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fish oil

Indications: 1) hypertriglyceridemia - *2-4 g/day may diminish serum triglyceride by 45% [2]; also see Omacor 2) *may reduce risk of cardiac death 15-50% [2] 3) *may improve attention is subgroups of elderly men & apoE4 carriers [3] 4) *modest benefit in patients with heart failure [4] 5) fish oil supplementation during pregnancy & lactation reduces risk for allergic sensitization to egg at 1 year (RR=0.69) [9] 6) increases semen volume & total sperm count in young healthy men [12] 7) fish oil supplementation & higher plasma n-3 PUFA levels, especially DHA, associated with lower risks of macrovascular complications & microvascular complications in patients with type 2 diabetes [16] - beneficial role of fish oil in preventing diabetic nephropathy - may be mediated by HbA1c, serum CRP & serum HDL-cholesterol [17] 8) may lower risk of certain cancers - higher levels of omega-3s from fish oil associated with lower risk of colon cancer, stomach cancer & other GI cancers, lung cancer - higher levels of omega-3s from fish oil associated with lower risk of brain cancer, melanoma, bladder cancer & others [18] Contraindications: - does not improve age-related cognitive decline in elderly [11] - does not prevent post-operative atrial fibrillation - chemotherapy: fatty acid 16:4(n-3) in fish oil associated with resistance to chemotherapy, cisplatin specifically cited [8] - 3000 mg QD no better than olive oil for treatment of xerophthalmia [10] Dosage: - 2-4 g/day for treatment of hypertriglyceridemia [2] Radiology: - may diminish CNS white matter hyperintensities [3] Adverse effects: - may be a risk factor for atrial fibrillation & embolic stroke [15] - marine omega-3 supplementation > 1 g/day is associated with an increased risk of atrial fibrillation (RR=1.25) [13] Drug interactions: - fish oil increases risk of bleeding in patients taking anticoagulants [14] Notes: Fatty acid composition of fish oil (%) Common name 18:3w3 20:5w3 22:5w3 22:6w3 Cod, Atlantic <1 18 1 38 Salmon, Chinook 1 8 2 6 Salmon, Pink 1 13 3 19 sardine 1 10 3 8 haddock <1 14 1 24 halibut - 13 2 19 snapper - 4 1 34 tuna, albacore - 6 1 18 trout, rainbow 5 5 3 19 clam, littleneck 2 10 2 14 crab, blue 1 13 1 11 mussel - 14 1 28 oyster, Pacific 2 22 1 20 scallop, sea <1 21 1 26 - omega-3 fatty acid composition of farm-raised salmon is as high or higher than wild salmon - fish oil apparently also contains fatty acid 16:4(n-3) [8]

Related

fatty acid, omega-3 (Epanova) omega-3-fatty acid ethyl esters (Omacor, Lovaza)

Specific

cod liver oil krill oil salmon oil

General

dietary fat dietary supplement (nutraceutical, medicinal food)

References

  1. Prescriber's Letter 12(7): 2005 Omega-3 Fatty Acids Detail-Document#: 210709 (subscription needed) http://www.prescribersletter.com
  2. Fish oil supplements: Do they contain mercury? http://www.mayoclinic.com/invoke.cfm?id=AN00797
  3. van de Rest O et al. Effect of fish oil on cognitive performance in older subjects: A randomized, controlled trial. Neurology 2008 Aug 5; 71:430 PMID: 18678826 - Virtanen JK et al. Fish consumption and risk of subclinical brain abnormalities on MRI in older adults. Neurology 2008 Aug 5; 71:439. PMID: 18678827
  4. Prescriber's Letter 15(11): 2008 Statins and Fish Oil for Heart Failure Detail-Document#: 241103 (subscription needed) http://www.prescribersletter.com
  5. Mozaffarian D et al. Fish oil and postoperative atrial fibrillation: The omega-3 fatty acids for prevention of post-operative atrial fibrillation (OPERA) randomized trial. JAMA 2012 Nov 5 PMID: 23128104 http://jama.jamanetwork.com/article.aspx?articleid=1389226
  6. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  7. Eslick GD1, Howe PR, Smith C, Priest R, Bensoussan A. Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis. Int J Cardiol. 2009 Jul 24;136(1):4-16 PMID: 18774613
  8. Daenen LGM et al Increased Plasma Levels of Chemoresistance-Inducing Fatty Acid 16:4(n-3) After Consumption of Fish and Fish Oil. JAMA Oncol. Published online April 02, 2015. PMID: 26181186 http://oncology.jamanetwork.com/article.aspx?articleid=2212208
  9. Garcia-Larsen V, Ierodiakonou D, Jarrold K et al Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine. February 28, 2018 PMID: 29489823 http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002507
  10. The Dry Eye Assessment and Management Study Research Group n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018 Apr 13. [Epub ahead of print] PMID: 29652551 Free Article http://www.nejm.org/doi/full/10.1056/NEJMoa1709691
  11. Danthiir V, Hosking DE, Nettlelbeck T et al An 18-mo randomized, double-blind, placebo-controlled trial of DHA-rich fish oil to prevent age-related cognitive decline in cognitively normal older adults. Am J Clin Nutr. 2018 May 1;107(5):754-762 PMID: 29722833
  12. Jensen TK, Priskorn L, Holmboe SA et al. Associations of fish oil supplement use with testicular function in young men. JAMA Netw Open 2020 Jan 17; 3:e1919462. PMID: 31951274 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758861
  13. Gencer B, Djousse L, Al-Ramady OT et al. Effect of long-term marine omega-3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: A systematic review and meta-analysis. Circulation 2021 Oct 6 PMID: 34612056 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055654
  14. Incze M. Vitamins and nutritional supplements: what do I need to know? JAMA Intern Med. 2019;179:460. PMID: 30615020
  15. Chen G, Qian ZM, Zhang J et al Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study. BMJ Med. 2024 May 21;3(1):e000451. PMID: 38800667 PMCID: PMC11116879 Free PMC article.
  16. Choudry J Fish Oil Supplements Cut Diabetes Complication Risk. Medscape. July 23, 2024 https://www.medscape.com/viewarticle/fish-oil-supplements-cut-diabetes-complication-risk-2024a1000diz - Tian S, Guo T, Qian F et al Fish Oil, Plasma n-3 PUFAs, and Risk of Macro- and Microvascular Complications among Individuals with Type 2 Diabetes. J Clin Endocrinol Metab. 2024 Jul 12:dgae482. PMID: 38994586 https://www.medscape.com/viewarticle/fish-oil-supplements-cut-diabetes-complication-risk-2024a1000diz
  17. Ao Y, Ye H, Liu X et a; Fish oil supplementation in relation to the risk of chronic kidney disease among patients with diabetes. Diabetes Obes Metab. 2024 Aug 27. PMID: 39192528 https://dom-pubs.onlinelibrary.wiley.com/doi/abs/10.1111/dom.15880
  18. Zhang Y, Sun Y, Song S Associations of plasma omega-6 and omega-3 fatty acids with overall and 19 site- specific cancers: A population-based cohort study in UK Biobank. Int J Cancer. 2024 Oct 17. PMID: 39417685 https://onlinelibrary.wiley.com/doi/10.1002/ijc.35226