School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Clin Nutr. 2022 Aug;41(8):1798-1807. doi: 10.1016/j.clnu.2022.06.034. Epub 2022 Jun 30.
BACKGROUND & AIMS: Considerable attention has focused on the role of omega-3 polyunsaturated fatty acids (PUFA) in the prevention of cardiometabolic diseases, which has led to dietary recommendations to increase omega-3 fatty acid intake. A meta-analysis was conducted to summarize evidence from prospective studies regarding associations between omega-3 PUFA biomarkers and risk of developing major chronic diseases.
Four electronic databases were searched for articles from inception to March 1, 2022. Random-effects model was used to estimate the pooled relative risk (RR) and 95% confidence intervals (CIs) for the association of omega-3 PUFAs, including α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA), with risk of developing type 2 diabetes (T2D), cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, cancer, and mortality. The Grades of Recommendation, Assessment, Development and Evaluation assessment tool was used to rates the confidence in estimates.
A total of 67 prospective studies comprised of 310,955 participants were identified. Individual omega-3 PUFAs showed divergent associations with the study outcomes of interest. A significant inverse association with T2D risk was observed across categories of ALA (relative risk [RR]: 0.89, 95% confidence interval [CI]: 0.82-0.96), EPA (RR: 0.85, 95% CI: 0.72-0.99) and DPA (RR: 0.84, 95% CI: 0.73-0.96) biomarkers. The marine-origin omega-3 fatty acids biomarkers but not ALA was significantly associated with lower risks of total CVD, CHD, and overall mortality, with RRs ranging from 0.70 for DHA-CHD association to 0.85 for EPA-CHD association. A lower risk of colorectal cancer was observed at higher levels of DPA (RR: 0.76, 95% CI: 0.59-0.98) and DHA (RR: 0.80; 95% CI: 0.65-0.99), whereas no association was noted for other outcomes. In addition, a dose-response relationship was observed between an increasing level of EPA, DPA, or DHA biomarker and lower risk of CVD.
Higher concentrations of marine-derived omega-3 PUFA biomarkers were associated with a significantly reduced risk of total CVD, CHD, and total mortality. Levels of ALA were inversely associated with a lower risk of T2D but not CVD-related outcomes. These data support the dietary recommendations advocating the role of omega-3 PUFAs in maintaining an overall lower risk of developing cardiovascular disease and premature deaths.
人们对 ω-3 多不饱和脂肪酸（PUFA）在预防心血管代谢疾病中的作用给予了相当多的关注，这导致了增加 ω-3 脂肪酸摄入量的饮食建议。进行了一项荟萃分析，以总结前瞻性研究中关于 ω-3 PUFA 生物标志物与主要慢性疾病发展风险之间关联的证据。
从数据库建立到 2022 年 3 月 1 日，检索了四个电子数据库中的文章。使用随机效应模型来估计 ω-3 PUFA（包括 α-亚麻酸（ALA）、二十碳五烯酸（EPA）、二十二碳五烯酸（DPA）和二十二碳六烯酸（DHA））与 2 型糖尿病（T2D）、心血管疾病（CVD）、包括冠心病（CHD）和中风、癌症和死亡率风险之间关联的汇总相对风险（RR）和 95%置信区间（CI）。使用推荐评估、制定与评估分级工具来评估估计的置信度。
共确定了 67 项包含 310955 名参与者的前瞻性研究。单独的 ω-3 PUFAs 与研究结果显示出不同的关联。ALA（RR：0.89，95%CI：0.82-0.96）、EPA（RR：0.85，95%CI：0.72-0.99）和 DPA（RR：0.84，95%CI：0.73-0.96）生物标志物与 T2D 风险呈显著负相关。海洋来源的 ω-3 脂肪酸生物标志物而不是 ALA 与总 CVD、CHD 和总体死亡率的较低风险显著相关，RR 范围从 DHA-CHD 关联的 0.70 到 EPA-CHD 关联的 0.85。较高水平的 DPA（RR：0.76，95%CI：0.59-0.98）和 DHA（RR：0.80；95%CI：0.65-0.99）与结直肠癌风险降低相关，而其他结果无关联。此外，观察到 EPA、DPA 或 DHA 生物标志物水平与 CVD 风险降低之间存在剂量反应关系。
较高浓度的海洋衍生 ω-3 PUFA 生物标志物与总 CVD、CHD 和总死亡率的显著降低风险相关。ALA 水平与 T2D 风险降低呈负相关，但与 CVD 相关结局无关。这些数据支持饮食建议，即 ω-3 PUFAs 可降低患心血管疾病和过早死亡的整体风险。
