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International Urology and Nephrology

, Volume 49, Issue 10, pp 1851–1858 | Cite as

The impact of fish oil and wheat germ oil combination on mineral-bone and inflammatory markers in maintenance hemodialysis patients: a randomized, double-blind, placebo-controlled clinical trial

  • Hadeer ZakariaEmail author
  • Tarek M. Mostafa
  • Gamal A. El-Azab
  • Ahmed M. Abd El Wahab
  • Heba Elshahawy
  • Nagy AH Sayed-Ahmed
Nephrology - Original Paper

Abstract

Purpose

This study aimed to examine the impact of combined supplementation of fish oil (FO) with antioxidants like wheat germ oil (WGO) on mineral-bone and inflammatory markers in maintenance HD patients.

Methods

This randomized, double-blind, placebo-controlled trial involved 46 HD patients who were randomly assigned into two groups to receive daily 3000 mg of FO [1053 mg omega-3 fatty acids (ω-3 FAs)] plus 300 mg of WGO [0.765 mg vitamin E] or placebo for 4 months. Blood concentrations of hemoglobin (Hgb), white blood cells, mineral-bone parameters including serum calcium (Ca), phosphorus, calcium–phosphorus product, parathyroid hormone, alkaline phosphatase, and osteoprotegerin and serum concentrations of inflammatory markers including high-sensitivity C-reactive protein, ferritin, and uric acid were measured before and after the intervention.

Results

Eighty-seven percentage of patients in each group completed the study. The mean serum Ca levels increased significantly in the supplemented group at the end of study (p = 0.0016), and this increment was also significant as compared to placebo group (p = 0.0418). No significant alterations were observed in the other measured parameters within each group during the study (as p values were >0.05).

Conclusion

FO plus WGO supplementation showed beneficial effect on serum Ca levels of HD patients without any statistically significant effect on other mineral-bone and inflammatory markers. Further investigations are required to confirm it.

Keywords

Fish oil Wheat germ oil Mineral-bone Inflammation Hemodialysis 

Notes

Acknowledgements

The authors would like to thank Sedico Pharmaceutical Company, Egypt, for providing both placebo and Omega-3 plus® soft-gel capsules free of charge. The authors also acknowledge the great efforts and contributions of all staff members of the hemodialysis unit of Mansoura University Hospital and all participants in this study since without them, this study would have never been accomplished.

Compliance with ethical standards

Conflict of interest

All the authors declare no conflict of interest in this work.

Ethical approval

The study protocol was approved by the institutional research board (IRB) of Mansoura University (Code number: MS/15.09.34). All participants signed a written informed consent before the start of the study.

References

  1. 1.
    Nigwekar SU, Tamez H, Thadhani RI (2014) Vitamin D and chronic kidney disease-mineral bone disease (CKD-MBD). Bonekey Rep 3:498. doi: 10.1038/bonekey.2013.232 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Reddy YN, Abraham G, Nagarajan P, Matthew M, Jayaseelan T, Padma G (2014) Mineral bone disease in maintenance hemodialysis patients: association with morbidity and mortality. Indian J Nephrol 24(5):302–307. doi: 10.4103/0971-4065.132988 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Eleftheriadis T, Kartsios C, Antoniadi G, Kazila P, Dimitriadou M, Sotiriadou E, Koltsida M, Golfinopoulos S, Liakopoulos V, Christopoulou-Apostolaki M (2008) The impact of chronic inflammation on bone turnover in hemodialysis patients. Ren Fail 30(4):431–437. doi: 10.1080/08860220801964251 CrossRefPubMedGoogle Scholar
  4. 4.
    Hardy R, Cooper MS (2009) Bone loss in inflammatory disorders. J Endocrinol 201(3):309–320. doi: 10.1677/JOE-08-0568 CrossRefPubMedGoogle Scholar
  5. 5.
    Jung SM, Kim KW, Yang CW, Park SH, Ju JH (2014) Cytokine-mediated bone destruction in rheumatoid arthritis. J Immunol Res 2014:263625. doi: 10.1155/2014/263625 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gharekhani A, Khatami MR, Dashti-Khavidaki S, Razeghi E, Noorbala AA, Hashemi-Nazari SS, Mansournia MA (2014) The effect of omega-3 fatty acids on depressive symptoms and inflammatory markers in maintenance hemodialysis patients: a randomized, placebo-controlled clinical trial. Eur J Clin Pharmacol 70(6):655–665. doi: 10.1007/s00228-014-1666-1 CrossRefPubMedGoogle Scholar
  7. 7.
    Perunicic-Pekovic GB, Rasic ZR, Pljesa SI, Sobajic SS, Djuricic I, Maletic R, Ristic-Medic DK (2007) Effect of n-3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients. Nephrology (Carlton) 12(4):331–336. doi: 10.1111/j.1440-1797.2007.00777.x CrossRefGoogle Scholar
  8. 8.
    Saifullah A, Watkins BA, Saha C, Li Y, Moe SM, Friedman AN (2007) Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients—a pilot study. Nephrol Dial Transpl 22(12):3561–3567. doi: 10.1093/ndt/gfm422 CrossRefGoogle Scholar
  9. 9.
    Rasic-Milutinovic Z, Perunicic G, Pljesa S, Gluvic Z, Sobajic S, Djuric I, Ristic D (2007) Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Ren Fail 29(3):321–329. doi: 10.1080/08860220601184092 CrossRefPubMedGoogle Scholar
  10. 10.
    Bowden RG, Wilson RL, Deike E, Gentile M (2009) Fish oil supplementation lowers C-reactive protein levels independent of triglyceride reduction in patients with end-stage renal disease. Nutr Clin Pract 24(4):508–512. doi: 10.1177/0884533609335376 CrossRefPubMedGoogle Scholar
  11. 11.
    Kooshki A, Taleban FA, Tabibi H, Hedayati M (2011) Effects of marine omega-3 fatty acids on serum systemic and vascular inflammation markers and oxidative stress in hemodialysis patients. Ann Nutr Metab 58(3):197–202. doi: 10.1159/000329727 CrossRefPubMedGoogle Scholar
  12. 12.
    Poulia KA, Panagiotakos DB, Tourlede E, Rezou A, Stamatiadis D, Boletis J, Zampelas A (2011) Omega-3 fatty acids supplementation does not affect serum lipids in chronic hemodialysis patients. J Ren Nutr 21(6):479–484CrossRefPubMedGoogle Scholar
  13. 13.
    Gharekhani A, Khatami MR, Dashti-Khavidaki S, Razeghi E, Abdollahi A, Hashemi-Nazari SS, Mansournia MA (2014) Effects of oral supplementation with omega-3 fatty acids on nutritional state and inflammatory markers in maintenance hemodialysis patients. J Ren Nutr 24(3):177–185CrossRefPubMedGoogle Scholar
  14. 14.
    Pipingas A, Sinclair A, Croft KD, Januszewski AS, Jenkins AJ, Mori TA, Cockerell R, Grima NA, Stough C, Scholey A, Myers SP, Sali A, Pase MP (2015) Fish oil and multivitamin supplementation reduces oxidative stress but not inflammation in healthy older adults: a randomised controlled trial 19. J Funct Foods B. doi: 10.1016/j.jff.2014.10.028 Google Scholar
  15. 15.
    Jamilian M, Hashemi Dizaji S, Bahmani F, Taghizadeh M, Memarzadeh MR, Karamali M, Akbari M, Asemi Z (2016) A Randomized controlled clinical trial investigating the effects of omega-3 fatty acids and vitamin e co-supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in gestational diabetes. Can J Diabetes. doi: 10.1016/j.jcjd.2016.09.004 PubMedGoogle Scholar
  16. 16.
    Rani B (2013) Dietary antioxidants to prop up vigour & vitality: an overview. J Drug Discov Therapeutics 1(7):106–122Google Scholar
  17. 17.
    Tayebi-Khosroshahi H, Dehgan R, Habibi Asl B, Safaian A, Panahi F, Estakhri R, Purasgar B (2013) Effect of omega-3 supplementation on serum level of homocysteine in hemodialysis patients. Iran J Kidney Dis 7(6):479–484PubMedGoogle Scholar
  18. 18.
    Gharekhani A, Khatami MR, Dashti-Khavidaki S, Razeghi E, Abdollahi A, Hashemi-Nazari SS, Mansournia MA (2014) Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients. Daru 22(1):11. doi: 10.1186/2008-2231-22-11 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Haag M, Magada ON, Claassen N, Bohmer LH, Kruger MC (2003) Omega-3 fatty acids modulate ATPases involved in duodenal Ca absorption. Prostaglandins Leukot Essent Fat Acids 68(6):423–429CrossRefGoogle Scholar
  20. 20.
    Haag M, Kruger MC (2001) Upregulation of duodenal calcium absorption by poly-unsaturated fatty acids: events at the basolateral membrane. Med Hypotheses 56(5):637–640CrossRefPubMedGoogle Scholar
  21. 21.
    Lee SM, Son YK, Kim SE, An WS (2015) The effects of omega-3 fatty acid on vitamin D activation in hemodialysis patients: a pilot study. Mar Drugs 13(2):741–755. doi: 10.3390/md13020741 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Giray B, Kan E, Bali M, Hincal F, Basaran N (2003) The effect of vitamin E supplementation on antioxidant enzyme activities and lipid peroxidation levels in hemodialysis patients. Clin Chim Acta 338(1–2):91–98CrossRefPubMedGoogle Scholar
  23. 23.
    Peralta-Ramirez A, Montes de Oca A, Raya AI, Pineda C, Lopez I, Guerrero F, Diez E, Munoz-Castaneda JR, Martinez J, Almaden Y, Rodriguez M, Aguilera-Tejero E (2014) Vitamin E protection of obesity-enhanced vascular calcification in uremic rats. Am J Physiol Ren Physiol 306(4):F422–F429. doi: 10.1152/ajprenal.00355.2013 CrossRefGoogle Scholar
  24. 24.
    Lappe J, Kunz I, Bendik I, Prudence K, Weber P, Recker R, Heaney RP (2013) Effect of a combination of genistein, polyunsaturated fatty acids and vitamins D3 and K1 on bone mineral density in postmenopausal women: a randomized, placebo-controlled, double-blind pilot study. Eur J Nutr 52(1):203–215. doi: 10.1007/s00394-012-0304-x CrossRefPubMedGoogle Scholar
  25. 25.
    Fonolla-Joya J, Reyes-Garcia R, Garcia-Martin A, Lopez-Huertas E, Munoz-Torres M (2016) Daily intake of milk enriched with n-3 fatty acids, oleic acid, and calcium improves metabolic and bone biomarkers in postmenopausal women. J Am Coll Nutr. doi: 10.1080/07315724.2014.1003114 PubMedGoogle Scholar
  26. 26.
    Coetzee M, Haag M, Kruger MC (2007) Effects of arachidonic acid, docosahexaenoic acid, prostaglandin E(2) and parathyroid hormone on osteoprotegerin and RANKL secretion by MC3T3-E1 osteoblast-like cells. J Nutr Biochem 18(1):54–63. doi: 10.1016/j.jnutbio.2006.03.002 CrossRefPubMedGoogle Scholar
  27. 27.
    Poulsen RC, Wolber FM, Moughan PJ, Kruger MC (2008) Long chain polyunsaturated fatty acids alter membrane-bound RANK-L expression and osteoprotegerin secretion by MC3T3-E1 osteoblast-like cells. Prostaglandins Other Lipid Mediat 85(1–2):42–48. doi: 10.1016/j.prostaglandins.2007.10.004 CrossRefPubMedGoogle Scholar
  28. 28.
    Kolahi S, Ghorbanihaghjo A, Alizadeh S, Rashtchizadeh N, Argani H, Khabazzi AR, Hajialilo M, Bahreini E (2010) Fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio in female patients with rheumatoid arthritis. Clin Biochem 43(6):576–580. doi: 10.1016/j.clinbiochem.2009.12.011 CrossRefPubMedGoogle Scholar
  29. 29.
    Martin-Bautista E, Munoz-Torres M, Fonolla J, Quesada M, Poyatos A, Lopez-Huertas E (2010) Improvement of bone formation biomarkers after 1-year consumption with milk fortified with eicosapentaenoic acid, docosahexaenoic acid, oleic acid, and selected vitamins. Nutr Res 30(5):320–326. doi: 10.1016/j.nutres.2010.05.007 CrossRefPubMedGoogle Scholar
  30. 30.
    Ahmadi A, Mazooji N, Roozbeh J, Mazloom Z, Hasanzade J (2013) Effect of alpha-lipoic acid and vitamin E supplementation on oxidative stress, inflammation, and malnutrition in hemodialysis patients. Iran J Kidney Dis 7(6):461–467PubMedGoogle Scholar
  31. 31.
    Kalantar-Zadeh K, Rodriguez RA, Humphreys MH (2004) Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transpl 19(1):141–149CrossRefGoogle Scholar
  32. 32.
    Smith KS, Lee CL, Ridlington JW, Leonard SW, Devaraj S, Traber MG (2003) Vitamin E supplementation increases circulating vitamin E metabolites tenfold in end-stage renal disease patients. Lipids 38(8):813–819CrossRefPubMedGoogle Scholar
  33. 33.
    Beciragic A, Resic H, Prohic N, Karamehic J, Smajlovic A, Masnic F, Ajanovic S, Coric A (2015) Correlation between C-reactive protein and non-enzymatic antioxidants (albumin, ferritin, uric acid and bilirubin) in hemodialysis patients. Mater Soc Med 27(2):87CrossRefGoogle Scholar
  34. 34.
    Bouzidi N, Mekki K, Boukaddoum A, Dida N, Kaddous A, Bouchenak M (2010) Effects of omega-3 polyunsaturated fatty-acid supplementation on redox status in chronic renal failure patients with dyslipidemia. J Ren Nutr 20(5):321–328. doi: 10.1053/j.jrn.2010.01.002 CrossRefPubMedGoogle Scholar
  35. 35.
    Uzum A, Toprak O, Gumustas MK, Ciftci S, Sen S (2006) Effect of vitamin E therapy on oxidative stress and erythrocyte osmotic fragility in patients on peritoneal dialysis and hemodialysis. J Nephrol 19(6):739–745PubMedGoogle Scholar
  36. 36.
    Atilla U, Omer T, MKoray G, Senturk C, Saniye S (2010) Effect of vitamin E supplementation on plasma lipid, apolipoprotein and lipoprotein profiles in patients on peritoneal dialysis and hemodialysis. Nephro Urol Mon 2(02):320–329Google Scholar
  37. 37.
    Eleftheriadis T, Antoniadi G, Liakopoulos V, Stefanidis I (2010) Alpha-Tocopherol administration decreases serum urate levels in hemodialysis patients. Ther Apher Dial 14(6):605–606. doi: 10.1111/j.1744-9987.2010.00840.x CrossRefPubMedGoogle Scholar
  38. 38.
    Kris-Etherton PM, Harris WS, Appel LJ (2003) Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol 23(2):151–152CrossRefPubMedGoogle Scholar
  39. 39.
    Food and Drug Administration (2004) FDA announces qualified health claims for omega-3 fatty acids. http://www.fda.gov/SiteIndex/ucm108351.htm. Accessed 20 Feb 2017

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Department of PharmacyMansoura Fever HospitalMansouraEgypt
  2. 2.Department of Clinical PharmacyFaculty of PharmacyTantaEgypt
  3. 3.Department of Internal MedicineFaculty of MedicineMansouraEgypt
  4. 4.Department of Clinical PathologyFaculty of MedicineMansouraEgypt

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