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Predicting the effects of supplemental EPA and DHA on the omega-3 index

Walker RE, Jackson KH, Tintle NL, Shearer GC, Bernasconi A, Masson S, Latini R, Heydari B, Kwong RY, Flock M, Kris-Etherton PM, Hedengran A, Carney RM, Skulas-Ray A, Gidding SS, Dewell A, Gardner CD, Grenon SM, Sarter B, Newman JW, Pedersen TL, Larson MK, Harris WS (2019) Am J Clin Nutr.  2019 Aug.  pii: nqz161. doi: 10.1093/ajcn/nqz161. [Epub ahead of print] 

Web URL: Read this and related abstracts on PubMed here

Abstract:

BACKGROUND:

Supplemental long-chain omega-3 (n-3) fatty acids (EPA and DHA) raise erythrocyte EPA + DHA [omega-3 index (O3I)] concentrations, but the magnitude or variability of this effect is unclear.

OBJECTIVE:

The purpose of this study was to model the effects of supplemental EPA + DHA on the O3I.

METHODS:

Deidentified data from 1422 individuals from 14 published n-3 intervention trials were included. Variables considered included dose, baseline O3I, sex, age, weight, height, chemical form [ethyl ester (EE) compared with triglyceride (TG)], and duration of treatment. The O3I was measured by the same method in all included studies. Variables were selected by stepwise regression using the Bayesian information criterion.

RESULTS:

Individuals supplemented with EPA + DHA (n = 846) took a mean ± SD of 1983 ± 1297 mg/d, and the placebo controls (n  = 576) took none. The mean duration of supplementation was 13.6 ± 6.0 wk. The O3I increased from 4.9% ± 1.7% to 8.1% ± 2.7% in the supplemented individuals ( P < 0.0001).

The final model included dose, baseline O3I, and chemical formulation type (EE or TG), and these explained 62% of the variance in response (P < 0.0001). The model predicted that the final O3I (and 95% CI) for a population like this, with a baseline concentration of 4.9%, given 850 mg/d of EPA + DHA EE would be ∼6.5% (95% CI: 6.3%, 6.7%).

Gram for gram, TG-based supplements increased the O3I by about 1 percentage point more than EE products.

CONCLUSIONS:

Of the factors tested, only baseline O3I, dose, and chemical formulation were significant predictors of O3I response to supplementation. The model developed here can be used by researchers to help estimate the O3I response to a given EPA + DHA dose and chemical form.

FAB RESEARCH COMMENT:

The effects of supplementation with omega-3 EPA/DHA depend on both baseline status of these nutrients, and on the form in which these omega-3 are provided, according to this new study.

The researchers analysed results from human clinical trials to derive a formula for use in the design of future treatment studies - and their results suggest that many of the inconsistencies in trials of 'omega-3' may reflect the failure to use appropriate dosages for the population studied.

Findings showed that much higher doses of EPA/DHA are needed to achieve an optimal 'omega-3 index' - i.e. EPA and DHA making up at least 8% of total blood fats - for populations with lower baseline blood omega-3 levels.  For initial omega-3 indices of 2% vs 6%, the daily dose needed to achieve the 8% target ranged from 2200 mg/day to 750mg/day respectively.

The results also confirmed that slightly lower dosages are needed if the EPA/DHA is provided in the triglyceride vs ethyl ester form.

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