Addition Of Omega-3 Fatty Acids Research Articles

Effect of Omega-3 Fatty Acids on Coronary Plaque Morphology - A Serial Computed Tomography Angiography Study.

Omega-3 fatty acids have been proposed to be useful in the prevention of cardiac events. High-risk plaque (HRP) and plaque progression on serial coronary computed tomography angiography (CTA) have been suggested to be the predecessor of acute coronary syndrome (ACS). The purpose of this study was to investigate whether addition of omega-3 fatty acids to statin therapy for secondary prevention would lead to change in plaque characteristics detected by using serial CTA.Methods and Results: This study enrolled 210 patients with ACS: no eicosapentaenoic acid (EPA)/ docosahexaenoic acid (DHA; EPA/DHA), low-dose EPA+DHA, high-dose EPA+DHA, and high-dose EPA alone. HRP was significantly more frequent in patients with plaque progression (P=0.0001). There was a significant interaction between plaque progression and EPA dose regardless of the DHA dose; 20.3% in EPA-none (no EPA/DHA), 15.7% in EPA-low (low-dose EPA+DHA), and 5.6% in EPA-high (high-dose EPA+DHA and high-dose EPA alone). On multivariate logistic regression analysis, HRP (OR 6.44, P<0.0001), EPA-high (OR 0.13, P=0.0004), and Rosvastatin (OR 0.24, P=0.0079) were the independent predictors for plaque progression. In quantitative analyses (n=563 plaques), the interval change of low attenuation plaque (LAP) volume was significantly different based on EPA dose; LAP was significantly increased in the EPA-none group and significantly decreased in the EPA-high group. In patients with ACS, addition of high-dose EPA (EPA-high) to statin therapy, compared to statin therapy without EPA, was associated with a lower rate of plaque progression.

A Fishy Topic: VITAL, REDUCE-IT, STRENGTH, and Beyond: Putting Omega-3 Fatty Acids into Practice in 2021.

To examine recently published data from clinical outcome and arteriographic studies that examined the addition of omega-3 fatty acids, eicosapentaenoic acid (EPA) + docosahexanoic acid (DHA), to standard of care therapy on cardiovascular disease (CVD) risk. Several trials that tested purified EPA (JELIS, REDUCE-IT, EVAPORATE) were associated with reduced CVD risk and regression of low attenuation coronary plaque volume, whereas studies that employed the combination EPA/DHA (VITAL, OMEMI, STRENGTH) failed to derive clinical benefit. Trials testing purified EPA consistently demonstrated reduction in atheromatous volume or CVD events beyond standard of care therapies, whereas the combination of EPA/DHA did not, despite producing similar reductions in triglycerides. Experimental and in vitro data suggest that compared to DHA, EPA exhibits antioxidant, anti-inflammatory, and membrane stabilizing properties that enhance vascular function and CVD risk. Consequently, purified EPA appears to be the treatment of choice for high-risk patients with hypertriglyceridemia.

Features of nutritional support during stem cell transplantation

This article presented a review of the literature on the features of nutritional support for oncohematological patients who have undergone allogeneic (alloHSCT)/autologous hematopoietic stem cell transplantation (autoHSCT). Bone marrow transplantation associated with a high risk of developing nutritional deficiencies. Nutritional support (NP) is indicated for patients undergoing alloHSCT and autoHSCT in order to reduce the incidence of infectious complications and reduce the risk of developing severe forms of acute and chronic GVHD. Currently, there are recommendations for conducting NP in alloHSCT, while there are no recommendations for patients with autoHSCT. An important task in planning NP is the calculation of the daily energy requirement. Bone marrow transplantation accompanied by a prolonged negative nitrogen balance. The protein requirement for alloHSCT is significantly higher than for patients with chemotherapy alone – 1.5–2 g/kg per day. An effective method of controlling the needs of hematological patients during the analysis of HSCT and alloHSCT is the calculation of the nitrogen balance and the daily protein norm. In this article was analyzed the role of macronutrients and immunonutrients in the recovery of patients during alloHSCT. It has been shown that low levels of vitamin D and vitamin A increase the risk of development and the severity of the transplant versus host reaction. The addition of omega-3 fatty acids helps maintain an optimal proportion of calorie intake from lipids, as well as maintain the necessary level of triglycerides in the blood. The article presents data on reducing the risk of developing acute GVHD with systemic addition of omega-3 fatty acids. For a final assessment of the effect of the neutropenic diet on the development of infectious complications in oncohematological patients, randomized prospective multicenter studies with the development of a unified approach in choosing a diet for HSCT are needed.

Can omega-3 fatty acid addition during pregnancy help improve maternal outcomes?

Can omega-3 fatty acid addition during pregnancy help improve maternal outcomes?

Can omega-3 fatty acid addition during pregnancy help improve birth/infant outcomes?

Can omega-3 fatty acid addition during pregnancy help improve birth/infant outcomes?

Omega-3 Fatty Acid Addition During Pregnancy

(Abstracted from Cochrane Database Syst Rev 2018;11:CD003402) Preterm birth is a leading cause of disability or death in the first 5 years of life. Higher intake of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as fish, during pregnancy has been associated with longer gestations and improved perinatal outcomes.

A summary of a Cochrane review: Omega-3 fatty acid addition during pregnancy

A summary of a Cochrane review: Omega-3 fatty acid addition during pregnancy

Omega-3 Fatty Acid Addition During Pregnancy: Summary of a Cochrane Review

Sustainability, i.e. the goal of maintaining a human-ecosystem equilibrium, is a comprehensive topic and suggestive ideal prompted by many current threats from and to humanity, such as climate change, environmental pollution, fatal drug reactions in modern medicine, and the like. Today, sustainable concepts are desperately needed, also in terms of medical treatment. Homeopathy offers an approach of rational and yet innocuous therapeutics, methodically not being reliant on prior animal testing and mass production of drugs, avoiding contamination of soil, air, or water, and toxic side-effects. It is based on a concept of specifically empowering the life-force of the patient to rid itself from pathogenic influences. Homeopathy, as outlined by its founder Samuel Hahnemann, may indeed be understood in a broader sense than just medicinal, and applied in a pedagogical, psychological, and political context as well. A similar methodically related approach may be found in Mahatma Gandhi's strategy of Satyagraha (holding onto truth) which also aims to specifically prompt and compel people to renounce their vices in a sustainable way. Both ways of healing in a moral sense, however, rest on premises whose plausibility has increasingly been questioned in the recent past. Thus, the waning appreciation of Hahnemann's and Gandhi's mindset is mirroring unsettling changes in the world's socioeconomic constitution rather than indicating its putative ineptitude to achieve sustainability on a global scale.

Omega-3 fatty acid addition during pregnancy.

Omega-3 fatty acid addition during pregnancy.

Liver and Nutrition. An Optimal Diet for Non-Alcoholic Fatty Liver Disease

Aim. This review study is aimed at characterizing the nutrition of patients with non-alcoholic fatty liver disease (NAFLD).General findings.A high-calorie diet, followed even for a short period of time, can lead to an increase in the lipid content in hepatocytes and an increase in ALT values. These changes occur much earlier than weight gain, glucose metabolism disorders and other clinically obvious changes. So far, only the Mediterranean diet (or the Mediterranean type of food) has been scientifically confirmed as beneficial for human health. It is recommended for patients with NAFLD both by Russian and international clinical guidelines. The molecular mechanisms of beneficial effects on human health have been confirmed for such Mediterranean diet components as polyphenols, carotenoids, oleic acid, polyunsaturated fatty acids and dietary fiber. The enrichment of the Mediterranean diet with olive oil (+10 g) reduces the risk of diabetes mellitus by 40 %. The addition of Omega-3 fatty acids to food reduces the risk of hepatocellular cancer. A balanced ratio of omega 3 and omega 6 in the diet is more important than the absolute amount of individual fatty acids. Vegetables and fruit contain two main classes of antioxidants: polyphenols and carotenoids. In patients with NAFLD, they exhibit an anti-inflammatory and antifibrotic effect both in vivo and in vitro. Food produced from whole grain has a lower energy potential as compared to that produced from refined grain. Meat contains various nutrients, such as proteins, iron, zinc, B12 vitamin, as well as sodium, saturated fatty acids and cholesterol, which serve as risk factors for the development of NAFLD and other cardio-metabolic disorders. In this paper, we present a clinical observation of a 51-year-old patient with NAFLD and cardio-metabolic disorders. Practical recommendations are given on changes in his lifestyle and the choice of optimal therapy with the application of multifunctional drugs affecting all disease aspects.Conclusion.The concepts of ‘correct or healthy’ nutrition and ‘lifestyle modification’ are increasingly attracting much attention both in terms of the prevention and treatment of liver diseases. Proper nutrition is important for a good life prognosis in patients with non-alcoholic fatty liver disease (NAFLD).

PRM18 - Total Parenteral Nutrition in Asian Countries – A Systematic Literature Review of Cost-Effectiveness Studies

An ever-growing proportion of critically ill adult patients require parenteral nutrition (PN) as a lifesaving therapy when enteral nutrition is inadequate or impossible. It is estimated that PN utilization will significantly grow in Asia Pacific region in the near future. The objective of this study was to evaluate cost-effectiveness of different PN formulations in Asian countries using systematic literature review. The literature search was conducted in PubMed/Medline and Tufts registry. Cost-effectiveness studies assessing different parenteral formulations in malnourished adults in Asian countries were included. Two independent reviewers screened and evaluated studies using the 24-item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Four articles satisfied predefined inclusion criteria. The studies evaluated addition of omega-3 fatty acids (n=2) or structured triglycerides (n=1) to standard lipid emulsions and cost-benefit of a nutritional support team for PN (n=1). The studies were performed in Chinese (n=3) and Japanese (n=1) healthcare contexts. All of the studies analyzed healthcare costs from patients’ perspective over a short time horizon, limited to the length of hospital stay. The most commonly employed model type was discrete event simulation model (n=2). All four studies demonstrated cost-effectiveness of the new technologies vs. standard PN treatment. The mean CHEERS score for the studies was 15 (SD=4.30) and studies mostly failed to justify the choice of model and time horizon. No study reported cost per quality-adjusted life year. The present study demonstrated that only few studies assessed cost-effectiveness of PN in Asian countries. All of them showed that novel PN formulations were cost-effective in comparison to standard treatment. However, a longer time horizon and focus on subgroups with homogenous prognoses are required to provide sufficient evidence and direct PN to “all patients who need it, in a cost-effective manner”, as recommended by World Health Organization.

Chicken surimi fortified by omega-3 fatty acid addition: manufacturing and quality properties.

The meat of spent hens is hard to use owing to its small amount and poor quality. A washing process to remove sarcoplasmic proteins and other impurities can prolong the shelf life of surimi-like products. Owing to the benefits of omega-3 polyunsaturated fatty acids (ω-3 PUFAs), functional foods fortified with ω-3 PUFAs are increasingly being marketed. Hence, in this study, ω-3 FA-fortified chicken surimi was manufactured, and how to ameliorate its lipid peroxidation during frozen storage was investigated. A 0.10% (w/v) solution of sodium chloride (NaCl) instead of distilled water in the third washing step decreased (P < 0.05) myofibrillar protein loss and moisture content of spent hen breast protein recoveries. Oil droplets in fish, flaxseed or soybean oil-added chicken surimi were well distributed. Moreover, flaxseed oil addition increased (P < 0.05) total ω-3 FAs and ω-3/ω-6 FA ratio, while only fish oil provided long-chain PUFAs. Oil addition decreased (P < 0.05) hardness and gumminess of chicken surimi, while flaxseed oil resulted in more (P < 0.05) yellow surimi than fish and soybean oil. Fish oil-added samples showed higher (P < 0.05) lipid oxidation than flaxseed or soybean oil-added samples under -15 to -10 °C storage, but α-tocopherol addition ameliorated it. A novel semi-manufactured chicken surimi product with nutritional benefits could be developed by fortification with fish or flaxseed oil.

Ketogenic Diet Patients’ Lipid Profiles Improved With KetoCal 4:1 Liquid

Objective. The ketogenic diet (KD) can result in hyperlipidemias. We report improvements in the lipid profiles of 3 children who were switched from KetoCal 4:1 powder (formulation prior to fall 2013) to KetoCal 4:1 Liquid formula. Compared with the KetoCal 4:1 powder formulation prior to fall 2013, KetoCal 4:1 Liquid has no trans-fatty acids, reduced saturated fatty acids, added omega-3 fatty acids, and added fiber. Methods. A retrospective chart review revealed 3 patients in our KD program with elevated lipid profiles while receiving 100% of their nutritional needs from KetoCal 4:1 powder. The patients were switched to KetoCal 4:1 Liquid and treated for &gt;3 months. Fasting lipid profiles were obtained before and 2 to 3 months after the formula switch. All patients were on ≥4:1 ratio KD formula. Results. After changing formulas, the lipid profiles of all 3 patients improved. Mean total cholesterol, triglycerides, and low-density lipoprotein were reduced by 29%, 33%, and 58%, respectively. High-density lipoprotein increased by 10% on average. Conclusion. A decrease in lipid levels was observed with the transition to KetoCal 4:1 Liquid after an average of 2.1 months. Changes in dietary fat profile (including addition of omega-3 fatty acids) and the addition of fiber in enteral formulas can positively affect lipid profiles of tube-fed KD patients.

Cost-effectiveness of omega-3 fatty acid supplements in parenteral nutrition therapy in hospitals: A discrete event simulation model

A recent meta-analysis showed that supplementation of omega-3 fatty acids in parenteral nutrition (PN) regimens is associated with a statistically and clinically significant reduction in infection rate, and length of hospital stay (LOS) in medical and surgical patients admitted to the ICU and in surgical patients not admitted to the ICU. The objective of this present study was to evaluate the cost-effectiveness of the addition of omega-3 fatty acids to standard PN regimens in four European countries (Italy, France, Germany and the UK) from the healthcare provider perspective. Using a discrete event simulation scheme, a patient-level simulation model was developed, based on outcomes from the Italian ICU patient population and published literature. Comparative efficacy data for PN regimens containing omega-3 fatty acids versus standard PN regimens was taken from the meta-analysis of published randomised clinical trials (n = 23 studies with a total of 1502 patients), and hospital LOS reduction was further processed in order to split the reduction in ICU stay from that in-ward stays for patients admitted to the ICU. Country-specific cost data was obtained for Italian, French, German and UK healthcare systems. Clinical outcomes included in the model were death rates, nosocomial infection rates, and ICU/hospital LOS. Probabilistic and deterministic sensitivity analyses were undertaken to test the reliability of results. PN regimens containing omega-3 fatty acids were more effective on average than standard PN both in ICU and in non-ICU patients in the four countries considered, reducing infection rates and overall LOS, and resulting in a lower total cost per patient. Overall costs for patients receiving PN regimens containing omega-3 fatty acids were between €14 144 to €19 825 per ICU patient and €5484 to €14 232 per non-ICU patient, translating into savings of between €3972 and €4897 per ICU patient and savings of between €561 and €1762 per non-ICU patient. Treatment costs were completely offset by the reduction in hospital stay costs and antibiotic costs. Sensitivity analyses confirmed the robustness of these findings. These results suggest that the supplementation of PN regimens with omega-3 fatty acids would be cost effective in Italian, French, German and UK hospitals.

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Introduction: Sepsis and septic shock syndrome are one of the leading causes of death in critically ill patients. Lipopolysaccharide (LPS) released by bacteria within the colon can translocate across a compromised lumen, leading to oxidative stress, inflammation, sepsis and eventually death. Traditional enteral feeds are casein based which are thought to be proteo-toxic and can exacerbate these issues. We hypothesized that an enteral formula based on whey-proteins and that are high in cysteine (antioxidant precursor), and the addition of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and prebiotic fructooligosaccharides (FOS) are protective against LPS induced sepsis in a mouse model. Methods: Mice were fed (1) whey peptide based diet with high protein and EPA-DHA (PAF), (2) whey peptide based diet without EPA-DHA (PSTD), or casein based control diet (CONT). Results: We found that mice fed PAF or PSTD were protected against LPS induced weight loss. Whey-based diets suppressed inflammatory cytokine release such as IL-6, TNFα, and IFNγ. Furthermore, whey-based diets were able to limit oxidative stress damage. PAF and PSTD were able to inhibit autophagy, a mechanism in which the cell recycles damaged organelles suggesting less cellular damage. We believe these effects are likely due to whey-proteins ability to activate mTOR a negative regulator for autophagy. These anti-inflammatory and anti-oxidative effects of PSTD and PAF resulted in decreased liver inflammation and intestinal damage and promoted protective microflora within the intestines. Conclusions: Taken together, these data suggest a clinical role for whey-protein based diets in promoting healing and recovery in the critically ill.

Pediatric parenteral admixture compounding in a highly specialized university hospital

Introduction: The aim of this paper is to describe personalized pediatric parenteral admixture compounding in a specialized University Hospital. Materials and methods: Pediatric formulations require small volumes, high concentrations of nutrients and electrolyte micro-additions, thus they must be carefully evaluated by pharmacists and compounded by means of an automatic filling system in a “clean room”. Different kinds of lipid emulsions are used according to the patients’ needs: composite lipids or long and medium chain triglycerides with or without fish oil-based omega-3 fatty acid addition. Admixture stability is defined by determining particle diameter, which must be in the range of 0.4-1.0 µm, like chylomicra, for a safe infusion to patients. Analyses were carried out by means of a laser diffraction technique. Results: In the last 3 years 21,500 personalized pediatric admixtures were compounded (15,480 for children and 6,020 for neonates); the total number of treated patients was 1,700, including 550 neonates. Stability studies pointed out that, in all admixtures, the physicochemical stability did not change between t=0 and t=96 hours and particle diameter was in the expected range of 0.4-1.0 µm provided calcium concentration remained below 9 mEq/L. When calcium exceeded this level, as it is often required for neonates, in the admixtures containing fish oil-based emulsion, 12% of the particles had a diameter larger than 1.0 µm and 2% exceeded 5.0 µm immediately after compounding. Conclusions: Pediatric admixture compounding in a centralized service, and stability studies allowed to prepare any required formulation, providing patients with a safe and effective product. In particular, our analyses pointed out that admixtures containing fish oil-based emulsion and calcium concentrations higher than 9 mEq/L cannot be safely infused to pediatric patients; in these cases it is advisable to infuse the fish oil-based emulsion alone through a second intravenous line.

Does too much sugar make for lost memories?

Does too much sugar make for lost memories?

Tratamiento combinado con fenofibrato. Eficacia

The present article reviews the efficacy of fenofibrate in combination with routinely used lipid-lowering drugs, some oral antidiabetic agents and other drugs in improving lipid profile and reducing cardiovascular risk. Because of its ability to reduce triglyceride (TG) levels and increase high-density lipoprotein-cholesterol (HDL-c), fenofibrate is an effective complementary agent to cholesterol-lowering drugs in the treatment of patients with mixed dyslipidemia or low HDL-c levels. Thus, the addition of fenofibrate to statin therapy produces a complementary reduction in TG of 7%–34%, an additional increase in HCL-c of 2%–20%, a reduction in non-HCL-c of 6%–8% and an increase in the proportion of large/small LDL particle subspecies in comparison with statin therapy alone. In the subgroup of patients in the ACCORD study with TG ≥ 204mg/dL and HDL-c ≤ 34mg/dL, fenofibrate contributed to the reduction in cardiovascular risk. These results have been corroborated by two recent meta-analyses of the main studies with fibrates. The combination of fenofibrate and ezetimibe produced greater reductions in non-HDL-c, apoB and C-reactive protein than that produced by either of these two drugs alone. The addition of omega-3 fatty acids to fenofibrate significantly reduced TG levels by 17.5%–28%. The combination of fenofibrate and metformin allowed TG and HDL-c to return to normal levels in 50% and 35%, respectively. Fenofibrate also reduces hypertriglyceridemia if combined with pioglitazone.

From the Editor

The addition of omega-3 fatty acids to our diet via the ingestion of more fish and certain vegetable products has been touted for many years. The authors of two large clinical trials documenting reduced cardiovascular events with relatively small doses (0.85 grams per day in the Gissi II trial and 1.8 grams per day in the JELIS study) have provided the strongest evidence for supplements if necessary to assure the consumption of 0.5 to 1 gram per day for all adults. We now have various preparations of omega-3 fatty acids that provide such doses in one or two capsules per day. One omega-3 preparation has been approved as a prescription agent in the case of ethyl esters of eicosapentanoic acid and docosahexaenoic acid derived from fish. The only specific indication for this preparation is reducing triglyceride concentrations in excess of 500 mg/dL to prevent pancreatitis. The Food and Drug Administration has not recognized the vascular effects. New preparations of these fats are being tested in clinical trials to show safety and efficacy in reducing triglycerides. Dr. Maki reports studies with one of these preparations in conjunction with atorvastatin in patients with hypertriglyceridemia in this issue of the Journal. The clinical use of omega-3 fatty acids as prescription agents and the current efforts to add to the number of preparations available to clinicians is also discussed in some detail by three experts in the Roundtable in this issue.

Treatment of Aspirin-Resistant Patients with Omega-3 Fatty Acids versus Aspirin Dose Escalation

Conclusion: Aspirin resistance can be treated by increasing the aspirin dose or adding omega-3 fatty acids. Summary: There is a wide interindividual variability in aspirin response (Circulation 2002;105:1650-5). The prevalence of aspirin resistance or low response is estimated to be <1% to 45%. Aspirin resistance is associated with an odds ratio of almost 4 for development of cardiovascular events (BMJ 2008;336:195-8). It is unclear whether increasing the dose in patients with aspirin resistance will provide adequate antiplatelet effects or if an alternative strategy, such as adding additional substances that would inhibit the cyclooxygenase (COX)-1 pathway, would be effective. Omega-3 fatty acids, components of dietary fish oil, lead to replacement of n-6 fatty acids, such as arachidonic acid (AA), by n-3 fatty acids in cell membranes. This leads to an increase in eicosapentaenoic acid (EPA). EPA competes with AA as a substrate of the COX-1 pathway, leading to inhibition of collagen-induced platelet aggregation and mild prolongation of bleeding time (Am J Clin Nutr 1997;65:1687-98s). The authors sought to determine whether addition of omega-3 fatty acids or increases in aspirin dose improves response to low-dose aspirin among aspirin-resistant patients. There were 485 patients with stable coronary artery disease treated with 75 to 162 mg of aspirin daily for at least 1 week screened for aspirin response with the VerifyNow Aspirin Assay. Aspirin resistance was defined by ≥2 of 3 criteria; VerifyNow score >550, 0.5 mg/mL AA-induced aggregation ≥20%, and 10 μmol/L adenosine diphosphate (ADP)-induced aggregation ≥70%. Thirty patients (6.2%) were aspirin-resistant and were randomized to receive either low-dose aspirin plus omega-3 fatty acids or aspirin at 325 mg/d. Patients were retested for aspirin activity 30 days later. After treatment, there were significant reductions in VerfiyNow scores and in AA-induced and ADP-induced platelet aggregation. Thromboxane B2 was also reduced in both groups (39.6% decrease in the aspirin group and 56.8% reduction in the omega-3 fatty acid group). After treatment, 12 patients (80%) who received omega-3 fatty acid and 11 (73%) who received aspirin at 325-mg doses were no longer aspirin-resistant. Comment: The article potentially provides a therapeutic approach to managing and overcoming aspirin resistance in patients treated with low-dose aspirin. One can either increase the aspirin dose or add omega-3 fatty acids to overcome aspirin resistance. The study is a pharmacologic study only. Larger studies will be required to assess whether the addition of omega-3 fatty acids to low-dose aspirin will translate into a clinical benefit in patients with cardiovascular disease resistant to low-dose aspirin. Given that many patients cannot tolerate 325 mg of aspirin daily, one wonders if there is any downside to just adding omega-3 fatty acids to the medication regimen of patients treated with low-dose aspirin?