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n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits.
n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits.
Gebauer SK, Psota TL, Harris WS, Kris-Etherton PM.
Am J Clin Nutr. 2006 Jun;83(6 Suppl):1526S-1535S. Review.
PMID: 16841863
Dietary recommendations have been made for n–3 fatty acids, including {alpha}-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) to achieve nutrient adequacy and to prevent and treat cardiovascular disease. These recommendations are based on a large body of evidence from epidemiologic and controlled clinical studies. The n–3 fatty acid recommendation to achieve nutritional adequacy, defined as the amount necessary to prevent deficiency symptoms, is 0.6–1.2% of energy for ALA; up to 10% of this can be provided by EPA or DHA. To achieve recommended ALA intakes, food sources including flaxseed and flaxseed oil, walnuts and walnut oil, and canola oil are recommended. The evidence base supports a dietary recommendation of {approx}500 mg/d of EPA and DHA for cardiovascular disease risk reduction. For treatment of existing cardiovascular disease, 1 g/d is recommended. These recommendations have been embraced by many health agencies worldwide. A dietary strategy for achieving the 500-mg/d recommendation is to consume 2 fish meals per week (preferably fatty fish). Foods enriched with EPA and DHA or fish oil supplements are a suitable alternate to achieve recommended intakes and may be necessary to achieve intakes of 1 g/d.
Intake of Fish and n3 Fatty Acids and Risk of Coronary Heart Disease Among Japanese: The Japan Public Health Center-Based (JPHC) Study Cohort I -- Iso et al. 113 (2): 195 -- Circulation
Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I.
Iso H, Kobayashi M, Ishihara J, Sasaki S, Okada K, Kita Y, Kokubo Y, Tsugane S; JPHC Study Group.
Circulation. 2006 Jan 17;113(2):195-202. Epub 2006 Jan 9.
PMID: 16401768
doi: 10.1161/CIRCULATIONAHA.105.581355
Conclusions— Compared with a modest fish intake of once a week or &20 g/d, a higher intake was associated with substantially reduced risk of coronary heart disease, primarily nonfatal cardiac events, among middle-aged persons.
Fish Oil-Derived Fatty Acids, Docosahexaenoic Acid and Docosapentaenoic Acid, and the Risk of Acute Coronary Events : The Kuopio Ischaemic Heart Disease Risk Factor Study -- Rissanen et al. 102 (22): 2677 -- Circulation
Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events: the Kuopio ischaemic heart disease risk factor study.
Rissanen T, Voutilainen S, Nyyssönen K, Lakka TA, Salonen JT.
Circulation. 2000 Nov 28;102(22):2677-9.
PMID: 11094031
Methods and Results—We studied this association in the Kuopio Ischaemic Heart Disease Risk Factor Study, a prospective population study in Eastern Finland. Subjects were randomly selected and included 1871 men aged 42 to 60 years who had no clinical coronary heart disease at baseline examination. A total of 194 men had a fatal or nonfatal acute coronary event during follow-up. In a Cox proportional hazards’ model adjusting for other risk factors, men in the highest fifth of the proportion of serum DHA+DPA in all fatty acids had a 44% reduced risk (P=0.014) of acute coronary events compared with men in the lowest fifth. Men in the highest fifth of DHA+DPA who had a low hair content of mercury (<=2.0 µg/g) had a 67% reduced risk (P=0.016) of acute coronary events compared with men in the lowest fifth who had a high hair content of mercury (>2.0 µg/g). There was no association between proportion of eicosapentaenoic acid and the risk of acute coronary events.
Conclusions—Our data provide further confirmation for the concept that fish oil–derived fatty acids reduce the risk of acute coronary events. However, a high mercury content in fish could attenuate this protective effect.
Fish Consumption Shifts Lipoprotein Subfractions to a Less Atherogenic Pattern in Humans -- Li et al. 134 (7): 1724 -- Journal of Nutrition
Fish consumption shifts lipoprotein subfractions to a less atherogenic pattern in humans.
Li Z, Lamon-Fava S, Otvos J, Lichtenstein AH, Velez-Carrasco W, McNamara JR, Ordovas JM, Schaefer EJ.
J Nutr. 2004 Jul;134(7):1724-8.
PMID: 15226460
The effect of fish consumption on plasma lipoprotein subfraction concentrations was studied in 22 men and women (age > 40 y). Subjects were provided an average American diet (AAD, 35% of energy as fat, 14% as saturated fat, and 35 mg cholesterol/MJ) for 6 wk before being assigned to a National Cholesterol Education Program (NCEP) Step 2 high-fish diet (n = 11, 26% of energy as fat, 4.5% as saturated fat, and 15 mg cholesterol/MJ) or a NCEP Step 2 low-fish diet (n = 11, 26% of energy as fat, 4.0% as saturated fat, and 11 mg cholesterol/MJ) for 24 wk. All food and drink were provided to study participants. Consumption of the high-fish NCEP Step 2 diet was associated with a significant reduction in medium and small VLDL, compared with the AAD diet, whereas the low-fish diet did not affect VLDL subfractions. Both diets significantly reduced LDL cholesterol concentrations, without modifying LDL subfractions. Both diets also lowered HDL cholesterol concentrations. However, the high-fish diet significantly lowered only the HDL fraction containing both apolipoprotein (apo) AI and AII (LpAI:AII) and did not change HDL subfractions assessed by NMR, whereas the low-fish diet significantly lowered the HDL fraction containing only apo AI (LpAI) and the large NMR HDL fractions, resulting in a significant reduction in HDL particle size. Neither diet affected VLDL and LDL particle size. Our data indicate that within the context of a diet restricted in fat and cholesterol, a higher fish content favorably affects VLDL and HDL subspecies
Clinical Prevention of Sudden Cardiac Death by n-3 Polyunsaturated Fatty Acids and Mechanism of Prevention of Arrhythmias by n-3 Fish Oils -- Leaf et al. 107 (21): 2646 -- Circulation
Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils.
Leaf A, Kang JX, Xiao YF, Billman GE.
Circulation. 2003 Jun 3;107(21):2646-52. Review.
PMID: 12782616
doi: 10.1161/01.CIR.0000069566.78305.33
This review will be limited specifically to the beneficial prevention by the n-3 polyunsaturated fatty acids (PUFAs) of arrhythmic deaths, including sudden cardiac death, which annually causes some 300 000 deaths in the United States and millions more worldwide. We will also show that the growing body of positive clinical studies is supported by what has been learned in animal and laboratory studies regarding the mechanism by which n-3 PUFAs prevent cardiac arrhythmias.
n-3 Fatty acids and cardiovascular disease -- Breslow 83 (6): S1477 -- American Journal of Clinical Nutrition
n-3 fatty acids and cardiovascular disease.
Breslow JL.
Am J Clin Nutr. 2006 Jun;83(6 Suppl):1477S-1482S. Review.
PMID: 16841857
The results of prospective cohort studies indicate that consuming fish or fish oil containing the n–3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is associated with decreased cardiovascular death, whereas consumption of the vegetable oil–derived n–3 fatty acid {alpha}-linolenic acid is not as effective. Randomized control trials (RCTs) in the context of secondary prevention also indicate that the consumption of EPA plus DHA is protective at doses <1 g/d. The therapeutic effect appears to be due to suppression of fatal arrhythmias rather than stabilization of atherosclerotic plaques. At doses >3 g/d, EPA plus DHA can improve cardiovascular disease risk factors, including decreasing plasma triacylglycerols, blood pressure, platelet aggregation, and inflammation, while improving vascular reactivity. Mainly on the basis of the results of RCTs, the American Heart Association recommends that everyone eat oily fish twice per week and that those with coronary heart disease eat 1 g/d of EPA plus DHA from oily fish or supplements. Directions for future research include 1) RCTs to confirm the initial trials showing that EPA plus DHA decreases cardiovascular death and additional studies to determine whether this effect is due to EPA, DHA, or the combination; the dosage of the effective components; and whether the mechanism of action in humans is prevention of fatal arrhythmias. 2) Clinical studies to determine whether the reduction in cardiovascular disease risk factors is due to EPA, DHA, or the combination and the dosage of the effective components. 3) Clinical studies to determine whether vegetable oil–derived {alpha}-linolenic acid added to a diet enriched in n–6 fatty acids can effectively substitute for fish oil–derived EPA plus DHA.
Fish Intake and Risk of Incident Atrial Fibrillation -- Mozaffarian et al. 110 (4): 368 -- Circulation
Fish intake and risk of incident atrial fibrillation.
Mozaffarian D, Psaty BM, Rimm EB, Lemaitre RN, Burke GL, Lyles MF, Lefkowitz D, Siscovick DS.
Circulation. 2004 Jul 27;110(4):368-73. Epub 2004 Jul 19.
PMID: 15262826
doi: 10.1161/01.CIR.0000138154.00779.A5
Conclusions— Among elderly adults, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower incidence of AF. Fish intake may influence risk of this common cardiac arrhythmia.
Cardiac Benefits of Fish Consumption May Depend on the Type of Fish Meal Consumed: The Cardiovascular Health Study -- Mozaffarian et al. 107 (10): 1372 -- Circulation
Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study.
Mozaffarian D, Lemaitre RN, Kuller LH, Burke GL, Tracy RP, Siscovick DS; Cardiovascular Health Study.
Circulation. 2003 Mar 18;107(10):1372-7.
PMID: 12642356
doi: 10.1161/01.CIR.0000055315.79177.16
Conclusions— Among adults aged >=65 years, modest consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower risk of IHD death, especially arrhythmic IHD death. Cardiac benefits of fish consumption may vary depending on the type of fish meal consumed.
Effect of Fish Oil on Heart Rate in Humans: A Meta-Analysis of Randomized Controlled Trials -- Mozaffarian et al. 112 (13): 1945 -- Circulation
Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials.
Mozaffarian D, Geelen A, Brouwer IA, Geleijnse JM, Zock PL, Katan MB.
Circulation. 2005 Sep 27;112(13):1945-52. Epub 2005 Sep 19.
PMID: 16172267
doi: 10.1161/CIRCULATIONAHA.105.556886
Conclusions— In randomized controlled trials in humans, fish oil reduces HR, particularly in those with higher baseline HR or longer treatment duration. These findings provide firm evidence that fish oil consumption directly or indirectly affects cardiac electrophysiology in humans. Po
n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects -- Jung et al. 87 (6): 2003S -- American Journal of Clinical Nutrition
n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects.
Jung UJ, Torrejon C, Tighe AP, Deckelbaum RJ.
Am J Clin Nutr. 2008 Jun;87(6):2003S-9S.
PMID: 18541602
Dietary n–3 fatty acids, particularly eicosapentaenoic acid and docosahexaenoic acid, are important nutrients through the life cycle. Evidence from observational, clinical, animal, and in vitro studies indicates a beneficial role of n–3 fatty acids in the prevention and management of cardiovascular disease. Although the precise mechanisms are still unclear, clinical and preclinical studies indicate that the cardioprotective effects of n–3 fatty acids may be attributed to a number of distinct biological effects on lipid and lipoprotein metabolism, blood pressure, platelet function, arterial cholesterol delivery, vascular function, and inflammatory responses.
Substantial evidence supports n–3 fatty acids as a practical, therapeutic adjuvant for promoting cardiovascular health and preventing and treating disease. n–3 Fatty acids modulate a number of important physiologic responses that can contribute to their cardioprotective effects. The multiple and complex mechanisms through which DHA and EPA exert their action appear to be distinct but also complementary. However, more studies are needed to quantify their protective effects and to define exact mechanisms of action.
Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease -- Erkkilä et al. 80 (3): 626 -- American Journal of Clinical Nutrition
Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease.
Erkkilä AT, Lichtenstein AH, Mozaffarian D, Herrington DM.
Am J Clin Nutr. 2004 Sep;80(3):626-32.
PMID: 15321802
Conclusions: Consumption of fish is associated with a significantly reduced progression of coronary artery atherosclerosis in women with coronary artery disease.
The Effect of Select Nutrients on Serum High-Density Lipoprotein Cholesterol and Apolipoprotein A-I Levels -- Mooradian et al. 27 (1): 2 -- Endocrine Reviews
The effect of select nutrients on serum high-density lipoprotein cholesterol and apolipoprotein A-I levels.
Mooradian AD, Haas MJ, Wong NC.
Endocr Rev. 2006 Feb;27(1):2-16. Epub 2005 Oct 21. Review.
PMID: 16243964
One of the factors contributing to the increased risk of developing premature atherosclerosis is low plasma concentrations of high-density lipoprotein (HDL) cholesterol (HDLc). Multiple potential mechanisms account for the cardioprotective effects of HDL and its main protein apolipoprotein A-I (apo A-I). The low plasma concentrations of HDL could be the result of increased fractional clearance and reduced expression of apo A-I. To this end, nutrients play an important role in modulating the fractional clearance rate, as well as the rate of apo A-I gene expression. Because medical nutrition therapy constitutes the cornerstone of management of dyslipidemias, it is essential to understand the mechanisms underlying the changes in HDL level in response to alterations in dietary intake. In this review, we will discuss the effect of select nutrients on serum HDLc and apo A-I levels. Specifically, we will review the literature on the effect of carbohydrates, fatty acids, and ketones, as well as some of the nutrient-related metabolites, such as glucosamine and the prostanoids, on apo A-I gene expression. Because there are multiple mechanisms involved in the regulation of serum HDLc levels, changes in gene transcription do not necessarily correlate with clinical observations on serum levels of HDLc.
NEJM -- Fish Consumption and the 30-Year Risk of Fatal Myocardial Infarction
Fish consumption and the 30-year risk of fatal myocardial infarction.
Daviglus ML, Stamler J, Orencia AJ, Dyer AR, Liu K, Greenland P, Walsh MK, Morris D, Shekelle RB.
N Engl J Med. 1997 Apr 10;336(15):1046-53.
PMID: 9091800
Conclusions These data show an inverse association between fish consumption and death from coronary heart disease, especially nonsudden death from myocardial infarction.
NEJM -- Mercury, Fish Oils, and the Risk of Myocardial Infarction
Mercury, fish oils, and the risk of myocardial infarction.
Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, Aro A, Gómez-Aracena J, Kark JD, Riemersma RA, Martín-Moreno JM, Kok FJ; Heavy Metals and Myocardial Infarction Study Group.
N Engl J Med. 2002 Nov 28;347(22):1747-54.
PMID: 12456850
Conclusions The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.
NEJM -- Mercury and the Risk of Coronary Heart Disease in Men
Mercury and the risk of coronary heart disease in men.
Yoshizawa K, Rimm EB, Morris JS, Spate VL, Hsieh CC, Spiegelman D, Stampfer MJ, Willett WC.
N Engl J Med. 2002 Nov 28;347(22):1755-60.
PMID: 12456851
Conclusions Our findings do not support an association between total mercury exposure and the risk of coronary heart disease, but a weak relation cannot be ruled out.
Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis - J Intern Med. 2000 Nov - Wiley InterScience :: Article :: HTML Full Text
Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis.
Salonen JT, Nyyssönen K, Salonen R, Lakka HM, Kaikkonen J, Porkkala-Sarataho E, Voutilainen S, Lakka TA, Rissanen T, Leskinen L, Tuomainen TP, Valkonen VP, Ristonmaa U, Poulsen HE.
J Intern Med. 2000 Nov;248(5):377-86.
PMID: 11123502
DOI: 10.1046/j.1365-2796.2000.00752.x
Conclusions. Our study shows that a combined supplementation with reasonable doses of both vitamin E and slow-release vitamin C can retard the progression of common carotid atherosclerosis in men. This may imply benefits with regard to other atherosclerosis-based events.
Six-Year Effect of Combined Vitamin C and E Supplementation on Atherosclerotic Progression: The Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study -- Salonen et al. 107 (7): 947 -- Circulation
Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression: the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study.
Salonen RM, Nyyssönen K, Kaikkonen J, Porkkala-Sarataho E, Voutilainen S, Rissanen TH, Tuomainen TP, Valkonen VP, Ristonmaa U, Lakka HM, Vanharanta M, Salonen JT, Poulsen HE; Antioxidant Supplementation in Atherosclerosis Prevention Study.
Circulation. 2003 Feb 25;107(7):947-53.
PMID: 12600905
doi: 10.1161/01.CIR.0000050626.25057.51
Conclusions— These data replicate our 3-year findings confirming that the supplementation with combination of vitamin E and slow-release vitamin C slows down atherosclerotic progression in hypercholesterolemic persons.
Dark Chocolate Consumption Increases HDL Cholesterol Concentration and Chocolate Fatty Acids May Inhibit Lipid Peroxidation in Healthy Humans - ScienceDirect - Free Radical Biology and Medicine
Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans.
Mursu J, Voutilainen S, Nurmi T, Rissanen TH, Virtanen JK, Kaikkonen J, Nyyssönen K, Salonen JT.
Free Radic Biol Med. 2004 Nov 1;37(9):1351-9.
PMID: 15454274
doi:10.1016/j.freeradbiomed.2004.06.002
Cocoa polyphenols may increase the concentration of HDL cholesterol, whereas chocolate fatty acids may modify the fatty acid composition of LDL and make it more resistant to oxidative damage.
High dietary methionine intake increases the risk of acute coronary events in middle-aged men
High dietary methionine intake increases the risk of acute coronary events in middle-aged men.
Virtanen JK, Voutilainen S, Rissanen TH, Happonen P, Mursu J, Laukkanen JA, Poulsen H, Lakka TA, Salonen JT.
Nutr Metab Cardiovasc Dis. 2006 Mar;16(2):113-20. Epub 2005 Nov 2.
PMID: 16487911
doi:10.1016/j.numecd.2005.05.005
Conclusions
The main finding of this study is that long-term, moderately high dietary methionine intake may increase the risk of acute coronary events in middle-aged Finnish men free of prior CHD. More prospective research is needed to confirm the role of dietary methionine in the development of CVD, and whether its effects are independent of homocysteine.
Fish consumption and risk of major chronic disease in men -- Virtanen et al. 88 (6): 1618 -- American Journal of Clinical Nutrition
Fish consumption and risk of major chronic disease in men.
Virtanen JK, Mozaffarian D, Chiuve SE, Rimm EB.
Am J Clin Nutr. 2008 Dec;88(6):1618-25.
PMID: 19064523
doi:10.3945/ajcn.2007.25816
Conclusions: Modest fish consumption was associated with a lower risk of total cardiovascular disease, consistent with cardiac mortality benefits but not with total cancer or overall major chronic disease; n–6 fatty acid consumption did not influence these relations.
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