Li Tingting, Shi Yihui, Cai Lijun
The First School of Clinical Medicine Zhejiang Chinese Medical University Hangzhou China.
Department of Gastroenterology The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine) Hangzhou China.
Food Sci Nutr. 2025 Aug 6;13(8):e70769. doi: 10.1002/fsn3.70769. eCollection 2025 Aug.
Although omega-3 polyunsaturated fatty acid (n-3PUFA) is generally considered to have positive effects on bowel health, the understanding of the impacts of n-3PUFA on bowel function is limited. This study aimed to deeply investigate the association between n-3PUFA, diarrhea, and constipation and discussed the role of different subclasses of n-3PUFA. 12,704 adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were collected in this study. Constipation and diarrhea were measured by bowel frequency and the Bristol Stool Form Scale (BSFS). Dietary n-3PUFA intake was collected by 24-h dietary interviews. Weighted logistic regression results showed that the highest quartile of n-3PUFA intake (OR: 0.70; 95% CI: 0.52-0.96) was associated with a reduced risk of constipation, and the third quartile of n-3PUFA (OR: 0.70; 95% CI: 0.56-0.87) was linked to a lower risk of diarrhea (compared to the lowest). According to restricted cubic spline (RCS) analysis, n-3PUFA showed a nonlinear association with diarrhea and a negative linear correlation with constipation. Moderate intake of n-3PUFA (1.38-2.25 g/day) was associated with a reduced risk of diarrhea. When the intake of n-3PUFA was more than 2.25 g per day, the risk of diarrhea increased. RCS-adjusted logistic regression indicated that the highest ALA quartile (vs. lowest) was associated with 31% lower odds of diarrhea (OR: 0.69; 95% CI: 0.57-0.85) with a U-shaped relationship. Conversely, higher DHA (OR: 0.60; 95% CI: 0.43-0.84) and EPA (OR: 0.70; 95% CI: 0.52-0.95) quartiles reduced constipation odds, showing negative linear (DHA) and nonlinear (EPA) associations. WQS regression quantified joint effects of n-3PUFA subclasses on constipation/diarrhea. For diarrhea, n-3PUFA contributions were: ALA 82.9%, EPA 16.5%, DHA 0.5%, DPA 0.1%; for constipation: DHA 75.8%, EPA 20.2%, ALA 3.0%, DPA 1.0%. Sensitivity analyses confirmed robust n-3PUFA and subclass associations with diarrhea/constipation. This large-scale study establishes differential impacts of n-3PUFA subclasses on bowel disorders, revealing ALA's U-shaped protection against diarrhea and DHA/EPA's linear constipation alleviation, providing evidence for targeted dietary interventions. However, the causal relationship still needs to be verified by prospective studies.
尽管ω-3多不饱和脂肪酸（n-3PUFA）通常被认为对肠道健康有积极影响，但对n-3PUFA对肠道功能影响的了解有限。本研究旨在深入调查n-3PUFA、腹泻和便秘之间的关联，并探讨n-3PUFA不同亚类的作用。本研究收集了2005年至2010年美国国家健康与营养检查调查（NHANES）中的12704名成年人。通过排便频率和布里斯托大便分类量表（BSFS）来衡量便秘和腹泻情况。通过24小时饮食访谈收集膳食n-3PUFA摄入量。加权逻辑回归结果显示，n-3PUFA摄入量最高四分位数（OR：0.70；95%CI：0.52 - 0.96）与便秘风险降低相关，n-3PUFA第三四分位数（OR：0.70；95%CI：0.56 - 0.87）与腹泻风险降低相关（与最低四分位数相比）。根据受限立方样条（RCS）分析，n-3PUFA与腹泻呈非线性关联，与便秘呈负线性相关。适度摄入n-3PUFA（1.38 - 2.25克/天）与腹泻风险降低相关。当n-3PUFA摄入量超过2.25克/天时，腹泻风险增加。RCS调整后的逻辑回归表明，α-亚麻酸（ALA）最高四分位数（与最低四分位数相比）与腹泻几率降低31%相关（OR：0.69；95%CI：0.57 - 0.85），呈U形关系。相反，较高的二十二碳六烯酸（DHA）（OR：0.60；95%CI：0.43 - 0.84）和二十碳五烯酸（EPA）（OR：0.70；95%CI：0.52 - 0.95）四分位数降低了便秘几率，分别呈现负线性（DHA）和非线性（EPA）关联。加权分位数和（WQS）回归量化了n-3PUFA亚类对便秘/腹泻的联合作用。对于腹泻，n-3PUFA的贡献分别为：ALA 82.9%，EPA 16.5%，DHA 0.5%，二十二碳五烯酸（DPA）0.1%；对于便秘：DHA 75.8%，EPA 20.2%，ALA 3.0%，DPA 1.0%。敏感性分析证实了n-3PUFA及其亚类与腹泻/便秘之间的稳健关联。这项大规模研究确定了n-3PUFA亚类对肠道疾病的不同影响，揭示了ALA对腹泻的U形保护作用以及DHA/EPA对便秘的线性缓解作用，为有针对性的饮食干预提供了证据。然而，因果关系仍需前瞻性研究来验证。
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