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Nutrients 2017, 9(12), 1305; doi:10.3390/nu9121305

Effects of Omega-3 Long Chain Polyunsaturated Fatty Acid Supplementation on Cardiovascular Mortality: The Importance of the Dose of DHA

1
School of Medicine, Lipid Research Centre, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
2
Welten Institute―Research Centre for Learning, Teaching, and Technology, Open University of The Netherlands, 6419 AT Heerlen, The Netherlands
3
Department of Complex Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands
*
Author to whom correspondence should be addressed.
Received: 21 September 2017 / Revised: 16 November 2017 / Accepted: 24 November 2017 / Published: 30 November 2017
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Abstract

Recent evidence on the relationship between omega-3 long chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation and cardiovascular health suggests that n-3 LCPUFA may no longer be efficacious. This review summarises the randomised controlled trials (RCTs) that assess the effect of n-3 LCPUFA supplementation on cardiovascular mortality. It appears that in the RCTs that showed no effect of n-3 LCPUFA on cardiovascular mortality, the dose of n-3 LCPUFA (in particular docosahexaenoic acid (DHA)) and hence the n-3 LCPUFA status, may not have been sufficiently high to demonstrate the efficacy, and/or the baseline n-3 LCPUFA status was already too high. The intention-to-treat analysis (ITT) is the gold standard for analysing RCTs and ITT is used for drug intervention trials where exposure to the drug versus no drug exposure provides two clearly distinct groups to determine the efficacy of the drug being studied. This differs in nutrition trials as often the nutrient of interest being studied is already being consumed by both groups (placebo and active) and therefore a true placebo group with absolutely no intake of the nutrient being studied is highly unlikely. Therefore, in n-3 LCPUFA supplementation trials, as there is no clear distinction between the two groups (placebo and n-3 LCPUFA), a per-protocol analysis (comparison of groups that includes only those participants that fully completed the original intervention allocation) should be conducted in addition to ITT analysis. Furthermore, blood analysis pre- and post-supplementation should be conducted to ensure that: (1) that the baseline n-3 status is not too high, in order to alleviate a potential ceiling effect; and (2) that the dose is high enough and hence the increase in omega-3 status will be high enough in order to assess the efficacy of n-3 LCPUFA supplementation. View Full-Text
Keywords: omega-3; long chain polyunsaturated fatty acids; cardiovascular disease; randomised controlled trials; dose of omega-3; omega-3 status omega-3; long chain polyunsaturated fatty acids; cardiovascular disease; randomised controlled trials; dose of omega-3; omega-3 status
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MDPI and ACS Style

Meyer, B.J.; Groot, R.H.M. Effects of Omega-3 Long Chain Polyunsaturated Fatty Acid Supplementation on Cardiovascular Mortality: The Importance of the Dose of DHA. Nutrients 2017, 9, 1305.

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