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Liu Y, Liu JE, He H, Qin M, Lei H, Meng J, Liu C, Chen X, Luo W, Zhong S. Characterizing the metabolic divide: distinctive metabolites differentiating CAD-T2DM from CAD patients. Cardiovasc Diabetol 2024; 23:14. [PMID: 38184583 PMCID: PMC10771670 DOI: 10.1186/s12933-023-02102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/25/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE To delineate the metabolomic differences in plasma samples between patients with coronary artery disease (CAD) and those with concomitant CAD and type 2 diabetes mellitus (T2DM), and to pinpoint distinctive metabolites indicative of T2DM risk. METHOD Plasma samples from CAD and CAD-T2DM patients across three centers underwent comprehensive metabolomic and lipidomic analyses. Multivariate logistic regression was employed to discern the relationship between the identified metabolites and T2DM risk. Characteristic metabolites' metabolic impacts were further probed through hepatocyte cellular experiments. Subsequent transcriptomic analyses elucidated the potential target sites explaining the metabolic actions of these metabolites. RESULTS Metabolomic analysis revealed 192 and 95 significantly altered profiles in the discovery (FDR < 0.05) and validation (P < 0.05) cohorts, respectively, that were associated with T2DM risk in univariate logistic regression. Further multivariate regression analyses identified 22 characteristic metabolites consistently associated with T2DM risk in both cohorts. Notably, pipecolinic acid and L-pipecolic acid, lysine derivatives, exhibited negative association with CAD-T2DM and influenced cellular glucose metabolism in hepatocytes. Transcriptomic insights shed light on potential metabolic action sites of these metabolites. CONCLUSIONS This research underscores the metabolic disparities between CAD and CAD-T2DM patients, spotlighting the protective attributes of pipecolinic acid and L-pipecolic acid. The comprehensive metabolomic and transcriptomic findings provide novel insights into the mechanism research, prophylaxis and treatment of comorbidity of CAD and T2DM.
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Affiliation(s)
- Yingjian Liu
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Ju-E Liu
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Huafeng He
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Min Qin
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Heping Lei
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Jinxiu Meng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenwei Luo
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Shilong Zhong
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China.
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
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Ağagündüz D, Icer MA, Yesildemir O, Koçak T, Kocyigit E, Capasso R. The roles of dietary lipids and lipidomics in gut-brain axis in type 2 diabetes mellitus. J Transl Med 2023; 21:240. [PMID: 37009872 PMCID: PMC10068184 DOI: 10.1186/s12967-023-04088-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM), one of the main types of Noncommunicable diseases (NCDs), is a systemic inflammatory disease characterized by dysfunctional pancreatic β-cells and/or peripheral insulin resistance, resulting in impaired glucose and lipid metabolism. Genetic, metabolic, multiple lifestyle, and sociodemographic factors are known as related to high T2DM risk. Dietary lipids and lipid metabolism are significant metabolic modulators in T2DM and T2DM-related complications. Besides, accumulated evidence suggests that altered gut microbiota which plays an important role in the metabolic health of the host contributes significantly to T2DM involving impaired or improved glucose and lipid metabolism. At this point, dietary lipids may affect host physiology and health via interaction with the gut microbiota. Besides, increasing evidence in the literature suggests that lipidomics as novel parameters detected with holistic analytical techniques have important roles in the pathogenesis and progression of T2DM, through various mechanisms of action including gut-brain axis modulation. A better understanding of the roles of some nutrients and lipidomics in T2DM through gut microbiota interactions will help develop new strategies for the prevention and treatment of T2DM. However, this issue has not yet been entirely discussed in the literature. The present review provides up-to-date knowledge on the roles of dietary lipids and lipidomics in gut-brain axis in T2DM and some nutritional strategies in T2DM considering lipids- lipidomics and gut microbiota interactions are given.
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Affiliation(s)
- Duygu Ağagündüz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490, Ankara, Turkey.
| | - Mehmet Arif Icer
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Amasya University, 05100, Amasya, Turkey
| | - Ozge Yesildemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bursa Uludag University, 16059, Bursa, Turkey
| | - Tevfik Koçak
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490, Ankara, Turkey
| | - Emine Kocyigit
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ordu University, 52200, Ordu, Turkey
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, Portici, 80055, Naples, Italy.
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Shetty SS, Kumari S. Fatty acids and their role in type-2 diabetes (Review). Exp Ther Med 2021; 22:706. [PMID: 34007315 PMCID: PMC8120551 DOI: 10.3892/etm.2021.10138] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
Age, lifestyle and diet are major risk factors for the onset of type 2 diabetes mellitus (T2DM). Insulin resistance (IR) and β-cell dysfunction underlie the pathophysiology of T2DM. Diabetic populations are also prone to lipid and lipoprotein abnormalities as an indirect effect of IR on key metabolic enzymes. However, recent studies suggested that lipid changes may not only be a consequence of impaired glucose metabolism but also a causative factor. Fatty acids (FAs) influence translocation of glucose transporters and insulin receptor binding and signalling, in addition to cell membrane fluidity and permeability. It is thus suggested that FAs may have an essential role in the development of IR and T2DM. Specific combinations of FAs within phospholipids and triglycerides were indicated to exhibit the strongest associations with the risk of T2DM. The aim of the present review was to investigate the role of FAs in the pathogenesis of T2DM, as it has yet to be fully elucidated.
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Affiliation(s)
- Shilpa S Shetty
- Central Research Laboratory, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, Karnataka 575018, India
| | - Suchetha Kumari
- Department of Biochemistry, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, Karnataka 575018, India
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Shetty SS, Kumari N S, Shetty PK. ω-6/ω-3 fatty acid ratio as an essential predictive biomarker in the management of type 2 diabetes mellitus. Nutrition 2020; 79-80:110968. [PMID: 32919185 DOI: 10.1016/j.nut.2020.110968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Intake of dietary fatty acid may play a major role in the prevention and management of lifestyle-related diseases such as type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to find an association between ω-6 to ω-3 fatty acid ratio and T2DM. METHODS Fasting plasma glucose, glycated hemoglobin, and insulin were measured using commercially available kits. Fatty acid methyl esters were prepared using standard protocols. Delta-5 desaturase (D5D) and delta-6 desaturase (D6D) activities were determined from product-to-precursor ratios of individual fatty acids in plasma. Statistical analysis was performed using SPSS version 20. RESULTS The ratio of ω-6 to ω-3 was higher in the group with diabetes (13:1) when compared with the group without diabetes (4:1) and was statistically significant (P < 0.0001). Further association studies showed that univariate model with the ω-6 to ω-3 ratio and a multivariate model with D5D, D6D, and ω-6 to ω-3 ratio could serve as predictive polyunsaturated fatty acid pathway models for T2DM. CONCLUSIONS From the study results, it is evident that ω-6 to ω-3 fatty acid ratios can serve as essential predictive biomarkers in the management of patients with T2DM. This would not only help in management but would also aid in prevention of increased T2DM incidence in India. These results potentiate the need to maintain an ideal balance of ω-6 to ω-3, as prevention is always better than cure.
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Affiliation(s)
- Shilpa S Shetty
- Central Research Laboratory, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, India.
| | - Suchetha Kumari N
- Department of Biochemistry, K.S.Hegde Medical Academy,Nitte (Deemed to be University), Deralakatte, Mangalore, India.
| | - Praveen Kumar Shetty
- Professor, Department of Biochemistry, K.S.Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore, India.
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Chacińska M, Zabielski P, Książek M, Szałaj P, Jarząbek K, Kojta I, Chabowski A, Błachnio-Zabielska AU. The Impact of OMEGA-3 Fatty Acids Supplementation on Insulin Resistance and Content of Adipocytokines and Biologically Active Lipids in Adipose Tissue of High-Fat Diet Fed Rats. Nutrients 2019; 11:nu11040835. [PMID: 31013835 PMCID: PMC6520951 DOI: 10.3390/nu11040835] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022] Open
Abstract
It has been established that OMEGA-3 polyunsaturated fatty acids (PUFAs) may improve lipid and glucose homeostasis and prevent the "low-grade" state of inflammation in animals. Little is known about the effect of PUFAs on adipocytokines expression and biologically active lipids accumulation under the influence of high-fat diet-induced obesity. The aim of the study was to examine the effect of fish oil supplementation on adipocytokines expression and ceramide (Cer) and diacylglycerols (DAG) content in visceral and subcutaneous adipose tissue of high-fat fed animals. The experiments were carried out on Wistar rats divided into three groups: standard diet-control (SD), high-fat diet (HFD), and high-fat diet + fish oil (HFD+FO). The fasting plasma glucose and insulin concentrations were examined. Expression of carnitine palmitoyltransferase 1 (CPT1) protein was determined using the Western blot method. Plasma adipocytokines concentration was measured using ELISA kits and mRNA expression was determined by qRT-PCR reaction. Cer, DAG, and acyl-carnitine (A-CAR) content was analyzed by UHPLC/MS/MS. The fish oil supplementation significantly decreased plasma insulin concentration and Homeostatic Model Assesment for Insulin Resistance (HOMA-IR) index and reduced content of adipose tissue biologically active lipids in comparison with HFD-fed subjects. The expression of CPT1 protein in HFD+FO in both adipose tissues was elevated, whereas the content of A-CAR was lower in both HFD groups. There was an increase of adiponectin concentration and expression in HFD+FO as compared to HFD group. OMEGA-3 fatty acids supplementation improved insulin sensitivity and decreased content of Cer and DAG in both fat depots. Our results also demonstrate that PUFAs may prevent the development of insulin resistance in response to high-fat feeding and may regulate the expression and secretion of adipocytokines in this animal model.
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Affiliation(s)
- Marta Chacińska
- Department of Hygiene, Epidemiology and Metabolic Disorders, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
- Department of Physiology, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
| | - Piotr Zabielski
- Department of Medical Biology, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
| | - Monika Książek
- Department of Physiology, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
| | - Przemysław Szałaj
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Jana Kilińskiego 1, 15-089 Bialystok, Poland.
- BioStat, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium.
- Centre of New Technologies, University of Warsaw, Stefana Banacha 2C, 02-097 Warsaw, Poland.
| | - Katarzyna Jarząbek
- Department of Reproduction and Gynaecological Endocrinology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A, 15-089 Bialystok, Poland.
| | - Iwona Kojta
- Department of Hygiene, Epidemiology and Metabolic Disorders, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
| | - Agnieszka Urszula Błachnio-Zabielska
- Department of Hygiene, Epidemiology and Metabolic Disorders, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
- Department of Physiology, Medical University of Bialystok, Mickiewicza 2c, 15-089 Bialystok, Poland.
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Yang L, Song Z, Wang F, Xia H, Liu H, Shu G, Lu H, Wang S, Sun G. Effects of Linoleic and Alpha-Linolenic Ratios and Concentrations on In Vitro Endothelial Cell Responses. EUR J LIPID SCI TECH 2018. [DOI: 10.1002/ejlt.201700468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ligang Yang
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
| | - Zhixiu Song
- Second Clinical Medical College; Nanjing University of Traditional Chinese Medicine; Nanjing P. R. China
| | - Feng Wang
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
| | - Hechun Liu
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
| | - Guofang Shu
- Zhongda Hospital Affiliated; Southeast University; Nanjing P. R. China
| | - Huixia Lu
- Zhongda Hospital Affiliated; Southeast University; Nanjing P. R. China
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering; Ministry of Education; Department of Nutrition and Food Hygiene; School of Public Health, Southeast University; 87 Ding Jia Qiao Road Nanjing Jiangsu 210009 P. R. China
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Ramos-Lopez O, Milagro FI, Allayee H, Chmurzynska A, Choi MS, Curi R, De Caterina R, Ferguson LR, Goni L, Kang JX, Kohlmeier M, Marti A, Moreno LA, Pérusse L, Prasad C, Qi L, Reifen R, Riezu-Boj JI, San-Cristobal R, Santos JL, Martínez JA. Guide for Current Nutrigenetic, Nutrigenomic, and Nutriepigenetic Approaches for Precision Nutrition Involving the Prevention and Management of Chronic Diseases Associated with Obesity. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2017; 10:43-62. [PMID: 28689206 DOI: 10.1159/000477729] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic diseases, including obesity, are major causes of morbidity and mortality in most countries. The adverse impacts of obesity and associated comorbidities on health remain a major concern due to the lack of effective interventions for prevention and management. Precision nutrition is an emerging therapeutic approach that takes into account an individual's genetic and epigenetic information, as well as age, gender, or particular physiopathological status. Advances in genomic sciences are contributing to a better understanding of the role of genetic variants and epigenetic signatures as well as gene expression patterns in the development of diverse chronic conditions, and how they may modify therapeutic responses. This knowledge has led to the search for genetic and epigenetic biomarkers to predict the risk of developing chronic diseases and personalizing their prevention and treatment. Additionally, original nutritional interventions based on nutrients and bioactive dietary compounds that can modify epigenetic marks and gene expression have been implemented. Although caution must be exercised, these scientific insights are paving the way for the design of innovative strategies for the control of chronic diseases accompanying obesity. This document provides a number of examples of the huge potential of understanding nutrigenetic, nutrigenomic, and nutriepigenetic roles in precision nutrition.
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Affiliation(s)
- Omar Ramos-Lopez
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara "Fray Antonio Alcalde" and Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
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Simopoulos AP, DiNicolantonio JJ. The importance of a balanced ω-6 to ω-3 ratio in the prevention and management of obesity. Open Heart 2016; 3:e000385. [PMID: 27843563 PMCID: PMC5093368 DOI: 10.1136/openhrt-2015-000385] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 02/06/2023] Open
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Simopoulos AP. An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients 2016; 8:128. [PMID: 26950145 PMCID: PMC4808858 DOI: 10.3390/nu8030128] [Citation(s) in RCA: 868] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022] Open
Abstract
In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity.
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Affiliation(s)
- Artemis P Simopoulos
- The Center for Genetics, Nutrition and Health, 4330 Klingle Street NW, Washington, DC 20016, USA.
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Kang JX. Nutritional Problems and Solutions for the Modern Health Epidemic. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2015; 7:188-90. [DOI: 10.1159/000375471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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