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Dicklin MR, Anthony JC, Winters BL, Maki KC. ω-3 Polyunsaturated Fatty Acid Status Testing in Humans: A Narrative Review of Commercially Available Options. J Nutr 2024:S0022-3166(24)00164-0. [PMID: 38522783 DOI: 10.1016/j.tjnut.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
There is an increasing body of evidence supporting a link between low intakes of ω-3 long-chain polyunsaturated fatty acids (LCPUFA) and numerous diseases and health conditions. However, few people are achieving the levels of fish/seafood or eicosapentaenoic acid and docosahexaenoic acid intake recommended in national and international guidelines. Knowledge of a person's ω-3 LCPUFA status will benefit the interpretation of research results and could be expected to lead to an increased effort to increase intake. Dietary intake survey methods are often used as a surrogate for measuring ω-3 PUFA tissue status and its impact on health and functional outcomes. However, because individuals vary widely in their ability to digest and absorb ω-3 PUFA, analytical testing of biological samples is desirable to accurately evaluate ω-3 PUFA status. Adipose tissue is the reference biospecimen for measuring tissue fatty acids, but less-invasive methods, such as measurements in whole blood or its components (e.g., plasma, serum, red blood cell membranes) or breast milk are often used. Numerous commercial laboratories provide fatty acid testing of blood and breast milk samples by different methods and present their results in a variety of reports such as a full fatty acid profile, ω-3 and ω-6 fatty acid profiles, fatty acid ratios, as well as the Omega-3 Index, the Holman Omega-3 Test, OmegaScore, and OmegaCheck, among others. This narrative review provides information about the different ways to measure ω-3 LCPUFA status (including both dietary assessments and selected commercially available analytical tests of blood and breast milk samples) and discusses evidence linking increased ω-3 LCPUFA intake or status to improved health, focusing on cardiovascular, neurological, pregnancy, and eye health, in support of recommendations to increase ω-3 LCPUFA intake and testing.
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Affiliation(s)
| | | | | | - Kevin C Maki
- Midwest Biomedical Research, Addison, IL, United States; Indiana University School of Public Health, Bloomington, IN, United States.
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Panda C, Varadharaj S, Voruganti VS. PUFA, genotypes and risk for cardiovascular disease. Prostaglandins Leukot Essent Fatty Acids 2022; 176:102377. [PMID: 34915303 DOI: 10.1016/j.plefa.2021.102377] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022]
Abstract
Polyunsaturated fatty acids (PUFAs) are long chain fatty acids that are characterized by the presence of more than one double bond. These include fatty acids such as ꞷ-3-α-linolenic acid (ALA) and ꞷ-6 -linoleic acid (LA) which can only be obtained from dietary sources and are therefore termed essential fatty acids. They contain the building blocks for dihomo-γ-linolenic acid and arachidonic acid in the ꞷ-6 family as well as eicosapentaenoic acid and docosahexaenoic acid in the ꞷ-3 family. Both ALA and LA are important constituents of animal and plant cell membranes and are important components of anti-inflammatory and pro-inflammatory hormones and therefore, often modulate cellular immunity under chronic inflammatory states. The variation in physiological PUFA levels is under significant genetic influence, the fatty acid desaturase (FADS) genes being key regulators of PUFA metabolism. These genetic variants have been shown to alter fatty acid metabolism and influence the onset and progression of various metabolic conditions. This detailed review discusses the role of PUFAs, diet and genotypes in risk for cardiovascular diseases.
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Affiliation(s)
- Chinmayee Panda
- Department of Nutrition and Nutrition Research Institute, University of North Carolina at Chapel Hill, United States; Standard Process Inc, United States
| | | | - Venkata Saroja Voruganti
- Department of Nutrition and Nutrition Research Institute, University of North Carolina at Chapel Hill, United States.
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Susekov AV. [Omega-3 Polyunsaturated Fatty Acids in Patients with Hypertriglyceridemias and Atherosclerosis]. ACTA ACUST UNITED AC 2021; 61:88-96. [PMID: 34311692 DOI: 10.18087/cardio.2021.6.n1578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
Along with increased levels of low-density cholesterol, lipid factors of the risk of cardiovascular complications (CVC) include hypertriglyceridemia, particularly increased plasma levels of remnant particles. Omega-3 polyunsaturated fatty acids (ω-3 PUFA) are essential for normal functioning of cell membranes, retina, nerve tissue, skeletal muscles, etc. Among the large family of fatty acids (FA), eicosapentaenoic (EPC) and docosahexaenoic (DHX) FA are most studied. The beneficial effect of ω-3 PUFA consumption on the cardiovascular system is related with improvement of blood rheology, antiarrhythmic and anti-inflammatory effects, and a decrease in triglycerides. Large randomized studies of ω-3 PUFA (mixed EPC and DHX or only EPC) have demonstrated their efficiency and safety and a capability for reducing the incidence of CVC and sudden death as well as improvement of the prognosis in various patient populations. In the STRENGTH study (combination of omega-3 and statins), no significant decrease in the risk of CVC was achieved in patients with high triglycerides and low high-density lipoproteins. The ω-3 PUFA treatment is regulated by current international Guidelines and Consensuses as a part of combination therapy with statins for reduction of the risk of CVC and correction of pronounced hypertriglyceridemia.
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Affiliation(s)
- A V Susekov
- Academy for Postgraduate Medical Education, Moscow
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Effect of a chronotype-adjusted diet on weight loss effectiveness: A randomized clinical trial. Clin Nutr 2020; 39:1041-1048. [DOI: 10.1016/j.clnu.2019.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/22/2022]
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2020; 3:CD003177. [PMID: 32114706 PMCID: PMC7049091 DOI: 10.1002/14651858.cd003177.pub5] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3)), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) may benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess the effects of increased intake of fish- and plant-based omega-3 fats for all-cause mortality, cardiovascular events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to February 2019, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to August 2019, with no language restrictions. We handsearched systematic review references and bibliographies and contacted trial authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation or advice to increase LCn3 or ALA intake, or both, versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 86 RCTs (162,796 participants) in this review update and found that 28 were at low summary risk of bias. Trials were of 12 to 88 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most trials assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5 g a day to more than 5 g a day (19 RCTs gave at least 3 g LCn3 daily). Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.93 to 1.01; 143,693 participants; 11,297 deaths in 45 RCTs; high-certainty evidence), cardiovascular mortality (RR 0.92, 95% CI 0.86 to 0.99; 117,837 participants; 5658 deaths in 29 RCTs; moderate-certainty evidence), cardiovascular events (RR 0.96, 95% CI 0.92 to 1.01; 140,482 participants; 17,619 people experienced events in 43 RCTs; high-certainty evidence), stroke (RR 1.02, 95% CI 0.94 to 1.12; 138,888 participants; 2850 strokes in 31 RCTs; moderate-certainty evidence) or arrhythmia (RR 0.99, 95% CI 0.92 to 1.06; 77,990 participants; 4586 people experienced arrhythmia in 30 RCTs; low-certainty evidence). Increasing LCn3 may slightly reduce coronary heart disease mortality (number needed to treat for an additional beneficial outcome (NNTB) 334, RR 0.90, 95% CI 0.81 to 1.00; 127,378 participants; 3598 coronary heart disease deaths in 24 RCTs, low-certainty evidence) and coronary heart disease events (NNTB 167, RR 0.91, 95% CI 0.85 to 0.97; 134,116 participants; 8791 people experienced coronary heart disease events in 32 RCTs, low-certainty evidence). Overall, effects did not differ by trial duration or LCn3 dose in pre-planned subgrouping or meta-regression. There is little evidence of effects of eating fish. Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20; 19,327 participants; 459 deaths in 5 RCTs, moderate-certainty evidence),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25; 18,619 participants; 219 cardiovascular deaths in 4 RCTs; moderate-certainty evidence), coronary heart disease mortality (RR 0.95, 95% CI 0.72 to 1.26; 18,353 participants; 193 coronary heart disease deaths in 3 RCTs; moderate-certainty evidence) and coronary heart disease events (RR 1.00, 95% CI 0.82 to 1.22; 19,061 participants; 397 coronary heart disease events in 4 RCTs; low-certainty evidence). However, increased ALA may slightly reduce risk of cardiovascular disease events (NNTB 500, RR 0.95, 95% CI 0.83 to 1.07; but RR 0.91, 95% CI 0.79 to 1.04 in RCTs at low summary risk of bias; 19,327 participants; 884 cardiovascular disease events in 5 RCTs; low-certainty evidence), and probably slightly reduces risk of arrhythmia (NNTB 91, RR 0.73, 95% CI 0.55 to 0.97; 4912 participants; 173 events in 2 RCTs; moderate-certainty evidence). Effects on stroke are unclear. Increasing LCn3 and ALA had little or no effect on serious adverse events, adiposity, lipids and blood pressure, except increasing LCn3 reduced triglycerides by ˜15% in a dose-dependent way (high-certainty evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and low-certainty evidence suggests that increasing LCn3 slightly reduces risk of coronary heart disease mortality and events, and reduces serum triglycerides (evidence mainly from supplement trials). Increasing ALA slightly reduces risk of cardiovascular events and arrhythmia.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Teesside UniversitySchool of Social Sciences, Humanities and LawMiddlesboroughUKTS1 3BA
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
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6
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Weber B, Bersch-Ferreira ÂC, Torreglosa CR, Marcadenti A, Lara ES, da Silva JT, Costa RP, Santos RHN, Berwanger O, Bosquetti R, Pagano R, Mota LGS, de Oliveira JD, Soares RM, Galante AP, da Silva SA, Zampieri FG, Kovacs C, Amparo FC, Moreira P, da Silva RA, Dos Santos KG, Monteiro AS, Paiva CCJ, Magnoni CD, Moreira ASB, Peçanha DO, Missias KCS, de Paula LS, Marotto D, Souza P, Martins PRT, Dos Santos EM, Santos MR, Silva LP, Torres RS, Barbosa SNAA, de Pinho PM, de Araujo SHA, Veríssimo AOL, Guterres AS, Cardoso AFR, Palmeira MM, de Ataíde BRB, Costa LPS, Marinho HA, de Araújo CBP, Carvalho HMS, Maquiné RO, Caiado AC, de Matos CH, Barretta C, Specht CM, Onofrei M, Bertacco RTA, Borges LR, Bertoldi EG, Longo A, Ribas BLP, Dobke F, Pretto ADB, Bachettini NP, Gastaud A, Necchi R, Souza GC, Zuchinali P, Fracasso BM, Bobadra S, Sangali TD, Salamoni J, Garlini LM, Shirmann GS, de Los Santos MLP, Bortonili VMS, Dos Santos CP, Bragança GCM, Ambrózio CL, E Lima SB, Schiavini J, Napparo AS, Boemo JL, Nagano FEZ, Modanese PVG, Cunha NM, Frehner C, da Silva LF, Formentini FS, Ramos MEM, Ramos SS, Lucas MCS, Machado BG, Ruschel KB, Beiersdorf JR, Nunes CE, Rech RL, Damiani M, Berbigier M, Poloni S, Vian I, Russo DS, Rodrigues JA, de Moraes MAP, da Costa LM, Boklis M, El Kik RM, Adorne EF, Teixeira JM, Trescastro EP, Chiesa FL, Telles CT, Pellegrini LA, Reis LF, Cardoso RGM, Closs VE, Feres NH, da Silva NF, Silva NE, Dutra ES, Ito MK, Lima MEP, Carvalho APPF, Taboada MIS, Machado MMA, David MM, Júnior DGS, Dourado C, Fagundes VCFO, Uehara RM, Sasso S, Vieira JSO, de Oliveira BAS, Pereira JL, Rodrigues IG, Pinho CPS, Sousa ACS, Almeida AS, de Jesus MT, da Silva GB, Alves LVS, Nascimento VOG, Vieira SA, Coura AGL, Dantas CF, Leda NMFS, Medeiros AL, Andrade ACL, Pinheiro JMF, de Lima LRM, Sabino LS, de Souza CVS, Vasconcelos SML, Costa FA, Ferreira RC, Cardoso IB, Navarro LNP, Ferreira RB, Júnior AES, Silva MBG, Almeida KMM, Penafort AM, de Queirós APO, Farias GMN, Carlos DMO, Cordeiro CGNC, Vasconcelos VB, de Araújo EMVMC, Sahade V, Ribeiro CSA, Araujo GA, Gonçalves LB, Teixeira CS, Silva LMAJ, da Costa LB, Souza TS, de Jesus SO, Luna AB, da Rocha BRS, Santos MA, Neto JAF, Dias LPP, Cantanhede RCA, Morais JM, Duarte RCL, Barbosa ECB, Barbosa JMA, de Sousa RML, Dos Santos AF, Teixeira AF, Moriguchi EH, Bruscato NM, Kesties J, Vivian L, de Carli W, Shumacher M, Izar MCO, Asoo MT, Kato JT, Martins CM, Machado VA, Bittencourt CRO, de Freitas TT, Sant'Anna VAR, Lopes JD, Fischer SCPM, Pinto SL, Silva KC, Gratão LHA, Holzbach LC, Backes LM, Rodrigues MP, Deucher KLAL, Cantarelli M, Bertoni VM, Rampazzo D, Bressan J, Hermsdorff HHM, Caldas APS, Felício MB, Honório CR, da Silva A, Souza SR, Rodrigues PA, de Meneses TMX, Kumbier MCC, Barreto AL, Cavalcanti AB. Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial. Am Heart J 2019; 215:187-197. [PMID: 31349110 DOI: 10.1016/j.ahj.2019.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.
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Affiliation(s)
| | | | - Camila R Torreglosa
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to PhD studant at Graduation Program in Global Health and Sustainability, University of São Paulo, São Paulo-SP, Brazil
| | - Aline Marcadenti
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Annie S B Moreira
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | - Lais S de Paula
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Deborah Marotto
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Paula Souza
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | - Luisa P Silva
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aline Longo
- Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | | | | | | | | | | | | | | | | | | | - Sara Bobadra
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | - Joyce Salamoni
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | - Luíza M Garlini
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Paulo V G Modanese
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Natalia M Cunha
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Caroline Frehner
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Lannay F da Silva
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | | | - Maria E M Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Salvador S Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marilia C S Lucas
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Bruna G Machado
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Karen B Ruschel
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | | | - Cristine E Nunes
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Rafael L Rech
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Mônica Damiani
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marina Berbigier
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Soraia Poloni
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Izabele Vian
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Diana S Russo
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | | | | | - Laura M da Costa
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Mirena Boklis
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Raquel M El Kik
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Elaine F Adorne
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Joise M Teixeira
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Eduardo P Trescastro
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Fernanda L Chiesa
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Cristina T Telles
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Livia A Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Luisa F Reis
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Roberta G M Cardoso
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Vera E Closs
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Naoel H Feres
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Neyla E Silva
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Marina K Ito
- Hospital Universitário de Brasília, Brasília-DF, Brazil
| | | | | | | | | | - Marta M David
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Délcio G S Júnior
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Camila Dourado
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | - Rose M Uehara
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Sandramara Sasso
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | | | - Juliana L Pereira
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Isa G Rodrigues
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | - Claudia P S Pinho
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | | | | | | | | | | | | | | | - Amanda G L Coura
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Clenise F Dantas
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Neuma M F S Leda
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | - Ana C L Andrade
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viviane Sahade
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | - Givaldo A Araujo
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | | | | | - Laís B da Costa
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Tainah S Souza
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Sende O de Jesus
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Adriana B Luna
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | | | - Maria A Santos
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | - José A F Neto
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Luciana P P Dias
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Jadson M Morais
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Rita C L Duarte
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Elza C B Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Janaina M A Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | | | - Adriana F Teixeira
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Neide M Bruscato
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Josiele Kesties
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Lilian Vivian
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Waldemar de Carli
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Marina Shumacher
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | | | - Marina T Asoo
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | | | | | | | | | | | - Júlia D Lopes
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | - Sônia L Pinto
- Universidade Federal de Tocantins, Palmas-TO, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simone R Souza
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro-RJ, Brazil
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7
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Torshin IY, Gromova OA, Kobalava ZD. Concerning the “repression” of ω -3 polyunsaturated fatty acids by adepts of evidence-based medicine. ACTA ACUST UNITED AC 2019. [DOI: 10.17749/2070-4909.2019.12.2.91-114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I. Yu. Torshin
- Federal Research Center “Informatics and Management”, Russian Academy of Sciences; Moscow State University
| | - O. A. Gromova
- Federal Research Center “Informatics and Management”, Russian Academy of Sciences; Moscow State University
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8
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Jones-O'Connor M, Natarajan P. Optimal Non-invasive Strategies to Reduce Recurrent Atherosclerotic Cardiovascular Disease Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:38. [PMID: 31254118 PMCID: PMC6739861 DOI: 10.1007/s11936-019-0741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) remains the leading cause of death worldwide, with coronary artery disease (CAD) responsible for the vast majority of these deaths. Incidence is increasing in developing countries, and prevalence is increasing globally as populations age. Once CAD is manifest, recurrent event risk remains high. RECENT FINDINGS Multiple therapeutic avenues have had significant recent developments, including diet, low-density lipoprotein cholesterol management, triglycerides, hypoglycemic agents, antiplatelet agents, and oral anticoagulants. Combined approaches involving specific, tailored lifestyle, and pharmacological interventions will provide the most effective strategy for reducing the risk of recurrent CVD events. Here, we review risk prediction and non-invasive non-pharmacologic and pharmacologic approaches to mitigate residual coronary artery disease risk.
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Affiliation(s)
- Maeve Jones-O'Connor
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Pradeep Natarajan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard & MIT, Cambridge, MA, USA.
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9
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 11:CD003177. [PMID: 30521670 PMCID: PMC6517311 DOI: 10.1002/14651858.cd003177.pub4] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5g/d LCn3 to > 5 g/d (16 RCTs gave at least 3g/d LCn3).Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs) and ALA may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence with greater effects in trials at low summary risk of bias), and probably reduces risk of arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, except LCn3 reduced triglycerides by ˜15% in a dose-dependant way (high-quality evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event and arrhythmia risk.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Durham UniversityWolfson Research InstituteDurhamUKDH1 3LE
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Fai K AlAbdulghafoor
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
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10
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Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KHO, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 7:CD003177. [PMID: 30019766 PMCID: PMC6513557 DOI: 10.1002/14651858.cd003177.pub3] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. MAIN RESULTS We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet.Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence). AUTHORS' CONCLUSIONS This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia.
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Affiliation(s)
- Asmaa S Abdelhamid
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Tracey J Brown
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Julii S Brainard
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Priti Biswas
- University of East AngliaMED/HSCNorwich Research ParkNorwichUKNR4 7TJ
| | - Gabrielle C Thorpe
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Helen J Moore
- Durham UniversityWolfson Research InstituteDurhamUKDH1 3LE
| | - Katherine HO Deane
- University of East AngliaSchool of Health SciencesEarlham RoadNorwichUKNR4 7TJ
| | - Fai K AlAbdulghafoor
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Fujian Song
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichUKNR4 7TJ
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11
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Abstract
The aim of this article is to provide an overview of the importance of good nutritional care in chronic obstructive pulmonary disease (COPD). It will highlight the importance of nutritional screening and discuss the Managing Malnutrition Pathway in COPD published by BAPEN in 2016. The remainder of the article will provide guidance on what nutritional advice should be provided to COPD patients while undertaking pulmonary rehabilitation.
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Affiliation(s)
- Rachel Long
- Dietitian, Pulmonary Rehabilitation Bridgend
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12
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Lentjes MAH, Keogh RH, Welch AA, Mulligan AA, Luben RN, Wareham NJ, Khaw KT. Longitudinal associations between marine omega-3 supplement users and coronary heart disease in a UK population-based cohort. BMJ Open 2017; 7:e017471. [PMID: 29030414 PMCID: PMC5652534 DOI: 10.1136/bmjopen-2017-017471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Assess the association between marine omega-3 polyunsaturated fatty acid (n-3 PUFA) intake from supplements, mainly cod liver oil, and coronary heart disease (CHD) mortality. DESIGN Prospective cohort study, with three exposure measurements over 22 years. SETTING Norfolk-based European Prospective Investigation into Cancer (EPIC-Norfolk, UK). PARTICIPANTS 22 035 men and women from the general population, 39-79 years at recruitment. EXPOSURE Supplement use was assessed in three questionnaires (1993-1998; 2002-2004; 2004-2011). Participants were grouped into non-supplement users (NSU), n-3 PUFA supplement users (SU+n3) and non-n-3 PUFA supplement users (SU-n3). Cox regression adjusted for time-point specific variables: age, smoking, prevalent illnesses, body mass index, alcohol consumption, physical activity and season and baseline assessments of sex, social class, education and dietary intake (7-day diet diary). PRIMARY AND SECONDARY OUTCOME MEASURES During a median of 19-year follow-up, 1562 CHD deaths were registered for 22 035 included participants. RESULTS Baseline supplement use was not associated with CHD mortality, but baseline food and supplement intake of n-3 PUFA was inversely associated with CHD mortality after adjustment for fish consumption. Using time-varying covariate analysis, significant associations were observed for SU+n3 (HR: 0.74, 95% CI 0.66 to 0.84), but not for SU-n3 versus NSU. In further analyses, the association for SU+n3 persisted in those who did not take other supplements (HR: 0.83, 95% CI 0.71 to 0.97). Those who became SU+n3 over time or were consistent SU+n3 versus consistent NSU had a lower hazard of CHD mortality; no association with CHD was observed in those who stopped using n-3 PUFA-containing supplements. CONCLUSIONS Recent use of n-3 PUFA supplements was associated with a lower hazard of CHD mortality in this general population with low fish consumption. Residual confounding cannot be excluded, but the findings observed may be explained by postulated biological mechanisms and the results were specific to SU+n3.
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Affiliation(s)
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ailsa A Welch
- Department of Population Health and Primary Care, University of East Anglia, Norwich, UK
| | - Angela A Mulligan
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Kay-Tee Khaw
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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13
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Abstract
Diet is likely to be an important determinant of cardiovascular disease (CVD) risk. In this article, we will review the evidence linking the consumption of fruit and vegetables and CVD risk. The initial evidence that fruit and vegetable consumption has a protective effect against CVD came from observational studies. However, uncertainty remains about the magnitude of the benefit of fruit and vegetable intake on the occurrence of CVD and whether the optimal intake is five portions or greater. Results from randomized controlled trials do not show conclusively that fruit and vegetable intake protects against CVD, in part because the dietary interventions have been of limited intensity to enable optimal analysis of their putative effects. The protective mechanisms of fruit and vegetables may not only include some of the known bioactive nutrient effects dependent on their antioxidant, anti-inflammatory, and electrolyte properties, but also include their functional properties, such as low glycemic load and energy density. Taken together, the totality of the evidence accumulated so far does appear to support the notion that increased intake of fruits and vegetables may reduce cardiovascular risk. It is clear that fruit and vegetables should be eaten as part of a balanced diet, as a source of vitamins, fiber, minerals, and phytochemicals. The evidence now suggests that a complicated set of several nutrients may interact with genetic factors to influence CVD risk. Therefore, it may be more important to focus on whole foods and dietary patterns rather than individual nutrients to successfully impact on CVD risk reduction. A clearer understanding of the relationship between fruit and vegetable intake and cardiovascular risk would provide health professionals with significant information in terms of public health and clinical practice.
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Affiliation(s)
- Eman M Alissa
- a Faculty of Medicine, King Abdul Aziz University , Jeddah , Saudi Arabia
| | - Gordon A Ferns
- b Medical Education and Metabolic Medicine, Brighton and Sussex Medical School, University of Brighton , Brighton , United Kingdom
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14
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DHA-supplemented diet increases the survival of rats following asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation. Sci Rep 2016; 6:36545. [PMID: 27811958 PMCID: PMC5109906 DOI: 10.1038/srep36545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/17/2016] [Indexed: 12/27/2022] Open
Abstract
Accumulating evidence illustrates the beneficial effects of dietary docosahexaenoic acid (DHA) on cardiovascular diseases. However, its effects on cardiac arrest (CA) remain controversial in epidemiological studies and have not been reported in controlled animal studies. Here, we examined whether dietary DHA can improve survival, the most important endpoint in CA. Male Sprague-Dawley rats were randomized into two groups and received either a control diet or a DHA-supplemented diet for 7–8 weeks. Rats were then subjected to 20 min asphyxia-induced cardiac arrest followed by 30 min cardiopulmonary bypass resuscitation. Rat survival was monitored for additional 3.5 h following resuscitation. In the control group, 1 of 9 rats survived for 4 h, whereas 6 of 9 rats survived in the DHA-treated group. Surviving rats in the DHA-treated group displayed moderately improved hemodynamics compared to rats in the control group 1 h after the start of resuscitation. Rats in the control group showed no sign of brain function whereas rats in the DHA-treated group had recurrent seizures and spontaneous respiration, suggesting dietary DHA also protects the brain. Overall, our study shows that dietary DHA significantly improves rat survival following 20 min of severe CA.
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Radcliffe J, Thomas J, Bramley A, Kouris-Blazos A, Radford B, Scholey A, Pipingas A, Thomas C, Itsiopoulos C. Controversies in omega-3 efficacy and novel concepts for application. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2016. [DOI: 10.1016/j.jnim.2016.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Abstract
SummaryWhile the Inuit diet was highly cardio-protective and consuming oily fish within a Western diet is to a lesser degree, the case for purified fish oil supplements is less convincing. Purification of fish oil removes lipophilic polyphenols which likely contribute to the health benefits of oily fish; leaving the ω3 highly unsaturated fatty acids exposed and prone to conferring oxidative and inflammatory stress. The authors believe that due to such issues as dietary shift, it may now be inadvisable to prescribe or sell purified ω3 highly unsaturated fatty acids supplements, unless the appropriate co-factors are included.
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Affiliation(s)
- Paul R Clayton
- Institute of Food, Brain & Behaviour, Oxford OX4 1JE, UK
| | - Szabolcs Ladi
- Deparment of Public Health, University of Pecs, Hungary
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Weber B, Bersch-Ferreira ÂC, Torreglosa CR, Ross-Fernandes MB, da Silva JT, Galante AP, de Sousa Lara E, Costa RP, Soares RM, Cavalcanti AB, Moriguchi EH, Bruscato NM, Kesties J, Vivian L, Schumacher M, de Carli W, Backes LM, Reolão BR, Rodrigues MP, Baldissera DM, Tres GS, Lisbôa HR, Bem JB, Reolão JB, Deucher KL, Cantarelli M, Lucion A, Rampazzo D, Bertoni V, Torres RS, Verríssimo AO, Guterres AS, Cardos AF, Coutinho DB, Negrão MG, Alencar MF, Pinho PM, Barbosa SN, Carvalho AP, Taboada MI, Pereira SA, Heyde RV, Nagano FE, Baumgartner R, Resende FP, Tabalipa R, Zanini AC, Machado MJ, Araujo H, Teixeira ML, Souza GC, Zuchinali P, Fracasso BM, Ulliam K, Schumacher M, Pierotto M, Hilário T, Carlos DM, Cordeiro CG, Carvalho DA, Gonçalves MS, Vasconcelos VB, Bosquetti R, Pagano R, Romano ML, Jardim CA, de Abreu BN, Marcadenti A, Schmitt AR, Tavares AM, Faria CC, Silva FM, Fink JS, El Kik RM, Prates CF, Vieira CS, Adorne EF, Magedanz EH, Chieza FL, Silva IS, Teixeira JM, Trescastro EP, Pellegrini LA, Pinto JC, Telles CT, Sousa AC, Almeida AS, Costa AA, Carmo JA, Silva JT, Alves LV, Sales SO, Ramos ME, Lucas MC, Damiani M, Cardoso PC, Ramos SS, Dantas CF, Lopes AG, Cabral AM, Lucena AC, Medeiros AL, Terceiro BB, Leda NM, Baía SR, Pinheiro JM, Cassiano AN, Melo AN, Cavalcanti AK, Souza CV, Queiroz DJ, Farias HN, Souza LC, Santos LS, Lima LR, Hoffmann MS, Ribeiro ÁSS, Vasconcelos DF, Dutra ES, Ito MK, Neto JA, Santos AF, Sousa RM, Dias LPP, Lima MT, Modanesi VG, Teixeira AF, Estrada LC, Modanesi PV, Gomes AB, Rocha BR, Teti C, David MM, Palácio BM, Junior DG, Faria ÉH, Oliveira MC, Uehara RM, Sasso S, Moreira AS, Cadinha AC, Pinto CW, Castilhos MP, Costa M, Kovacs C, Magnoni D, Silva Q, Germini MF, da Silva RA, Monteiro AS, Santos KGD, Moreira P, Amparo FC, Paiva CC, Poloni S, Russo DS, Silveira IV, Moraes MA, Boklis M, Cardoso QI, Moreira AS, Damaceno AM, Santos EM, Dias GM, Pinho CP, Cavalcanti AC, Bezerra AS, Queiroga AV, Rodrigues IG, Leal TV, Sahade V, Amaral DA, Souza DS, Araújo GA, Curvello K, Heine M, Barretto MM, Reis NA, Vasconcelos SM, Vieira DC, Costa FA, Fontes JM, Neto JG, Navarro LN, Ferreira RC, Marinho PM, Abib RT, Longo A, Bertoldi EG, Ferreira LS, Borges LR, Azevedo NA, Martins CM, Kato JT, Izar MC, Asoo MT, de Capitani MD, Machado VA, Fonzar WT, Pinto SL, Silva KC, Gratão LH, Machado SD, de Oliveira SR, Bressan J, Caldas AP, Lima HC, Hermsdorff HH, Saldanha TM, Priore SE, Feres NH, de Queiroz Neves A, Cheim LM, Silva NF, Reis SR, Penafort AM, de Queirós APO, Farias GM, de los Santos ML, Ambrozio CL, Camejo CN, dos Santos CP, Schirmann GS, Boemo JL, Oliveira RE, Lima SM, Bortolini VM, Matos CH, Barretta C, Specht CM, de Souza SR, Arruda CS, Rodrigues PA, Berwanger O. The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial). Am Heart J 2016; 171:73-81.e1-2. [PMID: 26699603 DOI: 10.1016/j.ahj.2015.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/08/2015] [Indexed: 11/25/2022]
Abstract
This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.
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Anand SS, Hawkes C, de Souza RJ, Mente A, Dehghan M, Nugent R, Zulyniak MA, Weis T, Bernstein AM, Krauss RM, Kromhout D, Jenkins DJA, Malik V, Martinez-Gonzalez MA, Mozaffarian D, Yusuf S, Willett WC, Popkin BM. Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System: A Report From the Workshop Convened by the World Heart Federation. J Am Coll Cardiol 2015; 66:1590-1614. [PMID: 26429085 PMCID: PMC4597475 DOI: 10.1016/j.jacc.2015.07.050] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
Abstract
Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD.
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Affiliation(s)
- Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Corinna Hawkes
- Centre for Food Policy, City University, London, United Kingdom
| | - Russell J de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, Washington
| | | | - Tony Weis
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Adam M Bernstein
- Center for Lifestyle Medicine, Cleveland Clinic, Lyndhurst, Ohio
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, Oakland, California
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vasanti Malik
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Walter C Willett
- Departamento de Medicina Preventiva y Salud Publica, Universidad de Navarra-CIBEROBN, Pamplona, Spain
| | - Barry M Popkin
- Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, North Carolina.
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Affiliation(s)
- M. Murphy
- British Nutrition Foundation; London UK
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Li S, Flint A, Pai JK, Forman JP, Hu FB, Willett WC, Rexrode KM, Mukamal KJ, Rimm EB. Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study. BMJ 2014; 348:g2659. [PMID: 24782515 PMCID: PMC4004785 DOI: 10.1136/bmj.g2659] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality. DESIGN Prospective cohort study. SETTING Two large prospective cohort studies of US women and men with repeated dietary measurements: the Nurses' Health Study and the Health Professionals Follow-Up Study. PARTICIPANTS 2258 women and 1840 men who were free of cardiovascular disease, stroke, or cancer at enrollment, survived a first MI during follow-up, were free of stroke at the time of initial onset of MI, and provided food frequency questionnaires pre-MI and at least one post-MI. MAIN OUTCOME MEASURES Associations of dietary fiber post-MI and changes from before to after MI with all cause and cardiovascular mortality using Cox proportional hazards models, adjusting for drug use, medical history, and lifestyle factors. RESULTS Higher post-MI fiber intake was significantly associated with lower all cause mortality (comparing extreme fifths, pooled hazard ratio 0.75, 95% confidence interval 0.58 to 0.97). Greater intake of cereal fiber was more strongly associated with all cause mortality (pooled hazard ratio 0.73, 0.58 to 0.91) than were other sources of dietary fiber. Increased fiber intake from before to after MI was significantly associated with lower all cause mortality (pooled hazard ratio 0.69, 0.55 to 0.87). CONCLUSIONS In this prospective study of patients who survived MI, a greater intake of dietary fiber after MI, especially cereal fiber, was inversely associated with all cause mortality. In addition, increasing consumption of fiber from before to after MI was significantly associated with lower all cause and cardiovascular mortality.
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Affiliation(s)
- Shanshan Li
- Department of Epidemiology, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
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Individual variation in lipidomic profiles of healthy subjects in response to omega-3 Fatty acids. PLoS One 2013; 8:e76575. [PMID: 24204640 PMCID: PMC3811983 DOI: 10.1371/journal.pone.0076575] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/27/2013] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Conflicting findings in both interventional and observational studies have resulted in a lack of consensus on the benefits of ω3 fatty acids in reducing disease risk. This may be due to individual variability in response. We used a multi-platform lipidomic approach to investigate both the consistent and inconsistent responses of individuals comprehensively to a defined ω3 intervention. METHODS The lipidomic profile including fatty acids, lipid classes, lipoprotein distribution, and oxylipins was examined multi- and uni-variately in 12 healthy subjects pre vs. post six weeks of ω3 fatty acids (1.9 g/d eicosapentaenoic acid [EPA] and 1.5 g/d docosahexaenoic acid [DHA]). RESULTS Total lipidomic and oxylipin profiles were significantly different pre vs. post treatment across all subjects (p=0.00007 and p=0.00002 respectively). There was a strong correlation between oxylipin profiles and EPA and DHA incorporated into different lipid classes (r(2)=0.93). However, strikingly divergent responses among individuals were also observed. Both ω3 and ω6 fatty acid metabolites displayed a large degree of variation among the subjects. For example, in half of the subjects, two arachidonic acid cyclooxygenase products, prostaglandin E2 (PGE2) and thromboxane B2 (TXB2), and a lipoxygenase product, 12-hydroxyeicosatetraenoic acid (12-HETE) significantly decreased post intervention, whereas in the other half they either did not change or increased. The EPA lipoxygenase metabolite 12-hydroxyeicosapentaenoic acid (12-HEPE) varied among subjects from an 82% decrease to a 5,000% increase. CONCLUSIONS Our results show that certain defined responses to ω3 fatty acid intervention were consistent across all subjects. However, there was also a high degree of inter-individual variability in certain aspects of lipid metabolism. This lipidomic based phenotyping approach demonstrated that individual responsiveness to ω3 fatty acids is highly variable and measurable, and could be used as a means to assess the effectiveness of ω3 interventions in modifying disease risk and determining metabolic phenotype.
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Abstract
A high intake of fruit and vegetables (FV) has been shown to be associated with reduced risk of a number of chronic diseases, including CVD. This review aims to provide an overview of the evidence that increased FV intake reduces risk of CVD, focusing on studies examining total FV intake. This evidence so far available is largely based on prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke. Controlled intervention trials examining either clinical or cardiovascular risk factor endpoints are scarce. However, such trials have shown that an increase in FV consumption can lower blood pressure and also improve microvascular function, both of which are commensurate with a reduced risk of CVD. The effects of increased FV consumption on plasma lipid levels, risk of diabetes and body weight have yet to be firmly established. In conclusion, evidence that FV consumption reduces the risk of CVD is so far largely confined to observational epidemiology, with further intervention studies required.
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Affiliation(s)
| | - S. Coe
- British Nutrition Foundation; London; UK
| | | | - S. Stanner
- British Nutrition Foundation; London; UK
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Peter S, Chopra S, Jacob JJ. A fish a day, keeps the cardiologist away! - A review of the effect of omega-3 fatty acids in the cardiovascular system. Indian J Endocrinol Metab 2013; 17:422-429. [PMID: 23869297 PMCID: PMC3712371 DOI: 10.4103/2230-8210.111630] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Dyslipidemia and its consequences are emerging as epidemics with deleterious consequences on cardiovascular (CV) health. The beneficial effects of omega-3-fatty acids on cardiac and extra cardiac organs have been extensively studied in the last two decades, and continue to show great promise in the primary and secondary prevention of cardiovascular diseases (CVDs). Omega-3-fatty acid supplementation has been proven to have beneficial action on lipid profile, cytokine cascade, oxidant-anti-oxidant balance, parasympathetic and sympathetic tone and nitric oxide synthesis. This review summarizes the current knowledge on the basis of its cardiac and non-cardiac benefits, present results from clinical trials and the recommendations for its use in cardiac diseases and dyslipidemias.
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Affiliation(s)
- Soumia Peter
- Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
| | - Sandeep Chopra
- lDepartment of Cardiology, Christian Medical College, Ludhiana, Punjab, India
| | - Jubbin J. Jacob
- Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
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Abstract
A high intake of fruit and vegetables (FV) is associated with reduced risk of chronic disease, although the evidence base is mostly observational. Blood biomarkers offer an objective indicator of FV intake, potentially improving estimates of intakes based on traditional methods. A valid biomarker of overall FV intake would be able to confirm population intakes, more precisely evaluate the association between intakes and health outcomes and confirm compliance in FV interventions. Several substances have been proposed as biomarkers of FV intake: vitamin C, the carotenoids and polyphenols. Certain biomarkers are strong predictors of single FV; however, the proposed single biomarkers of FV consumption are only modestly predictive of overall FV consumption. This is likely to be due to the complexity of the FV food group. While accurately measuring FV intake is important in nutrition research, another critical question is: how best can an increase in FV intake be achieved? Increased FV intake has been achieved in efficacy studies using intensive dietary advice. Alternative, less intensive methods for encouraging FV consumption need to be developed and tested for population level intervention. Systematic reviews suggest peer support to be an effective strategy to promote dietary change. This review will describe the evidence for a link between increased FV intake and good health, outline possible novel biomarkers of FV consumption, present the most recently available data on population intake of FV and examine the usefulness of different approaches to encourage increased consumption of FV.
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Jump DB, Depner CM, Tripathy S. Omega-3 fatty acid supplementation and cardiovascular disease. J Lipid Res 2012; 53:2525-45. [PMID: 22904344 DOI: 10.1194/jlr.r027904] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Epidemiological studies on Greenland Inuits in the 1970s and subsequent human studies have established an inverse relationship between the ingestion of omega-3 fatty acids [C(20-22) ω 3 polyunsaturated fatty acids (PUFA)], blood levels of C(20-22) ω 3 PUFA, and mortality associated with cardiovascular disease (CVD). C(20-22) ω 3 PUFA have pleiotropic effects on cell function and regulate multiple pathways controlling blood lipids, inflammatory factors, and cellular events in cardiomyocytes and vascular endothelial cells. The hypolipemic, anti-inflammatory, anti-arrhythmic properties of these fatty acids confer cardioprotection. Accordingly, national heart associations and government agencies have recommended increased consumption of fatty fish or ω 3 PUFA supplements to prevent CVD. In addition to fatty fish, sources of ω 3 PUFA are available from plants, algae, and yeast. A key question examined in this review is whether nonfish sources of ω 3 PUFA are as effective as fatty fish-derived C(20-22) ω 3 PUFA at managing risk factors linked to CVD. We focused on ω 3 PUFA metabolism and the capacity of ω 3 PUFA supplements to regulate key cellular events linked to CVD. The outcome of our analysis reveals that nonfish sources of ω 3 PUFA vary in their capacity to regulate blood levels of C(20-22) ω 3 PUFA and CVD risk factors.
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Affiliation(s)
- Donald B Jump
- Nutrition Program, School of Biological and Population Health Sciences, The Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA.
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Abstract
PURPOSE OF REVIEW Regular intake of fruit and vegetables (F&Vs) has been widely recommended to improve the health of the population. Observational studies show a preventive effect of long-term consumption of adequate nutrients on cancer, diabetes, dementia and other age-related diseases. However, the short-term impact of F&V intake in more specific populations has been under-researched. In the hospital setting, economic choices and logistic problems result in poor quality of food in general, and particularly in fresh F&Vs. As hospital geriatricians, we set out to address the issue of F&V intake in elderly hospitalized patients, for whom we felt F&Vs might be beneficial in association with a protein and energy-dense diet. RECENT FINDINGS In the community and in nursing homes, F&V consumption is associated with better overall food intake and improved quality of life in older patients. SUMMARY General inspection of the literature suggests that F&Vs may be beneficial to elderly hospitalized patients, but no clinical studies have been conducted. There is a need to address the question of the impact of improved quality and quantity of F&Vs on quality of life, total food intake and constipation, particularly in hospitalized elderly patients who often stay in hospital for long periods. Positive results might help to promote F&V consumption in diverse populations, with the objective of improving eating pleasure for better health.
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Krishnamurthy VMR, Wei G, Baird BC, Murtaugh M, Chonchol MB, Raphael KL, Greene T, Beddhu S. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int 2011; 81:300-6. [PMID: 22012132 DOI: 10.1038/ki.2011.355] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The prevalence of chronic kidney disease (estimated glomerular filtration rate less than 60 ml/min per 1.73 m(2)) was 5.8%. For each 10-g/day increase in total fiber intake, the odds of elevated serum C-reactive protein levels were decreased by 11% and 38% in those without and with kidney disease, respectively. Dietary total fiber intake was not significantly associated with mortality in those without but was inversely related to mortality in those with kidney disease. The relationship of total fiber with inflammation and mortality differed significantly in those with and without kidney disease. Thus, high dietary total fiber intake is associated with lower risk of inflammation and mortality in kidney disease and these associations are stronger in magnitude in those with kidney disease. Interventional trials are needed to establish the effects of fiber intake on inflammation and mortality in kidney disease.
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Flock MR, Kris-Etherton PM. Dietary Guidelines for Americans 2010: Implications for Cardiovascular Disease. Curr Atheroscler Rep 2011; 13:499-507. [DOI: 10.1007/s11883-011-0205-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Omega-3 fatty acids, which are found abundantly in fish oil, are increasingly being used in the management of cardiovascular disease. It is clear that fish oil, in clinically used doses (typically 4 g/d of eicosapentaenoic acid and docosahexaenoic acid) reduce high triglycerides. However, the role of omega-3 fatty acids in reducing mortality, sudden death, arrhythmias, myocardial infarction, and heart failure has not yet been established. This review will focus on the current clinical uses of fish oil and provide an update on their effects on triglycerides, coronary artery disease, heart failure, and arrhythmia. We will explore the dietary sources of fish oil as compared with drug therapy, and discuss the use of fish oil products in combination with other commonly used lipid-lowering agents. We will examine the underlying mechanism of fish oil's action on triglyceride reduction, plaque stability, and effect in diabetes, and review the newly discovered anti-inflammatory effects of fish oil. Finally, we will examine the limitations of current data and suggest recommendations for fish oil use.
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Goldberg IJ, Eckel RH, McPherson R. Triglycerides and heart disease: still a hypothesis? Arterioscler Thromb Vasc Biol 2011; 31:1716-25. [PMID: 21527746 DOI: 10.1161/atvbaha.111.226100] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this article is to review the basic and clinical science relating plasma triglycerides and cardiovascular disease. Although many aspects of the basic physiology of triglyceride production, its plasma transport, and its tissue uptake have been known for several decades, the relationship of plasma triglyceride levels to vascular disease is uncertain. Are triglyceride-rich lipoproteins, their influence on high-density lipoprotein and low-density lipoprotein, or the underlying diseases that lead to defects in triglyceride metabolism the culprit? Animal models have failed to confirm that anything other than early fatty lesions can be produced by triglyceride-rich lipoproteins. Metabolic products of triglyceride metabolism can be toxic to arterial cells; however, these studies are primarily in vitro. Correlative studies of fasting and postprandial triglycerides and genetic diseases implicate very-low-density lipoprotein and their remnants and chylomicron remnants in atherosclerosis development, but the concomitant alterations in other lipoproteins and other risk factors obscure any conclusions about direct relationships between disease and triglycerides. Genes that regulate triglyceride levels also correlate with vascular disease. Human intervention trials, however, have lacked an appropriately defined population and have produced outcomes without definitive conclusions. The time is more than ripe for new and creative approaches to understanding the relationship of triglycerides and heart disease.
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Affiliation(s)
- Ira J Goldberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Peterson J, Dwyer J, Adlercreutz H, Scalbert A, Jacques P, McCullough ML. Dietary lignans: physiology and potential for cardiovascular disease risk reduction. Nutr Rev 2010; 68:571-603. [PMID: 20883417 DOI: 10.1111/j.1753-4887.2010.00319.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The present review of the literature on lignan physiology and lignan intervention and epidemiological studies was conducted to determine if lignans decrease the risks of cardiovascular disease in Western populations. Five intervention studies using flaxseed lignan supplements indicated beneficial associations with C-reactive protein, and a meta-analysis that included these studies also suggested lignans have a lowering effect on plasma total and low-density lipoprotein cholesterol. Three intervention studies using sesamin supplements indicated possible lipid- and blood pressure-lowering associations. Eleven human observational epidemiological studies examined dietary intakes of lignans in relation to cardiovascular disease risk. Five showed decreased risk with either increasing dietary intakes of lignans or increased levels of serum enterolactone (an enterolignan used as a biomarker of lignan intake), five studies were of borderline significance, and one was null. The associations between lignans and decreased risk of cardiovascular disease are promising, but they are yet not well established, perhaps due to low lignan intakes in habitual Western diets. At the higher doses used in intervention studies, associations were more evident.
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Affiliation(s)
- Julia Peterson
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachussets, USA
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Abstract
This article discusses alternative therapies for secondary prevention and treatment of major cardiac disorders: congestive heart failure, hypertension, dyslipidemias, and peripheral vascular disease. The role of various therapies (eg, herbal and botanic preparations, supplements, mind/body interventions, other alternative modalities of care) are addressed relative to each disease state and will hopefully give the practitioner or student a readily accessible suite of integrative therapies for common cardiac illnesses.
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Affiliation(s)
- Coleman Pratt
- Department of Family and Community Medicine, Tulane University Health Science Center, School of Medicine, 1430 Tulane Avenue TB3, New Orleans, LA 70112, USA.
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Session 4: CVD, diabetes and cancer Evidence for the use of the Mediterranean diet in patients with CHD. Proc Nutr Soc 2009; 69:45-60. [DOI: 10.1017/s0029665109991856] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diet is associated with the development of CHD. The incidence of CHD is lower in southern European countries than in northern European countries and it has been proposed that this difference may be a result of diet. The traditional Mediterranean diet emphasises a high intake of fruits, vegetables, bread, other forms of cereals, potatoes, beans, nuts and seeds. It includes olive oil as a major fat source and dairy products, fish and poultry are consumed in low to moderate amounts. Many observational studies have shown that the Mediterranean diet is associated with reduced risk of CHD, and this result has been confirmed by meta-analysis, while a single randomised controlled trial, the Lyon Diet Heart study, has shown a reduction in CHD risk in subjects following the Mediterranean diet in the secondary prevention setting. However, it is uncertain whether the benefits of the Mediterranean diet are transferable to other non-Mediterranean populations and whether the effects of the Mediterranean diet will still be feasible in light of the changes in pharmacological therapy seen in patients with CHD since the Lyon Diet Heart study was conducted. Further randomised controlled trials are required and if the risk-reducing effect is confirmed then the best methods to effectively deliver this public health message worldwide need to be considered.
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Abstract
Diet plays an important part in the maintenance of optimal cardiovascular health. This Review summarizes the evidence for a relationship between fruit and vegetable consumption and the occurrence of coronary heart disease. This evidence is based on observational cohort studies, nutrition prevention trials with fruit and vegetables, and investigations of the effects of fruit and vegetables on cardiovascular risk factors. Most of the evidence supporting a cardioprotective effect comes from observational epidemiological studies; these studies have reported either weak or nonsignificant associations. Controlled nutritional prevention trials are scarce and the existing data do not show any clear protective effects of fruit and vegetables on coronary heart disease. Under rigorously controlled experimental conditions, fruit and vegetable consumption is associated with a decrease in blood pressure, which is an important cardiovascular risk factor. However, the effects of fruit and vegetable consumption on plasma lipid levels, diabetes, and body weight have not yet been thoroughly explored. Finally, the hypothesis that nutrients in fruit and vegetables have a protective role in reducing the formation of atherosclerotic plaques and preventing complications of atherosclerosis has not been tested in prevention trials. Evidence that fruit and vegetable consumption reduces the risk of cardiovascular disease remains scarce thus far.
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Affiliation(s)
- Luc Dauchet
- Department of Epidemiology and Public Health, INSERM 744, Institut Pasteur de Lille and University of Lille Nord de France, Lille, France
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Omacor (prescription omega-3-acid ethyl esters 90): From severe rhythm disorders to hypertriglyceridemia. Adv Ther 2009; 26:675-90. [PMID: 19629408 DOI: 10.1007/s12325-009-0045-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Indexed: 01/19/2023]
Abstract
Despite progress made in post-myocardial infarction (MI) revascularization and background therapy for the failing heart, the prevention of adverse cardiac remodeling associated with severe rhythm disorders remains an important drug target. Part of the remodeling can be counteracted by modulating the activity of ion channels and exchangers by omega-3 acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In the GISSI-Prevenzione and GISSI-HF trials, omega-3 fatty acids were administered as ethyl esters (Omacor Solvay Pharmaceuticals) and not as triglycerides present in fish oil. Ethyl esters result in a sustained intestinal absorption of EPA and DHA and require various purification steps during production, thereby minimizing the content of environmental toxins. Also the rather high (38%) DHA content of Omacor should not be ignored since in rats with low dose intake of omega-3 acids, DHA but not EPA inhibited ischemia-induced arrhythmias. In patients on multiple tablets, 840 mg EPA+DHA in one capsule is preferred to increase compliance. It is not justified to refer to Omacor as "n-3 polyunsaturated fatty acid supplementation" or even "fish oil" and, based on controlled clinical trials, there is no evidence that fish oil could be a substitute of Omacor. To avoid further confusion, guidelines should be precise and refer to the medication, eg, as in NICE guideline CG48: "Omega-3-acid ethyl esters treatment licensed for secondary prevention post-MI." The anti-arrhythmogenic action of Omacor should be seen in the context of implantable cardioverter-defibrillator trials (DINAMIT, IRIS) where non-sudden death was increased and total mortality unaltered. However, Omacor administered in the GISSI-HF trial reduced the incidence of severe arrhythmic events and mortality. Also in the GISSI-Prevenzione trial, arrhythmic death and mortality were reduced. At higher dosages (daily, 3-4 g) Omacor exhibits more pronounced cardiovascular benefits and, as a licensed indication, improves hypertriglyceridemia and related lipid parameters.
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Sun Q, Ma J, Campos H, Rexrode KM, Albert CM, Mozaffarian D, Hu FB. Blood concentrations of individual long-chain n-3 fatty acids and risk of nonfatal myocardial infarction. Am J Clin Nutr 2008; 88:216-23. [PMID: 18614744 PMCID: PMC6598701 DOI: 10.1093/ajcn/88.1.216] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whereas dietary intake of long-chain n-3 fatty acids has been associated with risk of nonfatal myocardial infarction (MI), few studies have examined the relation for blood concentrations. OBJECTIVE We aimed to investigate the effect of long-chain n-3 fatty acids in blood on the risk of nonfatal MI. DESIGN Baseline blood samples were collected from 32 826 participants of the Nurses' Health Study in 1989-1990, among whom 146 incident cases of nonfatal MI were ascertained during 6 y of follow-up and matched with 288 controls. RESULTS After multivariate adjustment, the relative risks (95% CI) comparing the highest with the lowest quartiles in plasma were 0.23 (0.09, 0.55; P for trend = 0.001) for eicosapentaenoic acid (EPA), 0.40 (0.20, 0.82; P for trend = 0.004) for docosapentaenoic acid (DPA), and 0.46 (0.18, 1.16; P for trend = 0.07) for docosahexaenoic acid (DHA). The associations for these fatty acids in erythrocytes were generally weaker and nonsignificant. In contrast to EPA and DHA, blood concentrations of DPA were not correlated with dietary consumption of n-3 fatty acids. Higher plasma concentrations of EPA, DPA, and DHA were associated with higher plasma concentrations of HDL cholesterol and lower concentrations of triacylglycerol and inflammatory markers. CONCLUSIONS Higher plasma concentrations of EPA and DPA are associated with a lower risk of nonfatal MI among women. These findings may partly reflect dietary consumption but, particularly for DPA, may indicate important risk differences based on metabolism of long-chain n-3 fatty acids.
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Affiliation(s)
- Qi Sun
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
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Abstract
Consumers' food choices and dietary behaviour can be markedly affected by communication and information. Whether the provided information is processed by the receiver, and thus becomes likely to be effective, depends on numerous factors. The role of selected determinants such as uncertainty, knowledge, involvement, health-related motives and trust, as well as message content variables, are discussed in the present paper based on previous empirical studies. The different studies indicate that: uncertainty about meat quality and safety does not automatically result in more active information search; subjective knowledge about fish is a better predictor of fish consumption than objective knowledge; high subjective knowledge about functional foods as a result of a low trusted information source such as mass media advertising leads to a lower probability of adopting these foods in the diet. Also, evidence of the stronger impact of negative news as compared with messages promoting positive outcomes of food choices is discussed. Finally, three audience-segmentation studies based on consumers' involvement with fresh meat, individuals' health-related-motive orientations and their use of and trust in fish information sources are presented. A clear message from these studies is that communication and information provision strategies targeted to a specific audience's needs, interests or motives stand a higher likelihood of being attended to and processed by the receiving audience, and therefore also stand a higher chance of yielding their envisaged impact in terms of food choice and dietary behaviour.
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Index of Authors. Proc Nutr Soc 2007. [DOI: 10.1017/s0029665107005927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Index of Subjects. Proc Nutr Soc 2007. [DOI: 10.1017/s0029665107005939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Anil E. The impact of EPA and DHA on blood lipids and lipoprotein metabolism: influence of apoE genotype. Proc Nutr Soc 2007; 66:60-8. [PMID: 17343773 DOI: 10.1017/s0029665107005307] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fish and fish oil-rich sources of long-chainn-3 fatty acids have been shown to be cardio-protective, through a multitude of different pathways including effects on arrythymias, endothelial function, inflammation and thrombosis, as well as modulation of both the fasting and postprandial blood lipid profile. To date the majority of studies have examined the impact of EPA and DHA fed simultaneously as fish or fish oil supplements. However, a number of recent studies have compared the relative biopotency of EPAv. DHA in relation to their effect on blood lipid levels. Although many beneficial effects of fish oils have been demonstrated, concern exists about the potential deleterious impact of EPA and DHA on LDL-cholesterol, with a highly-heterogenous response of this lipid fraction reported in the literature. Recent evidence suggests that apoE genotype may be in part responsible. In the present review the impact of EPA and DHA on cardiovascular risk and the blood lipoprotein profile will be considered, with a focus on the apoE gene locus as a possible determinant of lipid responsiveness to fish oil intervention.
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Affiliation(s)
- Eliz Anil
- Hugh Sinclair Unit of Human Nutrition, Department of Food Biosciences, PO Box 226, University of Reading, Whiteknights, Reading RG6 6AP, UK.
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