ω-3 多不饱和脂肪酸补充剂是否能改善代谢综合征及相关心血管疾病？一项随机对照试验的系统评价和荟萃分析。
Does omega-3 PUFAs supplementation improve metabolic syndrome and related cardiovascular diseases? A systematic review and meta-analysis of randomized controlled trials.
机构信息
National Engineering Research Center for Functional Food, State Key Lab of Food Science and Technology, International Joint Research Laboratory for Lipid Nutrition and Safety, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
National Engineering Laboratory for Agri-product quality Traceability, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.
出版信息
Crit Rev Food Sci Nutr. 2024 Sep;64(26):9455-9482. doi: 10.1080/10408398.2023.2212817. Epub 2023 May 24.
Literature is inconsistent regarding the effects of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) supplementation on patients with metabolic syndrome (MetS) and related cardiovascular diseases (CVDs). Therefore, the aim of this systematic review and meta-analysis is to summarize data from available randomized controlled trials (RCTs) on the effect of omega-3 PUFAs on lipid profiles, blood pressure, and inflammatory markers. We systematically searched PubMed, Embase, and Cochrane Library databases to identify the relevant RCTs until 1 November 2022. Weighed mean difference (WMD) was combined using a random-effects model. Standard methods were applied to assess publication bias, sensitivity analysis, and heterogeneity among included studies. A total of 48 RCTs involving 8,489 subjects met the inclusion criteria. The meta-analysis demonstrated that omega-3 PUFAs supplementation significantly reduced triglyceride (TG) (WMD: -18.18 mg/dl; 95% CI: -25.41, -10.95; < 0.001), total cholesterol (TC) (WMD: -3.38 mg/dl; 95% CI: -5.97, -0.79; = 0.01), systolic blood pressure (SBP) (WMD: -3.52 mmHg; 95% CI: -5.69, -1.35; = 0.001), diastolic blood pressure (DBP) (WMD: -1.70 mmHg; 95% CI: -2.88, -0.51; = 0.005), interleukin-6 (IL-6) (WMD: -0.64 pg/ml; 95% CI: -1.04, -0.25; = 0.001), tumor necrosis factor-α (TNF-α) (WMD: -0.58 pg/ml; 95% CI: -0.96, -0.19; = 0.004), C-reactive protein (CRP) (WMD: -0.32 mg/l; 95% CI: -0.50, -0.14; < 0.001), and interleukin-1 (IL-1) (WMD: -242.95 pg/ml; 95% CI: -299.40, -186.50; < 0.001), and significantly increased in high-density lipoprotein (HDL) (WMD: 0.99 mg/dl; 95% CI: 0.18, 1.80; = 0.02). However, low-density lipoprotein (LDL), monocyte chemoattractant protein-1 (MCP-1), intracellular adhesion molecule-1 (ICAM-1), and soluble endothelial selectin (sE-selectin) were not affected. In subgroup analyses, a more beneficial effect on overall health was observed when the dose was ≤ 2 g/day; Omega-3 PUFAs had a stronger anti-inflammatory effect in patients with CVDs, particularly heart failure; Supplementation with omega-3 PUFAs was more effective in improving blood pressure in MetS patients and blood lipids in CVDs patients, respectively. Meta-regression analysis showed a linear relationship between the duration of omega-3 PUFAs and changes in TG ( = 0.023), IL-6 ( = 0.008), TNF-α ( = 0.005), and CRP ( = 0.025). Supplementation of omega-3 PUFAs had a favorable effect on improving TG, TC, HDL, SBP, DBP, IL-6, TNF-α, CRP, and IL-1 levels, yet did not affect LDL, MCP-1, ICAM-1, and sE-selectin among patients with MetS and related CVDs.
文献对于ω-3 多不饱和脂肪酸（ω-3 PUFAs）补充剂对代谢综合征（MetS）和相关心血管疾病（CVDs）患者的影响不一致。因此，本系统评价和荟萃分析的目的是总结现有随机对照试验（RCTs）中关于 ω-3 PUFAs 对血脂谱、血压和炎症标志物影响的数据。我们系统地检索了 PubMed、Embase 和 Cochrane Library 数据库，以确定截至 2022 年 11 月 1 日的相关 RCTs。使用随机效应模型合并加权均数差（WMD）。应用标准方法评估发表偏倚、敏感性分析和纳入研究的异质性。共有 48 项 RCT 纳入了 8489 名受试者。荟萃分析表明，ω-3 PUFAs 补充剂可显著降低甘油三酯（TG）（WMD：-18.18mg/dl；95%CI：-25.41，-10.95；<0.001）、总胆固醇（TC）（WMD：-3.38mg/dl；95%CI：-5.97，-0.79；=0.01）、收缩压（SBP）（WMD：-3.52mmHg；95%CI：-5.69，-1.35；=0.001）、舒张压（DBP）（WMD：-1.70mmHg；95%CI：-2.88，-0.51；=0.005）、白细胞介素-6（IL-6）（WMD：-0.64pg/ml；95%CI：-1.04，-0.25；=0.001）、肿瘤坏死因子-α（TNF-α）（WMD：-0.58pg/ml；95%CI：-0.96，-0.19；=0.004）、C 反应蛋白（CRP）（WMD：-0.32mg/l；95%CI：-0.50，-0.14；<0.001）和白细胞介素-1（IL-1）（WMD：-242.95pg/ml；95%CI：-299.40，-186.50；<0.001），并显著增加高密度脂蛋白（HDL）（WMD：0.99mg/dl；95%CI：0.18，1.80；=0.02）。然而，低密度脂蛋白（LDL）、单核细胞趋化蛋白-1（MCP-1）、细胞间黏附分子-1（ICAM-1）和可溶性内皮选择素（sE-选择素）没有受到影响。在亚组分析中，当剂量≤2g/天时，对整体健康的有益影响更大；ω-3 PUFAs 在 CVD 患者中具有更强的抗炎作用，尤其是心力衰竭；ω-3 PUFAs 补充剂在改善 MetS 患者的血压和 CVD 患者的血脂方面更有效。Meta 回归分析显示，ω-3 PUFAs 的持续时间与 TG（=0.023）、IL-6（=0.008）、TNF-α（=0.005）和 CRP（=0.025）的变化呈线性关系。ω-3 PUFAs 补充剂对改善 TG、TC、HDL、SBP、DBP、IL-6、TNF-α、CRP 和 IL-1 水平有良好的效果，但对 MetS 和相关 CVDs 患者的 LDL、MCP-1、ICAM-1 和 sE-选择素没有影响。
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