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Table 3 Studies assessing the lipid lowering effects of n-3 PUFA utilizing a supplement

From: A review of the effect of omega-3 polyunsaturated fatty acids on blood triacylglycerol levels in normolipidemic and borderline hyperlipidemic individuals

Study

Subject Characteristics

n-3 PUFA Source and Dose

Study Design

Duration

Lipid Outcomes

Other Findings

Average baseline TG, Total-C, LDL-C (mg/dL)

Fakhrzadeh (2010) [43]

73 females, 51 males

1 capsule of fish oil

Randomized, double-blind, placebo controlled, parallel arm

26 weeks

TG levels increased 15 % in the placebo group and decreased 2 % in the treatment group (sig. between group effect)

 

Age: 65+

(TG – 145, Total-C - 190, LDL-C - 114)

0.18 g EPA + 0.12 g DHA

LDL-c, HDL-c, or total-c did not change

Vs.

Placebo

Sanders (2011) [44]

225 female, 142 males

3 capsules of fish oil (1:5 ratio of EPA:DHA) containing:

Randomized, placebo controlled, parallel arm, double-blind

52 weeks

TG levels reduced 16.5 % by 1.8 g/day, and was unchanged in both 0.45 g/day and 0.9 g/day (sig)

No change in blood pressure, arterial stiffness, or measures of endothelial function after supplementation

Age: 45–70

(TG – 100, Total-C - 210, LDL-C - 125)

a) 0.45 g n-3 PUFA

Vs.

b) 0.9 g n-3 PUFA

Total-c , HDL-c and LDL-c was unchanged after supplementation at each dose

Vs.

c) 1.8 g n-3 PUFA

Vs.

Placebo

Hlais (2013) [45]

112 males

Fish oil (FO) capsules (Per gram: 0.737 g of n-3 PUFA: 0.495 g EPA + 0.196 g DHA):

Randomized, single blind, parallel arm study

6 and 12 weeks

After 6 weeks :

No significant effects on glycemic and blood pressure parameters were noted

Age: 18–35

(TG – 125, Total-C - 187, LDL-C - 118)

A) 2 g of FO

TG was reduced by 15 %, 4 %, 10 % in Groups A, B, D, respectively, and elevated by 6 %, 3 % in Groups C, E, respectively (only group A was sig)

Vs.

B) 1 g of FO and 8 g of sunflower oil

Vs.

Total-c and LDL-c was elevated by 2-8 % in Groups A, B, C, E (non-sig) and by 7 % and 13 % in Group D, respectively (sig)

C) 2 g of FO and 8 g of sunflower oil

Vs.

HDL-c was elevated by 4-6 % in Groups A, C, D and reduced by 10 % and 3 % in Groups B, E, respectively (non-sig)

D) 4 g of FO and 8 g of sunflower oil

Vs.

After 12 weeks :

TG was reduced by 12 %, 12 %, 2 %, 5 % in Groups A, B, D, E respectively, and elevated by 1 % in Groups C (non-sig)

Total-c was elevated by 4 % in Groups A, D, and reduced by 1 %, 4 % and 10 % in groups B, C, E, respectively (only Group E was sig)

E) 8 g of sunflower oil

LDL-c was elevated by 3-7 % in Groups A, B, D (non-sig) and reduced by 5 % and 13 % in Group C, E, respectively (only Group E was sig)

HDL-c was elevated by 6 %, 2 % in Groups A, D, respectively, and reduced by 5-7 % in Groups B, C, E, (non-sig)

Nilsson (2012) [46]

28 females, 10 males

5 capsules of fish oil

Randomized, placebo controlled, crossover study

5 weeks

TG reduced 12 % (sig)

Systolic and Diastolic blood pressure was reduced by 5 %

Age: 51–72

1.5 g EPA, 1.05 g DHA, and 0.45 g of other n-3 PUFA

(TG – 142)

Inflammatory markers were unchanged

Vs.

Placebo

Rizza (2009) [47]

25 females, 25 males

2 capsules of fish oil (0.6 g EPA, 0.4 g DHA per capsule)

Randomized, double-blind, parallel designed, placebo controlled

12 weeks

TG levels reduced 26 % with treatment (sig)

Improvement in flow mediated dilation in treatment group

Age: 29.9+/− 6.6

(TG – 118, Total-C - 192, LDL-C - 122)

Vs.

HDL-c, LDL-c and total-c did not change

Placebo

Lovegrove (2004) [48]

84 Males

4 capsules of fish oil

Randomized, double bind, placebo controlled, parallel arm

12 weeks

TG was reduced 31 % (sig)

 

Age: 30–70

1.5 g EPA, 1.0 g DHA

HDL-c increased (sig)

(TG – 128, Total-C - 207, LDL-C - 128)

Vs.

No effect on total-c or LDL-c was observed

Placebo

Ciubotaru (2003) [49]

30 Post Menopausal Females on Hormone Replacement Therapy

Fish oil

Randomized, double blind, placebo controlled

5 weeks

TG reduced 26 % in group receiving 14 g of fish oil (sig) and 4 % in group receiving 7 g of fish oil

CRP reduced, IL-6 reduced in groups receiving fish oil supplements

Randomized to three groups:

Age: 60+/− 5

a) 14 g safflower oil (0 g EPA/DHA)

(TG – 121, Total-C - 220, LDL-C - 126)

Vs.

Group receiving safflower oil alone experienced a 21 % increase in TG levels

b) 7 g safflower oil + 7 g fish oil (1.45 g EPA + DHA)

No change in LDL-c or total-c

Vs.

14 g fish oil

(2.9 g EPA+ DHA)

Offman (2013) [50]

15 Females, 37 Males

Fish oil: 4 g of Epanova or 4 g of Lovaza

Open label, parallel group cohorts

2 weeks

Participants receiving Epanova had reductions in TG, HDL-c and LDL-c of 21 %, 5 % and 4 %, respectively

Epanova raised plasma total EPA + DHA concentrations 3 times the level as subject’s receiving Lovaza

Age: 18–55

(TG – 166, Total-C - 189, LDL-C - 128)

Lovaza: 1.8 g of EPA, 1.5 g of DHA

Participants receiving Lovaza had reductions in TG and HDL-c levels of 8 % and 7 %, respectively, while raising LDL-c by 0.4 %

Epanova: 2.2 g of EPA and 0.8 g of DHA

(effects on TG between groups were significant)

Laidlaw (2003) [51]

31 Females

Fish oil capsules (4 g of EPA + DHA) with:

Randomized, parallel arm study

4 weeks

TG was reduced 35-40 % in groups receiving 0 g, 1 g and 2 g of GLA (sig), and TG was reduced 7 % in the group receiving 4 g of GLA

 

Age: 36–68

(TG – 112, Total-C - 213, LDL-C - 134)

0 g of gamma-linolenic acid (GLA)

Vs.

All groups had reductions in total-c of 1-9 %

1 g of GLA

LDL-c was reduced in all groups by 2-13 %, except in the group receiving 1 g of GLA (only sig in the group receiving 2 g of GLA)

Vs.

2 g of GLA

Vs.

4 g of GLA

Mann (2010) [52]

19 Females, 11 Males

10 capsules containing:

Randomized, double-blind, parallel designed study

2 weeks

TG was reduced 25 % in the group receiving Seal oil and 21 % in the group receiving Tuna oil (sig)

CRP was reduced by 11 % and 25 % in the groups receiving tuna oil and fish oil, respectively

Age: 20–50

Tuna oil (0.21 g of EPA, 0.03 g of DPA, 0.81 g of DHA)

(TG – 120, Total-C - 196, LDL-C - 134)

Vs.

Seal oil (0.34 g of EPA, 0.23 g of DPA, 0.45 g of DHA)

LDL-c was elevated through both interventions by 3 %

Vs.

Placebo

Vanschoonbeek (2004) [53]

20 Males

9 capsules of fish oil:1.05 g EPA, 0.75 g, DHA, and 1.2 g other n-3 PUFA

Intervention (no placebo, compared initial vs. final values)

4 weeks

TG was reduced 10 % (sig)

Treatment lowered integrin activation, as well as plasma levels of fibrinogen and factor V

Age: 48.5+/− 9.8

Total-c was unchanged

(TG – 141, Total-C - 218, LDL-C - 151)

LDL-c increased 5 % and remained borderline high

Di Stasi (2004) [54]

18 Females, 18 Males

Fish Oil Capsules (46 % and 39 % of n-3 PUFA was EPA and DHA, respectively):

Randomized, parallel arm study

12 weeks

There was no significant change in TG levels from baseline within each group, however, a significant dose response was noted. n-3 PUFA provided at 2 g and 4 g per day resulted in TG reductions by 15 and 20 %, respectively.

 

Age: 21–51

(TG – 87, Total-C - 211)

1 g of n-3 PUFA/day

 

Vs.

2 g of n-3 PUFA/day

Vs.

4 g of n-3 PUFA/day

Stark (2000) [55]

35 Postmenopausal Females

8 Fish Oil capsules:

Randomized, double blind, placebo controlled, cross-over study

4 weeks

n-3 PUFA produced a 26 % reduction in serum TG levels (sig)

 

2.4 g EPA + 1.6 g of DHA

n-3 PUFA produced a 5 % increase in LDL-c levels

Age: 43–60

Vs.

(TG – 120, Total-C - 213, LDL-C - 122)

Placebo (primrose oil)

Damsgaard (2008) [56]

66 males

10 capsules of fish oil (2.0 g EPA, 1.25 g DHA)

Randomized, double-blind placebo controlled, 2x2 factorial design

8 weeks

TG levels were reduced 19 % with high LA intake (sig) and 51 % reduction with low LA intake (sig)

-No change in inflammatory markers

Age: 19–40

(TG – 89, Total-C - 153, LDL-C - 99)

Vs.

Placebo

Supplementation with either high LA in diet or low LA in diet

No changes in HDL-c, LDL-c, total-c

Brady (2004) [57]

29 Males

fish oil capsules

Double-blind, parallel, dietary intervention

6 weeks

TG was reduced 20 % and 25 % in high and moderate groups, respectively (sig)

 

Age: 35–70

(2.5 g EPA+ DHA) with either:

Moderate n-6 PUFA diet (olive oil)

No changes in HDL-c, LDL-c, total-c

(TG – 137, Total-C - 186, LDL-C - 114)

Vs.

High n-6 PUFA diet (corn oil)

Kaul (2008) [58]

54 females, 34 males

2, 1 g capsules per day containing

Randomized, double blind, placebo controlled, parallel arm study

12 weeks

Fish oil produced a 4 % and 7 % increase in total-c and LDL-c, respectively

No significant change in CRP or TNF-É‘ levels

Age: 31–36

(TG – 113, Total-C - 184, LDL-C - 102)

Fish oil (0.606 g of n-3 PUFA; 0.242 g of DHA + 0.352 g of EPA)

Flaxseed oil produced a 4 % and 12 % increase in total-c and LDL-c, respectively

No significant change in platelet aggregation stimulated by thrombin or collagen

Hempseed oil produced a 4 % increase in both total-c and LDL-c and an 18 % increase in TG

Vs.

Flaxseed oil (1.02 g of ALA)

Vs.

Hempseed oil (0.372 g of ALA,1.14 g of LA)

Vs.

Sunflower oil (1.36 g of LA)

Buckley (2004) [59]

20 Females, 22 Males

9 capsules of EPA or DHA-rich oil

Randomized, double bind, placebo controlled, parallel arm

4 weeks

EPA treatment: TG decreased 22 % (sig)

 

Age: 20–70

4.8 g EPA

(TG – 106, Total-C - 205, LDL-C - 124)

Vs.

DHA treatment: TG decreased 38 % (sig)

4.9 g DHA

Total-c decreased (p = 0.06)

Vs.

Placebo

No changes in LDL-c or HDL-c

Sanders (2006) [60]

40 Females, 39 Males

4 capusles of DHA-rich oil from Schizochytrium sp.

Randomized double bind, placebo controlled, parallel arm

4 weeks

TG decreased from baseline 14 % (sig)

 

Age: 31 +/− 14

No changes in total-c or LDL-c levels

(TG – 89, Total-C – 175, LDL-C – 96)

1.5 g DHA + 0.6 g DPA

Vs.

HDL-c increased by 9 % (sig)

Placebo

Stark (2004) [61]

32 Postmenopausal Females

12, 500 mg Capsules containing DHA from an algal source

Randomized, double blind, placebo controlled, cross-over study

4 weeks

DHA decreased TG by 8 % (sig).

DHA was able to reduce resting heart rate by 7 %

Age: 45–70

2.8 g of DHA

DHA elevated HDL-c by 8 %, total-c by 4 % and reducing LDL-c by 8 %

(TG - 132, Total-C – 216, LDL-C – 125)

Vs.

Placebo (corn and soy oil mixture)

Wu (2006) [62]

25 Postmenopausal Vegetarian Females

Capsules providing 6 g of DHA rich algae oil

Randomized, single blind, placebo controlled study

6 weeks

DHA decreased TG by 18 %, Total-c by 3 % and LDL-C by 3 % while elevating HDL-C by 6 %

No changes in levels of urinary estrogen metabolites, or markers of oxidative stress (e.g. É‘-tocopherol)

Age: 52 +/− 5 yrs

2.4 g of DHA

(TG - 124, Total-C – 158, LDL-C - 90)

Vs.

*Only between group analysis was performed

Placebo (corn oil)

Geppert (2006) [63]

87 Females, 87 Males Vegetarians

4 capusles of DHA-rich oil from Ulkenia sp.

Randomized, double blind, parallel design, placebo controlled

8 weeks

TG reduced 23 % in the group receiving DHA rich oil (sig).

No significant changes in haemostatic factors

Age: 28–43

0.94 g of DHA

Total cholesterol, LDL-c and HDL-c increased 6-11 % in the group consuming DHA rich oil (sig)

Vs.

(TG - 95, Total-C – 180, LDL-C – 97)

Placebo (olive oil)

No changes in the placebo group

Cazzola (2007) [64]

93 Young Males, 63 Older Males

9 capsules of EPA-rich fish oil containing either:

Randomized, double blind, placebo controlled

12 weeks

TG levels were reduced ~25 % after 1.35, 2.7 or 4.05 g of EPA across all ages (sig)

EPA supplementation tended to decrease soluble ICAM-1

a) 1.35 g EPA

Age: Young, 18–42; Old, 53–70

Vs.

b) 2.7 g EPA

(TG - 82, Total-C – 162, LDL-C – 103)

Vs.

No effect on HDL-c, LDL-c, or total-c in any group

c) 4.05 g EPA

Vs.

Placebo

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Lipids in Health and Disease

ISSN: 1476-511X