Abstract
We conducted a systematic review and meta-analysis to assess the effects of increasing dietary omega-3, omega-6 and mixed polyunsaturated fatty acids (PUFA) on musculoskeletal health, functional status, sarcopenia and risk of fractures. We searched Medline, Embase, The Cochrane library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) databases for Randomised Controlled Trials (RCTs) of adults evaluating the effects of higher versus lower oral omega-3, omega-6 or mixed PUFA for ≥ 6 months on musculoskeletal and functional outcomes. We included 28 RCTs (7288 participants, 31 comparisons), 23 reported effects of omega-3, one of omega-6 and four of mixed total PUFA. Participants and doses were heterogeneous. Six omega-3 trials were judged at low summary risk of bias. We found low-quality evidence that increasing omega-3 increased lumbar spine BMD by 2.6% (0.03 g/cm2, 95% CI − 0.02 to 0.07, 463 participants). There was also the suggestion of an increase in femoral neck BMD (of 4.1%), but the evidence was of very low quality. There may be little or no effect of omega-3 on functional outcomes and bone mass; effects on other outcomes were unclear. Only one study reported on effects of omega-6 with very limited data. Increasing total PUFA had little or no effect on BMD or indices of fat-free (skeletal) muscle mass (low-quality evidence); no data were available on fractures, BMD or functional status and data on bone turnover markers were limited. Trials assessing effects of increasing omega-3, omega-6 and total PUFA on functional status, bone and skeletal muscle strength are limited with data lacking or of low quality. Whilst there is an indication that omega-3 may improve BMD, high-quality RCTs are needed to confirm this and effects on other musculoskeletal outcomes.
Highlights
Decline in musculoskeletal health presents a significant risk to functional ability for older individuals, with concomitant reduction in quality of life, greater demand on health and social care services and higher risk of mortality
Study flow from 37,810 titles and abstracts generated by electronic searches through to our database of 363 Randomised Controlled Trials (RCTs) of at least 6 months duration comparing higher with lower omega-3, omega-6 and/or total polyunsaturated fatty acids (PUFA) intake has been detailed previously [35]
There was a suggestion that increasing total PUFA increased femoral neck bone mineral density (BMD) (MD 0.07 g/cm2, 95% CI 0.03 to 0.1, 1 RCT, 60 participants), but there were no suggested effects at any other site
Summary
Decline in musculoskeletal health presents a significant risk to functional ability for older individuals, with concomitant reduction in quality of life, greater demand on health and social care services and higher risk of mortality. Loss of bone mass starts in adults around 30 to 40 years of age and women in the post-menopausal decade experience a high rate of decline. Together sarcopenia and fractures have high prevalence and economic burden [7, 8] This is predicted to increase so that by 2045, 13% to 22% of those aged > 65 years in Europe will be sarcopenic [9], and 20% of women and 5% of men aged > 50 years will have osteoporosis. As the number of individuals aged ≥ 60 is expected to double worldwide by 2050 [10] development and implementation of effective strategies to reduce the global burden of musculoskeletal decline is critical to avoid unsustainable demands on future health and social care systems. Dietary intervention to reduce or delay musculoskeletal decline may represent a relatively achievable component of such strategies, and it is of particular public health importance to further our understanding of how nutritional factors contribute to musculoskeletal health during ageing
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