Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus
People with type 2 diabetes mellitus are at increased risk from cardiovascular disease. Dietary omega-3 polyunsaturated fatty acids (PUFAs) are known to reduce triglyceride levels, but their impact on cholesterol levels, glycemic control and vascular outcomes are not well known.
To determine the effects of omega-3 PUFA supplementation on cardiovascular outcomes, cholesterol levels and glycemic control in people with type 2 diabetes mellitus.
We carried out a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, bibliographies of relevant papers and contacted experts for identifying additional trials.
All randomised controlled trials were included where omega-3 PUFA supplementation or dietary intake was randomly allocated and unconfounded in people with type 2 diabetes. Authors of large trials were contacted for missing information.
Trials were assessed for inclusion. Authors were contacted for missing information. Data was extracted and quality assessed independently in duplicate. Fixed-effect meta-analysis was carried out.
Twenty three randomised controlled trials (1075 participants) were included with a mean treatment duration of 8.9 weeks. The mean dose of omega-3 PUFA used in the trials was 3.5 g/d. No trials with vascular events or mortality endpoints were identified. Among those taking omega-3 PUFA triglyceride levels were significantly lowered by 0.45 mmol/L (95% confidence interval (CI) -0.58 to -0.32, P < 0.00001) and VLDL cholesterol lowered by -0.07 mmol/L (95% CI -0.13 to 0.00, P = 0.04). LDL cholesterol levels were raised by 0.11 mmol/L (95% CI 0.00 to 0.22, P = 0.05). No significant change in or total or HDL cholesterol, HbA1c, fasting glucose, fasting insulin or body weight was observed. The increase in VLDL remained significant only in trials of longer duration and in hypertriglyceridemic patients. The elevation in LDL cholesterol was non-significant in subgroup analyses. No adverse effects of the intervention were reported.
Omega-3 PUFA supplementation in type 2 diabetes lowers triglycerides and VLDL cholesterol, but may raise LDL cholesterol (although results were non-significant in subgroups) and has no statistically significant effect on glycemic control or fasting insulin. Trials with vascular events or mortality defined endpoints are needed.
Available from: Caio Reis
- "The n-3 PUFA intake has many beneficial physiological effects, can reduce insulin response to oral glucose without altering the glycemic response in healthy humans 33 . Regarding T2DM people, Hartweg et al., (2008) reported in a review study (n = 1,075) that n-3 PUFA supplementation has no significant change in HbA1c, fasting glucose and fasting insulin 11 . Akintunde et al., (2011), in a meta-analysis study (n = 618) showed that n-3 PUFA intervention had no effects on insulin sensitivity compared to placebo in a T2DM subjects 34 . "
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ABSTRACT: Introduction: Type 2 diabetes mellitus increases the risk of hypertriglyceridemia and is an independent risk factor for cardiovascular diseases. Current literature reveals the beneficial effects of n-3 polyunsaturated fatty acids (n-3 PUFA) in hypertriglyceridemia treatment, however the safety for type 2 diabetic subjects are still debatable. This literature review discusses the safety on glucose metabolism of n-3 PUFA supplementation in the treatment of hypertriglyceridemia in subjects with type 2 diabetes mellitus. Methods: A literature review was conducted on EMBASE and MEDLINE database to investigate clinical trials published since 1990 until June 2014 that investigated the effects of dietary/supplementation n-3 PUFA intake in hypertriglyceridemia treatment in subjects with type 2 diabetes mellitus. Results and Discussion: Fourteen clinical trials (n = 2,105) were included in this review. All trials reported a reduction in triglycerides levels between 12 - 34% in intra- group and 15 - 36% in between-groups analysis. Four trials showed a significant increase in LDL-c (6 - 18%) and another four in HDL-c levels (4 - 15%). No significant changes were found to total cholesterol, VLDL-c, fasting glucose, HbA1C, and insulin sensitivity index. Conclusions: The n-3 PUFA supplementation leads an improvement on TG levels and did not result in any impairment on glucose metabolism in hypertriglyceridemic patients with type 2 diabetes mellitus being a safe option to treat the diabetic population.
Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Available from: Josely Correa Koury
- "However, the test group showed a significant reduction in LDL level at T1, and increased insulin and glycated hemoglobin after 12 months. Our results are somewhat in agreement with previous studies that have reported an unfavorable effect or no effect of ω-3 PUFA on glucose metabolism [31,32]. Others have shown that DHA supplementation increases HDL and LDL, and reduces triglyceride [33,34]. "
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We aimed to investigate the impact of nonsurgical periodontal treatment combined with one-year dietary supplementation with omega (ω)-3 on the serum levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and arachidonic acid (AA).
Fifteen patients with chronic generalized periodontitis were treated with scaling and root planing. The test group consisted of seven patients (43.1±6.0 years) supplemented with ω-3, consisting of EPA plus DHA, three capsules, each of 300 mg of ω-3 (180-mg EPA/120-mg DHA), for 12 months. The control group was composed of eight patients (46.1±11.6 years) that took a placebo capsule for 12 months. The periodontal examination and the serum levels of DPA, EPA, DHA, and AA were performed at baseline (T0), and 4 (T1), and 12 (T2) months after therapy.
In the test group, AA and DPA levels had been reduced significantly at T1 (P<0.05). AA and EPA levels had been increased significantly at T2 (P<0.05). The ΔEPA was significantly higher in the test compared to the placebo group at T2-T0 (P=0.02). The AA/EPA had decreased significantly at T1 and T2 relative to baseline (P<0.05).
Nonsurgical periodontal treatment combined with ω-3 supplementation significantly increased the EPA levels and decreased the AA/EPA ratio in serum after one year follow-up. However, no effect on the clinical outcome of periodontal therapy was observed.
Available from: Pavol Bohov
- "A recent study reported that EPA and DHA supplements may improve insulin sensitivity in young obese individuals . While some meta-studies have failed to show an effect between n-3 PUFA intake and incident type 2 diabetes mellitus (T2DM) [25,26], others indicate a reduced risk of T2DM with increased intake of PUFAs [27,28]. Based on findings in humans and from recent animal studies, PL supplements could be expected to have potent effects on glucose metabolism. "
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Herring roe is an underutilized source of n-3 polyunsaturated fatty acids (PUFAs) for human consumption with high phospholipid (PL) content. Studies have shown that PL may improve bioavailability of n-3 PUFAs. Arctic Nutrition’s herring roe product MOPL™30 is a PL: docosahexaenoic acid (DHA)-rich fish oil mixture, with a DHA:eicosapentaenoic acid (EPA) ratio of about 3:1, which is also rich in choline. In this pilot study, we determined if MOPL30 could favorably affect plasma lipid parameters and glucose tolerance in healthy young adults.
Twenty female and one male adults, between 22 and 26 years of age, participated in the study. Participants took encapsulated MOPL30, 2.4 g/d EPA + DHA, for 14 days, and completed a three-day weighed food record before and during the capsule intake. Plasma lipids and their fatty acid (FA) composition, plasma and red blood cell (RBC) phosphatidylcholine (PC) FA composition, acylcarnitines, choline, betaine and insulin were measured before and after supplementation (n = 21), and one and four weeks after discontinuation of supplementation (n = 14). An oral glucose tolerance test was performed before and after supplementation.
Fasting plasma triacylglycerol and non-esterified fatty acids decreased and HDL-cholesterol increased after 14 days of MOPL30 intake (p < 0.05). The dietary records showed that PUFA intake prior to and during capsule intake was not different. Fasting plasma glucose was unchanged from before to after supplementation. However, during oral glucose tolerance testing, blood glucose at both 10 and 120 min was significantly lower after supplementation with MOPL30 compared to baseline measurements. Plasma free choline and betaine were increased, and the n-6/n-3 polyunsaturated (PUFA) ratio in plasma and RBC PC were decreased post-supplementation. Four weeks after discontinuation of MOPL30, most parameters had returned to baseline, but a delayed effect was observed on n-6 PUFAs.
Herring roe rich in PL improved the plasma lipid profile and glycemic control in young adults with an overall healthy lifestyle.
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