Omega-3 Fatty Acids: A Growing Ocean of Choices
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There has been increasing interest in the health benefits of supplemental and/or dietary omega-3 polyunsaturated fatty acids (PUFAs), particularly in their role in disease prevention. This interest escalated once their effects on cardiovascular health were observed from numerous observational studies in populations whose diet consisted mainly of fish. Research has since been undertaken on omega-3 PUFAs to investigate their health benefits in a vast array of medical conditions, including primary and secondary prevention. This article discusses the evidence and controversies concerning omega-3 PUFAs in various health conditions. In addition to the effects on cardiovascular health, omega-3 PUFAs have been shown to prevent the development of dementia, reduce systemic inflammatory diseases, prevent prostate cancer, and possibly have a role in the treatment of depression and bipolar disorder.
KeywordsPolyunsaturated fatty acids Cardiovascular disease
Coronary heart disease
Fish Oil Research with Omega-3 for Atrial Fibrillation Recurrence Delaying
Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Heart Failure
Japan Eicosapentaenoic Acid Lipid Intervention Study
Multi-Center, Placebo-Controlled, Randomized, Double-Blind, 12-Week Study with an Open-Label Extension
Outcome Reduction with Initial Glargine Intervention
Polyunsaturated fatty acids
Sudden cardiac death
Type 2 diabetes
Compliance with Ethics Guidelines
Conflict of Interest
Hassan Fares, James DiNicolantonio, and Richard V. Milani declare that they have no conflict of interest.
Carl J. Lavie is a consultant to GlaxoSmithKline, Amarin, and Abbott.
James H. O’Keefe has received honoraria from GlaxoSmithKline and is Chief Medical Officer and the founder of CardioTabs, in which he has a major ownership interest that is nonmonetary. CardioTabs sells products that contain omega-3 fatty acids.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Rombaldi Bernardi J, de Souza Escobar R, Ferreira CF, Pelufo Silveira P. Fetal and neonatal levels of omega-3: effects on neurodevelopment, nutrition, and growth. Sci World J. 2012;2012:202473.Google Scholar
- 34.GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354(9177):447–55.Google Scholar
- 36.Von Schacky C, Angerer P, Kothny W, Theisen K, Mudra H. The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1999;130(7):554–62.Google Scholar
- 37.Balk E, Chung M, Lichtenstein A, et al. Effects of omega-3 fatty acids on cardiovascular risk factors and intermediate markers of cardiovascular disease. Evid Rep Technol Assess (Summ). 2004;(93):1–6.Google Scholar
- 38.••DiNicolantonio JJ, Niazi AK, Keefe JHO, Lavie CJ. Explaining the recent fish oil trial “failures”. J Glycomics Lipidomics. 2012;2(4):10–3. This article demonstrates the flaws in study designs of trials which showed no benefits of PUFAs. Google Scholar
- 45.Yamagishi K, Iso H, Date C, et al. Fish, omega-3 polyunsaturated fatty acids, and mortality from cardiovascular diseases in a nationwide community-based cohort of Japanese men and women the JACC (Japan Collaborative Cohort Study for Evaluation of Cancer Risk) study. J Am Coll Cardiol. 2008;52(12):988–96.PubMedGoogle Scholar
- 47.•Nodari S, Triggiani M, Manerba A, Milesi G, Dei Cas L. Effects of supplementation with polyunsaturated fatty acids in patients with heart failure. Intern Emerg Med. 2011;6 Suppl 1:37–44. This article illustrates the mechanism of action of PUFAs in arrhythmia prevention in HF patients.PubMedGoogle Scholar
- 60.Marchioli R, Barzi F, Bomba E, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105(16):1897–903.PubMedGoogle Scholar
- 64.•He Z, Yang L, Tian J, Yang K, Wu J, Yao Y. Efficacy and safety of omega-3 fatty acids for the prevention of atrial fibrillation: a meta-analysis. Can J Cardiol. 2013;29(2):196–203. This trial showed a decrease in the incidence of AF with the use of PUFAs after open heart surgery.PubMedGoogle Scholar
- 66.Armaganijan L, Lopes RD, Healey JS, Piccini JP, Nair GM, Morillo CA. Do omega-3 fatty acids prevent atrial fibrillation after open heart surgery? A meta-analysis of randomized controlled trials. Clin (Sao Paulo). 2011;66(11):1923–8.Google Scholar
- 67.Benedetto U, Angeloni E, Melina G, et al. n-3 polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials. J Cardiovasc Med (Hagerstown). 2013;14(2):104–9.Google Scholar
- 75.•Macchia A, Grancelli H, Varini S, et al. Omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation: results of the FORWARD (randomized trial to assess efficacy of PUFA for the maintenance of sinus rhythm in persistent atrial fibrillation) trial. J Am Coll Cardiol. 2013;61(4):463–8. This trial refutes the benefits of PUFAs in AF prevention.PubMedGoogle Scholar
- 77.••Ballantyne CM, Bays HE, Kastelein JJ, et al. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardiol. 2012;110(7):984–92. This is one of two key trials demonstrating the beneficial effects of PUFAs on hypertriglyceridemia.PubMedGoogle Scholar
- 78.••Bays HE, Ballantyne CM, Kastelein JJ, Isaacsohn JL, Braeckman RA, Soni PN. Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels (from the Multi-center, plAcebo-controlled, Randomized, double-blINd, 12-week study with an open-label Extension [MARINE] trial). Am J Cardiol. 2011;108(5):682–90. This is the second of two major trials demonstrating the beneficial effects of PUFAs on hypertriglyceridemia.PubMedGoogle Scholar
- 80.Koski RR. Omega-3-acid ethyl esters (Lovaza) for severe hypertriglyceridemia. Pharm Ther. 2008;33(5):271.Google Scholar
- 85.MacLean CH, Mojica WA, Morton SC, et al. Effects of omega-3 fatty acids on lipids and glycemic control in type II diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus, and osteoporosis. Evid Rep Technol Assess (Summ). 2004;(89):1–4.Google Scholar
- 89.•Shannon J, O’Malley J, Mori M, Garzotto M, Palma AJ, King IB. Erythrocyte fatty acids and prostate cancer risk: a comparison of methods. Prostaglandins Leukot Essent Fatty Acids. 2010;83(3):161–9. This article investigates the mechanisms of action of PUFAs in chemoprevention in prostate cancer.PubMedCentralPubMedGoogle Scholar
- 100.Wainwright PE. Dietary essential fatty acids and brain function: a developmental perspective on mechanisms. Proc Nutr Soc. 2007;61(01):61–9.Google Scholar