of Nursing; Qingdao University Medical College; Qingdao China
| | - Yan Lin
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Yili Wu
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
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Casula M, Soranna D, Catapano AL, Corrao G. Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: A meta-analysis of randomized, placebo controlled trials [corrected]. ATHEROSCLEROSIS SUPP 2014; 14:243-51. [PMID: 23958480 DOI: 10.1016/s1567-5688(13)70005-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although omega-3 fatty acids have well documented properties which would reduce the cardiovascular (CV) disease risk, the evidence from randomized controlled trials (RCTs) remains inconclusive. We performed a meta-analysis of the available RCTs for investigating the CV preventive effect of administrating at least 1 gram/day, and for at least 1 year, omega-3 fatty acid supplements to patients with existing CV disease. METHODS RCTs published up to March 2013 were searched from PubMed, EMBASE, and the Cochrane Library. Two of us independently reviewed and selected eligible trials. RESULTS Of 360 articles retrieved, 11 randomized, double-blind, placebo controlled trials fulfilling inclusion criteria, overall involving 15,348 patients with a history of CV disease, were considered in the final analyses. No statistically significant association was observed for all-cause mortality (RR, 0.89; 95% CI, 0.78 to 1.02) and stroke (RR, 1.31; 95% CI, 0.90 to 1.90). Conversely, statistically significant protective effects were observed for cardiac death (RR, 0.68; 95% CI, 0.56 to 0.83), sudden death (RR, 0.67; 95% CI, 0.52 to 0.87), and myocardial infarction (RR, 0.75; 95% CI, 0.63 to 0.88). CONCLUSION Overall, our results supply evidence that long-term effect of high dose omega-3 fatty acid supplementation may be beneficial for the onset of cardiac death, sudden death and myocardial infarction among patients with a history of cardiovascular disease.
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Affiliation(s)
- Manuela Casula
- Centre of Epidemiology and Preventive Pharmacology-SEFAP, Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy.
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Silva V, Barazzoni R, Singer P. Biomarkers of Fish Oil Omega-3 Polyunsaturated Fatty Acids Intake in Humans. Nutr Clin Pract 2013; 29:63-72. [DOI: 10.1177/0884533613516144] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Veronica Silva
- Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Pierre Singer
- Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of General Intensive Care, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Weintraub H. Update on marine omega-3 fatty acids: Management of dyslipidemia and current omega-3 treatment options. Atherosclerosis 2013; 230:381-9. [DOI: 10.1016/j.atherosclerosis.2013.07.041] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 07/18/2013] [Accepted: 07/19/2013] [Indexed: 01/25/2023]
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Fish intake or omega-3 fatty acids: greater than the sum of all parts? Eur J Epidemiol 2013; 27:891-4. [PMID: 23283593 DOI: 10.1007/s10654-012-9757-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/16/2012] [Indexed: 12/21/2022]
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