Impact of n-3 fatty acids on endothelial function: results from human interventions studies

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSION

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

Effects of Dietary α-Linolenic Acid Treatment and the Efficiency of Its Conversion to Eicosapentaenoic and Docosahexaenoic Acids in Obesity and Related Diseases

The essential fatty acid alpha-linolenic acid (ALA) is present in high amounts in oils such as flaxseed, soy, hemp, rapeseed, chia, and perilla, while stearidonic acid is abundant in echium oil. ALA is metabolized to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) by desaturases and elongases in humans. The conversion of ALA to EPA and DHA is limited, and these long-chain n−3 polyunsaturated fatty acids (PUFAs) are mainly provided from dietary sources (fish and seafood). This review provides an overview of studies that explored the effects of dietary supplementation with ALA in obesity and related diseases. The obesity-associated changes of desaturase and elongase activities are summarized, as they could influence the metabolic conversion of ALA. Generally, supplementation with ALA or ALA-rich oils leads to an increase in EPA levels and has no effect on DHA or omega-3 index. According to the literature data, stearidonic acid could enhance conversion of ALA to long-chain n−3 PUFA in obesity. Recent studies confirm that EPA and DHA intake should be considered as a primary dietary treatment strategy for improving the omega-3 index in obesity and related diseases.

Modulation of endothelium function by fatty acids

The endothelium acts as the barrier that prevents circulating lipids such as lipoproteins and fatty acids into the arterial wall; it also regulates normal functioning in the circulatory system by balancing vasodilation and vasoconstriction, modulating the several responses and signals. Plasma lipids can interact with endothelium via different mechanisms and produce different phenotypes. Increased plasma-free fatty acids (FFAs) levels are associated with the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). Because of the multi-dimensional roles of plasma FFAs in mediating endothelial dysfunction, increased FFA level is now considered an essential link in the onset of endothelial dysfunction in CVD. FFA-mediated endothelial dysfunction involves several mechanisms, including dysregulated production of nitric oxide and cytokines, metaflammation, oxidative stress, inflammation, activation of the renin-angiotensin system, and apoptosis. Therefore, modulation of FFA-mediated pathways involved in endothelial dysfunction may prevent the complications associated with CVD risk. This review presents details as to how endothelium is affected by FFAs involving several metabolic pathways.

Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

Potential Cardiovascular and Metabolic Beneficial Effects of ω-3 PUFA in Male Obesity Secondary Hypogonadism Syndrome

Long-chain ω-3 polyunsaturated fatty acids (PUFAs) are fundamental biocomponents of lipids and cell membranes. They are involved in the maintenance of cellular homeostasis and they are able to exert anti-inflammatory and cardioprotective actions. Thanks to their potential beneficial effects on the cardiovascular system, metabolic axis and body composition, we have examined their action in subjects affected by male obesity secondary hypogonadism (MOSH) syndrome. MOSH syndrome is characterized by the presence of obesity associated with the alteration of sexual and metabolic functions. Therefore, this review article aims to analyze scientific literature regarding the possible benefits of ω-3 PUFA administration in subjects affected by MOSH syndrome. We conclude that there are strong evidences supporting ω-3 PUFA administration and/or supplementation for the treatment and management of MOSH patients.

Nut Consumption and Renal Function Among Women With a History of Gestational Diabetes

OBJECTIVE

Nut intake has been associated with reduced cardiometabolic risk, but few studies have examined its association with renal function. We examined associations between nut intake and renal function among women with previous gestational diabetes mellitus (GDM), a population with an increased risk for renal dysfunction.

DESIGN AND METHODS

This study included 607 women with a history of GDM who participated in the Diabetes & Women's Health Study (2012-2014) follow-up clinical examination in Denmark. At the clinic, biospecimens were collected, and habitual intake of nuts (9 types) in the past year was assessed using a food frequency questionnaire. A total of 330 women free of major chronic diseases were included in the analysis. Total nut intake was classified as none (≤1 serving/month), monthly (2-3 servings/month), weekly (1-6 servings/week), and daily (≥1 serving/day). One serving was defined as 28 g. Renal function markers included estimated glomerular rate (eGFR) and urinary albumin-to-creatinine ratio (UACR), calculated based on plasma creatinine (mg/dL), and urinary albumin (mg/L), and creatinine (mg/dL) measurements, respectively. We estimated percent differences with 95% confidence intervals for each outcome by nut intake, adjusted for current body mass index, age, physical activity, energy intake, alcohol consumption, and vegetables intake.

RESULTS

We observed a nonlinear association between total nut intake and UACR with lowest UACR values among women with weekly intake. Compared to women with weekly intake (n = 222), the adjusted UACR values were higher by 86% [95% confidence interval: 15%, 202%], 24% [-1%, 54%], and 117% [22%, 288%] among women with no (n = 13), monthly (n = 86), and daily (n = 9) intake, respectively. Compared to weekly consumers, daily nut consumers also had 9% [0%, 19%] significantly higher eGFR values, but eGFR values were similar among women with no and monthly intake.

CONCLUSION

Moderate nut consumption may be beneficial to kidney health among women with prior GDM.

The Postprandial Appearance of Features of Cardiometabolic Risk: Acute Induction and Prevention by Nutrients and Other Dietary Substances

The purpose of this review is to provide an overview of diets, food, and food components that affect postprandial inflammation, endothelial function, and oxidative stress, which are related to cardiometabolic risk. A high-energy meal, rich in saturated fat and sugars, induces the transient appearance of a series of metabolic, signaling and physiological dysregulations or dysfunctions, including oxidative stress, low-grade inflammation, and endothelial dysfunction, which are directly related to the amplitude of postprandial plasma triglycerides and glucose. Low-grade inflammation and endothelial dysfunction are also known to cluster together with insulin resistance, a third risk factor for cardiovascular diseases (CVD) and type-II diabetes, thus making a considerable contribution to cardiometabolic risk. Because of the marked relevance of the postprandial model to nutritional pathophysiology, many studies have investigated whether adding various nutrients and other substances to such a challenge meal might mitigate the onset of these adverse effects. Some foods (e.g., nuts, berries, and citrus), nutrients (e.g., l-arginine), and other substances (various polyphenols) have been widely studied. Reports of favorable effects in the postprandial state have concerned plasma markers for systemic or vascular pro-inflammatory conditions, the activation of inflammatory pathways in plasma monocytes, vascular endothelial function (mostly assessed using physiological criteria), and postprandial oxidative stress. Although the literature is fragmented, this topic warrants further study using multiple endpoints and markers to investigate whether the interesting candidates identified might prevent or limit the postprandial appearance of critical features of cardiometabolic risk.

Endothelial Regenerative Capacity and Aging: Influence of Diet, Exercise and Obesity

Background:

The endothelium plays an important role in cardiovascular regulation, from blood flow to platelet aggregation, immune cell infiltration and demargination. A dysfunctional endo-thelium leads to the onset and progression of Cardiovascular Disease (CVD). The aging endothelium displays significant alterations in function, such as reduced vasomotor functions and reduced angio-genic capabilities. This could be partly due to elevated levels of oxidative stress and reduced endothe-lial cell turnover. Circulating angiogenic cells, such as Endothelial Progenitor Cells (EPCs) play a significant role in maintaining endothelial health and function, by supporting endothelial cell prolifera-tion, or via incorporation into the vasculature and differentiation into mature endothelial cells. Howev-er, these cells are reduced in number and function with age, which may contribute to the elevated CVD risk in this population. However, lifestyle factors, such as exercise, physical activity obesity, and dietary intake of omega-3 polyunsaturated fatty acids, nitrates, and antioxidants, significantly af-fect the number and function of these circulating angiogenic cells.

Conclusion:

This review will discuss the effects of advancing age on endothelial health and vascular regenerative capacity, as well as the influence of diet, exercise, and obesity on these cells, the mecha-nistic links and the subsequent impact on cardiovascular health

Polyunsaturated fatty acids, inflammation, and metabolic syndrome in South Asian Americans in Maryland

Metabolic syndrome (MetS) is characterized by the accumulation of cardiovascular risk factors among men and women worldwide. The use of very long-chain polyunsaturated fatty acids (VLC PUFA) could potentially benefit individuals with MetS. The goal was to better understand the relationship between MetS and VLC PUFA in South Asian (SA) Americans who experience an elevated risk for heart disease. We analyzed a cross section of South Asian (SA) using the automated self-administered 24-hr recall (ASA24) and clinic data in a low-income SA in Maryland. We found no correlation between MetS indicators (high-density lipoprotein (HDL) cholesterol, triglycerides, fasting blood glucose, diastolic blood pressure, and waist circumference (WC)) and dietary n-3 PUFA (eicosapentaenoic, docosapentaenoic acids). However, dietary n-6 VLC PUFA (arachidonic acid [AA]) was associated with cholesterol and fasting blood glucose levels. SA with MetS did not have a significantly low level of dietary VLC PUFA intake, and there were no SA group differences in the intake of VLC PUFA but there were significant gender differences. Dietary practices in SA may contribute to increased proinflammatory markers and play a role in elevated MetS components.

Omega-3 fatty acids does not affect physical activity and body weight in primary school children - a double-blind randomized placebo-controlled trial

It was hypothesized that supplementation of omega-3 fatty acids could increase physical activity (PA) levels, where traditional interventions often fail. The aim of this double-blind, randomized, placebo-controlled trail was to evaluate the effects of 15-week administration of omega-3 fatty acids on objectively measured PA and relative body weight in 8–9 year-old children. The children were randomly assigned to supplementation of omega-3 fatty acids or placebo. Primary outcome was change in PA counts per minute (cpm), and secondly change in body mass index standard deviation score (BMI SDS). Covariance models were applied adjusting for age, gender, weight status, PA and intervention season. Compliance was controlled for by analyzing fatty acid composition in plasma. The intention to treat population consisted of 362 children (omega-3 n = 177, placebo n = 185). No significant effects of omega-3 fatty acids on PA or relative body weight were observed. In covariance models no effects were observed by gender, weight status or change in PA (all p > 0.05), but inactive children increased their PA more than children classified as active at baseline (p < 0.05).

The Effect of Daily Walnut Consumption on Dyslipidemia

The aim of this study was to investigate the effect of daily walnut consumption on dyslipidemia in dietary. Within a year, the patients who have been suggested taking walnut or not in their individual dietary were scanned retrospectively and randomized into 2 groups. The first group consists of 72 cases (only those taken on the diet program) and the second group consists of 73 cases (walnut consumption in regulated diet). Baseline blood lipid parameters and anthropometric measurements were assessed in both groups and compared with values at 3rd month. p values < 0.05 were considered statistically significant. In addition, Maras 18 walnut cultivar was analyzed to determine the fatty acid profiles by chromatographic technique. When comparing lipid parameters at baseline and at the 3rd month, total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and triglyceride levels significantly decreased and high-density lipoprotein cholesterol levels significantly increased. As compared with the end of 3rd month values of the groups, the reduction in total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, triglyceride levels of the subjects group (walnut consumption in regulated diet) were significantly higher than the control group (only regulated diet). Also, there was no significant difference in increase on high-density lipoprotein cholesterol levels between the groups. The results showed that daily consumption of walnut improved blood lipid levels. However, more extensive studies are needed on therapeutic usage in dyslipidemia.

Omega 3 Polyunsaturated Fatty Acids Improve Endothelial Dysfunction in Chronic Renal Failure: Role of eNOS Activation and of Oxidative Stress

Background: Endothelial dysfunction is a key vascular alteration in chronic kidney disease (CKD). Omega 3 (n-3) polyunsaturated fatty acids (PUFA) reduce vascular oxidative stress and inflammation. We investigated whether n-3 PUFA could reverse endothelial dysfunction in CKD by improving endothelial nitric oxide synthase (eNOS) function and oxidative stress. Methods: 5/6 nephrectomized male Wistar rats (CKD; n = 10) and sham operated animals (SHAM; n = 10) were treated for 6 weeks with standard diet. An additional group of CKD rats were fed an n-3 PUFA enriched diet (CKD + PUFA; n = 10). We then measured endothelium-dependent (EDD) and -independent vasodilation, markers of endothelial function and of oxidative stress in thoracic aortas. Results: Compared to SHAM, in CKD aortas EDD and eNOS expression were reduced (p < 0.05) and 3-nitrotyrosine levels were increased, while expression of NADPH oxidase subunits NOX4 and p22^phox was similar. In-vitro incubation with Tiron failed to reverse endothelial dysfunction in CKD. In CKD + PUFA, EDD improved (p < 0.05) compared with CKD rats, while blockade of eNOS by L-NAME worsened EDD. These effects were accompanied by increased (p < 0.05) eNOS and reduced (p < 0.05) expression of NOX4 and 3-nitrotyrosine levels. Conclusion: Collectively, these findings indicate that n-3 PUFA improve endothelial dysfunction by restoring NO bioavailability in CKD.

Targeting vascular (endothelial) dysfunction

Cardiovascular diseases are major contributors to global deaths and disability-adjusted life years, with hypertension a significant risk factor for all causes of death. The endothelium that lines the inner wall of the vasculature regulates essential haemostatic functions, such as vascular tone, circulation of blood cells, inflammation and platelet activity. Endothelial dysfunction is an early predictor of atherosclerosis and future cardiovascular events. We review the prognostic value of obtaining measurements of endothelial function, the clinical techniques for its determination, the mechanisms leading to endothelial dysfunction and the therapeutic treatment of endothelial dysfunction. Since vascular oxidative stress and inflammation are major determinants of endothelial function, we have also addressed current antioxidant and anti-inflammatory therapies. In the light of recent data that dispute the prognostic value of endothelial function in healthy human cohorts, we also discuss alternative diagnostic parameters such as vascular stiffness index and intima/media thickness ratio. We also suggest that assessing vascular function, including that of smooth muscle and even perivascular adipose tissue, may be an appropriate parameter for clinical investigations.

LINKED ARTICLES

This article is part of a themed section on Redox Biology and Oxidative Stress in Health and Disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.12/issuetoc.

Marine n-3 polyunsaturated fatty acids affect the blood pressure control in patients with newly diagnosed hypertension - a 1-year follow-up study

Marine long-chained n-3 polyunsaturated fatty acids (PUFA) are recognized for their cardio-protective effects, including potential lowering of blood pressure. We hypothesized that higher habitual fish intake and n-3 PUFA plasma levels were associated with lower blood pressure and being less likely to receive antihypertensive medication after one-year follow-up. In this prospective study of 115 patients, we assessed 24 h ambulatory and central blood pressure, plasma phospholipid fatty acid composition using gas chromatography and participants completed a food frequency questionnaire, including fish-eating habits. All measurements were repeated at one-year follow-up. At baseline, patients consuming fish ≥2 times per month for dinner had significantly higher plasma levels of total marine n-3 PUFA, docosahexaenoic acid and eicosapentaenoic acid as well as significantly lower central blood pressure and a trend towards lower peripheral blood pressure. At follow-up, 21 patients (18%) without antihypertensive medication had significantly higher plasma levels of n-3 PUFA, docosahexaenoic acid and eicosapentaenoic acid as well as a higher, but still acceptable 24 h ambulatory blood pressure (137/85 mmHg) compared to subjects receiving antihypertensive medication. The untreated group was more prone to take fish oil capsules and increased their plasma levels of n-3 PUFA compared to baseline. In patients with newly diagnosed, untreated hypertension, regular fish consumption was accompanied by lower blood pressure. After one year, patients without antihypertensive medication were characterized by a significant increase and higher plasma levels of n-3 PUFA. This supports a blood pressure-lowering effect and suggests an increase in marine n-3 PUFA intake as part of non-pharmacological treatment of hypertension.

Platelets and cardiovascular risk

Atherosclerosis and its late sequels are still the number one cause of death in Western societies. Platelets are a driving force not only during the genesis of atherosclerosis, but especially in its late stages, as evidenced by complications such as arterial thrombosis, myocardial infarction, and ischaemic stroke. Platelets are small, anucleate blood elements of critical importance in cardiovascular disease, a major cause of morbidity and mortality. Numerous risk scores exist to identify healthy individuals at increased risk of developing atherosclerosis and cardiovascular disease. However, markers of cardiovascular risk not routinely assessed (i.e. platelet activity, mean platelet volume and P-selectin) may also contribute to be useful in calculating cardiovascular risk. The present review and meta-analysis summarizes the evidence for measuring platelet function indices to identify patients at risk of developing cardiovascular events.

Iberian Cured-Ham Consumption Improves Endothelial Function in Healthy Subjects

OBJECTIVES

Previous studies have shown that dietary components such as oleic acid or polyphenols exert beneficial effects on endothelium. We aimed to assess the impact of regular consumption of Iberian cured-ham (ICH) on endothelial function.

DESIGN

An open-label, randomized controlled parallel study.

SETTING

Volunteers recruited through advertisements at a hospital in Madrid, Spain.

PARTICIPANTS

102 Caucasian adults (76.8% females) aged 25-55 years, and free from cardiometabolic disease.

INTERVENTION

Participants were randomized to an ICH-enriched ad libitum diet or an ad libitum diet without ICH for 6 weeks. Subjects in ICH group were randomly provided with either acorn- or mixed-fed ICH, and followed up for an additional 6-week period under their usual diet.

MEASUREMENTS

Clinical parameters, biomarkers of endothelial function and oxidative stress, microvascular vasodilatory response to hyperemia and arterial stiffness were measured before and after the intervention.

RESULTS

After 6 weeks, a larger decrease in PAI-1 was observed in subjects consuming ICH compared to the Control group (-6.2±17.7 vs. 0.3±1.4 ng/ml; p=0.020). Similarly, microvascular vasodilatory response to hyperemia showed a significant increase (112.4±391.7 vs. -56.0±327.9%; p=0.007). However, neither oxidative stress, hemodynamic nor clinical parameters differed significantly over the study. Additionally, after stopping ICH consumption, improvements in PAI-1 remained for 6 additional weeks with respect to baseline (p=0.006).

CONCLUSION

The present study demonstrates, for the first time, that regular consumption of ICH improves endothelial function in healthy adults. Strategies aimed to preserve or improve the endothelial function may have implications in vascular aging beyond the prevention of the atherothrombotic disease.

Dietary polyunsaturated fatty acids and incidence of end-stage renal disease in the Southern Community Cohort Study

BACKGROUND

Whether polyunsaturated fatty acids (PUFA) are associated with end-stage renal disease (ESRD) in populations with a high burden of risk factors for kidney disease is unknown. We sought to determine whether PUFA intake is associated with ESRD.

METHODS

We conducted a nested case-control study of ESRD within the Southern Community Cohort Study (SCCS), a prospective cohort of low-income blacks and whites in the southeastern US (2002-2009). Through 2012, 1,074 incident ESRD cases were identified by linkage with the United States Renal Data System and matched to 3,230 controls by age, sex and race. Dietary intake of total, n-3 or n-6 PUFA was assessed from a validated food frequency questionnaire administered at baseline. Odds ratios (ORs) and 95 % confidence intervals (CIs) were computed from logistic regression models that included matching variables, body mass index, smoking, diabetes, hypertension, education, income, total energy intake and percent energy from protein and saturated fat.

RESULTS

The mean (SD) age of participants was 55 (9) years. Most participants were women (55 %), black (87 %), with hypertension (67 %) and on average obtained 8 % of their energy from PUFA. Higher PUFA intake was marginally associated with a lower risk of ESRD in adjusted analyses. The adjusted odds ratios (95 % confidence intervals) for ESRD for the 5th vs. 1st quintile of PUFA were 0.79 (0.60-1.05; P trend = 0.06) for total PUFA, 0.81 (0.61-1.06; P trend = 0.04) for n-6 PUFA and 0.93 (0.71-1.21; P trend = 0.45) for n-3 PUFA.

CONCLUSIONS

We observed a marginally significant inverse trend between dietary PUFA intake and ESRD incidence, mainly driven by n-6 fatty acid intake. Our findings require replication but suggest that a diet rich in n-6 PUFA may prevent ESRD development in a population with a high burden of kidney disease risk factors.

Long-chain omega-3 fatty acids and optimization of cognitive performance

Low consumption of the omega-3 fatty acids, eicosapentaenoic and docosahexaenonic acids, is linked to delayed brain development and, in late life, increased risk for Alzheimer's disease. The current review focuses on cognitive functioning during midlife and summarizes available scientific evidence relevant to the hypothesis that adequate dietary consumption of the long-chain omega-3 fatty acids is necessary for optimal cognitive performance. Taken together, the findings suggest that raising the currently low consumption among healthy adults may improve some aspects of cognitive performance. Nonetheless, evidence from randomized clinical trials is comparatively sparse and leaves unclear: (a) whether such effects are clinically significant, (b) whether effects of eicosapentaenoic acid and DHA differ, (c) which dimensions of cognitive function are affected, (d) the dose-response relationships, or (e) the time course of the response. Clarification of these issues through both laboratory and clinical investigations is a priority given the broad implications for public health, as well as for military personnel and other positions of high performance demand and responsibility.

Dietary Supplementation with Olive Oil or Fish Oil and Vascular Effects of Concentrated Ambient Particulate Matter Exposure in Human Volunteers

BACKGROUND

Exposure to ambient particulate matter (PM) induces endothelial dysfunction, a risk factor for cardiovascular disease. Olive oil (OO) and fish oil (FO) supplements have beneficial effects on endothelial function.

OBJECTIVE

In this study we evaluated the potential efficacy of OO and FO in mitigating endothelial dysfunction and disruption of hemostasis caused by exposure to particulate matter (PM).

METHODS AND RESULTS

Forty-two participants (58 ± 1 years of age) received either 3 g/day of OO or FO, or no supplements (naive) for 4 weeks prior to undergoing 2-hr exposures to filtered air and concentrated ambient particulate matter (CAP; mean, 253 ± 16 μg/m3). Endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery preexposure, immediately postexposure, and 20 hr postexposure. Levels of endothelin-1 and markers of fibrinolysis and inflammation were also measured. The FMD was significantly lower after CAP exposure in the naive (-19.4%; 95% CI: -36.4, -2.3 per 100 μg/m3 CAP relative to baseline; p = 0.03) and FO groups (-13.7%; 95% CI: -24.5, -2.9; p = 0.01), but not in the OO group (-7.6%; 95% CI: -21.5, 6.3; p = 0.27). Tissue plasminogen activator levels were significantly increased immediately after (11.6%; 95% CI: 0.8, 22.2; p = 0.04) and 20 hr after CAP exposure in the OO group. Endothelin-1 levels were significantly increased 20 hr after CAP exposure in the naive group only (17.1%; 95% CI: 2.2, 32.0; p = 0.03).

CONCLUSIONS

Short-term exposure to CAP induced vascular endothelial dysfunction. OO supplementation attenuated CAP-induced reduction of FMD and changes in blood markers associated with vasoconstriction and fibrinolysis, suggesting that OO supplementation may be an efficacious intervention to protect against vascular effects of exposure to PM.

CITATION

Tong H, Rappold AG, Caughey M, Hinderliter AL, Bassett M, Montilla T, Case MW, Berntsen J, Bromberg PA, Cascio WE, Diaz-Sanchez D, Devlin RB, Samet JM. 2015. Dietary supplementation with olive oil or fish oil and vascular effects of concentrated ambient particulate matter exposure in human volunteers. Environ Health Perspect 123:1173-1179; http://dx.doi.org/10.1289/ehp.1408988.

A review of recent evidence in human studies of n-3 and n-6 PUFA intake on cardiovascular disease, cancer, and depressive disorders: does the ratio really matter?

Polyunsaturated fatty acids (PUFAs) have been considered of great interest for human health due to their potential anti-inflammatory action that may protect from a number of chronic-degenerative diseases with an inflammatory pathogenesis. This review aimed to report the most updated evidence of both n-3 and n-6 PUFAs effect on cardiovascular disease, cancer, and depression in humans. Attention has been also paid to those studies exploring the effects of the ratio intake. Results from pooled analyses of human studies reported a general positive effect of n-3 PUFAs intake on all outcomes considered. In contrast, the role of n-6 PUFAs on human health needs to be better assessed in order to clearly identify which compound exerts beneficial/harmful effects. Only a limited number of clinical studies considered the n-3:n-6 PUFAs ratio, rather reporting contrasting results. A number of limitations when considering the ratio between these two families of PUFAs have risen.

Transcriptome-based identification of new anti-inflammatory and vasodilating properties of the n-3 fatty acid docosahexaenoic acid in vascular endothelial cell under proinflammatory conditions [corrected]

Scope

High intakes of n-3 fatty acids exert anti-inflammatory effects and cardiovascular protection, but the underlying molecular basis is incompletely defined. By genome-wide analysis we searched for novel effects of docosahexaenoic acid (DHA) on gene expression and pathways in human vascular endothelium under pro-inflammatory conditions.

Methods and Results

Human umbilical vein endothelial cells were treated with DHA and then stimulated with interleukin(IL)-1β. Total RNA was extracted, and gene expression examined by DNA microarray. DHA alone altered the expression of 188 genes, decreasing 92 and increasing 96. IL-1β changed the expression of 2031 genes, decreasing 997 and increasing 1034. Treatment with DHA before stimulation significantly affected the expression of 116 IL-1β-deregulated genes, counter-regulating the expression of 55 genes among those decreased and of 61 among those increased. Functional and network analyses identified immunological, inflammatory and metabolic pathways as the most affected. Newly identified DHA-regulated genes are involved in stemness, cellular growth, cardiovascular system function and cancer, and included cytochrome p450 4F2(CYP4F2), transforming growth factor(TGF)-β2, Cluster of Differentiation (CD)47, caspase recruitment domain(CARD)11 and phosphodiesterase(PDE)5α.

Conclusions

Endothelial exposure to DHA regulates novel genes and related pathways. Such unbiased identification should increase our understanding of mechanisms by which n-3 fatty acids affect human diseases.

Whatever happened to the epoxyeicosatrienoic Acid-like endothelium-derived hyperpolarizing factor? The identification of novel classes of lipid mediators and their role in vascular homeostasis

SIGNIFICANCE

Cytochrome P450 (CYP) epoxygenases metabolize arachidonic acid (AA) to generate epoxyeicosatrienoic acids (EETs). The latter are biologically active and reported to act as an endothelium-derived hyperpolarizing factor as well as to affect angiogenic and inflammatory signaling pathways.

RECENT ADVANCES

In addition to AA, the CYP enzymes also metabolize the ω-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid and docosahexaenoic acid to generate bioactive lipid epoxide mediators. The latter can be more potent than the EETs, but their actions are under investigated. The ω3-epoxides, like the EETs, are metabolized by the soluble epoxide hydrolase (sEH) to corresponding diols, and epoxide hydrolase inhibition increases epoxide levels and demonstrates anti-hypertensive as well as anti-inflammatory effects.

CRITICAL ISSUES

It seems that the overall consequences of CYP activation largely depend on enzyme substrate preference and the endogenous ω-3/ω-6 PUFA ratio.

FUTURE DIRECTIONS

More studies combining PUFA profiling with cell signaling and disease studies are required to determine the spectrum of molecular pathways affected by the different ω-6 and ω-3 PUFA epoxides and diols. Such information may help improve dietary studies aimed at promoting health via ω-3 PUFA supplementation and/or sEH inhibition.

Walnut ingestion in adults at risk for diabetes: effects on body composition, diet quality, and cardiac risk measures

BACKGROUND

Despite their energy density, walnuts can be included in the diet without adverse effects on weight or body composition. The effect of habitual walnut intake on total calorie intake is not well studied. Effects on overall diet quality have not been reported.

METHODS

Randomized, controlled, modified Latin square parallel design study with 2 treatment arms. The 112 participants were randomly assigned to a diet with or without dietary counseling to adjust calorie intake. Within each treatment arm, participants were further randomized to 1 of the 2 possible sequence permutations to receive a walnut-included diet with 56 g (providing 366 kcal) of walnuts per day and a walnut-excluded diet. Participants were assessed for diet quality, body composition, and cardiac risk measures.

RESULTS

When compared with a walnut-excluded diet, a walnut-included diet for 6 months, with or without dietary counseling to adjust caloric intake, significantly improved diet quality as measured by the Healthy Eating Index 2010 (9.14±17.71 vs 0.40±15.13; p=0.02 and 7.02±15.89 vs -5.92±21.84; p=0.001, respectively). Endothelial function, total and low-density lipoprotein (LDL) cholesterol improved significantly from baseline in the walnut-included diet. Body mass index, percent body fat, visceral fat, fasting glucose, glycated hemoglobin, and blood pressure did not change significantly.

CONCLUSIONS

The inclusion of walnuts in an ad libitum diet for 6 months, with or without dietary counseling to adjust calorie intake, significantly improved diet quality, endothelial function, total and LDL cholesterol, but had no effects on anthropometric measures, blood glucose level, and blood pressure.

TRIAL REGISTRATION NUMBER

NCT02330848.

Nutrients other than carbohydrates: their effects on glucose homeostasis in humans

Besides carbohydrates, other nutrients, such as dietary protein and amino acids; the supply of fat, vitamin D, and vitamin K; and sodium intake seem to affect glucose homeostasis. Although their effect is less pronounced than that of the amount and composition of carbohydrates, it seems reasonable to consider how nutrient intake habits may be modified to support an improved glucose homeostasis. For instance, taking into account the effect of some nutrients to lower blood glucose concentration on a day-by-day basis might support improvement of glucose homeostasis in the long run. On the other hand, lowering sodium intake too much, as recommended to avoid the development of hypertension, particularly in sodium-sensitive people, might lead to insulin resistance and thereby might risk increasing fasting as well as postprandial blood glucose concentrations. This review summarizes the state of our knowledge of how several nutrients other than carbohydrates, such as protein, fatty acids, vitamin D, vitamin K, magnesium, zinc, chromium, and sodium, affect blood glucose concentrations. Sufficient evidence exists to show that, in prospective studies based on randomized controlled trials, these selected nutrients affect blood glucose regulation. The review describes potential mechanisms leading to the observed effect. As much as is possible from the available data, the extent of the effect, is considered.

Impact of DHA on metabolic diseases from womb to tomb

Long chain polyunsaturated fatty acids (LC-PUFAs) are important mediators in improving and maintaining human health over the total lifespan. One topic we especially focus on in this review is omega-3 LC-PUFA docosahexaenoic acid (DHA). Adequate DHA levels are essential during neurodevelopment and, in addition, beneficial in cognitive processes throughout life. We review the impact of DHA on societal relevant metabolic diseases such as cardiovascular diseases, obesity, and diabetes mellitus type 2 (T2DM). All of these are risk factors for cognitive decline and dementia in later life. DHA supplementation is associated with a reduced incidence of both stroke and atherosclerosis, lower bodyweight and decreased T2DM prevalence. These findings are discussed in the light of different stages in the human life cycle: childhood, adolescence, adulthood and in later life. From this review, it can be concluded that DHA supplementation is able to inhibit pathologies like obesity and cardiovascular disease. DHA could be a dietary protector against these metabolic diseases during a person’s entire lifespan. However, supplementation of DHA in combination with other dietary factors is also effective. The efficacy of DHA depends on its dose as well as on the duration of supplementation, sex, and age.

Fish-oil supplementation alters numbers of circulating endothelial progenitor cells and microparticles independently of eNOS genotype

BACKGROUND

Emerging cellular markers of endothelial damage and repair include endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs), respectively. Effects of long-chain (LC) n-3 (omega-3) polyunsaturated fatty acids (PUFAs) and the influence of genetic background on these markers are not known.

OBJECTIVE

We investigated effects of fish-oil supplementation on both classical and novel markers of endothelial function in subjects prospectively genotyped for the Asp298 endothelial nitric oxide synthase (eNOS) polymorphism and at moderate risk of cardiovascular disease (CVD).

DESIGN

A total of 84 subjects with moderate risk of CVD (GG: n = 40; GT/TT: n = 44) completed a randomized, double-blind, placebo-controlled, 8-wk crossover trial of fish-oil supplementation that provided 1.5 g LC n-3 PUFAs/d. Effects of genotype and fish-oil supplementation on the blood lipid profile, inflammatory markers, vascular function (by using peripheral artery tonometry), and numbers of circulating EPCs and EMPs (by using flow cytometry) were assessed.

RESULTS

There was no significant effect of fish-oil supplementation on blood pressure, plasma lipids, or plasma glucose, although there was a trend (P = 0.069) toward a decrease in the plasma triglyceride concentration after fish-oil supplementation compared with placebo treatment. GT/TT subjects tended to have higher concentrations of total cholesterol and low-density lipoprotein cholesterol, but vascular function was not affected by either treatment or eNOS genotype. Biochemical markers of endothelial function were also unaffected by treatment and eNOS genotype. In contrast, there was a significant effect of fish-oil supplementation on cellular markers of endothelial function. Fish-oil supplementation increased numbers of EPCs and reduced numbers of EMPs relative to those with placebo treatment, which potentially favored the maintenance of endothelial integrity. There was no influence of genotype for any cellular markers of endothelial function, which indicated that effects of fish-oil supplementation were independent of eNOS genotype.

CONCLUSION

Emerging cellular markers of endothelial damage, integrity, and repair appear to be sensitive to potentially beneficial modification by dietary n-3 PUFAs. This trial was registered at www.controlled-trials.com/isrctn as ISRCTN76272133.

Treating coronary disease and the impact of endothelial dysfunction

Ischemic heart disease is the leading cause of morbidity and mortality throughout the world. Many clinical trials have suggested that lifestyle and pharmacologic interventions are effective in attenuating atherosclerotic disease progression and events development. However, an individualized approach with careful consideration to comprehensive vascular health is necessary to perform successful intervention strategies. Endothelial dysfunction plays a pivotal role in the early stage of atherosclerosis and is also associated with plaque progression and occurrence of atherosclerotic complications. The assessment of endothelial function provides us with important information about individual patient risk, progress and vulnerability of disease, and guidance of therapy. Thus, the application of endothelial function assessment might enable clinicians to innovate ideal individualized medicine. In this review, we summarize the current knowledge on the impact of pharmacological therapies for atherosclerotic cardiovascular disease on endothelial dysfunction, and argue for the utility of non-invasive assessment of endothelial function aiming at individualized medicine.

Effects of an energy-restricted diet rich in plant-derived α-linolenic acid on systemic inflammation and endothelial function in overweight-to-obese patients with metabolic syndrome traits

Plant-derived α-linolenic acid (ALA) may reduce the risk of CVD, possibly by decreasing systemic inflammation and improving endothelial function. In the present study, the effects of a hypoenergetic diet rich in ALA (3·4 g/d) on the biomarkers of systemic inflammation and vascular function were investigated in eighty-one overweight-to-obese patients with metabolic syndrome traits in comparison with a hypoenergetic diet low in ALA (0·9 g/d, control). After a 6-month dietary intervention, there were significant decreases in the serum concentrations of C-reactive protein (CRP), TNF-α, IL-6, soluble intercellular adhesion molecule-1 (sICAM-1), soluble endothelial selectin (sE-selectin) and asymmetric dimethylarginine in both dietary groups. However, no inter-group differences were observed for all these changes. The serum concentration of YKL-40 (human cartilage glycoprotein 39 or chitinase-3-like protein 1) decreased after the ALA diet when compared with the control diet (P< 0·05 for time × treatment interaction). Plasma concentrations of fibrinogen did not significantly change in the two dietary groups. The decreases in the serum concentrations of sICAM-1, sE-selectin, CRP and YKL-40 were significantly correlated with the decreases in body fat mass. In conclusion, the present study indicates that in overweight-to-obese patients with metabolic syndrome traits, both vascular function and inflammation are improved during body-weight loss. The high ALA intake led to a more pronounced reduction in the serum concentration of YKL-40 compared with the intake of the low-ALA control diet, indicating the existence of independent favourable physiological effects of ALA during weight loss.

Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials

BACKGROUND

Although a large body of literature has been devoted to examining the relationship between eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and blood pressure, past systematic reviews have been hampered by narrow inclusion criteria and a limited scope of analytical subgroups. In addition, no meta-analysis to date has captured the substantial volume of randomized controlled trials (RCTs) published in the past 2 years. The objective of this meta-analysis was to examine the effect of EPA+DHA, without upper dose limits and including food sources, on blood pressure in RCTs.

METHODS

Random-effects meta-analyses were used to generate weighted group mean differences and 95% confidence intervals (CIs) between the EPA+DHA group and the placebo group. Analyses were conducted for subgroups defined by key subject or study characteristics.

RESULTS

Seventy RCTs were included. Compared with placebo, EPA+DHA provision reduced systolic blood pressure (−1.52mm Hg; 95% confidence interval (CI) = −2.25 to −0.79) and diastolic blood pressure (−0.99mm Hg; 95% CI = −1.54 to −0.44) in the meta-analyses of all studies combined. The strongest effects of EPA+DHA were observed among untreated hypertensive subjects (systolic blood pressure = −4.51mm Hg, 95% CI = −6.12 to −2.83; diastolic blood pressure = −3.05mm Hg, 95% CI = −4.35 to −1.74), although blood pressure also was lowered among normotensive subjects (systolic blood pressure = −1.25mm Hg, 95% CI = −2.05 to −0.46; diastolic blood pressure = −0.62mm Hg, 95% CI = −1.22 to −0.02).

CONCLUSIONS

Overall, available evidence from RCTs indicates that provision of EPA+DHA reduces systolic blood pressure, while provision of ≥2 grams reduces diastolic blood pressure.

Clinical pharmacology of n-3 polyunsaturated fatty acids: non-lipidic metabolic and hemodynamic effects in human patients

A high dietary intake of n-3 long chain polyunsaturated fatty acids (PUFA), eicosapentaenoic and docosahexaenoic acids, is associated with a reduced incidence of coronary events. Supplementation with pharmacological doses of the same may improve survival in patients with previous myocardial infarction and established heart failure. Such protective effects may be explained by the action of n-3 PUFA on systemic inflammation, hypertension, endothelial dysfunction, thrombosis, cardiac arrhythmias, heart rate variability and atherosclerotic plaque instability, which are involved in the pathogenesis of these clinical conditions. In this short paper we will review the evidence in support of these pleiotropic effects of n-3 fatty acids.

Endothelial function and the regulation of muscle protein anabolism in older adults

Sarcopenia, the loss of skeletal muscle mass and function with aging, is a major contributor to frailty and morbidity in older adults. Recent evidence has emerged suggesting that endothelial dysfunction and insulin resistance of muscle protein metabolism may significantly contribute to the development of sarcopenia. In this article we review: 1) recent studies and theories on the regulation of skeletal muscle protein balance in older adults; 2) the link between insulin resistance of muscle protein synthesis and endothelial dysfunction in aging; 3) mechanisms for impaired endothelial responsiveness in aging; and 4) potential treatments that may restore the endothelial responsiveness and muscle protein anabolic sensitivity in older adults.

Docosahexaenoic acid supplementation, vascular function and risk factors for cardiovascular disease: a randomized controlled trial in young adults

Background

A high consumption of omega‐3 long‐chain polyunsaturated fatty acids, and particularly docosahexaenoic acid (DHA), has been suggested to reduce the risk of cardiovascular disease (CVD). However, while DHA supplementation may have benefits for secondary prevention, few studies have investigated the role of DHA in the primary prevention of CVD. Here, we tested the hypothesis that DHA supplementation improves endothelial function and risk factors for CVD.

Methods and Results

Healthy volunteers (n=328), aged 18 to 37 years, were randomly assigned to 1.6 g DHA/day (from a microalgae source) together with 2.4 g/day carrier oil (index group) or to 4.0 g/day olive oil (control) (both given in eight 500‐mg capsules/day for 16 weeks). Flow‐mediated endothelium‐dependent vasodilation (FMD) of the brachial artery (primary outcome) was measured before and after the intervention (n=268) using high‐resolution vascular ultrasound. FMD was the same in both groups at randomization (mean, SD; 0.27, 0.1 mm), but postintervention was higher in the control group (0.29, 0.1 mm) compared with the DHA‐supplemented group (0.26, 0.1 mm; mean difference −0.03 mm; 95% CI −0.005 to −0.06 mm; P=0.02). Of other outcomes, only triglyceride (mean difference −28%, 95% CI −40% to −15%; P<0.0001) and very low‐density lipoprotein concentrations were significant lower in DHA‐supplemented individuals compared with controls.

Conclusions

DHA supplementation did not improve endothelial function in healthy, young adults. Nevertheless, lower triglyceride concentrations with DHA supplementation was consistent with previous reports and could have benefits for the prevention of CVD.

Clinical Trial Registration Information

URL: http://www.controlled-trials.com/ Unique identifier: ISRCTN no: 19987575.

Recent findings on the effects of marine-derived n-3 polyunsaturated fatty acids on urinary albumin excretion and renal function

Albuminuria (this includes microalbuminuria and macroalbuminuria) and reduced glomerular filtration rate are present not only in high-risk populations, but also in the general population. These manifestations of renal disease are associated with an increased risk of cardiovascular disease and may reflect subclinical vascular disease. Long-chain n-3 polyunsaturated fatty acids have been vigorously studied for their potential cardioprotective effects. These fatty acids reduce the levels of serum lipids, blood pressure, inflammation, and endothelial dysfunction, all of which are associated with albuminuria and renal impairment; therefore, marine-derived n-3 fatty acids may potentially play a role in their prevention. This report reviews the recent findings relating marine-derived n-3 fatty acids to urinary albumin excretion and renal function and their risk factors. Although some evidence suggests that marine-derived n-3 fatty acids are associated with a lower incidence of albuminuria in diabetes, there is inadequate evidence supporting their role in glomerular filtration.

The acute and long-term effects of dietary fatty acids on vascular function in health and disease

PURPOSE OF REVIEW

Vascular function is recognized as an early and integrative marker of cardiovascular disease. While there is consistent evidence that the quantity of dietary fat has significant effects on vascular function, the differential effects of individual fatty acids is less clear. This review summarizes recent evidence from randomly controlled dietary studies on the impact of dietary fatty acids on vascular function, as determined by flow-mediated dilatation (FMD).

RECENT FINDINGS

Critical appraisal is given to five intervention studies (one acute, four chronic) which examined the impact of long-chain n-3 polyunsaturated fatty acid [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] on FMD. In the acute setting, a high dose of long-chain n-3 polyunsaturated fatty acid (4.9 g per 70 kg man) improved postprandial FMD significantly, compared with a saturated fatty acid-rich meal in healthy individuals. In longer-term studies, there was limited evidence for a significant effect of EPA/DHA on FMD in diseased groups.

SUMMARY

The strongest evidence for the benefits of EPA/DHA on vascular function is in the postprandial state. More evidence from randomly controlled intervention trials with foods will be required to substantiate the long-term effects of EPA/DHA, to inform public health and clinical recommendations.

Eicosapentaenoic Acid supplementation changes Fatty Acid composition and corrects endothelial dysfunction in hyperlipidemic patients

We investigated the effects of purified eicosapentaenoic acid (EPA) on vascular endothelial function and free fatty acid composition in Japanese hyperlipidemic subjects. In subjects with hyperlipidemia (total cholesterol ≥220 mg/dL and/or triglycerides ≥150 mg/dL), lipid profile and forearm blood flow (FBF) during reactive hyperemia were determined before and 3 months after supplementation with 1800 mg/day EPA. Peak FBF during reactive hyperemia was lower in the hyperlipidemic group than the normolipidemic group. EPA supplementation did not change serum levels of total, HDL, or LDL cholesterol, apolipoproteins, remnant-like particle (RLP) cholesterol, RLP triglycerides, or malondialdehyde-modified LDL cholesterol. EPA supplementation did not change total free fatty acid levels in serum, but changed the fatty acid composition, with increased EPA and decreased linoleic acid, γ-linolenic acid, and dihomo-γ-linolenic acid. EPA supplementation recovered peak FBF after 3 months. Peak FBF recovery was correlated positively with EPA and EPA/arachidonic acid levels and correlated inversely with dihomo-γ-linolenic acid. EPA supplementation restores endothelium-dependent vasodilatation in hyperlipidemic patients despite having no effect on serum cholesterol and triglyceride patterns. These results suggest that EPA supplementation may improve vascular function at least partly via changes in fatty acid composition.

Omega-3 fatty acids and coronary heart disease. The final verdict?

PURPOSE OF REVIEW

The fish fatty acids eicosapentenoic acid (EPA) and docosahexenoic acid (DHA) may be protective against fatal coronary heart disease (CHD) and sudden cardiac death. This review summarizes the recent findings of prospective cohort studies and randomized controlled trials.

RECENT FINDINGS

A recently published meta-analysis of 17 prospective cohort studies showed that eating fish once a week compared to eating less fish was associated with a 16% lower risk of fatal CHD. Epidemiologic studies with cardiac arrest or sudden cardiac death as endpoint observed also an inverse relation with fish consumption. In contrast, a recently published meta-analysis of 14 randomized, double-blind, placebo-controlled trials in cardiovascular patients did not show a protective effect of an additional amount of EPA-DHA on fatal CHD and sudden cardiac death. Subgroup analyses suggested that this could be because of a low absolute risk as a consequence of the state-of-the-art drug treatment.

SUMMARY

Eating fatty fish once or lean fish twice a week is recommended for both primary and secondary prevention of CHD. A definite statement cannot be made about the dosage of EPA-DHA required for secondary prevention of CHD.

Clinical correlates and heritability of erythrocyte eicosapentaenoic and docosahexaenoic acid content in the Framingham Heart Study

OBJECTIVES

Red blood cell (RBC) levels of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA, the omega-3 index, expressed as a percent of total fatty acids) are inversely related to risk for cardiovascular disease (CVD). Although several mechanisms underlying this relationship have been proposed, understanding the associations between the omega-3 index and markers of CVD in the community can shed additional light on this question. The objectives of this study were to define the relations between the omega-3 index and clinical factors and to determine the heritability of the omega-3 index.

METHODS

RBC samples (n = 3196) drawn between 2005 and 2008 from participants in the Framingham Study [Examination 8 of the Offspring cohort plus Examination 3 of the Omni (minorities) cohort] were analyzed for fatty acid composition by gas chromatography.

RESULTS

The mean (SD) omega-3 index was 5.6% (1.7%). In multivariable regression models, the factors significantly and directly associated with the omega-3 index were age, female sex, higher education, fish oil supplementation, dietary intake of EPA + DHA, aspirin use, lipid pharmacotherapy, and LDL-cholesterol. Factors inversely associated were Offspring cohort, heart rate, waist girth, triglycerides and smoking. The total explained variability in the omega-3 index for the fully adjusted model was 73%, which included major components due to heritability (24%), EPA + DHA intake (25%), and fish oil supplementation (15%).

CONCLUSION

The variability in the omega-3 index is determined primarily by dietary and genetic factors. An increased omega-3 index is associated with a generally cardioprotective risk factor milieu.

Application of polyunsaturated fatty acids in internal medicine: beyond the established cardiovascular effects

n-3 Polyunsaturated fatty acids (PUFAs) are organic acids, essential for mammals, whose deficiency is associated with different diseases. The American Heart Association recommends that all adults increase food-derived n-3 PUFA intake and also suggests that patients with documented coronary heart disease consume approximately 1 g of eicosapentaenoic acid and docosahexaenoic acid per day. However, recent evidence broadens their potential application to many other health disorders directly or indirectly associated with cardiovascular disease risk such as rheumatological diseases, mood depression, chronic kidney disease, chronic inflammatory lung diseases and others. These effects seem to be largely dependent on the dosages employed and on the characteristics of the selected patients. The cardiometabolic effects of PUFAs have been largely reviewed elsewhere, so the aim of our review is to point out the potential usefulness of such drugs with pleiotropic effects in the management of the actual typical aging patient, with co-morbidities and multidrug therapies.

Effect of combination therapy of fatty acids, calcium, vitamin D and boron with regular physical activity on cardiovascular risk factors in rat

The effect of consumption of fatty acids and selected nutrients, along with regular physical activity, on cardiovascular risk factors in rats was investigated.Male rats were divided into the seven groups: Group 1: regular food and drinking water, Group 2: same as Group. 1 + physical activity (whole body vibration; WBV), Group 3: same as Group. 2 + calcium, vitamin D, boron, Group 4: same as Group. 3 + canola oil, Group 5: same as Group. 3 + sunflower oil, Group 6: same as Group. 3 + mix of sunflower oil and canola oil, Group 7: same as Group. 3 + coconut oil. Rats were treated for 8 weeks, and analysis of the frozen plasmas was performed. A- Analysis between the treatment groups and control revealed that vibration training in Group 2 increased body weight (P = 0.04), plasma creatin kinase (CK), (P = 0.02), and estradiol (E2), (P = 0.03). Rats in Group 5 consumed less food and plasma levels of cholesterol and LDL-cholesterol (LDL-C) increased significantly (P = 0.02) in Group 6 and in Group 7 (p<0.05). B- Analysis of data among Group 4 - 7 (the oil consuming groups) and Group 3 revealed significant differences in cholesterol (Chol), LDL-C, HDL-cholesterol (HDL-C), triglycerides (TG), C- reactive protein (hs-CRP), estradiol (E2), atherogenic index (AI), and risk factor (RF), (p<0.05). In addition, plasma levels of testosterone (T) and free testosterone (FT) in Group 7 had a remarkable but non-significant increase. As a result of vibration training, a similar trend was observed for vitamin D in Group 2-7. The findings show that WBV is effective in improving health status by influencing cardiovascular disease (CVD) risk factors. Moreover, canola oil and sunflower oil, separately, showed beneficial impacts on CVD risk factors; whereas their combination had negative impacts on lipid profile. Coconut oil revealed to be efficient to provide health benefits in terms of CVD treatments.