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Aucoin M, LaChance L, van der Wurff I, Miller S, Naidoo U, Jenkins A, Cooley K. Dietary counselling plus omega-3 supplementation in the treatment of generalized anxiety disorder: protocol for a randomized wait-list controlled pilot trial (the "EASe-GAD Trial"). Pilot Feasibility Stud 2023; 9:186. [PMID: 37950301 PMCID: PMC10636887 DOI: 10.1186/s40814-023-01414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are prevalent and disabling conditions involving excessive worry and tension. Generalized anxiety disorder (GAD), the most common anxiety disorder, affects 5% of individuals from high-income countries and many individuals report that treatment options are not accessible, effective, or tolerable. Clinical evidence suggests that nutrition interventions, based on the Mediterranean diet and supplementation of omega-3 fatty acids, can significantly improve symptoms of depression; however, the effect of nutrition interventions on anxiety symptoms has not been studied in a clinical population. The primary objective of the present study is to assess the feasibility and acceptability of a dietary counselling and omega-3 fatty acid supplementation intervention delivered to adult women with GAD. The secondary objectives include assessing changes in anxiety symptom severity, assessing changes in quality of life, assessing changes in biomarkers, and evaluating the components of the program. METHODS This study is a randomized, wait-list controlled pilot trial delivering a 12-week, dietary counselling intervention and omega-3 supplementation to 50 adult women with GAD. Participants will complete seven individual counselling sessions which include education, personalized recommendations, mindful eating techniques, motivational interviewing, and goal setting. They will be provided with recipes, instructional videos, and food items. The intervention is designed based on the Social Cognitive Theory and previous research that has been done by the author team to identify dietary constituents with the most evidence to support their use in the treatment of anxiety disorders. Questionnaires and blood work will be completed at baseline, after the waiting period (for those in the waitlist group), and after the intervention. DISCUSSION Results from this study will lay the foundation for future large-scale studies in this area and may provide preliminary evidence of the role of diet counselling and omega-3 supplementation in the management of GAD. Research on the role of nutrition in psychiatric care has been identified as a priority by a number of international organizations. The present trial directly addresses the call for the research that is most needed to advance the field. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov on October 10, 2022; NCT05573672 . Trial sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416-498-1255. Steering committee: Composed of MA, LL, KC, IvdW, SM, UN, AJ. The committee meets monthly to oversee the trial. Protocol identifier: CCNM_EASe-GADCT_2201v4.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, Canada.
- University of Guelph, Guelph, Canada.
| | - Laura LaChance
- McGill University, Montreal, Canada
- St. Mary's Hospital, Montreal, Canada
| | - Inge van der Wurff
- Health Psychology, Faculty of Psychology, Open University of the Netherlands, Utrecht, Netherlands
| | | | - Umadevi Naidoo
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Kieran Cooley
- Canadian College of Naturopathic Medicine, Toronto, Canada
- Southern Cross University, Lismore, Australia
- University of Technology Sydney, Ultimo, Australia
- Pacific College of Health and Science, San Diego, USA
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2
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von Schacky C, Kuipers RS, Pijl H, Muskiet FAJ, Grobbee DE. Omega-3 fatty acids in heart disease-why accurately measured levels matter. Neth Heart J 2023; 31:415-423. [PMID: 36795219 PMCID: PMC10602979 DOI: 10.1007/s12471-023-01759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
Current guidelines barely support marine omega‑3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in cardiology, mainly because results of large trials were equivocal. Most large trials have tested EPA alone or EPA + DHA combined as a drug, thereby disregarding the relevance of their blood levels. These levels are frequently assessed with the Omega‑3 Index (percentage of EPA + DHA in erythrocytes), which is determined using a specific standardised analytical procedure. EPA and DHA are present in every human being at unpredictable levels (even in the absence of intake), and their bioavailability is complex. Both facts need to be incorporated into trial design and should direct clinical use of EPA and DHA. An Omega‑3 Index in the target range of 8-11% is associated with lower total mortality, fewer major adverse cardiac and other cardiovascular events. Moreover, functions of organs such as the brain benefit from an Omega‑3 Index in the target range, while untoward effects, such as bleeding or atrial fibrillation, are minimised. In pertinent intervention trials, several organ functions were improved, with improvements correlating with the Omega‑3 Index. Thus, the Omega‑3 Index is relevant in trial design and clinical medicine, which calls for a widely available standardised analytical procedure and a discussion on possible reimbursement of this test.
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Affiliation(s)
| | - R S Kuipers
- Heart Centre, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- Department of Cardiology, Dijklander Hospital, Purmerend/Hoorn, The Netherlands
| | - H Pijl
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - F A J Muskiet
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - D E Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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van der Wurff ISM, von Schacky C, Bergeland T, Zeegers MP, Kirschner PA, de Groot RHM. Krill oil supplementation's effect on school grades in typically developing adolescents. Prostaglandins Leukot Essent Fatty Acids 2023; 191:102553. [PMID: 36878083 DOI: 10.1016/j.plefa.2023.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
Long-chain polyunsaturated fatty acids (LCPUFA) are important for brain development and functioning and with that, possibly school performance. Several cross-sectional studies have shown significant positive associations between fish consumption, an important source of LCPUFA and school grades in adolescents. The effect of LCPUFA supplementation on school grades in adolescents has not been investigated yet. The goal of the current study was to investigate (I) the associations between the Omega-3 Index (O3I) at baseline and after 12 months respectively and school grades and (II) the effect of one year krill oil supplementation (source of LCPUFA) on school grades in adolescents with a low O3I at baseline. A double-blind randomised placebo-controlled trial with repeated measurements was executed. Participants received either 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day for the first three months in Cohort 1 and the nine months thereafter 800 mg EPA + DHA per day, Cohort 2 started immediately with 800 mg EPA + DHA per day,or a placebo. The O3I was monitored with a finger prick at baseline, three, six and twelve months. Subject grades for English, Dutch and math were collected, a standardised mathematics test was executed at baseline and at 12 months. Data was analysed with (I) explorative linear regressions to investigate associations at baseline and follow-up and (II) mixed model analyses separately for each of the subject grades and the standardised mathematics test to investigate the effect of supplementation after 12 months. The krill oil group had a small significant increase in the mean O3I at all time points. However, very few participants achieved the intended target O3I range of 8-11%. At baseline a significant association between baseline O3I and English grade was show, additionally a trend for an association with Dutch grade was shown. After 12 months no significant associations were found. Additionally, there was no significant effect of krill oil supplementation on subject grades or standardised mathematics test score. In this study, no significant effect of krill oil supplementation on subject grades or standardised mathematics test performance was found. However, as many participants dropped out and/or were non-adherent, results should be interpreted with caution.
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Affiliation(s)
- Inge S M van der Wurff
- Health Psychology, Faculty of Psychology, Open Univerity of the Netherlands, 6419 AT Heerlen, the Netherlands.
| | - Clemens von Schacky
- Omegametrix, 82 152 Martinsried, Germany; Preventive Cardiology, Medical Clinic and Poli-Clinic I, Ludwig Maximilians-University Munich, 80336 Munich, Germany
| | - Trygve Bergeland
- former employee of Aker BioMarine Antarctic AS, NO-1327 Lysaker, Norway
| | - Maurice P Zeegers
- Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University,6200 MD Maastricht, the Netherlands; Care and Public Health Research Institute (School CAPHRI), Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Paul A Kirschner
- Health Psychology, Faculty of Psychology, Open Univerity of the Netherlands, 6419 AT Heerlen, the Netherlands; Expertise Centre Effective Learning (ExCEL), Thomas More University of Applied Sciences, 2000 Antwerp, Belgium
| | - Renate H M de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 AT Heerlen, the Netherlands
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Alfhili MA, Alsughayyir J, Basudan A, Alfaifi M, Awan ZA, Algethami MR, Al-Sheikh YA. Blood indices of omega-3 and omega-6 polyunsaturated fatty acids are altered in hyperglycemia. Saudi J Biol Sci 2023; 30:103577. [PMID: 36816730 PMCID: PMC9932443 DOI: 10.1016/j.sjbs.2023.103577] [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: 11/27/2022] [Revised: 12/31/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs) may favorably influence the risk and clinical course of diabetes mellitus (DM). In particular, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) alleviate oxidative injury and insulin resistance characteristic of DM. Uncertainty still remains, however, as to the composition and proportions of blood PUFAs in relation to fasting blood glucose levels. This study, thus, aims to examine the patterns of blood PUFA indices in normoglycemic (NG) and hyperglycemic (HG) Saudi subjects. Age, gender, FA profiles, and laboratory records of 143 subjects collected from September 2014 to March 2018 were retrospectively analyzed. Means, prevalence rates, associations, risk measures, and the diagnostic accuracy of PUFAs were determined. HG subjects had significantly lower AA (0.70%, 95% CI: 0.59-0.80% vs 0.46%, 95% CI: 0.38-0.53%) and higher EPA/AA ratio (0.36, 95% CI: 0.30-0.42 vs 0.69, 95% CI: 0.61-0.77). Gender-wise comparisons revealed that ώ-6/ώ-3 ratio was the only PUFA index significantly elevated in HG males (0.36, 95% CI: 0.26-0.45 vs 5.68, 95% CI: 4.98-6.38) while both DHA (2.91%, 95% CI: 2.54-3.29% vs 3.37%, 95% CI: 3.13-3.60%) and ώ-3 index (3.1%, 95% CI: 2.70-3.49% vs 3.63%, 95% CI: 3.38-3.88%) were significantly elevated in HG females. Furthermore, reduced AA and elevated EPA/AA ratio were more prevalent in HG subjects (26.53 vs 28.72 and 30.61 vs 38.29, respectively) and exhibited the highest diagnostic accuracy for HG among all PUFA indices. Altogether, our study revealed that distinct, gender-specific blood PUFA indices are differentially regulated in HG subjects which may be valuable for DM management.
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Affiliation(s)
- Mohammad A. Alfhili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Jawaher Alsughayyir
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ahmed Basudan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mohammed Alfaifi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Zuhier A. Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
| | | | - Yazeed A. Al-Sheikh
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
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Berger M, Seemüller F, Voggt A, Obermeier M, Kirchberg F, Löw A, Riedel M, von Schacky C, Severus E. Omega-3 fatty acids in bipolar patients with a low omega-3 index and reduced heart rate variability: the "BIPO-3" trial. Int J Bipolar Disord 2022; 10:9. [PMID: 35362878 PMCID: PMC8975918 DOI: 10.1186/s40345-022-00253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Research suggests that a low omega-3 index may contribute to the low heart rate variability and the increased risk of cardiovascular morbidity and mortality in bipolar disorders. However, so far, no intervention trial with EPA and DHA has been conducted in bipolar patients attempting to increase their heart rate variability. Methods 119 patients with bipolar disorder according to DSM-IV were screened, with 55 euthymic bipolar patients—owing to inclusion criteria (e.g. low omega-3 index (< 6%), SDNN < 60 ms.)—being enrolled in a randomized, double-blind, 12-week parallel study design with omega-3 fatty acids (4 capsules of 530 mg EPA, 150 mg DHA) or corn oil as a placebo, in addition to usual treatment. Heart rate variability as well as the omega-3 index were measured at baseline and at the endpoint of the study. Results A total of 42 patients (omega-3: n = 23, corn oil: n = 19) successfully completed the study after 12 weeks. There was a significant increase in the omega-3 index (value at endpoint minus value at baseline) in the omega-3 group compared to the corn oil group (p < 0.0001). However, there was no significant difference in the change of the SDNN (value at endpoint minus value at baseline) between the treatment groups (p = 0.22). In addition, no correlation between changes in SDNN and change in the omega-3 index could be detected in the omega-3 group (correlation coefficient = 0.02, p = 0.94) or the corn oil group (correlation coefficient = − 0.11, p = 0.91). Similarly, no significant differences between corn oil and omega-3 group regarding the change of LF (p = 0.19), HF (p = 0.34) and LF/HF ratio (p = 0.84) could be demonstrated. Conclusions In our randomized, controlled intervention trial in euthymic bipolar patients with a low omega-3 index and reduced heart rate variability no significant effect of omega-3 fatty acids on SDNN or frequency-domain measures HF, LF and LF/HF ratio could be detected. Possible reasons include, among others, the effect of psychotropic medication present in our trial and/or the genetics of bipolar disorder itself. Further research is needed to test these hypotheses. Trial registration ClinicalTrials.gov, NCT00891826. Registered 01 May 2009–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT00891826
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Affiliation(s)
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Psychiatry, Psychosomatic and Psychotherapy, Kbo-Lech-Mangfall-Clinic Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Alessandra Voggt
- St. Joseph Krankenhaus, Klinik Für Seelische Gesundheit Im Kindes- Und Jugendalter, Berlin, Germany
| | | | - Franca Kirchberg
- Division of Metabolic and Nutritional Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anja Löw
- Department of Internal Medicine I - Cardiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Marion Von Tessin Memory-Zentrum gGmbH, Munich, Germany
| | - Clemens von Schacky
- Department of Preventive Cardiology, Ludwig- Maximilians-Universität München, Munich, Germany.,Omegametrix, GmbH, Planegg, Germany
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, TU Dresden, Dresden, Germany.
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Visioli F, Agostoni C. Omega 3 Fatty Acids and Health: The Little We Know after All These Years. Nutrients 2022; 14:239. [PMID: 35057418 PMCID: PMC8781196 DOI: 10.3390/nu14020239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
Elagizi et al. [1] provide an update on the effects of long-chain omega 3 fatty acids on the cardiovascular system [...].
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, 35122 Padova, Italy;
- IMDEA-Food, 28049 Madrid, Spain
| | - Carlo Agostoni
- Pediatric Area, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Kalache A, Bazinet RP, Carlson S, Evans WJ, Kim CH, Lanham-New S, Visioli F, Griffiths JC. Science-based policy: targeted nutrition for all ages and the role of bioactives. Eur J Nutr 2021; 60:1-17. [PMID: 34427766 PMCID: PMC8383919 DOI: 10.1007/s00394-021-02662-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 12/26/2022]
Abstract
Globally, there has been a marked increase in longevity, but it is also apparent that significant inequalities remain, especially the inequality related to insufficient 'health' to enjoy or at least survive those later years. The major causes include lack of access to proper nutrition and healthcare services, and often the basic information to make the personal decisions related to diet and healthcare options and opportunities. Proper nutrition can be the best predictor of a long healthy life expectancy and, conversely, when inadequate and/or improper a prognosticator of a sharply curtailed expectancy. There is a dichotomy in both developed and developing countries as their populations are experiencing the phenomenon of being 'over fed and under nourished', i.e., caloric/energy excess and lack of essential nutrients, leading to health deficiencies, skyrocketing global obesity rates, excess chronic diseases, and premature mortality. There is need for new and/or innovative approaches to promoting health as individuals' age, and for public health programs to be a proactive blessing and not an archaic status quo 'eat your vegetables' mandate. A framework for progress has been proposed and published by the World Health Organization in their Global Strategy and Action Plan on Ageing and Health (WHO (2017) Advancing the right to health: the vital role of law. https://apps.who.int/iris/bitstream/handle/10665/252815/9789241511384-eng.pdf?sequence=1&isAllowed=y . Accessed 07 Jun 2021; WHO (2020a) What is Health Promotion. www.who.int/healthpromotion/fact-sheet/en/ . Accessed 07 Jun 2021; WHO (2020b) NCD mortality and morbidity. www.who.int/gho/ncd/mortality_morbidity/en/ . Accessed 07 Jun 2021). Couple this WHO mandate with current academic research into the processes of ageing, and the ingredients or regimens that have shown benefit and/or promise of such benefits. Now is the time for public health policy to 'not let the perfect be the enemy of the good,' but to progressively make health-promoting nutrition recommendations.
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Affiliation(s)
- Alexandre Kalache
- International Longevity Centre-Brazil, Rio de Janiero, Brazil
- Age Friendly Institute, Boston, MA, USA
| | - Richard P Bazinet
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Susan Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Chi Hee Kim
- Global Government Affairs, Herbalife Nutrition, Los Angeles, CA, USA
| | - Susan Lanham-New
- Nutritional Sciences Department, University of Surrey, Guildford, UK
| | - Francesco Visioli
- Department of Molecular Sciences, University of Padova, Padova, Italy
- IMDEA-Food, Madrid, Spain
| | - James C Griffiths
- Council for Responsible Nutrition-International, Washington, DC, USA.
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Omega-3 fatty acid blood levels are inversely associated with cardiometabolic risk factors in HFpEF patients: the Aldo-DHF randomized controlled trial. Clin Res Cardiol 2021; 111:308-321. [PMID: 34453204 PMCID: PMC8873063 DOI: 10.1007/s00392-021-01925-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022]
Abstract
Objectives To evaluate associations of omega-3 fatty acid (O3-FA) blood levels with cardiometabolic risk markers, functional capacity and cardiac function/morphology in patients with heart failure with preserved ejection fraction (HFpEF). Background O3-FA have been linked to reduced risk for HF and associated phenotypic traits in experimental/clinical studies. Methods This is a cross-sectional analysis of data from the Aldo-DHF-RCT. From 422 patients, the omega-3-index (O3I = EPA + DHA) was analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e′ 7.1 ± 1.5; median NT-proBNP 158 ng/L (IQR 82–298). Pearson’s correlation coefficient and multiple linear regression analyses, using sex and age as covariates, were used to describe associations of the O3I with metabolic phenotype, functional capacity, echocardiographic markers for LVDF, and neurohumoral activation at baseline/12 months. Results The O3I was below (< 8%), within (8–11%), and higher (> 11%) than the target range in 374 (93%), 29 (7%), and 1 (0.2%) patients, respectively. Mean O3I was 5.7 ± 1.7%. The O3I was inversely associated with HbA1c (r = − 0.139, p = 0.006), triglycerides-to-HDL-C ratio (r = − 0.12, p = 0.017), triglycerides (r = − 0.117, p = 0.02), non-HDL-C (r = − 0.101, p = 0.044), body-mass-index (r = − 0.149, p = 0.003), waist circumference (r = − 0.121, p = 0.015), waist-to-height ratio (r = − 0.141, p = 0.005), and positively associated with submaximal aerobic capacity (r = 0.113, p = 0.023) and LVEF (r = 0.211, p < 0.001) at baseline. Higher O3I at baseline was predictive of submaximal aerobic capacity (β = 15.614, p < 0,001), maximal aerobic capacity (β = 0.399, p = 0.005) and LVEF (β = 0.698, p = 0.007) at 12 months. Conclusions Higher O3I was associated with a more favorable cardiometabolic risk profile and predictive of higher submaximal/maximal aerobic capacity and lower BMI/truncal adiposity in HFpEF patients. Graphic abstract Omega-3 fatty acid blood levels are inversely associated with cardiometabolic risk factors in HFpEF patients. Higher O3I was associated with a more favorable cardiometabolic risk profile and aerobic capacity (left) but did not correlate with echocardiographic markers for left ventricular diastolic function or neurohumoral activation (right). An O3I-driven intervention trial might be warranted to answer the question whether O3-FA in therapeutic doses (with the target O3I 8–11%) impact on echocardiographic markers for left ventricular diastolic function and neurohumoral activation in patients with HFpEF. This figure contains modified images from Servier Medical Art (https://smart.servier.com) licensed by a Creative Commons Attribution 3.0 Unported License. ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01925-9.
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Singer P, Richter V, Singer K, Löhlein I. Analyses and Declarations of Omega-3 Fatty Acids in Canned Seafood May Help to Quantify Their Dietary Intake. Nutrients 2021; 13:2970. [PMID: 34578847 PMCID: PMC8471815 DOI: 10.3390/nu13092970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
The American Heart Association (AHA) recently confirmed common recommendations of one to two fish dishes per week in order to prevent cardiovascular disease (CVD). Nevertheless, the natural fluctuations of lipids and fatty acids (FA) in processed seafood caught little public attention. Moreover, consumers of unprocessed seafood in general do not know how much omega-3 fatty acids (omega-3 FA) within servings they actually ingest. The few studies published until today considering this aspect have been re-evaluated in today's context. They included four observational studies with canned fatty coldwater fish (mackerel and herring from the same region, season, producer and research group). Their outcomes were similar to those conducted in the following years using supplements. Cans containing seafood (especially fatty coldwater fish) with declared content of omega-3 FA are ready-to-use products. Human studies have shown a higher bioavailability of omega-3 FA by joint uptake of fat. Canned fatty coldwater fish contain omega-3 FA plus plenty of fat in one and the same foodstuff. That suggests a new dietary paradigm with mixed concepts including several sources with declared content of omega-3 FA for reducing the cardiovascular risk and other acknowledged indications.
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Affiliation(s)
- Peter Singer
- European Omega-3 Council, 60598 Frankfurt am Main, Germany;
| | - Volker Richter
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, 04103 Leipzig, Germany;
| | - Konrad Singer
- A-Connect Consulting, Sao Paulo 01311-200, SP, Brazil;
| | - Iris Löhlein
- European Omega-3 Council, 60598 Frankfurt am Main, Germany;
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Importance of EPA and DHA Blood Levels in Brain Structure and Function. Nutrients 2021; 13:nu13041074. [PMID: 33806218 PMCID: PMC8066148 DOI: 10.3390/nu13041074] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
Brain structure and function depend on a constant and sufficient supply with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) by blood. Blood levels of EPA and DHA reflect dietary intake and other variables and are preferably assessed as percentage in erythrocytes with a well-documented and standardized analytical method (HS-Omega-3 Index®). Every human being has an Omega-3 Index between 2 and 20%, with an optimum of 8–11%. Compared to an optimal Omega-3 Index, a lower Omega-3 Index was associated with increased risk for total mortality and ischemic stroke, reduced brain volume, impaired cognition, accelerated progression to dementia, psychiatric diseases, compromises of complex brain functions, and other brain issues in epidemiologic studies. Most intervention trials, and their meta-analyses considered EPA and DHA as drugs with good bioavailability, a design tending to produce meaningful results in populations characterized by low baseline blood levels (e.g., in major depression), but otherwise responsible for many neutral results and substantial confusion. When trial results were evaluated using blood levels of EPA and DHA measured, effects were larger than comparing EPA and DHA to placebo groups, and paralleled epidemiologic findings. This indicates future trial design, and suggests a targeted use EPA and DHA, based on the Omega-3 Index.
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Metabolomics and Lipidomics: Expanding the Molecular Landscape of Exercise Biology. Metabolites 2021; 11:metabo11030151. [PMID: 33799958 PMCID: PMC8001908 DOI: 10.3390/metabo11030151] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 02/08/2023] Open
Abstract
Dynamic changes in circulating and tissue metabolites and lipids occur in response to exercise-induced cellular and whole-body energy demands to maintain metabolic homeostasis. The metabolome and lipidome in a given biological system provides a molecular snapshot of these rapid and complex metabolic perturbations. The application of metabolomics and lipidomics to map the metabolic responses to an acute bout of aerobic/endurance or resistance exercise has dramatically expanded over the past decade thanks to major analytical advancements, with most exercise-related studies to date focused on analyzing human biofluids and tissues. Experimental and analytical considerations, as well as complementary studies using animal model systems, are warranted to help overcome challenges associated with large human interindividual variability and decipher the breadth of molecular mechanisms underlying the metabolic health-promoting effects of exercise. In this review, we provide a guide for exercise researchers regarding analytical techniques and experimental workflows commonly used in metabolomics and lipidomics. Furthermore, we discuss advancements in human and mammalian exercise research utilizing metabolomic and lipidomic approaches in the last decade, as well as highlight key technical considerations and remaining knowledge gaps to continue expanding the molecular landscape of exercise biology.
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Huang C, Chiba L, Bergen W. Bioavailability and metabolism of omega-3 polyunsaturated fatty acids in pigs and omega-3 polyunsaturated fatty acid-enriched pork: A review. Livest Sci 2021. [DOI: 10.1016/j.livsci.2020.104370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Fatty Acids and Cardiovascular Risk. Evidence, Lack of Evidence, and Diligence. Nutrients 2020; 12:nu12123782. [PMID: 33317164 PMCID: PMC7764656 DOI: 10.3390/nu12123782] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
One of the most controversial areas of nutrition research relates to fats, particularly essential fatty acids, in the context of cardiovascular disease risk. A critical feature of dietary fatty acids is that they incorporate into the plasma membrane, modifying fluidity and key physiological functions. Importantly, they can reshape the bioavailability of eicosanoids and other lipid mediators, which direct cellular responses to external stimuli, such as inflammation and chronic stress conditions. This paper provides an overview of the most recent evidence, as well as historical controversies, linking fat consumption with human health and disease. We underscore current pitfalls in the area of fatty acid research and critically frame fatty acid intake in the larger context of diet and behavior. We conclude that fundamental research on fatty acids and lipids is appropriate in certain areas, but the rigor and reproducibility are lacking in others. The pros and cons are highlighted throughout the review, seeking to guide future research on the important area of nutrition, fat intake, and cardiovascular disease risk.
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Hołowko-Ziółek J, Cięszczyk P, Biliński J, Basak GW, Stachowska E. What Model of Nutrition Can Be Recommended to People Ending Their Professional Sports Career? An Analysis of the Mediterranean Diet and the CRON Diet in the Context of Former Athletes. Nutrients 2020; 12:E3604. [PMID: 33255295 PMCID: PMC7761328 DOI: 10.3390/nu12123604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 02/08/2023] Open
Abstract
Athletes who retire from their sporting career face an increase in body weight, leading to overweight or obesity. Simultaneously, a significant number of these athletes meet the criteria of metabolic syndrome. The available literature does not offer clearly defined standards of nutrition for the discussed group of people. In this situation, it seems advisable to develop different standards of dietary behavior typical of athletes finishing their sports careers. For this purpose, the study analyzed two types of diets: the Mediterranean diet and the Calorie Restriction with Optimal Nutrition (CRON) diet based on significant calorie restrictions. Both diets seem to meet the requirements of this group of people.
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Affiliation(s)
- Joanna Hołowko-Ziółek
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (J.H.-Z.); (E.S.)
- Department of Diabetology and Internal Diseases, Pomeranian Medical University in Szczecin, 72-010 Police, Poland
| | - Paweł Cięszczyk
- Department of Molecular Biology, Gdansk University of Physical Education and Sports, 80-307 Gdansk, Poland;
| | - Jarosław Biliński
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Grzegorz W. Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (J.H.-Z.); (E.S.)
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van der Wurff IS, Meyer BJ, de Groot RH. Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition in Children and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose of DHA and EPA. Nutrients 2020; 12:E3115. [PMID: 33053843 PMCID: PMC7599612 DOI: 10.3390/nu12103115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in the cardiovascular field is effective if a certain Omega-3 index (O3I) is achieved or the daily n-3 LCPUFA dose is high enough. Whether this applies to studies on cognition in children and adolescents is unclear. The aims of the current review were to investigate whether: (1) a certain O3I level and (2) a minimum daily n-3 LCPUFA dose are required to improve cognition in 4-25 year olds. Web of Science and PubMed were searched. Inclusion criteria: placebo controlled randomized controlled trial; participants 4-25 years; supplementation with docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA); assessing cognition; in English and ≥10 participants per treatment arm. Thirty-three studies were included, 21 in typically developing participants, 12 in those with a disorder. A positive effect on cognitive measures was more likely in studies with an increase in O3I to >6%. Half of the studies in typically developing children with daily supplementation dose ≥450 mg DHA + EPA showed improved cognition. For children with a disorder no cut-off value was found. In conclusion, daily supplementation of ≥450 mg DHA + EPA per day and an increase in the O3I to >6% makes it more likely to show efficacy on cognition in children and adolescents.
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Affiliation(s)
- Inge S.M. van der Wurff
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
| | - Barbara J. Meyer
- School of Medicine, Lipid Research Centre, Molecular Horizons, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Renate H.M. de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 Maastricht, The Netherlands
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High levels of eicosapentaenoic acid are associated with lower pericoronary adipose tissue attenuation as measured by coronary CTA. Atherosclerosis 2020; 316:73-78. [PMID: 33129586 DOI: 10.1016/j.atherosclerosis.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Higher pericoronary adipose tissue (PCAT) attenuation, a novel marker of inflammation in coronary CT angiography (CTA), has been shown to indicate increased cardiac mortality. Supplementation of eicosapentaenoic acid (EPA) has been shown to decrease cardiovascular death. Whether blood levels of n-3 fatty acids are associated with differences in PCAT attenuation is unknown. METHODS This is a cross-sectional analysis including 64 symptomatic patients who underwent coronary CTA. PCAT attenuation was measured in Hounsfield Units (HU) around the proximal 40 mm of the right coronary artery using semi-automated software. Erythrocyte membrane fatty acid composition was analyzed using gas chromatography. Individual fatty acids were expressed as a percentage of total identified fatty acids. RESULTS The patient cohort was divided into two groups using the median PCAT attenuation of -78.1 HU (each n = 32). No differences were seen in age, sex, BMI or traditional cardiovascular risk factors (CVRF) between groups (all p > 0.05). In univariable analysis, significantly higher values of EPA (1.00% [0.78; 1.26] vs. 0.78% [0.63; 0.99]; p = 0.02) were seen in patients with lower PCAT attenuation. All other fatty acids showed no differences (all p > 0.05). Moreover, a significant negative correlation was seen between PCAT attenuation and EPA (CC: 0.38; p = 0.002). In multivariable analysis, an inverse association of EPA with PCAT attenuation existed (ß = -0.31, p = 0.017), independent of age, gender, BMI and number of CVRF (all p > 0.1). CONCLUSIONS High levels of EPA are associated with lower PCAT attenuation on coronary CTA. This may indicate a different composition of pericoronary adipose tissue, potentially caused by a lower degree of coronary inflammation.
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Arnesen H, Myhre PL, Seljeflot I. Very Long Chain Marine n-3 Polyunsaturated Fatty Acids in Atherothrombotic Heart Disease. A Brief Review, with a Focus on Metabolic Effects. Nutrients 2020; 12:E3014. [PMID: 33008057 PMCID: PMC7601282 DOI: 10.3390/nu12103014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022] Open
Abstract
The global burden of atherothrombotic heart disease should be considered as a life-style disorder where differences in dietary habits and related risk factors like limited physical activity and adiposity together play important roles. Related metabolic changes have been scientifically elucidated in recent decades, and the role of the very-long-chain marine fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been much focused on, especially their possible effects on processes like inflammation and thrombosis. In the present brief review of related metabolic mechanisms, the effects of these fatty acids in a clinical setting have been referred to, including some of the authors' work on this topic. The main focus is the divergent results in the field and the important differences between the study population, the type of supplements and fresh marine sources, the proportion of EPA versus DHA dosages, and the duration of supplementation in clinical trials. We conclude that daily intake of at least 1 g of EPA + DHA may improve a dysmetabolic state in the population. The potential to reduce the risk and progression of atherothrombotic heart disease is still a matter of debate.
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Affiliation(s)
- Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Pb 4956 Nydalen, 0424 Oslo, Norway;
- Faculty of Medicine, University of Oslo, 0424 Oslo, Norway;
| | - Peder L. Myhre
- Faculty of Medicine, University of Oslo, 0424 Oslo, Norway;
- Division of Medicine, Department of Cardiology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Pb 4956 Nydalen, 0424 Oslo, Norway;
- Faculty of Medicine, University of Oslo, 0424 Oslo, Norway;
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18
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Abstract
The omega-3 index, the percentage of EPA plus DHA in erythrocytes (measured by standardised analysis), represents a human body's status in EPA and DHA. An omega-3 index is measured in many laboratories around the world; however, even small differences in analytical methods entail large differences in results. Nevertheless, results are frequently related to the target range of 8-11 %, defined for the original and scientifically validated method (HS-Omega-3 Index®), raising ethical issues, and calling for standardisation. No human subject has an omega-3 index <2 %, indicating a vital minimum. Thus, the absence of EPA and DHA cannot be tested against presence. Moreover, clinical events correlate with levels, less with the dose of EPA and DHA, and the bioavailability of EPA and DHA varies inter-individually. Therefore, the effects of EPA and DHA are difficult to demonstrate using typical drug trial methods. Recent epidemiologic data further support the relevance of the omega-3 index in the cardiovascular field, since total mortality, cardiovascular mortality, cardiovascular events such as myocardial infarction or stroke, or blood pressure all correlate inversely with the omega-3 index. The omega-3 index directly correlates with complex brain functions. Compiling recent data supports the target range for the omega-3 index of 8-11 % in pregnancy. Many other potential applications have emerged. Some, but not all health issues mentioned have already been demonstrated to be improved by increasing intake of EPA and DHA. Increasing the omega-3 index into the target range of 8-11 % with individualised doses of toxin-free sources for EPA and DHA is tolerable and safe.
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Affiliation(s)
- Clemens von Schacky
- Omegametrix, Martinsried, Germany and Preventive Cardiology, University of Munich, Germany
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Lechner K, von Schacky C. How to prevent cardiovascular events from recurring. Eur J Prev Cardiol 2020; 29:e295-e297. [PMID: 33611485 DOI: 10.1177/2047487320909943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Katharina Lechner
- German Heart Centre Munich, Technical University Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Clemens von Schacky
- Preventive Cardiology, Ludwig Maximilians-University, Germany.,Omegametrix, Germany
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García-Serrano A, Tomé-Carneiro J, Carmen Crespo M, Visitación Calvo M, Pereda-Pérez I, Baliyan S, Burgos-Ramos E, Montero O, Dávalos A, Venero C, Visioli F, Fontecha J. Concentrates of buttermilk and krill oil improve cognition in aged rats. Prostaglandins Leukot Essent Fatty Acids 2020; 155:102077. [PMID: 32145667 DOI: 10.1016/j.plefa.2020.102077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
Cognitive decline is one of the hallmarks of aging and can vary from mild cognitive impairment to dementia to Alzheimer's disease. In addition to some lifestyle interventions, there is room for the use of nutraceuticals/functional foods as pharma-nutritional tools to lessen the burden of cognitive decline before it worsens. We previously reported the promising molecular actions of milk fat globule membranes and krill oil concentrates in a rat model of aging. In this study, we concentrated on the activities on cognition, using an array of validated tests. We also performed lipidomic analyses of plasma, erythrocytes, and different brain areas. We report lower emotional memory (contextual fear conditioning) in aged rats supplemented with concentrates of polar lipids from buttermilk or krill oil at doses that approximate human consumption. No other behavioral parameter was significantly influenced by the supplements, calling for further research to confirm or not the purported salubrious activities of polar lipids, namely those rich in ω3 long-chain polyunsaturated fatty acids, on cognitive decline.
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Affiliation(s)
- Alba García-Serrano
- Bioactivity and Food Analysis Department, CIAL, CSIC-UAM, Madrid 28049, Spain
| | - Joao Tomé-Carneiro
- Bioactivity and Food Analysis Department, CIAL, CSIC-UAM, Madrid 28049, Spain; Bioactive Ingredients Food Group, IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - M Carmen Crespo
- Bioactive Ingredients Food Group, IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - M Visitación Calvo
- Bioactivity and Food Analysis Department, CIAL, CSIC-UAM, Madrid 28049, Spain
| | - Inmaculada Pereda-Pérez
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - Shishir Baliyan
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - Emma Burgos-Ramos
- Área de Bioquímica, Universidad de Castilla-La-Mancha, Toledo, Spain
| | - Olimpio Montero
- Centro para el Desarrollo de la Biotecnología, CSIC, Parque Tecnológico de Boecillo, Valladolid, Spain
| | - Alberto Dávalos
- Bioactive Ingredients Food Group, IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - César Venero
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - Francesco Visioli
- Bioactive Ingredients Food Group, IMDEA-Food, CEI UAM+CSIC, Madrid, Spain; Department of Molecular Medicine, University of Padova, Padova, 35121, Italy.
| | - Javier Fontecha
- Bioactivity and Food Analysis Department, CIAL, CSIC-UAM, Madrid 28049, Spain
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Omega-3 Fatty Acids in Pregnancy-The Case for a Target Omega-3 Index. Nutrients 2020; 12:nu12040898. [PMID: 32224878 PMCID: PMC7230742 DOI: 10.3390/nu12040898] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
Scientific societies recommend increasing intake of docosahexaenoic acid (DHA) by 200 mg/day during pregnancy. However, individually, clinical events correlate quite strongly with levels of eicosapentaenoic acid (EPA) and DHA in blood, but these levels poorly correlate with amounts ingested. EPA and DHA in erythrocytes (Omega-3 Index) have a low biologic variability. If analyzed with a standardized analytical procedure (HS-Omega-3 Index®), analytical variability is low. Thus, the largest database of any fatty acid analytical method was provided. Pregnant women in Germany had a mean Omega-3 Index below the target range suggested for cardiovascular disease of 8–11%, with large interindividual variation, and quite independent of supplementation with EPA and DHA. In Germany, premature birth is a major health issue. Premature birth and other health issues of pregnant women and their offspring correlate with levels of EPA and DHA in blood and can be reduced by increasing intake of EPA and DHA, according to individual trials and pertinent meta-analyses. Very high intake or levels of EPA and DHA may also produce health issues, like bleeding, prolonged gestation, or even premature birth. While direct evidence remains to be generated, evidence from various scientific approaches supports that the target range for the Omega-3 Index of 8–11% might also pertain to pregnancy and lactation.
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Innes JK, Calder PC. Marine Omega-3 (N-3) Fatty Acids for Cardiovascular Health: An Update for 2020. Int J Mol Sci 2020; 21:ijms21041362. [PMID: 32085487 PMCID: PMC7072971 DOI: 10.3390/ijms21041362] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found in seafood (especially fatty fish), supplements and concentrated pharmaceutical preparations. Long-term prospective cohort studies consistently demonstrate an association between higher intakes of fish, fatty fish and marine n-3 fatty acids (EPA + DHA) or higher levels of EPA and DHA in the body and lower risk of developing cardiovascular disease (CVD), especially coronary heart disease (CHD) and myocardial infarction (MI), and cardiovascular mortality in the general population. This cardioprotective effect of EPA and DHA is most likely due to the beneficial modulation of a number of known risk factors for CVD, such as blood lipids, blood pressure, heart rate and heart rate variability, platelet aggregation, endothelial function, and inflammation. Evidence for primary prevention of CVD through randomised controlled trials (RCTs) is relatively weak. In high-risk patients, especially in the secondary prevention setting (e.g., post-MI), a number of large RCTs support the use of EPA + DHA (or EPA alone) as confirmed through a recent meta-analysis. This review presents some of the key studies that have investigated EPA and DHA in the primary and secondary prevention of CVD, describes potential mechanisms for their cardioprotective effect, and evaluates the more recently published RCTs in the context of existing scientific literature.
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Affiliation(s)
- Jacqueline K. Innes
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | - Philip C. Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
- Correspondence: ; Tel.: +44-23281-205250
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Davinelli S, Intrieri M, Corbi G, Scapagnini G. Metabolic indices of polyunsaturated fatty acids: current evidence, research controversies, and clinical utility. Crit Rev Food Sci Nutr 2020; 61:259-274. [PMID: 32056443 DOI: 10.1080/10408398.2020.1724871] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The n-3 and n-6 polyunsaturated fatty acids (PUFA) are among the most studied nutrients in human metabolism. In the past few decades, prospective studies and controlled trials have supported the view that the effects of these essential fatty acids are clinically relevant. PUFA profiles in different blood compartments are reflections of both diet and metabolism, and their levels may be related to disease risk. Despite widespread interest, there is no consensus regarding which biomarkers best reflect PUFA status in the body. The measurement of PUFA levels is not straight-forward, and a wide variety of indices have been used in clinical studies, producing conflicting results. A major source of heterogeneity among studies is associated with research design, sampling, and laboratory analyses. To date, the n-3 index, n-6/n-3 ratio, and arachidonic acid (AA)/eicosapentaenoic acid (EPA) ratio are the most promising biomarkers associated with PUFA metabolism. Although hotly debated, these indices may be considered at least markers, if not risk factors, for several diseases, especially cardiovascular events and brain disorders. Here, we summarize the most updated evidence of n-3 and n-6 PUFA effects on human health, reviewing current controversies on the aforementioned indices and whether they can be considered valuable predictors of clinical outcomes.
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Affiliation(s)
- Sergio Davinelli
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Mariano Intrieri
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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Gollasch B, Dogan I, Rothe M, Gollasch M, Luft FC. Effects of hemodialysis on blood fatty acids. Physiol Rep 2020; 8:e14332. [PMID: 31981323 PMCID: PMC6981304 DOI: 10.14814/phy2.14332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/16/2022] Open
Abstract
Omega-3 (n-3) fatty acids have beneficial cardiovascular effects, perhaps also in chronic kidney disease (CKD) patients. A low omega-3 index is an independent cardiovascular risk factor in end-stage renal disease (ESRD) dialysis patients. However, the plasma measurements invariably ignore circulating blood cells, including the preponderant erythrocytes (RBCs). We measured fatty acids (HPLC-MS lipidomics) in all components of the circulating blood, since RBC n-3 fatty acid status has been linked to cardiovascular disease and mortality. We studied 15 healthy persons and 15 CKD patients undergoing regular hemodialysis treatments. While total fatty acid levels differed significantly in RBCs from healthy controls and CKD patients, the hemodialysis treatment had no effect on plasma or RBC fatty acid levels. No changes occurred in the percentage of eicosapentaenoic acid (C20:5 n-3, EPA) and docosahexaenoic acid (C22:6 n-3; DHA) (omega-3 quotient) in RBC membrane fatty acids. Nonetheless, hemodialysis treatments increased plasma levels of various total fatty acids, namely C12:0, C14:0, C16:0, C20:2 n-6, C20:4 n-6, and C22:6 n-3 (DHA), while plasma levels of free fatty acids were unchanged. These data suggest that despite significant changes in fatty acids signatures between healthy persons and CKD patients, hemodialysis does not alter RBC n-3 fatty acid status, including the omega-3 quotient. The dialysis treatment per se does not appear to be responsible for a lower omega-3 index in CKD patients.
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Affiliation(s)
- Benjamin Gollasch
- Experimental and Clinical Research Center (ECRC)A joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
- HELIOS Klinikum Berlin‐BuchBerlinGermany
| | | | | | - Maik Gollasch
- Experimental and Clinical Research Center (ECRC)A joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
- Universitätsmedizin GreifswaldKlinik für GeriatrieGreifswaldGermany
| | - Friedrich C. Luft
- Experimental and Clinical Research Center (ECRC)A joint institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
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[Confusion about the effects of omega-3 fatty acids : Contemplation of study data taking the omega-3 index into consideration]. Internist (Berl) 2019; 60:1319-1327. [PMID: 31591673 DOI: 10.1007/s00108-019-00687-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Confusion reigns about omega‑3 fatty acids and their effects. Scientific investigations did not appear to clarify the issue. Guidelines and regulatory authorities contradict each other. OBJECTIVE This article provides clarity by considering not intake but levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes as a percentage of all fatty acids measured (omega‑3 index). CURRENT DATA The largest database of all methods of fatty acid analyses has been generated with the standardized HS-Omega‑3 Index® (Omegametrix, Martinsried, Deutschland). The omega‑3 index assesses the in EPA+DHA status of a person, has a minimum of 2%, a maximum of 20%, and is optimal between 8% and 11%. In many western countries but not in Japan or South Korea, mean levels are suboptimal. Suboptimal levels correlate with increased total mortality, sudden cardiac death, fatal and non-fatal myocardial infarction, other cardiovascular diseases, cognitive impairment, major depression, premature birth and other health issues. Interventional studies on surrogate and intermediary parameters demonstrated many positive effects, correlating with the omega‑3 index when measured. Due to issues in methodology that became apparent from the perspective of the omega‑3 index many, even large interventional trials with clinical endpoints were not positive, which is reflected in pertinent meta-analyses. In contrast, interventional trials without issues in methodology the clinical endpoints mentioned were reduced. CONCLUSION All humans have levels of EPA+DHA that if methodologically correctly assessed in erythrocytes, are optimal between 8% and 11%. Deficits can cause serious health issues that can be prevented by optimal levels.
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Translating plasma eicosapentaenoic acid concentrations into erythrocyte percentages of eicosapentaenoic acid plus docosahexaenoic acid during treatment with icosapent ethyl. J Clin Lipidol 2019; 13:771-777. [PMID: 31401072 DOI: 10.1016/j.jacl.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) study demonstrated that 4 g/d of eicosapentaenoic acid (EPA) ethyl esters (icosapent ethyl [IPE]) reduced risk for major cardiovascular events by 25% in statin-treated patients with residual hypertriglyceridemia. How this treatment affected red blood cell (RBC) EPA and docosahexaenoic acid (DHA) levels (ie, the Omega-3 Index [O3I]) was not reported, but effects on plasma EPA concentrations were reported. OBJECTIVE The aim of the study was to estimate baseline and final O3I levels in REDUCE-IT. METHODS First, deidentified data from our laboratory on RBC and plasma EPA and DHA from 2311 patients with similar lipid profiles as those in REDUCE-IT were used to generate a regression equation, which was then used to estimate the O3I from plasma FA concentrations. Second, previously published data on the effects of IPE on RBC FA concentrations were also converted to the O3I. RESULTS Both approaches (from calculations and prior publications) suggested that baseline and follow-up O3I levels were about 5% and 7%, respectively. In addition, plasma EPA levels (but not the O3I) were noted to be influenced by triglyceride levels. CONCLUSION For patients using 4 g of IPE, an estimated O3I value of about 7% reflects a cardioprotective state. Plasma EPA concentrations may be ill-suited as treatment targets because they are confounded by triglyceride levels.
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Surface-Displayed Thermostable Candida rugosa Lipase 1 for Docosahexaenoic Acid Enrichment. Appl Biochem Biotechnol 2019; 190:218-231. [PMID: 31332676 DOI: 10.1007/s12010-019-03077-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/05/2019] [Indexed: 01/24/2023]
Abstract
Yeast surface display has emerged as a viable approach for self-immobilization enzyme as whole-cell catalysts. Herein, we displayed Candida rugosa lipase 1 (CRL LIP1) on the cell wall of Pichia pastoris for docosahexaenoic acid (DHA) enrichment in algae oil. After a 96-h culture, the displayed CRL LIP1 achieved the highest activity (380 ± 2.8 U/g) for hydrolyzing olive oil under optimal pH (7.5) and temperature (45 °C) conditions. Additionally, we improved the thermal stability of displayed LIP1, enabling retention of 50% of its initial bioactivity following 6 h of incubation at 45 °C. Furthermore, the content of DHA enhanced from 40.61% in original algae oil to 50.44% in glyceride, resulting in a 1.24-fold increase in yield. The displayed CRL LIP1 exhibited an improved thermal stability and a high degree of bioactivity toward its native macromolecule substrates algae oil and olive oil, thereby expanding its potential for industrial applications in fields of food and pharmaceutical. These results suggested that surface display provides an effective strategy for simultaneous convenient expression and target protein immobilization.
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Ostermann AI, West AL, Schoenfeld K, Browning LM, Walker CG, Jebb SA, Calder PC, Schebb NH. Plasma oxylipins respond in a linear dose-response manner with increased intake of EPA and DHA: results from a randomized controlled trial in healthy humans. Am J Clin Nutr 2019; 109:1251-1263. [PMID: 31006007 DOI: 10.1093/ajcn/nqz016] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The health effects of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) are partly mediated by their oxidized metabolites, i.e., eicosanoids and other oxylipins. Some intervention studies have demonstrated that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) increase systemic concentrations of n-3 PUFA-derived oxylipins and moderately decrease arachidonic acid-derived oxylipins. There is no information on the dose-response of oxylipin concentrations after n-3 PUFA intake. OBJECTIVE The aim of this study was to quantify oxylipins in human plasma samples from an intervention study in which participants were randomly assigned to different daily intakes of EPA and DHA for 12 mo. METHODS Healthy adult men and women with low habitual fish consumption (n = 121) were randomly assigned to receive capsules providing doses of n-3 PUFAs reflecting 3 patterns of consumption of oily fish [1, 2, or 4 portions/wk with 3.27 g EPA + DHA (1:1.2, wt:wt) per portion] or placebo. Oxylipins were quantified in plasma after 3 and 12 mo. Relative and absolute changes of individual oxylipins were calculated and concentrations were correlated with the dose and the content of EPA and DHA in blood lipid pools. RESULTS Seventy-three oxylipins, mostly hydroxy-, dihydroxy-, and epoxy-PUFAs, were quantified in the plasma samples. After 3 and 12 mo a linear increase with dose was observed for all EPA- and DHA-derived oxylipins. Cytochrome-P450-derived anti-inflammatory and cardioprotective epoxy-PUFAs increased linearly with n-3 PUFA dose and showed low interindividual variance (r2 > 0.95). Similarly, 5, 12-, and 15-lipoxygenase-derived hydroxy-PUFAs as well as those formed autoxidatively increased linearly. These include the precursors of so-called specialized pro-resolving lipid mediators (SPMs), e.g., 17-hydroxy-DHA and 18-hydroxy-EPA. CONCLUSIONS Plasma concentrations of biologically active oxylipins derived from n-3 PUFAs, including epoxy-PUFAs and SPM-precursors, increase linearly with elevated intake of EPA and DHA. Interindividual differences in resulting plasma concentrations are low. This trial was registered at controlled-trials.com as ISRCTN48398526.
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Affiliation(s)
- Annika I Ostermann
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Annette L West
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kirsten Schoenfeld
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Lucy M Browning
- Medical Research Council, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Celia G Walker
- Medical Research Council, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Susan A Jebb
- Medical Research Council, Elsie Widdowson Laboratory, Cambridge, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Philip C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nils Helge Schebb
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
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Gollasch B, Dogan I, Rothe M, Gollasch M, Luft FC. Maximal exercise and erythrocyte fatty-acid status: a lipidomics study. Physiol Rep 2019; 7:e14040. [PMID: 31016868 PMCID: PMC6479222 DOI: 10.14814/phy2.14040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
Omega-3 fatty acids have long been ascribed a positive cardiovascular function. However, the plasma measurements invariably ignore 40% of the blood specimen, cells that engage in continuous exchange with their environment. In our study, we included all components of the circulating blood. Erythrocyte or red-blood-cell (RBC) n-3 fatty acid status has been linked to cardiovascular disease and death. A low omega-3 index is an independent risk factor for cardiovascular disease and mortality. We tested the hypothesis that acute, maximal exercise would influence the relationship between RBC and serum fatty acids. RBC fatty acids profiling was achieved using targeted HPLC-MS mass spectrometry. Healthy volunteers performed maximal treadmill exercise testing using the modified Bruce protocol. Central hemodynamics were monitored and maximal workload was assessed in metabolic equivalents (METs). Venous blood was obtained for RBC lipidomics. With the incremental exercise test, no fatty acid-level variations were found in RBCs, while heart rate and arterial blood pressure increased significantly. No changes occurred in the omega-3 quotient, namely the percentage of eicosapentaenoic acid and docosahexaenoic acid in RBC fatty acids in the RBC membrane. Nonetheless, maximal (13.50 ± 1.97 METs) exercise intensity led to a decrease of RBC lauric acid (C12:0) in the recovery period. These data suggest that despite significant hemodynamic effects, short-term maximal exercise is insufficient to alter RBC n-3 and other fatty-acid status, including the omega-3 quotient, in healthy individuals. RBC lauric acid deserves further scrutiny as a potential regulator of cardiovascular and metabolic functions.
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Affiliation(s)
- Benjamin Gollasch
- Experimental and Clinical Research Center (ECRC)A Joint Institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
- HELIOS Klinikum Berlin‐BuchBerlinGermany
| | | | | | - Maik Gollasch
- Experimental and Clinical Research Center (ECRC)A Joint Institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
| | - Friedrich C. Luft
- Experimental and Clinical Research Center (ECRC)A Joint Institution of the Charité Medical Faculty and Max Delbrück Center (MDC) for Molecular MedicineBerlinGermany
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Medenwald D, Kluttig A, Lacruz ME, Schumann J. Serum dietary fatty acids and coronary heart disease risk - A nested case-control-study within the CARLA cohort. Nutr Metab Cardiovasc Dis 2019; 29:152-158. [PMID: 30642791 DOI: 10.1016/j.numecd.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Diet is known to play a decisive role in the development of coronary heart disease (CHD). One factor believed to decrease lifetime risk of CHD is the consumption of omega-3 fatty acids. Yet, conclusive evidence regarding the potential cardioprotective effects of fatty acids is far from being reached. The present study aimed to provide further evidence on the association of serum fatty acid profiles with CHD risk. METHODS AND RESULTS The CARdio-vascular Disease, Living and Ageing in Halle study (CARLA study) is an observational cohort study comprising an older adult's general population with a high level of cardiovascular risk factors. In a matched case-control design the serum fatty acid concentrations of 73 subjects with an incident fatal or nonfatal CHD event were compared to 146 controls matched for sex and age. Our data show that the participants of the CARLA study are underserved in unsaturated fatty acids with respect to current dietary recommendations. In addition, the ratio of omega-6 to omega-3 fatty acids was determined to be 8:1 which underlines the consumption of a Western-style diet enriched in omega-6 fatty acids. There were no significant differences in fatty acid patterns between cases and controls. Thus, no clear association of particular serum fatty acid levels with cardiovascular risk was found. CONCLUSION Our results support the conclusion that in populations with a homogenous low level of omega-3 polyunsaturated fatty acids consumption, serum fatty acid levels are not associated with CHD risk.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - M E Lacruz
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - J Schumann
- Clinic for Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Halle (Saale), Germany.
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31
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Isaksen T, Evensen LH, Johnsen SH, Jacobsen BK, Hindberg K, Brækkan SK, Hansen J. Dietary intake of marine n-3 polyunsaturated fatty acids and future risk of venous thromboembolism. Res Pract Thromb Haemost 2019; 3:59-69. [PMID: 30656277 PMCID: PMC6332709 DOI: 10.1002/rth2.12168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Studies on the association between long-chained n-3 polyunsaturated fatty acids (n-3 PUFAs) and risk of venous thromboembolism (VTE) are conflicting, potentially due to challenges related to assessment of n-3 PUFA intake and changes in diet during follow-up. OBJECTIVES To investigate whether dietary intake of marine n-3 PUFAs was associated with risk of incident VTE in a population-based cohort with repeated assessments of n-3 PUFA intake. METHODS We recruited 21 970 participants (after excluding 7570 with incomplete data) from the fourth (1994-1995) and sixth (2007-2008) surveys of the Tromsø Study, and recorded incident VTEs up to 2016. Intake of n-3 PUFAs was computed from self-reported consumption of fat and lean fish, fish spread, and supplements. Cox proportional hazards regression models with n-3 PUFA intake as a time-varying variable were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE across quartiles (Q) of n-3 PUFA intake. RESULTS There were 541 incident VTEs during follow-up. Compared to Q1, subjects in Q2-4 had 22%-26% lower risk of VTE (HR Q2 0.74, 95% CI 0.57-0.96; HR Q3 0.77, 95% CI 0.59-0.99; HR Q4 0.78, 95% CI 0.61-1.00). The association was most pronounced for provoked VTE, particularly provoked pulmonary embolism (PE), with risk estimates of 0.42 (95% CI 0.25-0.72), 0.40 (95% CI 0.23-0.68), and 0.61 (95% CI 0.38-0.96) for Q2-4, respectively. CONCLUSIONS Dietary intake of marine n-3 PUFAs was associated with a lower risk of VTE, particularly provoked PE. The association displayed a threshold pattern and suggested a protective effect of an n-3 PUFA intake ≥4.7 g/week.
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Affiliation(s)
- Trond Isaksen
- K.G Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Line H. Evensen
- K.G Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Stein Harald Johnsen
- Department of NeurologyUniversity Hospital of North NorwayTromsøNorway
- Brain and Circulation Research GroupDepartment of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
| | - Bjarne K. Jacobsen
- Centre for Sami Health Research and the Epidemiology of chronic diseases research groupDepartment of Community MedicineUiT‐The Arctic University of NorwayTromsøNorway
| | - Kristian Hindberg
- K.G Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
| | - Sigrid K. Brækkan
- K.G Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- K.G Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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32
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Irvine MA, Scholey A, King R, Gillings R, Vauzour D, Demichele SJ, Das T, Wesnes KA, Sutton BP, Cassidy A, Pipingas A, Potter JF, Johnson G, White D, Larsen R, Cohen NJ, Minihane AM. The Cognitive Ageing, Nutrition and Neurogenesis (CANN) trial: Design and progress. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:591-601. [PMID: 30426067 PMCID: PMC6222033 DOI: 10.1016/j.trci.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction The Cognitive Ageing, Nutrition and Neurogenesis trial hypothesizes that a combined intervention with long-chain n-3 polyunsaturated fatty acids (n-3) and cocoa flavan-3-ols (FLAV) will mitigate the cognitive decline anticipated to naturally occur over 1 year in older adults. Methods In a double-blinded, placebo-controlled parallel design, 259 individuals with mild cognitive impairment or subjective memory impairment were randomized to a control or n-3 FLAV group (1.5 g docosahexaenoic acid + eicosapentaenoic acid and 500 mg n-3 FLAV daily) for 12 months. Cognition was measured at 0, 3, and 12 months. The primary end-point is hippocampus-sensitive cognitive function (e.g., number of false-positives on the Picture Recognition Task of the Cognitive Drug Research test battery). Secondary outcomes include additional cognitive measures, brain atrophy and blood flow (assessed by magnetic resonance imaging), vascular function, circulating biomarkers of cardiovascular and cognitive health, gut microflora, red blood cell fatty acid status, and urine flavan-3-ol metabolites. Results Screening began in 2015, with all baseline visits completed in March 2017. The intervention was finished in March 2018. Discussion Cognitive Ageing, Nutrition and Neurogenesis aims to identify an effective diet-based intervention to prevent or delay cognitive impairment in cognitively at-risk individuals, which could ultimately contribute to a reduced population burden of dementia. Clinicaltrials.gov NCT02525198.
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Affiliation(s)
- Michael A Irvine
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rebecca King
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachel Gillings
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - David Vauzour
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - Stephen J Demichele
- Strategic Research and Development, Abbott Nutrition, Abbott Laboratories, Columbus, OH, USA
| | - Tapas Das
- Strategic Research and Development, Abbott Nutrition, Abbott Laboratories, Columbus, OH, USA
| | - Keith A Wesnes
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Brad P Sutton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbane, IL, USA.,Centre for Nutrition Learning and Memory, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbane, IL, USA
| | - Aedin Cassidy
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - John F Potter
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - Glyn Johnson
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
| | - David White
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ryan Larsen
- Strategic Research and Development, Abbott Nutrition, Abbott Laboratories, Columbus, OH, USA
| | - Neal J Cohen
- Strategic Research and Development, Abbott Nutrition, Abbott Laboratories, Columbus, OH, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbane, IL, USA
| | - Anne-Marie Minihane
- Department of Nutrition and Preventive Medicine, Norwich Medical School, BCRE, University of East Anglia, Norwich, UK
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Péter S, Navis G, de Borst MH, von Schacky C, van Orten-Luiten ACB, Zhernakova A, Witkamp RF, Janse A, Weber P, Bakker SJL, Eggersdorfer M. Public health relevance of drug-nutrition interactions. Eur J Nutr 2018; 56:23-36. [PMID: 28748481 PMCID: PMC5559559 DOI: 10.1007/s00394-017-1510-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug–nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug–nutrition interactions. Experts and stakeholders should advocate for the integration of drug–nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.
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Affiliation(s)
- Szabolcs Péter
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.
| | - Gerjan Navis
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Martin H de Borst
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Clemens von Schacky
- Preventive Cardiology, Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität München, Ziemssenstr. 15, 80336, Munich, Germany.,Omegametrix GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Anne Claire B van Orten-Luiten
- Division of Human Nutrition, Wageningen University, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.,Department of Geriatric Medicine, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Alexandra Zhernakova
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Renger F Witkamp
- Division of Human Nutrition, Wageningen University, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - André Janse
- Department of Geriatric Medicine, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.,University of Hohenheim, Schloß Hohenheim 1, 70599, Stuttgart, Germany
| | - Stephan J L Bakker
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Manfred Eggersdorfer
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.,University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Filipovic MG, Aeschbacher S, Reiner MF, Stivala S, Gobbato S, Bonetti N, Risch M, Risch L, Camici GG, Luescher TF, von Schacky C, Conen D, Beer JH. Whole blood omega-3 fatty acid concentrations are inversely associated with blood pressure in young, healthy adults. J Hypertens 2018; 36:1548-1554. [PMID: 29570511 PMCID: PMC6085127 DOI: 10.1097/hjh.0000000000001728] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/26/2018] [Accepted: 02/23/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Omega-3 fatty acids (n - 3 FA) may have blood pressure (BP)-lowering effects in untreated hypertensive and elderly patients. The effect of n - 3 FA on BP in young, healthy adults remains unknown. The Omega-3 Index reliably reflects an individuals' omega-3 status. We hypothesized that the Omega-3 Index is inversely associated with BP levels in young healthy adults. METHODS The current study (n = 2036) is a cross-sectional study investigating the baseline characteristics of a cohort, which includes healthy adults, age 25-41 years. Individuals with cardiovascular disease, known diabetes or a BMI higher than 35 kg/m were excluded. The Omega-3 Index was determined in whole blood using gas chromatography. Association with office and 24-h BP was assessed using multivariable linear regression models adjusted for potential confounders. RESULTS Median Omega-3 Index was 4.58% (interquartile range 4.08; 5.25). Compared with individuals in the lowest Omega-3 Index quartile, individuals in the highest had a SBP and DBP that was 4 and 2 mmHg lower, respectively (P < 0.01). A significant linear inverse relationship of the Omega-3 Index with 24-h and office BP was observed. Per 1-U increase in log-transformed Omega-3 Index the lowering in BP (given as multivariable adjusted β coefficients; 95% confidence interval) was -2.67 mmHg (-4.83; -0.51; P = 0.02) and -2.30 mmHg (-3.92; -0.68; P = 0.005) for 24-h SBP and DBP, respectively. CONCLUSION A higher Omega-3 Index is associated with statistically significant, clinically relevant lower SBP and DBP levels in normotensive young and healthy individuals. Diets rich in n - 3 FA may be a strategy for primary prevention of hypertension.
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Affiliation(s)
- Mark G. Filipovic
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden
- Center for Molecular Cardiology, University of Zurich, Zurich
| | - Stefanie Aeschbacher
- Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin F. Reiner
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden
- Center for Molecular Cardiology, University of Zurich, Zurich
| | - Simona Stivala
- Center for Molecular Cardiology, University of Zurich, Zurich
| | - Sara Gobbato
- Center for Molecular Cardiology, University of Zurich, Zurich
| | - Nicole Bonetti
- Center for Molecular Cardiology, University of Zurich, Zurich
| | - Martin Risch
- Labormedizinisches Zentrum Dr Risch, Vaduz, Liechtenstein
- Division of Laboratory Medicine, Cantonal Hospital Graubünden, Chur
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch, Vaduz, Liechtenstein
- Department of Laboratory Medicine, Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Berne, Berne, Switzerland
- Department of Preventative Cardiology, Private University Triesen, Triesen, Liechtenstein
| | | | - Thomas F. Luescher
- Department of Cardiology, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Clemens von Schacky
- Department of Preventive Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - David Conen
- Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Juerg H. Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden
- Center for Molecular Cardiology, University of Zurich, Zurich
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35
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Harris WS, Tintle NL, Etherton MR, Vasan RS. Erythrocyte long-chain omega-3 fatty acid levels are inversely associated with mortality and with incident cardiovascular disease: The Framingham Heart Study. J Clin Lipidol 2018; 12:718-727.e6. [PMID: 29559306 PMCID: PMC6034629 DOI: 10.1016/j.jacl.2018.02.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND The extent to which omega-3 fatty acid status is related to risk for death from any cause and for incident cardiovascular disease (CVD) remains controversial. OBJECTIVE To examine these associations in the Framingham Heart Study. DESIGN Prospective and observational. SETTING Framingham Heart Study Offspring cohort. MEASUREMENTS The exposure marker was red blood cell levels of eicosapentaenoic and docosahexaenoic acids (the Omega-3 Index) measured at baseline. Outcomes included mortality (total, CVD, cancer, and other) and total CVD events in participants free of CVD at baseline. Follow-up was for a median of 7.3 years. Cox proportional hazards models were adjusted for 18 variables (demographic, clinical status, therapeutic, and CVD risk factors). RESULTS Among the 2500 participants (mean age 66 years, 54% women), there were 350 deaths (58 from CVD, 146 from cancer, 128 from other known causes, and 18 from unknown causes). There were 245 CVD events. In multivariable-adjusted analyses, a higher Omega-3 Index was associated with significantly lower risks (P-values for trends across quintiles) for total mortality (P = .02), for non-CVD and non-cancer mortality (P = .009), and for total CVD events (P = .008). Those in the highest (>6.8%) compared to those in the lowest Omega-3 Index quintiles (<4.2%) had a 34% lower risk for death from any cause and 39% lower risk for incident CVD. These associations were generally stronger for docosahexaenoic acid than for eicosapentaenoic acid. When total cholesterol was compared with the Omega-3 Index in the same models, the latter was significantly related with these outcomes, but the former was not. LIMITATIONS Relatively short follow-up time and one-time exposure assessment. CONCLUSIONS A higher Omega-3 Index was associated with reduced risk of both CVD and all-cause mortality.
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Affiliation(s)
- William S Harris
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota; and OmegaQuant Analytics, LLC, Sioux Falls, SD, USA.
| | - Nathan L Tintle
- Department of Mathematics & Statistics, Dordt College, Sioux Center, IA, USA
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute's, Boston University's Framingham Heart Study, Framingham, MA, USA; Departments of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Mori TA. Reprint of: Marine OMEGA-3 fatty acids in the prevention of cardiovascular disease. Fitoterapia 2018; 126:8-15. [PMID: 29657077 DOI: 10.1016/j.fitote.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 02/08/2023]
Abstract
Omega-6 (ω6) and omega-3 (ω3) fatty acids are two classes of dietary polyunsaturated fatty acids derived from linoleic acid (18:2ω6) and α-linolenic acid (18:3ω3), respectively. Enzymatic metabolism of linoleic and α-linolenic acids generates arachidonic acid (20:4ω6) and eicosapentaenoic acid (20:5ω3; EPA), respectively, both of which are substrates for enzymes that yield eicosanoids with multiple and varying physiological functions. Further elongation and desaturation of EPA yields the 22-carbon fatty acid docosahexaenoic acid (22:6ω3; DHA). The main dietary source of EPA and DHA for human consumption is fish, especially oily fish. There is considerable evidence that EPA and DHA are protective against cardiovascular disease (heart disease and stroke), particularly in individuals with pre-existing disease. ω3 Fatty acids benefit multiple risk factors including blood pressure, blood vessel function, heart function and blood lipids, and they have antithrombotic, anti-inflammatory and anti-oxidative actions. ω3 Fatty acids do not adversely interact with medications. Supplementation with ω3 fatty acids is recommended in individuals with elevated blood triglyceride levels and patients with coronary heart disease. A practical recommendation for the general population is to increase ω3 fatty acid intake by incorporating fish as part of a healthy diet that includes increased fruits and vegetables, and moderation of salt intake. Health authorities recommend the general population should consume at least two oily fish meals per week.
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Affiliation(s)
- Trevor A Mori
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia and the Cardiovascular Research Centre, Perth, Western Australia, Australia.
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Lukaschek K, von Schacky C, Kruse J, Ladwig KH. Cognitive Impairment Is Associated with a Low Omega-3 Index in the Elderly: Results from the KORA-Age Study. Dement Geriatr Cogn Disord 2018; 42:236-245. [PMID: 27701160 DOI: 10.1159/000448805] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids (PUFA) may affect the risk of cognitive decline in older adults. METHODS Cross-sectional analysis was conducted among 720 (50.4% women) participants aged 68-92 years (mean age: 77.6, SD ±6.2) of the population-based KORA-Age study. Eicosapentaenoic acid and docosahexaenoic acid (omega-3 index) were measured in erythrocytes as a percentage of total fatty acids. The categories low (<5.7), intermediate (5.7-6.8), and high (>6.8) levels of the omega-3 index were built using tertiles. The association between cognitive status and omega-3 levels was assessed by logistic regression analyses with adjustments for important concurrent risk factors of cognitive decline. RESULTS In the sex- and age-adjusted model (model 1), subjects with a low omega-3 index were at a significantly higher risk for cognitive impairment (OR: 1.77, 95% CI: 1.15-2.73, p = 0.009). This association remained stable after further adjusting for educational level (model 2; OR: 1.75, 95% CI: 1.13-2.71, p = 0.01) and metabolic risk factors (model 3; OR: 1.77, 95% CI: 1.14-2.75, p = 0.01). After further controlling for affective disorders (model 4), the association did not attenuate (OR: 1.77, 95% CI: 1.14-2.76, p = 0.01). CONCLUSION A robust association was found between low omega-3 levels and cognitive impairment in an elderly population. Further research is needed to understand the link between omega-3 PUFA and cognitive functioning.
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Affiliation(s)
- Karoline Lukaschek
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen, Gießen, Germany
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Schmöcker C, Zhang IW, Kiesler S, Kassner U, Ostermann AI, Steinhagen-Thiessen E, Schebb NH, Weylandt KH. Effect of Omega-3 Fatty Acid Supplementation on Oxylipins in a Routine Clinical Setting. Int J Mol Sci 2018; 19:ijms19010180. [PMID: 29316682 PMCID: PMC5796129 DOI: 10.3390/ijms19010180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/17/2022] Open
Abstract
Omega-6 polyunsaturated fatty acid (n-6 PUFA) is the predominant polyunsaturated fatty acid (PUFA), especially in Western diet. A high omega-6/omega-3 ratio in Western diets is implicated in the development of cardiovascular diseases and inflammatory processes. Studies in animal models and in humans have demonstrated beneficial effects of omega-3 PUFA (n-3 PUFA) in a variety of diseases, including cardiac arrhythmias and inflammatory diseases, as well as breast and colon cancer. The molecular mechanisms underlying the effects of n-3 PUFA are still not well understood. Possible mechanisms include competition between n-3 and n-6 PUFAs at the cyclooxygenase (COX) and lipoxygenase (LOX) and cytochrome P450 levels, and subsequent formation of oxylipins with specific anti-inflammatory or anti-arrhythmic effects. In this study, we report the impact of routine long-term treatment with prescription-grade n-3 PUFA (either 840 mg or 1680 mg per day) on blood cell membrane fatty acid composition, as well as plasma oxylipin patterns, in a patient population with severe hyperlipidemia and cardiovascular disease who are on standard lipid-lowering and cardioprotective medications. Lipidomics analyses were performed by LC/ESI-MS/MS. Supplementation led to a dose-dependent increase in n-3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the blood cell fraction. We also observed a dose-dependent increase in EPA- and DHA-derived epoxy metabolites, whereas the effect of n-3 PUFA supplementation on LOX-dependent EPA- and DHA-derived hydroxy metabolites was less pronounced, with a tendency towards lower metabolites in subjects with higher n-3 PUFA levels. These data thus generally confirm effects of n-3 PUFA supplementation observed previously in healthy individuals. Additionally, they indicate a suppressive effect of high n-3 PUFA supplementation on the formation of LOX metabolites in the context of concomitant aspirin medication.
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Affiliation(s)
- Christoph Schmöcker
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
- Department of Gastroenterology, Sana Klinikum Lichtenberg, 10365 Berlin, Germany.
| | - Ingrid W Zhang
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Stefanie Kiesler
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
| | - Ursula Kassner
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Annika I Ostermann
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, 42119 Wuppertal, Germany.
- Institute for Food Toxicology, University for Veterinary Medicine Hannover, 30559 Hannover, Germany.
| | - Elisabeth Steinhagen-Thiessen
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Nils H Schebb
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, 42119 Wuppertal, Germany.
- Institute for Food Toxicology, University for Veterinary Medicine Hannover, 30559 Hannover, Germany.
| | - Karsten-H Weylandt
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
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Saito G, Zapata R, Rivera R, Zambrano H, Rojas D, Acevedo H, Ravera F, Mosquera J, Vásquez JE, Mura J. Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition. Surg Neurol Int 2017; 8:304. [PMID: 29404191 PMCID: PMC5764917 DOI: 10.4103/sni.sni_266_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Functional recovery after aneurysmal subarachnoid hemorrhage (SAH) remains a significant problem. We tested a novel therapeutic approach with long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) to assess the safety and feasibility of an effectiveness trial. METHODS We conducted a multicentre, parallel, randomized, open-label pilot trial. Patients admitted within 72 hours after SAH with modified Fisher scale scores of 3 or 4 who were selected for scheduled aneurysm clipping were allocated to receive either n-3 PUFA treatment (parenteral perioperative: 5 days; oral: 8 weeks) plus usual care or usual care alone. Exploratory outcome measures included major postoperative intracranial bleeding complications (PIBCs), cerebral infarction caused by delayed cerebral ischemia, shunt-dependent hydrocephalus, and consent rate. The computed tomography evaluator was blinded to the group assignment. RESULTS Forty-one patients were randomized, but one patient had to be excluded after allocation. Twenty patients remained for intention to treat analysis in each trial arm. No PIBs (95% confidence interval [CI]: 0.00 to 0.16) or other unexpected harm were observed in the intervention group (IG). No patient suspended the intervention due to side effects. There was a trend towards improvements in all benefit-related outcomes in the IG. The overall consent rate was 0.91 (95% CI: 0.78 to 0.96), and there was no consent withdrawal. CONCLUSIONS Although the balance between the benefit and harm of the intervention appears highly favourable, further testing on SAH patients is required. We recommend proceeding with amendments in a dose-finding trial to determine the optimal duration of parenteral treatment.
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Affiliation(s)
- Geisi Saito
- Department of Anaesthesiology, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Rodrigo Zapata
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Rodrigo Rivera
- Chief of Neuroradiology Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Héctor Zambrano
- Neurology Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - David Rojas
- Department of Neurological Sciences, Universidad de Chile, Santiago, Chile
- Neurosurgery Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Hernán Acevedo
- Neurosurgery Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Franco Ravera
- Chief of Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, and Department of Neurosurgery, Universidad de Chile, Santiago, Chile
| | - John Mosquera
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Juan E. Vásquez
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Jorge Mura
- Department of Neurological Sciences, Universidad de Chile, Santiago, Chile
- Chief of Cerebrovascular and Skull Base Surgery, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
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Abstract
PURPOSE OF REVIEW The objective of this review was to summarize evidence gathered for the prognostic value of routine and novel blood lipids and lipoproteins measured in patients with acute coronary syndromes (ACS). RECENT FINDINGS Data supports clear association with risk and actionable value for non-high-density lipoprotein (Non-HDL) cholesterol and plasma ceramides in a setting of ACS. The prognostic value and clinical actionability of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)] in ACS have not been thoroughly tested, while the data for omega-3 fatty acids and oxidized low-density lipoprotein (Ox-LDL) are either untested or more varied. Measuring basic lipids, which should include Non-HDL cholesterol, at the time of presentation for ACS is guideline mandated. Plasma ceramides also provide useful information to guide both treatment decisions and follow-up. Additional studies targeting ACS patients are necessary for apoB, Lp(a), omega-3 fatty acids, and Ox-LDL.
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.,Department of Cardiology, Mayo Clinic, Rochester, MN, USA
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Tittus J, Huber MT, Storck K, Köhler A, Köhler JM, von Arnim T, von Schacky C. Omega-3 Index and Obstructive Sleep Apnea: A Cross-Sectional Study. J Clin Sleep Med 2017; 13:1131-1136. [PMID: 28859717 DOI: 10.5664/jcsm.6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Erythrocyte levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (Omega-3 Index) were previously found to be associated with obstructive sleep apnea (OSA) at very low levels (< 5.0%) in only one epidemiologic study. OSA has comorbidities, such as arterial hypertension, heart failure, or major depression, also associated with a low Omega-3 Index. These comorbidities can be improved by increasing intake of EPA and DHA, and thus the Omega-3 Index, preferably to its target range of 8% to 11%. Symptoms of OSA might improve by increasing the Omega-3 Index, but more research is needed. METHODS In our sleep laboratory, 357 participants with OSA were recruited, and data from 315 participants were evaluated. Three categories of OSA (none/ mild, moderate, severe) were defined based on apnea-hypopnea index. Anthropometrics and lifestyle characteristics (smoking, alcohol, fish intake, omega-3 supplementation) were recorded. Erythrocyte fatty acid compositions were assessed with the HS-Omega-3 Index methodology. RESULTS The mean Omega-3 Index in all 3 categories of OSA was 5.7%, and no association with OSA was found. There were more male participants with severe OSA (79.7%, P = .042) than females, and participants with severe OSA had a significantly higher body mass index (32.11 ± 6.39 kg/m2, P = .009) than participants with mild or moderate OSA. Lifestyle characteristics were not significantly different. CONCLUSIONS In contrast to our hypothesis, an Omega-3 Index of 5.7% was not associated with OSA severity. Previously, an Omega-3 Index < 5.0% was associated. Although our results suggest aiming for an Omega-3 Index > 5.7% in an intervention trial with EPA and DHA in OSA, comorbidities of OSA suggest a target range of 8% to 11%.
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Affiliation(s)
- Janine Tittus
- Preventive Cardiology, University of Munich, Munich, Germany
| | | | - Klaus Storck
- Lungenärzte am Rotkreuzplatz Munich, Munich, Germany
| | - Anton Köhler
- Preventive Cardiology, University of Munich, Munich, Germany
| | - Jan M Köhler
- Preventive Cardiology, University of Munich, Munich, Germany
| | | | - Clemens von Schacky
- Preventive Cardiology, University of Munich, Munich, Germany.,Omegametrix, Martinsried, Germany
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Mori TA. Marine OMEGA-3 fatty acids in the prevention of cardiovascular disease. Fitoterapia 2017; 123:51-58. [PMID: 28964873 DOI: 10.1016/j.fitote.2017.09.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/20/2022]
Abstract
Omega-6 (ω6) and omega-3 (ω3) fatty acids are two classes of dietary polyunsaturated fatty acids derived from linoleic acid (18:2ω6) and α-linolenic acid (18:3ω3), respectively. Enzymatic metabolism of linoleic and α-linolenic acids generates arachidonic acid (20:4ω6) and eicosapentaenoic acid (20:5ω3; EPA), respectively, both of which are substrates for enzymes that yield eicosanoids with multiple and varying physiological functions. Further elongation and desaturation of EPA yields the 22-carbon fatty acid docosahexaenoic acid (22:6ω3; DHA). The main dietary source of EPA and DHA for human consumption is fish, especially oily fish. There is considerable evidence that EPA and DHA are protective against cardiovascular disease (heart disease and stroke), particularly in individuals with pre-existing disease. ω3 Fatty acids benefit multiple risk factors including blood pressure, blood vessel function, heart function and blood lipids, and they have antithrombotic, anti-inflammatory and anti-oxidative actions. ω3 Fatty acids do not adversely interact with medications. Supplementation with ω3 fatty acids is recommended in individuals with elevated blood triglyceride levels and patients with coronary heart disease. A practical recommendation for the general population is to increase ω3 fatty acid intake by incorporating fish as part of a healthy diet that includes increased fruits and vegetables, and moderation of salt intake. Health authorities recommend the general population should consume at least two oily fish meals per week.
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Affiliation(s)
- Trevor A Mori
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia and the Cardiovascular Research Centre, Perth, Western Australia, Australia.
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Nettleton JA, von Schacky C, Brouwer IA, Koletzko B. International Society for the Study of Fatty Acids and Lipids 2016 Debate: For Science-Based Dietary Guidelines on Fats, Meta-Analysis and Systematic Reviews Are Decisive. ANNALS OF NUTRITION AND METABOLISM 2017; 71:26-30. [PMID: 28675886 DOI: 10.1159/000478794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
This paper summarizes a debate on whether meta-analyses and systematic reviews are decisive in formulating guidelines for dietary fat. Held during the 12th congress of the International Society for the Study of Fatty Acids and Lipids in Stellenbosch, South Africa, September 7, 2016, the debate was hosted by the International Union of Nutritional Sciences and the International Expert Movement to Improve Dietary Fat Quality (IEM, www.theiem.org). Clemens von Schacky, Ludwig Maximilians-University, Munich, Germany, supported the statement, describing the types of weaknesses in individual studies and clinical trials. With examples of how to overcome such limitations, he concluded that nutritional guidelines on fat need a proper scientific basis in which randomized controlled trials (RCTs) with clinical endpoints and their meta-analyses are essential and decisive. In contention, Ingeborg Brouwer, Vrije Universiteit, Amsterdam, declared that recommendations on dietary fat intake should always be based on the totality of the evidence, including physiologic and biochemical knowledge and associations from observational epidemiology. RCTs and meta-analyses have their shortcomings, but well-conducted systematic reviews and meta-analyses support a transparent process for developing dietary fat guidelines. Participants agreed that evidence-based decision-making for dietary guidance should consider all the best available evidence using a transparent, systematic review.
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Sánchez-Borrego R, von Schacky C, Osorio MJA, Llaneza P, Pinto X, Losa F, Navarro MC, Lubián D, Mendoza N. Recommendations of the Spanish Menopause Society on the consumption of omega-3 polyunsaturated fatty acids by postmenopausal women. Maturitas 2017; 103:71-77. [PMID: 28778336 DOI: 10.1016/j.maturitas.2017.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/17/2017] [Accepted: 06/22/2017] [Indexed: 01/19/2023]
Abstract
The consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) has shown a great variety of beneficial effects, including cardiovascular, metabolic and inflammatory effects, which make them interesting for the postmenopausal woman. Because LCO3-PUFAs could be effective and safe during this period, a panel of experts from the Spanish Menopause Society met to establish a set of recommendations for their use in postmenopausal women based on the best available evidence. The decrease in triglycerides is the most consistent effect observed with LCO3-PUFAs (at doses greater than 3g/day). In addition, LCO3-PUFAs have antiarrhythmic effects, reduce blood pressure, improve depressive and psychotic symptoms, and do not increase the risk of cancer. However, further studies are needed to confirm the benefit of LCO3-PUFAs in the relief of menopause symptoms and osteoporosis.
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Affiliation(s)
| | - Clemens von Schacky
- Preventive Cardiology, Medizinische Klinik I, Ludwig Maximilians-University of Munich, Germany
| | | | - Plácido Llaneza
- Department of Obstetrics and Gynecology, University of Asturias, Spain
| | | | | | | | - Daniel Lubián
- Department of Obstetrics and Gynecology, University of Cadiz, Spain
| | - Nicolás Mendoza
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Spain.
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Abstract
A low Omega-3 Index (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes) is associated with cardiac, cerebral, and other health issues. Intake of EPA and DHA, but not of alpha-linolenic acid (ALA), increases the Omega-3 Index. We investigated bioavailability, safety, palatability and tolerability of EPA and DHA in a novel source: a variety of sausages. We screened 96 healthy volunteers, and recruited 44 with an Omega-3 Index <5%. Participants were randomly assigned to receive a variety of sausages enriched with approximately 250 mg EPA and DHA per 80 g (n = 22) daily for 8 weeks, or matching placebo sausages (n = 22). All sausages contained approximately 250 mg ALA/80 g. In the verum group, the mean Omega-3 Index increased from 4.18 ± 0.54 to 5.72 ± 0.66% (p < 0.001), while it remained unchanged in the placebo group. While ALA levels increased only in the placebo group, DPA levels increased in both groups. Inter-individual variability in the response was large. The mean increase of the Omega-3 Index per intake of EPA and DHA we observed was higher than for other sources previously studied, indicating superior bioavailability. As increasing production of EPA and DHA is difficult, improvements of bioavailability can facilitate reaching the target range for the Omega-3 Index (8-11%).
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Individual omega-9 monounsaturated fatty acids and mortality—The Ludwigshafen Risk and Cardiovascular Health Study. J Clin Lipidol 2017; 11:126-135.e5. [DOI: 10.1016/j.jacl.2016.10.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 11/23/2022]
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Reiner MF, Stivala S, Limacher A, Bonetti NR, Méan M, Egloff M, Rodondi N, Aujesky D, von Schacky C, Lüscher TF, Camici GG, Beer JH. Omega-3 fatty acids predict recurrent venous thromboembolism or total mortality in elderly patients with acute venous thromboembolism. J Thromb Haemost 2017; 15:47-56. [PMID: 27790827 DOI: 10.1111/jth.13553] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 01/02/2023]
Abstract
Essentials The role of omega-3 fatty acids (n-3 FAs) in recurrent venous thromboembolism (VTE) is unknown. Association of n-3 FAs with recurrent VTE or total mortality was investigated in 826 patients. Whole blood n-3 FAs were inversely correlated with recurrent VTE or total mortality. Major and non-major bleeding was not increased in patients with higher levels of n-3 FAs. SUMMARY Background The role of omega-3 fatty acids (n-3 FAs) in recurrent venous thromboembolism (VTE) remains unknown. Objectives To investigate the association of n-3 FAs with recurrent VTE or total mortality at 6 months and 3 years. Methods N-3 FAs were assessed in 826 patients aged ≥ 65 years, categorized into low, medium and high based on the 25th and 75th percentile. Mean follow-up was 29 months. Results At 6 months, subjects with medium (adjusted hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.22-0.62) and high n-3 FA levels (adjusted HR, 0.36; 95% CI, 0.20-0.67) were less likely to develop recurrent VTE or total mortality, compared with those with low n-3 FAs. At 3 years, medium levels (adjusted HR, 0.67; 95% CI, 0.47-0.96) were associated with lower risk of recurrent VTE or total mortality. As compared with low n-3 FAs, the adjusted sub-hazard ratio [SHR] of recurrent VTE was 0.39 (95% CI, 0.15-0.99) in patients with medium and 0.17 (95% CI, 0.03-0.82) in patients with high n-3 FAs. The cumulative incidence of recurrent VTE was lower in the medium and high n-3 FA groups as compared with the low n-3 FA groups, but seems to have worn off after 3 years. The incidence of major and non-major bleeding was not greater in the high n-3 FA group. Conclusion Higher levels of n-3 FAs were associated with a lower risk of recurrent VTE or total mortality in elderly patients with VTE, but not with greater bleeding risk.
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Affiliation(s)
- M F Reiner
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - S Stivala
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - A Limacher
- Clinical Trials Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - N R Bonetti
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - M Méan
- Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - M Egloff
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - N Rodondi
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C von Schacky
- Department of Preventive Cardiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - T F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - G G Camici
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - J H Beer
- Center for Molecular Cardiology, Laboratory for Platelet Research, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
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Kones R, Howell S, Rumana U. n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: Principles, Practices, Pitfalls, and Promises - A Contemporary Review. Med Princ Pract 2017; 26:497-508. [PMID: 29186721 PMCID: PMC5848472 DOI: 10.1159/000485837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
Amidst voluminous literature, inconsistencies and opposing results have confused rather than clarified cardiologists' ability to assess the potential benefits of n-3 polyunsaturated fatty acids (n-3 PUFA). In perspective, there are common themes that emerge from n-3 PUFA studies, even as imperfect as they may be. The approach taken was to identify and unite these themes into a manageable, cohesive, evidence-based, yet useful synthesis. In all reviews and meta-analyses, the selection of component studies and assumptions influences outcomes. This overarching principle must be combined with the totality of the data, particularly when evidence is incompletely understood and gaps in knowledge must be bridged. Both the older literature and the most recent rigorous meta-analyses indicate that n-3 PUFA are highly pleiotropic agents with many documented positive physiological effects. Concordance among preclinical, observational, randomized clinical trials and meta-analyses is impressive. These agents have modest, statistically significant benefits which accrue over time. Given their favorable safety profile, a risk reduction of about 10% justifies their potential use in cardiovascular disease.
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Affiliation(s)
- Richard Kones
- The Cardiometabolic Research Institute, Texas, USA
- *Richard Kones MD, FAHA, FESC, FRSM, FCCP, FAGS, FRSH, FRSB, Cardiometabolic Research Institute, 8181 Fannin Street, Building 3, Unit 314, Houston, TX 77054-2913 (USA), E-Mail
| | - Scott Howell
- Department of Medicine, BMU School of Medicine, Winston-Salem, North Carolina, USA
| | - Umme Rumana
- The Cardiometabolic Research Institute, Texas, USA
- University of Texas Health Science Center Houston, Houston, Texas, USA
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Schuchardt JP, Ostermann AI, Stork L, Kutzner L, Kohrs H, Greupner T, Hahn A, Schebb NH. Effects of docosahexaenoic acid supplementation on PUFA levels in red blood cells and plasma. Prostaglandins Leukot Essent Fatty Acids 2016; 115:12-23. [PMID: 27914509 DOI: 10.1016/j.plefa.2016.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Polyunsaturated fatty acids (PUFA) are metabolized in a complex network of elongation, desaturation and beta oxidation. MATERIAL AND METHODS The short (1 and 3 wk), and long term (6 and 12 wk) effect of 1076mg/d docosahexaenoic acid (DHA, free of eicosapentaenoic acid (EPA)) on (absolute) PUFA concentrations in plasma and red blood cells (RBC) of 12 healthy men (mean age 25.1±1.5 years) was investigated. RESULTS RBC DHA concentrations significantly (p<0.001) increased from 28±1.6µg/mL to 38±2.0µg/mL (wk 1), 52±3.3µg/mL (wk 3), 68±2.6µg/mL (wk 6), and 79±3.5µg/mL (wk 12). Arachidonic acid (AA) concentrations declined in response to DHA treatment, while the effect was more pronounced in plasma (wk 0: 183±9.9µg/mL, wk 12: 139±8.0µg/mL, -24%, p<0.001) compared to RBC (wk 0: 130±3.7µg/mL, wk 12: 108±4.0µg/mL, -16%, p=0.001). Furthermore, an increase of EPA concentrations in plasma (wk 0: 15±1.5µg/mL, wk 1:19±1.6µg/mL, wk 3: 27±2.3µg/mL, wk 6: 23±1.2µg/mL, wk 12: 25±1.7µg/mL, p<0.001) and RBC (wk 0: 4.7±0.33µg/mL, wk 1: 6.7±1.3µg/mL, wk 3: 8.0±0.66µg/mL, wk 6: 6.9±0.44µg/mL, wk 12: 6.7±0.45µg/mL, n.s.) was observed suggesting a retroconversion of DHA to EPA. CONCLUSION Based on PUFA concentrations we showed that DHA supplementation results in increased EPA levels, whereas it is not known if this impacts the formation of EPA-derived lipid mediators. Furthermore, shifts in the entire PUFA pattern after supplementation of EPA or DHA should be taken into account when discussing differential physiological effects of EPA and DHA.
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Affiliation(s)
| | - Annika I Ostermann
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Germany
| | - Lisa Stork
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Germany
| | - Laura Kutzner
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Germany
| | - Heike Kohrs
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Germany
| | - Theresa Greupner
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Germany
| | - Nils Helge Schebb
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Germany; Institute of Food Chemistry, University of Wuppertal, Germany
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50
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Chaudhary R, Saadin K, Bliden KP, Harris WS, Dinh B, Sharma T, Tantry US, Gurbel PA. Risk factors associated with plasma omega-3 fatty acid levels in patients with suspected coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 2016; 113:40-45. [PMID: 27720039 DOI: 10.1016/j.plefa.2016.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We sought to determine the associations between plasma eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels and various cardiovascular risk factors and with the use of fish oil supplements (FOS). PATIENTS AND METHODS Patients with suspected coronary artery disease (CAD) undergoing cardiac catheterization (n=433) were studied. Serum fatty acid (FA) composition, the concentrations of lipids and biomarkers of oxidative stress, and dietary/lifestyle factors were measured. RESULTS FOS use was associated with a higher plasma EPA+DHA levels (3.7±1.5 vs. 2.6±1.1%, p<0.0001). However, there was no relationship between FOS dose (mg/day) and EPA+DHA levels in 76 patients reporting FOS use (r=-0.21, p=0.07). Lower levels were inversely associated with risk factor profiles including lower ApoB100/ApoA1 ratios (p<0.001). DISCUSSION AND CONCLUSIONS Higher EPA+DHA levels characterized patients with lower CAD risk. The lack of relations between FOS dose and plasma EPA+DHA levels likely reflects uncaptured variability in EPA+DHA content of supplements.
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Affiliation(s)
| | - Katayoon Saadin
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - Kevin P Bliden
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - William S Harris
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States; OmegaQuant Analytics LLC, Sioux Falls, SD, United States.
| | - Bao Dinh
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - Tushar Sharma
- Sinai Hospital of Baltimore, Baltimore, MD, United States
| | - Udaya S Tantry
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - Paul A Gurbel
- Inova Heart and Vascular Institute, Fairfax, VA, United States
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