The effects of omega-3 fatty acid supplementation on inflammatory factors in HIV-infected patients: A systematic review and meta-analysis of randomized clinical trials

Omega-3 fatty acids and endothelial function: A GRADE-assessed systematic review and meta-analysis

INTRODUCTION

N-3 polyunsaturated fatty acids (PUFAs) supplementation has been reported to have an impact on flow-mediated dilatation (FMD), a conventionally used clinical technique for estimating endothelial dysfunction. However, its proven effects on endothelial function are unclear. This systematic review and meta-analysis were conducted to evaluate the effects of n-3 PUFAs supplementation on FMD of the brachial artery.

METHOD

This study was performed following the PRISMA guidelines. To identify eligible RCTs, a systematic search was completed in PubMed/Medline, Scopus and Web of Science using relevant keywords. A fixed- or random-effects model was utilized to estimate the weighted mean difference (WMD) and 95% confidence interval (95% CI).

RESULTS

Thirty-two studies (with 35 arms) were included in this meta-analysis, involving 2385 subjects with intervention duration ranging from 4 to 48 weeks. The pooled meta-analysis demonstrated a significant effect of omega-3 on FMD (WMD = 0.8%, 95% CI = 0.3-1.3, p = .001) and heterogeneity was significant (I2  = 82.5%, p < .001).

CONCLUSION

We found that n-3 PUFA supplementation improves endothelial function as estimated by flow-mediated dilatation of the brachial artery.

Should We "RESPECT EPA" More Now? EPA and DHA for Cardiovascular Risk Reduction

PURPOSE OF REVIEW

There has been much debate surrounding the use of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for cardiovascular (CV) risk reduction.

RECENT FINDINGS

Recent trials of EPA and DHA have offered conflicting evidence. Some demonstrate reduction in CV risk using EPA alone in select populations. Others have demonstrated no benefit, with potential for side effects, such as new-onset atrial fibrillation. Both EPA and DHA have favorable impact on lipids and inflammation, suggesting some biological plausibility for CV risk reduction. However, clinical trials of these agents have produced mixed results. Based on available evidence, EPA may work better for CV risk than DHA and EPA combined. The benefit of EPA seems to be dose dependent, though higher doses may have more side effects. Further research is needed to define the role of EPA and DHA in the landscape of CV risk reduction.

Fatty Acids Composition and HIV Infection: Altered Levels of n-6 Polyunsaturated Fatty Acids Are Associated with Disease Progression

Fatty acids (FAs) are important regulators of immune responses and innate defense mechanisms. We hypothesized that disturbed FA metabolism could contribute to the progression of HIV infection. Plasma levels of 45 FAs were analyzed with gas chromatography in healthy controls and HIV-infected patients with regard to Mycobacterium avium complex (MAC) infection. In vitro, we assessed MAC-PPD-induced release of inflammatory cytokines in peripheral and bone marrow mononuclear cells (PBMC and BMMC) according to levels of n-6 polyunsaturated fatty acids (PUFAs). While plasma saturated FAs were higher in HIV infection, PUFAs, and in particular the n-6 PUFA arachidonic acid (AA), were lower in patients with advanced disease. The ratio between AA and precursor dihomo-γ-linolenic acid, reflecting Δ5-desaturase activity, was markedly lower and inversely correlated with plasma HIV RNA levels in these patients. Depletion of AA was observed prior to MAC infection, and MAC-PPD-induced release of TNF and IL-6 in PBMC and BMMC was lower in patients with low plasma AA. Our findings suggest that dysregulated metabolism of n-6 PUFAs may play a role in the progression of HIV infection. While high AA may contribute to chronic inflammation in asymptomatic HIV-infected patients, low AA seems to increase the susceptibility to MAC infection in patients with advanced disease.

Nutritional and Lifestyle Therapy for NAFLD in People with HIV

HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.

Efficacy of the omega-3 fatty acids supplementation on inflammatory biomarkers: An umbrella meta-analysis

BACKGROUND

Existing meta-analyses on omega-3 polyunsaturated fatty acids and their anti-inflammatory effects have reported uncertain findings. The current umbrella meta-analysis aimed to assess the findings of multiple meta-analyses on the efficacy of n-3 PUFAs on inflammatory biomarkers in adults with different health conditions.

METHODS

Using suitable keywords, articles published until December 2021 were searched in PubMed/Medline, Web of Science, Scopus, EMBASE, and Google Scholar. Meta-analyses investigating the impact of supplementation of n-3 PUFAs on inflammatory biomarkers in adults were included. We performed this meta-analysis using a random-effects model.

RESULTS

Overall, 32 meta-analyses were qualified in this umbrella meta-analysis. Our findings demonstrated that the n-3 PUFA supplementation significantly reduced serum C-reactive protein (CRP) (ES = -0.40; 95 % CI: -0.56, -0.24, p < 0.001; I² = 89.5 %, p < 0.001), Tumour necrosis factor α (TNFα) (ES = -0.23; 95 % CI: -0.37, -0.08, p = 0.002; I² = 60.1 %, p < 0.001), and interleukin 6 (IL-6) concentrations (ES = -0.22; 95 % CI: -0.39, -0.05, p = 0.010; I² = 66.2 %, p < 0.001).

CONCLUSION

The current umbrella meta-analysis found that supplementation of n-3 PUFAs in adults can improve CRP, TNF-α, and IL-6 concentrations under various health conditions. n-3 PUFAs can be recommended as adjuvant anti-inflammatory agents.

Effects of omega-3 supplementation on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus: A randomized clinical trial

Background

Vascular dysfunction is a major complication of diabetes mellitus that leads to cardiovascular disease (CVD). This study aimed to examine the effects of omega-3 consumption on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus (T1DM).

Methods

In this randomized, double-blind, placebo-controlled clinical trial, 51 adolescents (10–18 years) with T1DM completed the study. Patients received 600 mg/day [containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexaenoic acid (DHA)] of omega-3 or placebo for 12 weeks. Flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, blood urea nitrogen (BUN), creatinine, fasting blood sugar (FBS), hemoglobin A1C (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), serum insulin (SI), urine albumin-creatinine ratio (uACR), blood pressure, and anthropometric indices were assessed at the baseline and after the intervention.

Results

Following supplementation, omega-3 significantly increased FMD (3.1 ± 4.2 vs. −0.6 ± 4%, p = 0.006) and decreased TG (−7.4 ± 10.7 vs. −0.1 ± 13.1 mg/dl, p = 0.022) in comparison with the placebo group. However, no significant difference was observed regarding CIMT (-0.005 ± 0.036 vs. 0.003 ± 0.021 mm, p = 0.33). Although hs-CRP was significantly decreased within the omega-3 group (p = 0.031); however, no significant change was observed compared to placebo group (p = 0.221). Omega-3 supplementation had no significant effect on other variables.

Conclusion

Given the elevation in FMD and reduction in TG, omega-3 supplementation can improve vascular function and may reduce the risk of cardiovascular disease in adolescents with T1DM patients.

Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis

BACKGROUND

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Although fish oil has been used as an immunonutritional preparations for the treatment of sepsis patients, there is still controversy as to whether it is beneficial to them. We systematically reviewed published clinical trial data to evaluate the effectiveness of fish oil-containing nutrition supplementation in sepsis patients.

METHODS

A systematic search was undertaken in PubMed, Embase, Chinese Biomedicine Database, the Cochrane Library and the China Knowledge Resource Integrated Database to obtain clinical controlled trails. RCTs on nutrition therapy containing fish oil among adult sepsis patients were selected for analysis in comparison with routine therapy.

RESULTS

Twenty-five published trials were included in the meta-analysis. Fish oil-containing nutrition supplementation reduced the mortality compared with the control group (relative risk (RR) 0.74, I ² = 0%). Fish oil also shortened the ICU stay (MD -3.57 days; 95% CI -4.54, -2.59; p<0.00001; I ² = 76%), hospital stay (MD -9.92 days; 95% CI -15.37, -4.46; p = 0.0004; I ² = 91%) and the duration of mechanical ventilation support (MD -2.26; 95% CI -4.27, -0.26; p = 0.03; I ² = 83%). A subgroup analysis based on the route of administration revealed that parenteral administration of fish oil could reduce mortality in septic patients (RR =0.68, I ² = 0%), but no significant difference in mortality was observed in the fish oil group administered by enteral route (RR = 0.80, I ² = 0%). No statistically significant publication biases were detected for the above clinical endpoints (p>0.05).

CONCLUSIONS

Parenteral nutrition containing fish oil could significantly decrease mortality in sepsis patients while enteral administration could not. Fish oil-containing nutrition supplementation.

Effect of Antarctic krill phospholipid (KOPL) on high fat diet-induced obesity in mice

Phospholipids are the main lipid components in Antarctic krill oil, and the combination of n-3 polyunsaturated fatty acids (n-3 PUFAs) shows multiple nutritional advantages. At present, the research about Antarctic krill phospholipid (KOPL) mainly focuses on the purification, and there are few reports on the anti-obesity effect. Thus, this study aimed at evaluating the effect of KOPL on the high-fat diet (HFD)-induced obesity mice. All the mice were divided into five groups, which were fed chow diet, HFD, and different doses of KOPL + HFD, respectively. The results showed that KOPL treatment could reduce the weight gain, fat accumulation, and liver tissue damage in HFD-induced mice. KOPL treatment could reduce the levels of serum lipid (TC, TG, L-LDL) and fasting blood glucose in HFD-induced mice, and the inflammatory cytokines (IL-1β and TNF-α) in serum. Further analysis showed that KOPL could promote the normal expression of lipid-synthesis-related genes and proteins, including sterol regulatory element-binding protein-1c (SREBP-1c), fatty acid synthetase (FAS), and peroxisome proliferator-activated receptor alpha (PPAR-α) in liver tissue. Besides, it inhibited the overexpression of inflammatory cytokine genes (IL-1β and TNF-α), but increased the expression of tight junction genes (ZO-1 and Occludin) in the colon tissue. Additionally, KOPL improved the decrease of diversity and imbalance of intestinal microbiota, which could contribute to its beneficial effects. In summary, the KOPL treatment improves the effects of HFD-induced obese mice by maintaining normal lipid levels, protecting the liver tissue, reducing inflammation response and intestinal damage, and regulating intestinal microbiota abnormalities. It refer to KOPL could be a promising dietary strategy for treating obesity and improving its related metabolic diseases.

Fish Consumption: A Review of Its Effects on Metabolic and Hormonal Health

Dietary habits are a major determinant of the risk of chronic disease, particularly metabolic and endocrine disorders. Fish as a food group are a unique source of nutrients with metabolic and hormonal importance including omega-3 fatty acids, iodine, selenium, vitamin D, taurine and carnitine. Fish are also a source of high quality protein and have in general low caloric density. The impact of these nutrients on cardiovascular risk has been extensively reviewed, but the impact of fish on the broader field of endocrine and metabolic health is sometimes not sufficiently appreciated. This article aimed to summarize the impact the effect of regular fish consumption on conditions like the metabolic syndrome, obesity, diabetes, hypothyroidism, polycystic ovary syndrome and the menopausal transition, which are in and of themselves significant causes of morbidity and mortality worldwide. The review revealed that scientific evidence from food science, translational research, epidemiologic studies and interventional trials shows that regular fish consumption has a positive impact on thyroid homeostasis, facilitates maintenance of a healthy body weight, reduces the magnitude of age-associated increases in blood pressure, improves glucose homeostasis helping prevent diabetes and the metabolic syndrome, and has a positive impact on muscle mass preservation among the elderly. These effects are mediated by multiple mechanisms, only some of which have been identified. For most of these effects it holds true that the potential benefits are more substantial when baseline fish consumption is low.

Associations of Fish and Omega-3 Fatty Acids Consumption With the Risk of Venous Thromboembolism. A Meta-Analysis of Prospective Cohort Studies

Objective: This study aims to investigate the effect of fish and omega-3 fatty acids consumption on the risk of VTE. Methods: A comprehensive literature search in the databases of PubMed, Web of Science, and Embase (up to September 2020), was conducted to identify the prospective cohort studies concerning the associations of fish and omega-3 fatty acids consumption with the risk of VTE. The pooled relative risk (RR) of VTE for the highest vs. lowest category of fish and omega-3 fatty acids consumption, as well as their corresponding 95% confidence interval (CI) were calculated. Results: A total of seven articles with eight prospective cohort studies were included. Specifically, six studies were related to fish consumption, and the overall multi-variable adjusted RR showed no significant relationship between fish consumption and the risk of VTE (RR = 1.02, 95% CI: 0.93-1.11; P = 0.709). In the four studies related to omega-3 fatty acids consumption, the overall multi-variable adjusted RR suggested that omega-3 fatty acids consumption was associated with a lower risk of VTE (RR = 0.89, 95% CI: 0.80-0.98; P = 0.024). Moreover, two studies were related to recurrent VTE, and the overall multi-variable adjusted RR demonstrated a significant inverse association between omega-3 fatty acids consumption and the risk of recurrent VTE (RR = 0.45, 95% CI: 0.25-0.81; P = 0.008). Conclusion: Although current evidence is still insufficient to demonstrate any relationship between fish consumption and the risk of VTE, omega-3 fatty acids consumption seems to be associated with a lower risk of both VTE and recurrent VTE. Further large well-designed prospective cohort studies are warranted to elaborate the issues examined in this study.