饮食及补充omega-3高不饱和脂肪酸摄入量、血液和组织中omega-3高不饱和脂肪酸浓度与结直肠息肉复发之间的关系：seAFOod息肉预防试验的二次分析
The Relationship Between Dietary and Supplemental omega-3 Highly Unsaturated Fatty Acid Intake, Blood and Tissue omega-3 Highly Unsaturated Fatty Acid Concentrations, and Colorectal Polyp Recurrence: A Secondary Analysis of the seAFOod Polyp Prevention Trial.
作者信息
Sun Ge, Fuller Harriett, Fenton Hayley, Race Amanda D, Downing Amy, Rees Colin J, Brown Louise C, Loadman Paul M, Williams Elizabeth A, Hull Mark A
机构信息
Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom.
Institute of Cancer Therapeutics, University of Bradford, Bradford, United Kingdom.
出版信息
J Nutr. 2025 Feb;155(2):549-558. doi: 10.1016/j.tjnut.2024.12.004. Epub 2024 Dec 13.
BACKGROUND
The seAFOod randomized controlled trial tested colorectal polyp prevention by the omega-3 (ω-3) highly unsaturated fatty acid (HUFA) eicosapentaenoic acid (EPA) and aspirin. Variable dietary intake of omega-3 HUFAs (also including docosahexaenoic acid [DHA]) and differential EPA capsule compliance could confound analysis of trial outcomes.
OBJECTIVE
The objective of this study was to investigate the relationship between total (diet and capsule) daily omega-3 HUFA intake, red blood cell (RBC), and rectal mucosa omega-3 HUFA concentrations, and colorectal polyp outcomes in a secondary analysis of the seAFOod trial.
METHODS
Individual-participant dietary omega-3 HUFA intake (mg/d) was derived from food frequency questionnaires using the European Prospective Investigation into Cancer and Nutrition-Norfolk fatty acid nutrient database. Capsule EPA intake (mg/d) was adjusted for compliance (capsule counting). Fatty acids were analyzed by liquid chromatography-tandem mass spectrometry (as % of total fatty acids). HUFA oxidation was measured using the HUFA/saturated fatty acid (SAT) ratio. The colorectal polyp detection rate (PDR; % with ≥1 polyps) and polyp number per participant were analyzed according to the change in RBC EPA concentrations during the trial (ΔEPA), irrespective of treatment allocation.
RESULTS
There was a small degree of HUFA degradation over time in RBC samples stored at > -80C at research sites (r = -0.36, P<0.001 for HUFA/SAT ratio over time), which did not affect analysis of omega-3 HUFA concentrations. Low baseline EPA concentration, as well as allocation to EPA and % compliance, were associated with a high ΔEPA. Individuals with a ΔEPA value >+0.5% points (ΔEPA), irrespective of allocation to EPA or placebo, had a lower PDR than ΔEPA individuals (odds ratio: 0.63; 95% confidence interval [CI]: 0.40, 1.01) and reduced colorectal polyp number (incidence rate ratio: 0.74; 95% CI: 0.54, 1.02).
CONCLUSIONS
Analysis of the seAFOod trial according to the change in EPA concentration, instead of treatment allocation, revealed a protective effect of EPA treatment on colorectal polyp recurrence (ISRCTN05926847).
背景
“海产品”随机对照试验对ω-3（ω-3）高度不饱和脂肪酸（HUFA）二十碳五烯酸（EPA）和阿司匹林预防结直肠息肉进行了测试。ω-3 HUFA（也包括二十二碳六烯酸 [DHA]）的可变饮食摄入量以及EPA胶囊依从性差异可能会混淆试验结果的分析。
目的
本研究的目的是在“海产品”试验的二次分析中，调查每日总（饮食和胶囊）ω-3 HUFA摄入量、红细胞（RBC）和直肠黏膜ω-3 HUFA浓度与结直肠息肉结果之间的关系。
方法
个体参与者的饮食ω-3 HUFA摄入量（mg/天）来自使用欧洲癌症与营养前瞻性调查 - 诺福克脂肪酸营养数据库的食物频率问卷。根据依从性（胶囊计数）调整胶囊EPA摄入量（mg/天）。通过液相色谱 - 串联质谱法分析脂肪酸（以总脂肪酸的百分比表示）。使用HUFA/饱和脂肪酸（SAT）比率测量HUFA氧化。根据试验期间红细胞EPA浓度的变化（ΔEPA）分析结直肠息肉检测率（PDR；≥1个息肉的百分比）和每位参与者的息肉数量，不考虑治疗分配情况。
结果
在研究地点，储存在>-80°C的红细胞样本中，HUFA随时间有一定程度的降解（r = -0.36，HUFA/SAT比率随时间变化P<0.001），但这并不影响ω-3 HUFA浓度的分析。低基线EPA浓度以及分配到EPA组和依从率与高ΔEPA相关。无论分配到EPA组还是安慰剂组，ΔEPA值>+0.5个百分点（ΔEPA）的个体的PDR低于ΔEPA较低的个体（优势比：0.63；95%置信区间[CI]：0.40，1.01），结直肠息肉数量减少（发病率比：0.74；95%CI：0.54，1.02）。
结论
根据EPA浓度的变化而非治疗分配对“海产品”试验进行分析，揭示了EPA治疗对结直肠息肉复发的保护作用（ISRCTN05926847）。
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