-
1.
Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition.
Troesch, B, Eggersdorfer, M, Laviano, A, Rolland, Y, Smith, AD, Warnke, I, Weimann, A, Calder, PC
Nutrients. 2020;(9)
Abstract
Life expectancy is increasing and so is the prevalence of age-related non-communicable diseases (NCDs). Consequently, older people and patients present with multi-morbidities and more complex needs, putting significant pressure on healthcare systems. Effective nutrition interventions could be an important tool to address patient needs, improve clinical outcomes and reduce healthcare costs. Inflammation plays a central role in NCDs, so targeting it is relevant to disease prevention and treatment. The long-chain omega-3 polyunsaturated fatty acids (omega-3 LCPUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to reduce inflammation and promote its resolution, suggesting a beneficial role in various therapeutic areas. An expert group reviewed the data on omega-3 LCPUFAs in specific patient populations and medical conditions. Evidence for benefits in cognitive health, age- and disease-related decline in muscle mass, cancer treatment, surgical patients and critical illness was identified. Use of DHA and EPA in some conditions is already included in some relevant guidelines. However, it is important to note that data on the effects of omega-3 LCPUFAs are still inconsistent in many areas (e.g., cognitive decline) due to a range of factors that vary amongst the trials performed to date; these factors include dose, timing and duration; baseline omega-3 LCPUFA status; and intake of other nutrients. Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use.
-
2.
Omega-3 PUFA Responders and Non-Responders and the Prevention of Lipid Dysmetabolism and Related Diseases.
Serini, S, Calviello, G
Nutrients. 2020;(5)
Abstract
The long-chain omega-3 polyunsaturated fatty acids (LC-omega-3 PUFAs) eicosapentaenoic acid and docosahexaenoic acid are the most popular dietary supplements recommended for the prevention/management of lipid dysmetabolisms and related diseases. However, remarkable inconsistencies exist among the outcomes of the human intervention studies in this field, which contrast with the impressive homogeneity of positive results of most of the preclinical studies. In the present review, we will firstly examine a series of factors-such as background diet composition, gut microbiota and genetic/epigenetic variants, which may lie beneath these inconsistencies. Moreover, we will discuss the recent advance in the knowledge of possible specific biomarkers (genetic-, epigenetic- and microbiota-related) that are being investigated with the goal to apply them in a personalized supplementation with omega-3 PUFAs. We will also consider the possibility of using already available parameters (Omega-3 index, Omega-6 PUFA/Omega-3 PUFA ratio) able to predict the individual responsiveness to these fatty acids and will discuss the optimal timing for their use. Finally, we will critically examine the results of those human studies that have already adopted the distinction of the subjects into omega-3 PUFA responders and non-responders and will discuss the advantage of using such an approach.
-
3.
Sports-related concussions and subconcussive impacts in athletes: incidence, diagnosis, and the emerging role of EPA and DHA.
Lust, CAC, Mountjoy, M, Robinson, LE, Oliver, JM, Ma, DWL
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2020;(8):886-892
-
-
Free full text
-
Abstract
Sports-related concussions (SRC) are traumatic brain injuries induced as the result of a biomechanical force to the body that temporarily impair neurological functions. Not all traumatic impacts reach the threshold necessary to produce concussive symptoms; however, the culmination of these events is known as a subconcussive impact (SCI). Athletes who have been diagnosed with a SRC or those who accumulate multiple SCI have exhibited structural damage to the brain, impairments to learning and memory, and an increase in depressive symptoms. This area is rapidly evolving, and current clinical definitions of injury, diagnosis, and treatment of SRC and SCI are reviewed. In tandem, there is also growing research examining the role of nutrition in brain injuries, focusing primarily on n-3 polyunsaturated fatty acids (PUFA). The potential role of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in reducing inflammation and promoting recovery following brain injury are also reviewed. Overall, advancements in the evaluation of SRC and SCI coupled with n-3 PUFA supplementation show promise in the management of brain injuries, leading to better long-term health outcomes for athletes. Novelty SRC have garnered widespread attention due to the growing body of reported prevalence in youth and professional sports. Current definitions and protocol(s) for diagnosing SRC and SCI have improved, but still require further evaluation. n-3, EPA and DHA, reduce inflammation and promote recovery following brain injuries in experimental models.
-
4.
Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19.
Rogero, MM, Leão, MC, Santana, TM, Pimentel, MVMB, Carlini, GCG, da Silveira, TFF, Gonçalves, RC, Castro, IA
Free radical biology & medicine. 2020;:190-199
-
-
Free full text
-
Abstract
Studies have shown that infection, excessive coagulation, cytokine storm, leukopenia, lymphopenia, hypoxemia and oxidative stress have also been observed in critically ill Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) patients in addition to the onset symptoms. There are still no approved drugs or vaccines. Dietary supplements could possibly improve the patient's recovery. Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present an anti-inflammatory effect that could ameliorate some patients need for intensive care unit (ICU) admission. EPA and DHA replace arachidonic acid (ARA) in the phospholipid membranes. When oxidized by enzymes, EPA and DHA contribute to the synthesis of less inflammatory eicosanoids and specialized pro-resolving lipid mediators (SPMs), such as resolvins, maresins and protectins. This reduces inflammation. In contrast, some studies have reported that EPA and DHA can make cell membranes more susceptible to non-enzymatic oxidation mediated by reactive oxygen species, leading to the formation of potentially toxic oxidation products and increasing the oxidative stress. Although the inflammatory resolution improved by EPA and DHA could contribute to the recovery of patients infected with SARS-CoV-2, Omega-3 fatty acids supplementation cannot be recommended before randomized and controlled trials are carried out.
-
5.
Very Long Chain Marine n-3 Polyunsaturated Fatty Acids in Atherothrombotic Heart Disease. A Brief Review, with a Focus on Metabolic Effects.
Arnesen, H, Myhre, PL, Seljeflot, I
Nutrients. 2020;(10)
Abstract
The global burden of atherothrombotic heart disease should be considered as a life-style disorder where differences in dietary habits and related risk factors like limited physical activity and adiposity together play important roles. Related metabolic changes have been scientifically elucidated in recent decades, and the role of the very-long-chain marine fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been much focused on, especially their possible effects on processes like inflammation and thrombosis. In the present brief review of related metabolic mechanisms, the effects of these fatty acids in a clinical setting have been referred to, including some of the authors' work on this topic. The main focus is the divergent results in the field and the important differences between the study population, the type of supplements and fresh marine sources, the proportion of EPA versus DHA dosages, and the duration of supplementation in clinical trials. We conclude that daily intake of at least 1 g of EPA + DHA may improve a dysmetabolic state in the population. The potential to reduce the risk and progression of atherothrombotic heart disease is still a matter of debate.
-
6.
The Differential Effects of Eicosapentaenoic Acid and Docosahexaenoic Acid on Cardiometabolic Risk Factors: A Systematic Review.
Innes, JK, Calder, PC
International journal of molecular sciences. 2018;(2)
Abstract
A large body of evidence supports the cardioprotective effects of the long-chain omega-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). There is increasing interest in the independent effects of EPA and DHA in the modulation of cardiometabolic risk factors. This systematic review aims to appraise the latest available evidence of the differential effects of EPA and DHA on such risk factors. A systematic literature review was conducted up to May 2017. Randomised controlled trials were included if they met strict eligibility criteria, including EPA or DHA > 2 g/day and purity ≥ 90%. Eighteen identified articles were included, corresponding to six unique studies involving 527 participants. Both EPA and DHA lowered triglyceride concentration, with DHA having a greater triglyceride-lowering effect. Whilst total cholesterol levels were largely unchanged by EPA and DHA, DHA increased high-density lipoprotein (HDL) cholesterol concentration, particularly HDL₂, and increased low-density lipoprotein (LDL) cholesterol concentration and LDL particle size. Both EPA and DHA inhibited platelet activity, whilst DHA improved vascular function and lowered heart rate and blood pressure to a greater extent than EPA. The effects of EPA and DHA on inflammatory markers and glycaemic control were inconclusive; however both lowered oxidative stress. Thus, EPA and DHA appear to have differential effects on cardiometabolic risk factors, but these need to be confirmed by larger clinical studies.
-
7.
Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults.
Stark, KD, Van Elswyk, ME, Higgins, MR, Weatherford, CA, Salem, N
Progress in lipid research. 2016;:132-52
Abstract
Studies reporting blood levels of the omega-3 polyunsaturated fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), were systematically identified in order to create a global map identifying countries and regions with different blood levels. Included studies were those of healthy adults, published in 1980 or later. A total of 298 studies met all inclusion criteria. Studies reported fatty acids in various blood fractions including plasma total lipids (33%), plasma phospholipid (32%), erythrocytes (32%) and whole blood (3.0%). Fatty acid data from each blood fraction were converted to relative weight percentages (wt.%) and then assigned to one of four discrete ranges (high, moderate, low, very low) corresponding to wt.% EPA+DHA in erythrocyte equivalents. Regions with high EPA+DHA blood levels (>8%) included the Sea of Japan, Scandinavia, and areas with indigenous populations or populations not fully adapted to Westernized food habits. Very low blood levels (≤4%) were observed in North America, Central and South America, Europe, the Middle East, Southeast Asia, and Africa. The present review reveals considerable variability in blood levels of EPA+DHA and the very low to low range of blood EPA+DHA for most of the world may increase global risk for chronic disease.
-
8.
EFFECT OF EICOSAPENTAENOIC ACID AND DOCOSAHEXAENOIC ACID SUPPLEMENTATIONS TO CONTROL COGNITIVE DECLINE IN DEMENTIA AND ALZHEIMER'S DISEASE: A SYSTEMATIC REVIEW.
de Souza Fernandes, DP, Canaan Rezende, FA, Pereira Rocha, G, De Santis Filgueiras, M, Silva Moreira, PR, Gonçalves Alfenas, Rde C
Nutricion hospitalaria. 2015;(2):528-33
Abstract
INTRODUCTION there is a lack of consensus on the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementations on cognition in dementia and/or Alzheimer's disease (AD) elderly. OBJECTIVE this study presents a systematic review of the results of randomized clinical trials about this topic. The adopted search criteria were randomized clinical trials involving elderly over 65 years of age with no limit to the year of publication of the study. RESULTS we identified 139 articles, and from the eligible ones a reverse search was conducted. The quality of the trials was assessed using the Jadad scale. Of the four selected studies, three were related to mild to moderate AD elderly, of both genders. Mini Mental State Examination, Alzheimer's Disease Assessment Scale Cognitive, and Clinical Dementia Rate were the main tests used to assess cognitive performance. CONCLUSION EPA and/or DHA supplementations did not affect scores obtained on the cognitive tests. However, supplementation with EPA and/or DHA improved verbal fluency and attention in patients who had only very mild dementia or AD or presented APOEε4 negative genotype. In case of advanced AD elderly patients, EPA and/or DHA supplementations did not reduce cognitive decline rates.
-
9.
The evidence for α-linolenic acid and cardiovascular disease benefits: Comparisons with eicosapentaenoic acid and docosahexaenoic acid.
Fleming, JA, Kris-Etherton, PM
Advances in nutrition (Bethesda, Md.). 2014;(6):863S-76S
-
-
Free full text
-
Abstract
Our understanding of the cardiovascular disease (CVD) benefits of α-linolenic acid (ALA, 18:3n-3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) and CVD. The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n-3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD. Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction.
-
10.
Stearidonic acid raises red blood cell membrane eicosapentaenoic acid.
Maki, KC, Rains, TM
The Journal of nutrition. 2012;(3):626S-629S
-
-
Free full text
-
Abstract
The consumption of EPA and DHA has been associated with reduced risk for cardiovascular disease morbidity and mortality. Mean intakes of EPA and DHA in the United States and elsewhere are below levels recommended by health authorities. The main non-marine source of dietary (n-3) fatty acids (α-linolenic acid) is poorly converted to EPA in humans. Stearidonic acid (SDA) is a non-marine fatty acid that appears to be more readily converted to EPA in humans. Results from previous studies suggested that SDA, relative to EPA, increases RBC EPA, with reported efficiencies ranging from ~16 to 30%. A recently published, randomized, single-blind, controlled, parallel group study in healthy men and women characterized the relationships between intakes of SDA and EPA and EPA enrichment of RBC membranes over a 12-wk period. %EPA in RBC membranes was greater after EPA (0.44, 1.3, or 2.7 g/d, respectively) and SDA (1.3, 2.6, or 5.2 g/d, respectively) consumption compared to a safflower control (all P < 0.02). Based on quadratic response surface models, for EPA intakes of 0.25, 0.50, and 0.89 g/d, SDA intakes of 0.61, 1.89, and 5.32 g/d, respectively, would be required to produce equivalent values for RBC %EPA, translating to relative efficiencies of 41.0, 26.5, and 16.7%. Thus, dietary SDA over a range of intakes increases RBC %EPA, with declining relative efficiency as SDA intake increases.