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Supporting Articles & Publications
A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk
Objective: To conduct meta-analyses of randomized controlled trials (RCTs) to estimate the effect of eicosapentaenoic and docosahexaenoic acid (EPAþDHA) on coronary heart disease (CHD), and to conduct meta-analyses of prospective cohort studies to estimate the association between EPAþDHA intake and CHD risk.
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EPA and Treatment of Major Depressive Disease
Peet,Malcolm; Stokes, Caroline
Omega-3 fatty acids in the treatment of psychiatric disorders
The importance of omega-3 fatty acids for physical health is now well recognised and there is increasing evidence that omega-3 fatty acids may also be important to mental health. The two main omega-3 fatty acids in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have important biological functions in the CNS. DHA is a major structural component of neuronal membranes, and changing the fatty acid composition of neuronal membranes leads to functional changes in the activity of receptors and other proteins embedded in the membrane phospholipid. EPA has important physiological functions that can affect neuronal activity. Epidemiological studies indicate
an association between depression and low dietary intake of omega-3 fatty acids, and biochemical studies have shown reduced levels of omega-3 fatty acids in red blood cell membranes in both depressive and schizophrenic patients.Five of six double-blind, placebo-controlled trials in schizophrenia, and four of six such trials in depression, have reported therapeutic benefit from omega-3 fatty acids in either the primary or secondary statistical analysis, particularly when EPA is added on to existing psychotropic medication. Individual clinical trials have suggested benefits of EPA treatment in borderline personality disorder and of combined omega-3 and omega-6 fatty acid treatment for attention-deficit hyperactivity disorder. The evidence to date supports the adjunctive use of omega-3 fatty acids in the management of treatment unresponsive depression and schizophrenia. As these conditions are associated with increased risk of coronary heart disease and diabetes mellitus, omega- 3 fatty acids should also benefit the physical state of these patients. However, as the clinical research evidence is preliminary, large, and definitive randomised controlled trials similar to those required for the licensing of any new pharmacological treatment are needed
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DRY EYE SYNDROME – DES
People with DES complains most frequently of a scratchy or foreign body sensation. Redness, pain, itching, inability to produce tears, light sensitivity, and blurred vision with difficulty driving after dark are common symptoms. The symptoms are located mainly to the pain sensitive cornea.
Recent animal experiments have demonstrated that DES is not exclusively a disease located to the cornea since inflammatory cells and immunological chemical mediators were found in the tear fluid. Since cornea does not contain tissue engaged in an inflammatory process the lacrimal gland and the conjunctiva have to participate in the syndrome even though symptoms relate to cornea.
A number of controlled clinical studies have been published where these fatty acids have been given in a placebo-controlled design. Rahul Bhargava and colleagues (1) included 264 DES subjects given 1g daily of marine omega3 fatty acids mainly eicosapentaenoic acid (EPA) and compared effects on symptoms, tear production and corneal cell integrity. A large control group of 254 individuals were given matching placebo. After three months, there was a significant reduction in symptom score in the omega3 group along with improvement in tear production and corneal cell integrity. Kawatita K et al (2) included 27 DES patients in a study providing half of the group with a product containing 1.3g of EPA and 0,5 g of docosahexaenoic acid (DHA) daily for 12 weeks. Symptoms were significantly reduced in the intervention group.
Kangari H and collaborators included sixty-four patients with dry eye symptoms (3). The subjects were randomized into two groups: 33 persons in the treatment group given 2 capsules of omega-3 (each containing 180 mg EPA and 120 mg DHA and 31 persons in the placebo group. The tear break-up time (TBUT), Schirmer’s score, and Ocular Surface Disease Index (OSDI) were measured 1 month after the intervention. Repeated-measures analysis of variance showed that improvements in TBUT, OSDI, and Schirmer’s scores were significantly better in the treatment group than in the placebo group. The changes in the treatment and placebo groups were 71% and 3.3% for TBUT (P<0.001), 26% and 4% (P=0.004) for dry eye symptoms, and 22.3% and 5.1% for Schirmer’s score (P=0.033), respectively. In conclusion, his study demonstrated that omega-3 fatty acids for 30 days was associated with a decrease in the rate of tear evaporation, an improvement in dry eye symptoms, and an increase in tear secretion.
In another study by Bhargava R and Kumar P 496 contact lens carriers with DES were randomly allocated to treatment with marine omega3 fatty acids (0.6g daily) or placebo for six months (4). The study demonstrated a significant improvement in dry eye symptoms and an increase in tear secretion in the omega3 treated group. The Bhargava group included 428 computer workers with DES in another study (5). Half the group were given the same dose of omega3 fatty acids as in study 7. The rest were provided with matching placebo capsules and followed for three months. There was a significant improvement in symptoms followed by increased tear production in the active treatment group. A recent study by Bhargava R and collaborators evaluated the effect of higher omega 3 fatty acid dose than in their previous studies namely 2,400 mg/day for 45 days on dry eye symptoms, tear production, stability, and conjunctival cytology in young and middle-aged visual display terminal (VDT) users (6). It was a randomized, double-blind, interventional study where 256 VDT users were randomized to receive omega-3 while 266 subjects received matching placebo capsules. Patients were evaluated at baseline, 30 days, and 45 days. The primary outcome measure was an improvement in dry eye symptoms. Secondary outcome measures were improvement in the Nelson grade on conjunctival impression cytology, Schirmer test values, and tear film breakup time (TBUT). In the omega3 group, the mean symptom score differed significantly between active treatment and placebo (P<0.005) as did the TBUT and Nelson grade evaluation. Schirmer test values did not differ significantly after adjustment for multiple comparisons. Consumption of 2,400 mg/day of O3FA supplement improved symptoms, tear stability, and conjunctival cytology but not tear production in symptomatic VDT users.
In a meta-analysis of published studies using a randomized, placebo-controlled design, Liu A and Yi J included a total of 790 participants in seven independent studies published between 2007 and 2013 (8). The authors concluded that based on the experience from these studies Omega3 fatty acid seemed to offer an effective therapy for DES.
Bhargava R, Kumar P, Kumar M, et al. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. International journal of ophthalmology 2013;6(6): 811-816
Kawakita T, Kawabata F, Tsuji T et al. Effects of dietary supplementation with fish oil on dry eye syndrome subjects: randomized controlled trial. Biomedical research 2013;34(5):215-220
Kangari H, Eftekhari MH, Sardari S et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology 2013;120(11):2191-2196
Bhargava R and Kumar P. Oral omega-3 fatty acid treatment for dry eye in contact lens wearers. Cornea 2015;34(4):413-420
Bhargava R, Kumar P, Phogat H et al. Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye. Contact lens & anterior eye 2015;38(3):206-210
Bhargava R, Kumar P, and Arora Y. Short-Term Omega 3 Fatty Acids Treatment for Dry Eye in Young and Middle-Aged Visual Display Terminal Users. Eye & contact lens 2016;42: 231-236
The Dry Eye Assessment and Management Study Research Group. n−3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease; The DREAM study. New England J of Med 2018 April 13.
Liu A and Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Medical science monitor 2014;20:1583-1589
Article below posted on the European Journal of Clinical Nutrition website.
Association of blood levels of marine omega-3 fatty acids with coronary calcification and calcium density in Japanese men
Clinical trials of eicosapentaenoic acid (EPA) among high-risk groups in Japan in which consumption of mairne-omega-3 fatty acids (OM3) is much higher than other countries showed slower progression of coronary atherosclerosis. We aimed to determine the cross-sectional associations of coronary artery calcification (CAC) and calcium density with OM3, EPA, and docosahexaenoic acid (DHA), two principal OM3, in the general population in Japan.
Read full article on Nature.com