Circulating polyunsaturated fatty acids, fish oil supplementation, and risk of incident dementia: a prospective cohort study of 440,750 participants

Dietary N-6 Polyunsaturated Fatty Acid Intake and Brain Health in Middle-Aged and Elderly Adults

BACKGROUND

Dietary intake of polyunsaturated fatty acids (PUFA) plays a significant role in the onset and progression of neurodegenerative diseases. Since the neuroprotective effects of n-3 PUFA have been widely validated, the role of n-6 PUFA remains debated, with their underlying mechanisms still not fully understood.

METHODS

In this study, 169,295 participants from the UK Biobank were included to analyze the associations between dietary n-6 PUFA intake and neurodegenerative diseases using Cox regression models with full adjustments for potential confounders. In addition, multiple linear regression models were utilized to estimate the impact of n-6 PUFA intake on brain imaging phenotypes.

RESULTS

Results indicated that low dietary n-6 PUFA intake was associated with increased risks of incident dementia (hazard ratio [95% confidence interval] = 1.30 [1.13, 1.49]), Parkinson's disease (1.42 [1.16, 1.74]), and multiple sclerosis (1.65 [1.03, 2.65]). Moreover, the low intake was linked to diminished volumes of various brain structures, including the hippocampus (β [95% confidence interval] = -0.061 [-0.098, -0.025]), thalamus (-0.071 [-0.105, -0.037]), and others. White matter integrity was also found to be compromised in individuals with low n-6 PUFA intake.

CONCLUSIONS

These findings enhanced our understanding of how dietary n-6 PUFA intake might affect neurological health, thereby providing epidemiological evidence for future clinical and public health interventions.

Plasma Polyunsaturated Fatty Acid Levels and Mental Health in Middle-Aged and Elderly Adults

Background: Polyunsaturated fatty acids (PUFAs) are promising nutrients for the prevention and management of psychiatric disorders. Both animal experiments and cohort studies have demonstrated the antidepressant effects of PUFAs, especially omega-3 PUFAs. However, inconsistent reports about specific types of PUFAs, such as the omega-3 and omega-6 PUFAs, still exist. Objectives: To assess the effects of specific PUFAs on mental disorders and related symptoms and explore the potential mechanisms involving white matter microstructure. Methods: Leveraging 102,252 residents from the UK Biobank, the effects of five PUFA measures on depressive disorder and anxiety disorder were explored through Cox regression models with full adjustment for possible confounders. Furthermore, the effects on related psychiatric symptoms and brain white matter microstructures were also estimated using logistic regression models and multiple linear regression models, respectively. Results: In this study, plasma levels of five PUFAs measured in quartile 4 were associated with lower risks of incident depressive disorder compared with the lowest quartile, with hazard ratios of 0.80 [95% confidence interval] = [0.71, 0.90] for total PUFAs, 0.86 [0.76, 0.97] for omega-3 PUFAs, 0.80 [0.71, 0.91] for docosahexaenoic acid, 0.79 [0.70, 0.89] for omega-6 PUFAs, and 0.77 [0.69, 0.87] for linoleic acid. Similar associations were observed between PUFAs and the incident risk of anxiety disorder. In addition, high plasma PUFA levels were also related to lower risks of occurrence of several adverse psychological symptoms, especially omega-3 PUFAs and DHA. Among the included participants, 8780 individuals with brain imaging information were included in further neuroimaging analyses, and significant associations with white matter microstructures were observed. Conclusions: Thus, this study provides population-based evidence to support the value of interventions to target PUFAs (specifically omega-3 PUFAs) for the prevention and improvement of mental health.

Association Between Preoperative Lymphocyte-to-Monocyte Ratio and Occurrence of Postoperative Cognitive Dysfunction: A Prospective Cohort Study

Purpose

Postoperative cognitive dysfunction (POCD) is a common postoperative complication. Studies have reported that lymphocyte-to-monocyte ratio (LMR) was a predictor of many diseases associated with inflammation. However, further examination of the relationship between preoperative LMR and POCD is needed. We aimed to investigate the association between POCD and preoperative LMR levels to examine the potential of LMR to predict POCD.

Patients and Methods

This was a prospective cohort study that included patients who underwent elective major abdominal surgery at our hospital between January 2019 and January 2022. Multivariate logistic regression analysis was used to analyze the effects of preoperative LMR on POCD development. The optimal threshold of preoperative LMR for predicting POCD was determined by receiver operating characteristic (ROC) approach. A subgroup analysis was performed according to age, sex, type of surgery and hypertension.

Results

Of 964 patients, 362 (37.6%) developed POCD. The preoperative LMR level in the Non-POCD group was higher than that in the POCD group. According to the ROC curve, a cutoff value of 3.758 of the preoperative LMR level could be used to predict POCD occurrence and the area under the curve (AUC) was 0.747 (95% CI: 0.715-0.779, P < 0.001). The results of the subgroup analyses were consistent with the primary ones, and no heterogeneity was observed in the subgroup analyses (P for interaction > 0.05).

Conclusion

LMR was significantly associated with the occurrence of POCD after major abdominal surgery. Preoperative low LMR levels can be used to identify patients who may be at high risk of POCD.

Novel Classification of Cardiovascular Disease Subtypes Reveals Associations Between Mortality and Polyunsaturated Fatty Acids: Insights from the United Kingdom Biobank Study

Background

Traditional association studies of cardiovascular disease (CVD) categorizations and polyunsaturated fatty acids (PUFAs) yielded conflicting findings. We propose a novel classification system based on fundamental characteristics of cardiovascular patients, such as age, body mass index, waist-hip ratio, to more accurately assess the impact of PUFAs (plasma measures) such as omega (ω)-3 (n-3) and ω-6 on mortality in cardiovascular patients.

Methods

Principal component analysis and k-means clustering were used to determine the CVD subtype. Variables included age, body mass index, waist-hip ratio, diastolic blood pressure, systolic blood pressure, total cholesterol, total triglycerides, high-density lipoprotein-cholesterol, apolipoprotein B:apolipoprotein A1, glycated hemoglobin, creatinine, albumin, C-reactive protein, white blood cell count, platelet count, and hemoglobin concentration. The association of PUFAs with all-cause, cardiovascular, and ischemic heart disease (IHD) mortality in patients with CVD was prospectively evaluated using restricted cubic splines and Cox proportional risk models.

Results

Among the 35,096 participants, 3,786 fatalities occurred. Three distinct CVD subtypes were identified, with cluster 3 characterized by older age, male gender, and low high-density lipoprotein-cholesterol, having the highest risk of mortality. Clusters 2 and 3 had the highest DHA and ω-6/ω-3 ratios, respectively, compared with Cluster 1. The protective effects of total PUFAs, ω-3, and DHA were mainly reflected in all-cause mortality and were more significant in clusters 2 and 3. Furthermore, the ω-6/ω-3 ratio of the highest quartile increased risk of all-cause [Q3: hazard ratio (HR): 1.14, 95% confidence interval [CI]: 1.00, 1.29; Q4: HR: 1.41, 95% CI: 1.24, 1.61], CVD (Q4: HR: 1.36, 95% CI: 1.07, 1.75), and IHD mortality (Q4: HR: 1.17, 95% CI: 1.12, 2.03) in cluster 3 compared with the first quartile.

Conclusions

Our findings highlight the heterogeneity of associations observed for the same type of PUFAs across distinct clusters. This association may be elucidated by the intricate interplay of various factors, encompassing inflammation, lipid metabolism, and cardiovascular health.

Fish oil supplementation and risk of incident systemic lupus erythematosus: a large population-based prospective study

BACKGROUND

Although fish oil has been considered to have an anti-inflammatory effect and has been proven to play a beneficial role in the incidence of numerous diseases, the association between fish oil supplementation and the risk of systemic lupus erythematosus (SLE) is still unknown. This study aimed at evaluating the correlation between fish oil use and incident SLE in a large population-based prospective cohort.

METHODS

390,277 participants without SLE at baseline from the UK Biobank were enrolled. Fish oil use was ascertained through a touchscreen questionnaire at baseline. The incidence of SLE was identified by the International Classification of Diseases version 10 code in medical records or self-report. Cox proportional hazard models were employed to estimate the association between fish oil use and SLE risk.

RESULTS

Fish oil users accounted for 31.47% of participants. During a median follow-up duration of 11.57 years, 141 participants without fish oil use (4.56/100 000 person-years) and 68 participants with fish oil use (4.78/100 000 person-years) developed SLE. In four models with adjustments for different amounts of confounders, there was no significant difference in the risk of SLE between fish oil users and fish oil non-users (all p-values > 0.05). In subgroup analyses, we found that fish oil supplementation was associated with a lower risk of SLE among females with ultraviolet radiation ≥ 3 h/day (hazard ratio: 0.63, 95% confidence interval: 0.40-0.98), which turned insignificant after further adjustment for female-related factors and sun protection measures.

CONCLUSIONS

No significant association between fish oil use and overall incident SLE was observed, except in females exposed to prolonged ultraviolet radiation. Subgroup analysis suggested that females exposed to prolonged ultraviolet radiation might benefit from fish oil supplementation in terms of preventing SLE, but it needs to be confirmed in further studies.

Fish oil supplementation and risk of dementia among diabetic patients: a prospective study of 16,061 older patients

BACKGROUND

Although n-3 Polyunsaturated fatty acids (PUFAs) may benefit cognitive performance, the association of n-3 PUFA intake with dementia risk under dysglycemia has not been examined. We aimed to evaluate the relationship between fish oil supplement use or fish consumption and dementia risk among older patients with diabetes.

METHOD

A total of 16,061 diabetic patients aged over 60 years were followed up in the UK Biobank. Fish oil supplements use (yes or no) was collected by the touch screen questionnaire. The diagnosis of dementia was ascertained by the UK Biobank Outcome Adjudication Group. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models.

RESULTS

A total of 337 cases of dementia were confirmed after a mean duration of 7.7 years (123,486 person-years) of follow-up. Habitual use of fish oil supplements showed a 24% lower dementia risk among older diabetic patients [HRs (95% CIs): 0.76 (0.60-0.98) (P = 0.031)] compared with non-users. Such inverse association was not modified by the APOE ε4 genotype. However, the consumption of both oily fish (≥2 times/week) and non-oily fish (≥2 times/week) had no significant association with dementia risk (p-trend = 0.271 and p-trend = 0.065) compared with non-consumers.

CONCLUSION

In summary, fish oil supplementation may play a protective role in cognitive function across all APOE genotypes, while non-oily fish and oily fish consumption have no protective association among older diabetic patients.

Plasma metabolic profiles predict future dementia and dementia subtypes: a prospective analysis of 274,160 participants

BACKGROUND

Blood-based biomarkers for dementia are gaining attention due to their non-invasive nature and feasibility in regular healthcare settings. Here, we explored the associations between 249 metabolites with all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) and assessed their predictive potential.

METHODS

This study included 274,160 participants from the UK Biobank. Cox proportional hazard models were employed to investigate longitudinal associations between metabolites and dementia. The importance of these metabolites was quantified using machine learning algorithms, and a metabolic risk score (MetRS) was subsequently developed for each dementia type. We further investigated how MetRS stratified the risk of dementia onset and assessed its predictive performance, both alone and in combination with demographic and cognitive predictors.

RESULTS

During a median follow-up of 14.01 years, 5274 participants developed dementia. Of the 249 metabolites examined, 143 were significantly associated with incident ACD, 130 with AD, and 140 with VaD. Among metabolites significantly associated with dementia, lipoprotein lipid concentrations, linoleic acid, sphingomyelin, glucose, and branched-chain amino acids ranked top in importance. Individuals within the top tertile of MetRS faced a significantly greater risk of developing dementia than those in the lowest tertile. When MetRS was combined with demographic and cognitive predictors, the model yielded the area under the receiver operating characteristic curve (AUC) values of 0.857 for ACD, 0.861 for AD, and 0.873 for VaD.

CONCLUSIONS

We conducted the largest metabolome investigation of dementia to date, for the first time revealed the metabolite importance ranking, and highlighted the contribution of plasma metabolites for dementia prediction.

Plasma Omega-3 Fatty Acids and Risk for Incident Dementia in the UK Biobank Study: A Closer Look

Dietary omega-3 fatty acids are promising nutrients in dementia. Several prospective cohort studies have examined the relationships between circulating omega-3 (an objective biomarker of dietary intake) and incident dementia, the largest to date being a report from the UK Biobank (n = 102,722). Given the recent release of new metabolomics data from baseline samples from the UK Biobank, we re-examined the association in a much larger sample (n = 267,312) and also focused on associations with total omega-3, docosahexaenoic acid (DHA), and non-DHA omega-3. Using Cox regression models, we observed that the total omega-3 status was inversely related to the risk of Alzheimer's (Q5 vs. Q1, hazard ratio [95% confidence interval] = 0.87 [0.76; 1.00]) and all-cause dementia (Q5 vs. Q1, 0.79 [0.72; 0.87]). The strongest associations were observed for total omega-3 (and non-DHA omega-3) and all-cause dementia. In prespecified strata, we found stronger associations in men, and in those aged ≥60 years at baseline (vs. those aged 50-59). Thus, in the largest study to date on this topic, we confirmed the favorable relationships between DHA and risk for dementia, and we also found evidence that non-DHA omega-3 may be beneficial. Finally, we have better defined the populations most likely to benefit from omega-3-based interventions.