Omega-3 Fatty Acids EPA and DHA: Health
Benefits Throughout Life
and Shaker A. Mousa
The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY;
Department of Community and
Preventive Medicine, and Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY;
College of Medicine, King Saud University, Riyadh, Saudi Arabia
Omega-3 [(n-3)] fatty acids have been linked to healthy aging throughout life. Recently, ﬁsh-derived omega-3 fatty acids EPA and DHA have been
associated with fetal development, cardiovascular function, and Alzheimer’s disease. However, because our bodies do not efficiently produce
some omega-3 fatty acids from marine sources, it is necessary to obtain adequate amounts through fish and fish-oil products. Studies have
shown that EPA and DHA are important for proper fetal development, including neuronal, retinal, and immune function. EPA and DHA may affect
many aspects of cardiovascular function including inflammation, peripheral artery disease, major coronary events, and anticoagulation. EPA and
DHA have been linked to promising results in prevention, weight management, and cognitive function in those with very mild Alzheimer’s
disease. Adv. Nutr. 3: 1–7, 2012.
Omega-3 [(n-3)] long-chain PUFA, including EPA and
DHA, are dietary fats with an array of health beneﬁts (1).
They are incorporated in many parts of the body including
cell membranes (2) and play a role in antiinﬂammatory pro-
cesses and in the viscosity of cell membranes (3,4). EPA and
DHA are essential for proper fetal development and healthy
aging (5). DHA is a key component of all cell membranes
and is found in abundance in the brain and retina (6).
EPA and DHA are also the precursors of several metabolites
that are potent lipid mediators, considered by many investi-
gators to be beneﬁcial in the prevention or treatment of sev-
eral diseases (7).
It can be challenging to get the appropriate intake of EPA
and DHA through diet alone, even though EPA and DHA
are produced by water plants such as algae and are prevalent
in marine animals. A shorter chain omega-3 fatty acid, a-li-
nolenic acid (ALA),
is a prominent component of our diet
as it is found in many land plants that are commonly eaten,
but it does not provide the health benefits seen with EPA and
DHA. Although it is possible for the body to convert ALA to
EPA and DHA by enlongase and desaturase enzymes, re-
search suggests that only a small amount can be synthesized
in the body from this process (8). For example, 1 study sug-
gested that only w2 to 10% of ALA is converted to EPA or
DHA (9), and other studies found even less: Goyens et al.
(10) found an ALA conversion of w7% for EPA, but only
0.013% for DHA; Hussein et al. (11) found an ALA conver-
sion of only 0.3% for EPA and <0.01% for DHA.
The current American diet has changed over time to be
high in SFA and low in omega-3 fatty acids (12). This change
in eating habits is centered on fast food containing high
amounts of saturated fat, which has small amounts of essen-
tial omega-3 PUFA compared with food prepared in the
home (13). Seafood sources such as ﬁsh and ﬁsh-oil supple-
ments are the primary contributors of the 2 biologically im-
portant dietary omega-3 fatty acids, EPA and DHA (14–16).
This low intake of dietary EPA and DHA is thought to be as-
sociated with increased inflammatory processes as well as
poor fetal development, general cardiovascular health, and
risk of the development of Alzheimer’s disease (AD).
This review focuses on the many beneﬁts of EPA and
DHA supplementation throughout life, including use during
pregnancy for proper fetal development and full-term gesta-
tion, to reduce many cardiovascular issues, and potential
uses in AD.
Supported by the Pharmaceutical Research Institute and in part by grant 10-NAN1034-02
from the Long-Term Comprehensive National Plan for Science, Technology and Innovation,
King Saud University, Kingdom of Saudi Arabia.
Author disclosures: D. Swanson, R. Block, and S.A. Mousa, no conflicts of interest.
* To whom correspondence should be addressed: E-mail: email@example.com.
Abbreviations used: AD, Alzheimer’s disease; ALA, a-linolenic acid; CRP, C-reactive protein;
MMSE, Mini-Mental State Examination; PAD, peripheral arterial disease.
ã2012 American Society for Nutrition. Adv. Nutr. 3: 1–7, 2012; doi:10.3945/an.111.000893. 1
Omega-3 fatty acids and fetal development
Maternal nutrition guidelines have always stressed a diet in-
cluding sufﬁcient caloric and protein requirements, but re-
cently fatty acids have also been deemed important (17).
This is partially due to the fact that EPA and DHA supple-
mentation during pregnancy has been associated with mul-
tiple beneﬁts for the infant (Table 1). During pregnancy, the
placenta transfers nutrients, including DHA, from the
mother to the fetus (18). The amount of omega-3 fatty
acid in the fetus is correlated with the amount ingested by
the mother, so it is essential that the mother has adequate
nutrition (19). The 2010 U.S. Department of Health and
Human Services dietary guidelines recommend that women
who are pregnant or breastfeeding should “consume 8 to 12
ounces of seafood per week from a variety of seafood types”
(12). Ingesting 8–12 oz of seafood per week, depending on
the type of fish, is equivalent to w300–900 mg EPA+DHA
per day. Unfortunately, this amount is not being met by
most mothers in the United States and Canada, which
means that infants many not be receiving adequate amounts
of these vital nutrients in the womb (20).
Several studies conﬁrmed the beneﬁt of omega-3 supple-
mentation during pregnancy in terms of proper develop-
ment of the brain and retina. Of the 2 most important
long-chain omega-3 fatty acids, EPA and DHA, DHA is
the more important for proper cell membrane function
and is vital to the development of the fetal brain and retina
(17). During the third trimester, vast amounts of DHA accu-
mulate in fetal tissue (20). The 2 most inﬁltrated fetal areas
include the retina and brain, which may correlate with nor-
mal eyesight and brain function (19). A study by Judge et al.
(20) found that children whose mothers had taken DHA
supplementation during pregnancy (n= 29) had signifi-
cantly better problem-solving skills at 9 mo old (P=
0.017) than those whose mothers had not taken DHA sup-
plementation during pregnancy (n= 15). Another study
provided a cognitive assessment of children 2.5 y after
maternal EPA+DHA supplementation during pregnancy
from 20 wk of gestation until delivery (n= 33) compared
with children in a placebo group (n= 39). Children in the
EPA + DHA–supplemented group attained significantly higher
scores for eye and hand coordination [mean score, 114
TABLE 1. Studies involving omega-3 fatty acid supplementation and pregnancy
No. of pregnant
Omega-3 fatty acids
assessed and amounts
Judge et al. (20) Double-blind,
29 DHA (average
consumption 1500 mg/wk
DHA (n= 14, gestation
week 24 until birth)
vs. placebo (n= 15)
Maternal DHA intake was associated
with enhanced infant problem-solving
skills but not recognition skills
at 9 mo old
Dunstan et al. (19) Double-blind,
98 DHA (2.2 g/d) and EPA
(1.1 g/d) (gestation
week 20 until birth)
vs. placebo (n= 39)
At 2.5 y old, children (n= 32) whose
mothers were supplemented had
significantly better scores of hand
and eye coordination
Olsen et al. (23) Randomized clinical
n= 435 supplemented,
n= 463 placebo
capsules with 2.7 g/d
Supplementation delayed onset of
delivery in subjects who had
experienced preterm delivery in
previous pregnancies and were
classified as low and medium fish
Olsen et al. (21) Placebo-controlled,
Supplemented (n= 263)
vs. placebo (n= 136)
capsules daily, 2.7 g/d
Supplementation during pregnancy
was associated with a decreased
incidence of asthma in the children
at 16 y old
Makrides et al. (25) Double-blind,
2399 (n= 1197
n= 1202 placebo;
726 children were
followed up with)
DHA (ﬁsh-oil capsules
providing 800 mg/d DHA)
Supplementation did not result
in lower levels of postpartum
depression in mothers or
improved cognitive and language
development in offspring during
Krauss-Etschmann et al. (26) Double-blind,
311 DHA+EPA daily with either
fish oil with DHA (0.5 g)
and EPA (0.15 g) or with
(400 mg), both, or placebo,
from gestation week 22
Fish-oil supplementation was
associated with decreased levels
of maternal inflammatory/T
cytokines and a decrease of fetal
Furuhjelm et al. (27) Placebo-controlled,
145 DHA+EPA daily with
either DHA (1.1 g) and
EPA (1.6 g), or placebo,
given from gestation
week 25 to an average
3–4 mo of breastfeeding
At 1 y old, infants whose mothers
were supplemented had a
decreased risk of food allergy
and IgE-associated eczema
2 Swanson et al.
(SD 10.2] than those in the placebo group [mean score, 108
(SD 11.3)] (P= 0.021, adjusted P= 0.008) (19).
Of great clinical importance, EPA and DHA supplemen-
tation during pregnancy has been associated with longer
gestation and increased concentrations of EPA and DHA
in fetal tissues (21). In 2005, preterm births accounted for
12.7% of all births in the United States, increasing the like-
lihood of health complications (22). Carrying a baby to term
is very important because prematurity is the cause of various
infant diseases and can lead to death; preterm delivery is an
underlying factor for 85% of the deaths of normally formed
infants (23). One mechanism by which EPA and DHA may
decrease the incidence of preterm birth is by decreasing
and prostaglandin F
fore reducing inflammation within the uterus, which could
be associated with preterm labor (21,24). Several studies in-
vestigated EPA and DHA intake during pregnancy and its
correlation with longer gestation. Conclusions were that
EPA+DHA supplementation during pregnancy delayed the
onset of delivery to term or closer to term; however, supple-
mentation did not delay delivery to the point of being post-
term (20,23,25). This supports the evidence that EPA+DHA
ingestion leads to optimal pregnancy length. EPA+DHA
supplementation reduced the HR of preterm delivery by
44% (95% CI: 14–64%) in those who consumed relatively
low amounts of fish and 39% (95% CI: 16–56%) in those
who consumed medium amounts of fish; however, a level
of statistical significance was not met (P= 0.10) (23). The
Judge et al. (20) study found that women who had DHA
supplementation from gestation week 24 until full-term de-
livery carried their infants significantly (P= 0.019) longer
than did the women in the placebo group. One study found
that DHA supplementation after gestation week 21 led to
fewer preterm births (<34 wk of gestation) in the DHA
group compared with the control group (1.09% vs. 2.25%;
adjusted RR, 0.49; 95% CI: 0.25–0.94; P= 0.03). Also, mean
birth weight was 68 g heavier (95% CI: 23–114 g; P=
0.003) and fewer infants were of low birth weight in the
DHA group compared with the control group (3.41% vs.
5.27%; adjusted RR, 0.65; 95% CI: 0.44–0.96; P= 0.03) (25).
There is also evidence that mothers who use EPA and
DHA supplementation during pregnancy and breastfeeding
may protect their children against allergies. This may be due
to the fact that ﬁsh-oil supplementation has been associated
with decreased levels of body cells associated with inﬂamma-
tion and immune response (26). In a study about food al-
lergy and IgE-associated eczema, the period prevalence of
food allergy was lower in the maternal EPA+DHA supple-
mentation group compared to placebo (P< 0.05), and the
incidence of IgE-associated eczema was also lower in the
maternal EPA+DHA supplementation group compared to
placebo (P< 0.05) (27).
Omega-3 fatty acids and cardiovascular disease
Cardiovascular disease is the cause of 38% of all deaths in
the United States, many of which are preventable (28).
Chronic inﬂammation is thought to be the cause of many
chronic diseases, including cardiovascular disease (29).
EPA and DHA are thought to have antiinﬂammatory effects
and a role in oxidative stress (30) and to improve cellular
function through changes in gene expression (31). In a study
that used human blood samples, EPA+DHA intake changed
the expression of 1040 genes and resulted in a decreased ex-
pression of genes involved in inﬂammatory and atherogen-
esis-related pathways, such as nuclear transcription factor
kB signaling, eicosanoid synthesis, scavenger receptor activ-
ity, adipogenesis, and hypoxia signaling (31). Circulating
markers of inflammation, such as C-reactive protein
(CRP), TNF a, and some ILs (IL-6, IL-1), correlate with
an increased probability of experiencing a cardiovascular
event (32). Inflammatory markers such as IL-6 trigger
CRP to be synthesized by the liver, and elevated levels of
CRP are associated with an increased risk of the develop-
ment of cardiovascular disease (33). A study of 89 patients
showed that those treated with EPA+DHA had a significant
reduction in high-sensitivity CRP (66.7%, P< 0.01) (33).
The same study also showed a significant reduction in
heat shock protein 27 antibody titers (57.69%, P< 0.05),
which have been shown to be overexpressed in heart muscle
cells after a return of blood flow after a period of ischemia
(ischemia-reperfusion injury) and may potentially have a
cardioprotective effect (33).
Therehavebeenconﬂicting results reported about EPA
and DHA and their use with regard to major coronary events
and their use after myocardial infarction. EPA+DHA has been
associated with a reduced risk of recurrent coronary artery
events and sudden cardiac death after an acute myocardial in-
farction (RR, 0.47; 95% CI: 0.219–0.995) and a reduction in
heart failure events (adjusted HR: 0.92; 99% CI: 0.849–0.999)
(34–36). A study using EPA supplementation in combination
with a statin, compared with statin therapy alone, found that,
after 5 y, the patients in the EPA group (n=262)whohada
history of coronary artery disease had a 19% relative reduc-
tion in major coronary events (P= 0.011). However, in pa-
tients with no history of coronary artery disease (n=104),
major coronary events were reduced by 18%, but this finding
was not significant (37). This Japanese population already has
a high relative intake of fish compared with other nations,
and, thus, these data suggest that supplementation has cardi-
ovascular benefits in those who already have sufficient base-
line EPA+DHA levels. Another study compared patients
with impaired glucose metabolism (n= 4565) with normo-
glycemic patients (n= 14,080). Impaired glucose metabolism
patients had a significantly higher coronary artery disease HR
(1.71 in the non-EPA group and 1.63 in the EPA group). The
primary endpoint was any major coronary event including
sudden cardiac death, myocardial infarction, and other non-
fatal events. Treatment of impaired glucose metabolism
patients with EPA showed a significantly lower major coro-
nary event HR of 0.78 compared with the non–EPA-treated
impaired glucose metabolism patients (95% CI: 0.60–0.998;
P= 0.048), which demonstrates that EPA significantly sup-
presses major coronary events (38). When looking at the
use of EPA+DHA and cardiovascular events after myocardial
Health beneﬁts of omega-3 fatty acids 3
infarction, of 4837 patients, a major cardiovascular event oc-
curred in 671 patients (13.9%) (39). A post hoc analysis of the
data from these diabetic patients showed that rates of fatal
coronary heart disease and arrhythmia-related events were
lower among patients in the EPA+DHA group than among
the placebo group (HR for fatal coronary heart disease:
0.51; 95% CI: 0.27–0.97; HR for arrhythmia-related events:
0.51; 95% CI: 0.24–1.11, not statistically significant) (39). An-
other study found that there was no significant difference in
sudden cardiac death or total mortality between an EPA
+DHA supplementation group and a control group in those
patients treated after myocardial infarction (40). Although
these last 2 studies appear to be negative in their results, it
is possible that the more aggressive treatment with medica-
tions in these more recent studies could attribute to this.
Omega-3 fatty acids have been found to play a role in ath-
erosclerosis and peripheral arterial disease (PAD). It is
thought that both EPA and DHA improve plaque stability,
decrease endothelial activation, and improve vascular per-
meability, thereby decreasing the chance of experiencing a
cardiovascular event (41). It was found that EPA supplemen-
tation is associated with signiﬁcantly higher amounts of EPA
in the carotid plaque than placebo (P< 0.0001), which may
lead to decreased plaque inflammation and increased stabil-
ity (42). PAD, a manifestation of atherosclerosis, is charac-
terized by buildup of plaque in the arteries of the leg and
can eventually lead to complete blockage of the arteries.
EPA+DHA supplementation has been shown to improve en-
dothelial function in patients with PAD by decreasing
plasma levels of soluble thrombomodulin from a median
value of 33.0 mg/L to 17.0 mg/L (P= 0.04) and improve
brachial artery flow–mediated dilation from 6.7% to
10.0% (P= 0.02) (43). Patients who had PAD and were sup-
plemented with EPA experienced a significantly lower major
coronary event HR than those who did not take EPA (HR:
0.44; 95% CI: 0.19–0.97; P= 0.041) (44).
Omega-3 fatty acids have been shown to increase platelet
responsiveness to subtherapeutic anticoagulation therapies,
including aspirin. Recently, it was noted that patient re-
sponse to aspirin for anticoagulation therapy is widely vari-
able (45), and, thus, the number of patients with a low
response to aspirin or aspirin resistance is estimated to range
from <1% to 45%, depending on many variables. However,
in patients with stable coronary artery disease taking low-
dose aspirin, EPA+DHA supplementation has been proven
to be as effective as aspirin dose escalation to 325 mg/d
for anticoagulation benefits (45). The antiplatelet drug clo-
pidogrel has also been associated with hyporesponsiveness
in some patients. This could be attributed to poor patient
compliance, differences in genes and platelet reactivity, var-
iability of drug metabolism, and drug interactions. More im-
portantly, in 1 study, patients receiving standard dual
antiplatelet therapy (aspirin 75 mg/d and clopidogrel 600-mg
loading dose followed by 75 mg/d) were assigned to either
EPA+DHA supplementation or placebo. After 1 mo of treat-
ment, the P2Y
receptor reactivity index (an indicator of
clopidogrel resistance) was significantly lower, by 22%, for
patients taking EPA+DHA compared with patients taking
placebo (P= 0.020) (46).
Omega-3 fatty acids and AD
AD is a devastating disease for which there are limited treat-
ment options and no cure. Memory loss is an early indicator
of the disease, which is progressive, and leads to the inability
of the patient to care for him- or herself and eventually to
death (47). Currently, the number of individuals with AD
is estimated to be 26.6 million and is expected to increase
to 106.2 million by 2050 (48). There have been many studies
conducted regarding the use of omega-3 fatty acid supple-
mentation and AD (Table 2). DHA is present in large
amounts in neuron membrane phospholipids, where it is in-
volved in proper function of the nervous system, which is
why it is thought to play a role in AD (49). A case-control
study consisting of 148 patients with cognitive impairment
[Mini-Mental State Examination (MMSE) score <24] and
45 control patients (MMSE score $24) showed that serum
cholesteryl ester-EPA and -DHA levels were significantly
lower (P< 0.05 and P< 0.001, respectively) in all MMSE
score quartiles of patients with AD compared with control
values (49). Another study found that a diet characterized
by higher intakes of foods high in omega-3 fatty acids (salad
dressing, nuts, fish, tomatoes, poultry, cruciferous vegeta-
bles, fruits, dark and green leafy vegetables), and a lower in-
take of foods low in omega-3 fatty acids (high-fat dairy
products, red meat, organ meat, butter) was strongly associ-
ated with a lower AD risk (50). Image analysis of brain sec-
tions of an aged AD mouse model showed that overall
plaque burden was significantly reduced by 40.3% in mice
with a diet enriched with DHA (P< 0.05) compared with
placebo. The largest reductions (40–50%) were seen in brain
regions that are thought to be involved with AD, the hippo-
campus and parietal cortex (51). A central event in AD is
thought to be the activation of multiple inflammatory cells
in the brain. Release of IL-1B, IL-6, and TNF afrom mi-
croglia cells may lead to dysfunction of the neurons in the
brain (52). In 1 study, AD patients treated with EPA
+DHA supplementation increased their plasma concentra-
tions of EPA and DHA, which were associated with reduced
release of inflammatory factors IL-1B, IL-6, and granulocyte
colony–stimulating factor from peripheral blood mononu-
clear cells (53).
Unintended weight loss is a problem that many patients
with AD may face, and EPA+DHA supplementation has
had a positive effect on weight gain in patients with AD.
In a study using EPA+DHA supplementation, patients’
weight significantly increased by 0.7 kg in the EPA+DHA
treatment group at 6 mo (P= 0.02) and by 1.4 kg at 12
mo (P< 0.001) and was observed mainly in patients with
a BMI <23 at the study start (54). This means that those pa-
tients with a lower BMI preferentially gained weight com-
pared with those patients already with a higher BMI.
Although results from studies regarding the disease pro-
cesses of AD seem to be promising, there are conﬂicting data
regarding the use of omega-3 fatty acids in terms of cognitive
4 Swanson et al.
function. Neuropsychiatric symptoms accompany AD from
early stages and tend to increase with the progression of the
disease (55). An analysis of 174 patients randomized to a
placebo group or to a group with mild to moderate AD
(MMSE score $15) treated with daily DHA (1.7 g) and
EPA (0.6 g) found that at 6 mo, the decline in cognitive func-
tion did not differ between the groups. Yet, in a subgroup
with very mild cognitive dysfunction (n= 32, MMSE score
>27), they observed a significant reduction in the MMSE de-
cline rate in the DHA+EPA-supplemented group compared
with the placebo group (47). Another study that looked at
DHA supplementation in individuals with mild to moderate
AD used the Alzheimer’s Disease Assessment Scale–Cognitive
subscale, which evaluates cognitive function on a 70-point
scale in terms of memory, attention, language, orientation,
and praxis. This study found that DHA supplementation
had no beneficial effect on cognition during the 18-mo trial
period for the DHA group vs. placebo (56).
The omega-3 PUFA EPA and DHA are important through-
out life and are a dietary necessity found predominantly in
ﬁsh and ﬁsh-oil supplements. The omega-3 fatty acids
EPA and DHA are essential for proper fetal development,
and supplementation during pregnancy has also been linked
to decreased immune responses in infants including de-
creased incidence of allergies in infants. Omega-3 fatty
acid consumption has been associated with improved cardi-
ovascular function in terms of antiinﬂammatory properties,
PAD, reduced major coronary events, and improved anti-
platelet effects in the face of aspirin resistance or clopidogrel
hyporesponsiveness. Patients with AD have been shown to
be deﬁcient in DHA, and supplementing them with EPA
+DHA not only reverses this deﬁciency, but may also im-
prove cognitive functioning in patients with very mild AD.
With increasing rates of pediatric allergies, cardiovascular
disease, and AD in the United States, EPA and DHA may
be a safe and inexpensive link to a healthier life. Further re-
search should be conducted in humans to assess a variety of
clinical outcomes including quality of life and mental status.
In addition, because potent lipid mediator metabolites of
EPA and DHA are of great interest currently, their inﬂuence
on these important outcomes should be assessed because
current evidence suggests that their antiinﬂammatory and
tissue-protective effects are nearly 1000 times greater than
those of EPA and DHA (7).
Thanks to Dr. Kelly A. Keating (Pharmaceutical Research In-
stitute at Albany College of Pharmacy and Health Sciences)
for her outstanding editorial support. All authors have read
and approved the ﬁnal version of this manuscript.
1. Su KP, Huang SY, Chiu TH, Huang KC, Huang CL, Chang HC, Pariante
CM. Omega-3 fatty acids for major depressive disorder during preg-
nancy: results from a randomized, double-blind, placebo-controlled
trial. J Clin Psychiatry. 2008;69:644–51.
2. Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME,
Arduini D. Low-dose aspirin and omega-3 fatty acids improve uterine
artery blood flow velocity in women with recurrent miscarriage due to
impaired uterine perfusion. Fertil Steril. 2009;92:296–300.
3. Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie
MJ, Mittendorfer B. Dietary omega-3 fatty acid supplementation
TABLE 2. Studies involving omega-3 fatty acid supplementation and Alzheimer’s disease
Study Design No. of patients
Omega-3 fatty acids
assessed and amounts Major ﬁnding
Omega AD study,
Freund-Levi et al. (47)
DHA (1.7 g/d) and
EPA (0.6 g/d)
Decline in cognitive function did
not differ between supplemented
group and placebo group at 6 mo.
However, patients with very mild
cognitive dysfunction (n= 32, MMSE
score .27) in the EPA+DHA-supplemented
group had a significant reduction in MMSE
score decline rate at 6 mo
Omega AD study,
Vedin et al. (53)
first subjects to be
randomized in the
Omega AD Study
DHA (1.7 g/d) and
EPA (0.6 g/d)
Supplementation was associated with
decreased levels of IL-1b, IL-6, and granulocyte
colony–stimulating factor from peripheral
blood mononuclear cells at 6 mo
Omega AD study,
Irving et al. (54)
DHA (1.7 g/d) and
EPA (0.6 g/d) for 6 mo,
then for all subjects
group and placebo
Supplementation was associated with positive
weight gain and appetite in supplementation
group at 6 mo, but not in the placebo group,
and for both groups at 12 mo
Omega AD study,
Quinn et al. (56)
295; mild to moderate
AD (MMSE score 14–26)
(n= 171), placebo group
DHA (2 g/d for
DHA supplementation led to no beneﬁcial
effect on rate of cognitive and functional
Subjects in the Omega AD study were patients with mild to moderate AD (n= 89) with acetylcholine esterase inhibitor use and an MMSE score between 15 and 30 and a
placebo group (n= 85). Supplementation was for 12 mo; the placebo group was started on supplementation after 6 mo. AD, Alzheimer’s disease; MMSE, Mini-Mental State
Health beneﬁts of omega-3 fatty acids 5
increases the rate of muscle protein synthesis in older adults: a random-
ized controlled trial. Am J Clin Nutr. 2011;93:402–12.
4. Conquer JA, Tierney MC, Zecevic J, Bettger WJ, Fisher RH. Fatty acid
analysis of blood plasma of patients with Alzheimer’s disease, other
types of dementia, and cognitive impairment. Lipids. 2000;35:1305–12.
5. Dunstan JA, Mitoulas LR, Dixon G, Doherty DA, Hartmann PE, Simmer
K, Prescott SL. The effects of fish oil supplementation in pregnancy on
breast milk fatty acid composition over the course of lactation: a ran-
domized controlled trial. Pediatr Res. 2007;62:689–94.
6. Krauss-Etschmann S, Shadid R, Campoy C, Hoster E, Demmelmair H,
Jimenez M, Gil A, Rivero M, Veszpremi B, Decsi T, et al. Effects of fish-
oil and folate supplementation of pregnant women on maternal and
fetal plasma concentrations of docosahexaenoic acid and eicosapentae-
noic acid: a European randomized multicenter trial. Am J Clin Nutr.
7. Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual
anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immu-
8. Neff LM, Culiner J, Cunningham-Rundles S, Seidman C, Meehan D,
Maturi J, Wittkowski KM, Levine B, Breslow JL. Algal docosahexaenoic
acid affects plasma lipoprotein particle size distribution in overweight
and obese adults. J Nutr. 2011;141:207–13.
Huang SY. The effects of omega-3 fatty acids monotherapy in Alzheimer’s
disease and mild cognitive impairment: a preliminary randomized double-
blind placebo-controlled study. Prog Neuropsychopharmacol Biol Psychi-
10. Goyens PL, Spilker ME, Zock PL, Katan MB, Mensink RP. Compartmen-
tal modeling to quantify alpha-linolenic acid conversion after longer term
intake of multiple tracer boluses. J Lipid Res. 2005;46:1474–83.
11. Hussein N, Ah-Sing E, Wilkinson P, Leach C, Griffin BA, Millward DJ.
Long-chain conversion of [13C]linoleic acid and alpha-linolenic acid in
response to marked changes in their dietary intake in men. J Lipid Res.
12. Dietary Guidelines for Americans. 2010. Washington, DC: U.S. Gov-
ernment Printing Office.
13. Dangardt F, Osika W, Chen Y, Nilsson U, Gan LM, Gronowitz E,
Strandvik B, Friberg P. Omega-3 fatty acid supplementation improves
vascular function and reduces inflammation in obese adolescents. Ath-
14. Leaf DA, Hatcher L. The effect of lean fish consumption on triglyceride
levels. Phys Sportsmed. 2009;37:37–43.
15. Mann NJ, O’Connell SL, Baldwin KM, Singh I, Meyer BJ. Effects of seal
oil and tuna-fish oil on platelet parameters and plasma lipid levels in
healthy subjects. Lipids. 2010;45:669–81.
16. Saito Y, Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Ishikawa
Y, Oikawa S, Sasaki J, Hishida H, Itakura H, et al. Effects of EPA on cor-
onary artery disease in hypercholesterolemic patients with multiple risk
factors: sub-analysis of primary prevention cases from the Japan EPA
Lipid Intervention Study (JELIS). Atherosclerosis. 2008;200:135–40.
17. Ramakrishnan U, Stein AD, Parra-Cabrera S, Wang M, Imhoff-Kunsch
B, Juarez-Marquez S, Rivera J, Martorell R. Effects of docosahexaenoic
acid supplementation during pregnancy on gestational age and size at
birth: randomized, double-blind, placebo-controlled trial in Mexico.
Food Nutr Bull. 2010;31:S108–16.
18. Helland IB, Smith L, Blomen B, Saarem K, Saugstad OD, Drevon CA.
Effect of supplementing pregnant and lactating mothers with n-3 very-
long-chain fatty acids on children’s IQ and body mass index at 7 years
of age. Pediatrics. 2008;122:e472–9.
19. Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment of
children at age 2(1/2) years after maternal fish oil supplementation in
pregnancy: a randomised controlled trial. Arch Dis Child Fetal Neona-
tal Ed. 2008;93:F45–50.
20. Judge MP, Harel O, Lammi-Keefe CJ. Maternal consumption of a do-
cosahexaenoic acid-containing functional food during pregnancy: ben-
efit for infant performance on problem-solving but not on recognition
memory tasks at age 9 mo. Am J Clin Nutr. 2007;85:1572–7.
21. Olsen SF, Osterdal ML, Salvig JD, Mortensen LM, Rytter D, Secher NJ,
Henriksen TB. Fish oil intake compared with olive oil intake in late preg-
nancy and asthma in the offspring: 16 y of registry-based follow-up from
a randomized controlled trial. Am J Clin Nutr. 2008;88:167–75.
22. Harper M, Thom E, Klebanoff MA, Thorp J, Jr., Sorokin Y, Varner MW,
Wapner RJ, Caritis SN, Iams JD, Carpenter MW, et al. Omega-3 fatty
acid supplementation to prevent recurrent preterm birth: a randomized
controlled trial. Obstet Gynecol. 2010;115:234–42.
23. Olsen SF, Osterdal ML, Salvig JD, Weber T, Tabor A, Secher NJ. Dura-
tion of pregnancy in relation to fish oil supplementation and habitual
fish intake: a randomised clinical trial with fish oil. Eur J Clin Nutr.
24. Roman AS, Schreher J, Mackenzie AP, Nathanielsz PW. Omega-3 fatty
acids and decidual cell prostaglandin production in response to the in-
flammatory cytokine IL-1beta. Am J Obstet Gynecol. 2006;195:1693–9.
25. Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P.
Effect of DHA supplementation during pregnancy on maternal depres-
sion and neurodevelopment of young children: a randomized con-
trolled trial. JAMA. 2010;304:1675–83.
26. Krauss-Etschmann S, Hartl D, Rzehak P, Heinrich J, Shadid R, Del
Carmen Ramirez-Tortosa M, Campoy C, Pardillo S, Schendel DJ, Decsi
T, et al. Decreased cord blood IL-4, IL-13, and CCR4 and increased TGF-
beta levels after fish oil supplementation of pregnant women. J Allergy
Clin Immunol. 2008;121:464–70 e6.
27. Furuhjelm C, Warstedt K, Larsson J, Fredriksson M, Bottcher MF,
Falth-Magnusson K, Duchen K. Fish oil supplementation in pregnancy
and lactation may decrease the risk of infant allergy. Acta Paediatr.
28. Kelley DS, Siegel D, Fedor DM, Adkins Y, Mackey BE. DHA supple-
mentation decreases serum C-reactive protein and other markers of in-
flammation in hypertriglyceridemic men. J Nutr. 2009;139:495–501.
29. Schubert R, Kitz R, Beermann C, Rose MA, Baer PC, Zielen S, Boehles
H. Influence of low-dose polyunsaturated fatty acids supplementation
on the inflammatory response of healthy adults. Nutrition. 2007;23:
30. Bloomer RJ, Larson DE, Fisher-Wellman KH, Galpin AJ, Schilling BK.
Effect of eicosapentaenoic and docosahexaenoic acid on resting and
exercise-induced inflammatory and oxidative stress biomarkers: a ran-
domized, placebo controlled, cross-over study. Lipids Health Dis. 2009;
31. Bouwens M, van de Rest O, Dellschaft N, Bromhaar MG, de Groot LC,
Geleijnse JM, Muller M, Afman LA. Fish-oil supplementation induces
antiinflammatory gene expression profiles in human blood mononu-
clear cells. Am J Clin Nutr. 2009;90:415–24.
32. Micallef MA, Garg ML. Anti-inflammatory and cardioprotective effects
of n-3 polyunsaturated fatty acids and plant sterols in hyperlipidemic
individuals. Atherosclerosis. 2009;204:476–82.
33. Ebrahimi M, Ghayour-Mobarhan M, Rezaiean S, Hoseini M, Parizade
SM, Farhoudi F, Hosseininezhad SJ, Tavallaei S, Vejdani A, Azimi-
Nezhad M, et al. Omega-3 fatty acid supplements improve the cardio-
vascular risk profile of subjects with metabolic syndrome, including
markers of inflammation and auto-immunity. Acta Cardiol. 2009;64:
34. Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil,
omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;
35. Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R,
Lucci D, Nicolosi GL, Porcu M, Tognoni G. Effect of n-3 polyunsatu-
rated fatty acids in patients with chronic heart failure (the GISSI-HF
trial): a randomised, double-blind, placebo-controlled trial. Lancet.
36. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R,
Franzosi MG, Geraci E, Levantesi G, Maggioni AP, et al. Early protec-
tion against sudden death by n-3 polyunsaturated fatty acids after my-
ocardial infarction: time-course analysis of the results of the Gruppo
Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GIS-
SI)-Prevenzione. Circulation. 2002;105:1897–903.
6 Swanson et al.
37. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa
Y, Oikawa S, Sasaki J, Hishida H, Itakura H, et al. Effects of eicosapen-
taenoic acid on major coronary events in hypercholesterolaemic pa-
tients (JELIS): a randomised open-label, blinded endpoint analysis.
38. Oikawa S, Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito
Y, Ishikawa Y, Sasaki J, Hishida H, Itakura H, et al. Suppressive effect of
EPA on the incidence of coronary events in hypercholesterolemia with
impaired glucose metabolism: Sub-analysis of the Japan EPA Lipid In-
tervention Study (JELIS). Atherosclerosis. 2009;206:535–9.
39. Kromhout D, Giltay EJ, Geleijnse JM. n-3 fatty acids and cardiovascular
events after myocardial infarction. N Engl J Med. 2010;363:2015–26.
40. Rauch B, Schiele R, Schneider S, Diller F, Victor N, Gohlke H, Gottwik
M, Steinbeck G, Del Castillo U, Sack R, et al. OMEGA, a randomized,
placebo-controlled trial to test the effect of highly purified omega-3
fatty acids on top of modern guideline-adjusted therapy after myocar-
dial infarction. Circulation. 2010;122:2152–9.
41. Dawczynski C, Martin L, Wagner A, Jahreis G. n-3 LC-PUFA-enriched
dairy products are able to reduce cardiovascular risk factors: a double-
blind, cross-over study. Clin Nutr. 2010;29:592–9.
42. Cawood AL, Ding R, Napper FL, Young RH, Williams JA, Ward MJ,
Gudmundsen O, Vige R, Payne SP, Ye S, et al. Eicosapentaenoic acid
(EPA) from highly concentrated n-3 fatty acid ethyl esters is incorpo-
rated into advanced atherosclerotic plaques and higher plaque EPA is
associated with decreased plaque inflammation and increased stability.
43. Schiano V, Laurenzano E, Brevetti G, De Maio JI, Lanero S, Scopacasa
F, Chiariello M. Omega-3 polyunsaturated fatty acid in peripheral arte-
rial disease: effect on lipid pattern, disease severity, inflammation pro-
file, and endothelial function. Clin Nutr. 2008;27:241–7.
44. Ishikawa Y, Yokoyama M, Saito Y, Matsuzaki M, Origasa H, Oikawa S,
Sasaki J, Hishida H, Itakura H, Kita T, et al. Preventive effects of eico-
sapentaenoic acid on coronary artery disease in patients with peripheral
artery disease. Circ J. 2010;74:1451–7.
45. Lev EI, Solodky A, Harel N, Mager A, Brosh D, Assali A, Roller M,
Battler A, Kleiman NS, Kornowski R. Treatment of aspirin-resistant pa-
tients with omega-3 fatty acids versus aspirin dose escalation. J Am Coll
46. Gajos G, Rostoff P, Undas A, Piwowarska W. Effects of polyunsaturated
omega-3 fatty acids on responsiveness to dual antiplatelet therapy in pa-
tients undergoing percutaneous coronary intervention: the OMEGA-PCI
(OMEGA-3 fatty acids after pci to modify responsiveness to dual anti-
platelet therapy) study. J Am Coll Cardiol. 2010;55:1671–8.
47. Freund-Levi Y, Eriksdotter-Jonhagen M, Cederholm T, Basun H, Faxen-
Irving G, Garlind A, Vedin I, Vessby B, Wahlund LO, Palmblad J.
Omega-3 fatty acid treatment in 174 patients with mild to moderate
Alzheimer disease: OmegAD study: a randomized double-blind trial.
Arch Neurol. 2006;63:1402–8.
48. Gillette-Guyonnet S, Andrieu S, Dantoine T, Dartigues JF, Touchon J,
Vellas B. Commentary on "A roadmap for the prevention of dementia
II. Leon Thal Symposium 2008." The Multidomain Alzheimer Preven-
tive Trial (MAPT): a new approach to the prevention of Alzheimer’s
disease. Alzheimers Dement. 2009;5:114–21.
49. Tully AM, Roche HM, Doyle R, Fallon C, Bruce I, Lawlor B, Coakley D,
Gibney MJ. Low serum cholesteryl ester-docosahexaenoic acid levels in
Alzheimer’s disease: a case-control study. Br J Nutr. 2003;89:483–9.
50. Gu Y, Nieves JW, Stern Y, Luchsinger JA, Scarmeas N. Food combina-
tion and Alzheimer disease risk: a protective diet. Arch Neurol. 2010;
51. Lim GP, Calon F, Morihara T, Yang F, Teter B, Ubeda O, Salem N, Jr.,
Frautschy SA, Cole GM. A diet enriched with the omega-3 fatty acid
docosahexaenoic acid reduces amyloid burden in an aged Alzheimer
mouse model. J Neurosci. 2005;25:3032–40.
52. Freund-Levi Y, Hjorth E, Lindberg C, Cederholm T, Faxen-Irving G,
Vedin I, Palmblad J, Wahlund LO, Schultzberg M, Basun H, et al. Ef-
fects of omega-3 fatty acids on inflammatory markers in cerebrospinal
fluid and plasma in Alzheimer’s disease: the OmegAD study. Dement
Geriatr Cogn Disord. 2009;27:481–90.
53. Vedin I, Cederholm T, Freund Levi Y, Basun H, Garlind A, Faxen Irving
G, Jonhagen ME, Vessby B, Wahlund LO, Palmblad J. Effects of doco-
sahexaenoic acid-rich n-3 fatty acid supplementation on cytokine re-
lease from blood mononuclear leukocytes: the OmegAD study. Am J
Clin Nutr. 2008;87:1616–22.
54. Irving GF, Freund-Levi Y, Eriksdotter-Jonhagen M, Basun H, Brismar
K, Hjorth E, Palmblad J, Vessby B, Vedin I, Wahlund LO, et al.
Omega-3 fatty acid supplementation effects on weight and appetite
in patients with Alzheimer’s disease: the omega-3 Alzheimer’s disease
study. J Am Geriatr Soc. 2009;57:11–7.
55. Freund-Levi Y, Basun H, Cederholm T, Faxen-Irving G, Garlind A, Grut
M, Vedin I, Palmblad J, Wahlund LO, Eriksdotter-Jonhagen M. Omega-3
supplementation in mild to moderate Alzheimer’s disease: effects on neu-
ropsychiatric symptoms. Int J Geriatr Psychiatry. 2008;23:161–9.
56. Quinn JF, Raman R, Thomas RG, Yurko-Mauro K, Nelson EB, Van
Dyck C, Galvin JE, Emond J, Jack CR, Jr., Weiner M, et al. Docosahex-
aenoic acid supplementation and cognitive decline in Alzheimer dis-
ease: a randomized trial. JAMA. 2010;304:1903–11.
Health beneﬁts of omega-3 fatty acids 7