Institute for Sport, Physical Activity & Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Cardiovasc Diabetol. 2018 Jul 7;17(1):98. doi: 10.1186/s12933-018-0740-x.
Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects.
Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate.
A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL [ES: - 0.10, (95% CI - 0.17, - 0.03); p = 0.007], VLDL (ES: - 0.26 (- 0.51, - 0.01); p = 0.044], triglycerides (ES: - 0.39 (- 0.55, - 0.24; p ≤ 0.001] and HbA1c (ES: - 0.27 (- 0.48, - 0.06); p = 0.010]. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α [ES: - 0.59 (- 1.17, - 0.01); p = 0.045] and IL-6 (ES: - 1.67 (- 3.14, - 0.20); p = 0.026]. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05).
n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802.
随机对照试验（RCTs）表明，ω-3 多不饱和脂肪酸（n-3PUFAs）的补充可能有利于改善 2 型糖尿病（T2DM）患者的心脏代谢生物标志物。以前的荟萃分析受到样本量不足和忽略荟萃回归技术的限制，自上一次全面的荟萃分析以来，大量的 RCTs 已经发表。因此，需要更新有关剂量、持续时间或这两个因素之间相互作用的信息，以评估 n-3PUFAs 补充对 T2DM 患者血脂谱、炎症参数、血压和血糖控制指标的影响，并确定治疗剂量、持续时间或两者之间的相互作用是否会改变这些影响。
搜索了包括 PubMed 和 MEDLINE 在内的数据库，以获取调查 n-3PUFAs 补充对血脂谱、炎症参数、血压和血糖控制指标影响的 RCTs。使用随机效应荟萃分析汇总数据，并以标准化均数差（Hedges g）和 95%置信区间（95%CI）表示。进行了荟萃回归分析，以调查补充持续时间和 n-3PUFAs 总剂量作为合适的调节变量的影响。
共确定了 45 项 RCT，涉及 2674 名 T2DM 患者。n-3PUFAs 补充与 LDL [ES：-0.10，（95%CI -0.17，-0.03）；p=0.007]、VLDL（ES：-0.26（-0.51，-0.01）；p=0.044）、甘油三酯（ES：-0.39（-0.55，-0.24；p≤0.001]和 HbA1c [ES：-0.27（-0.48，-0.06）；p=0.010]的显著降低相关。此外，n-3PUFAs 补充与血浆 TNF-α [ES：-0.59（-1.17，-0.01）；p=0.045]和 IL-6 [ES：-1.67（-3.14，-0.20）；p=0.026]水平的降低相关。所有其他脂质标志物、血糖控制指标、炎症参数和血压均无变化（p>0.05）。
n-3PUFAs 补充具有良好的降脂作用，可降低促炎细胞因子水平并改善血糖。持续时间和剂量都似乎无法解释对 n-3PUFAs 反应的异质性。
该试验在 http://www.crd.york.ac.uk 上注册为 CRD42016050802。
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