The Relationship Between Omega-3, Omega-6 and Total Polyunsaturated Fat and Musculoskeletal Health and Functional Status in Adults: A Systematic Review and Meta-analysis of RCTs

Abdelhamid, Asmaa; Hooper, Lee; Sivakaran, Ruksana; Hayhoe, Richard; Welch, Ailsa

doi:10.1007/s00223-019-00584-3

Cited by 46 publications

(30 citation statements)

References 74 publications

(78 reference statements)

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“…High intakes of total fat and SFA are typically viewed as risk factors for inflammation, while n -3 PUFA are more recognised for their anti-inflammatory properties and potential for increasing protein synthesis (17,116,118–120) . However, despite this, a recent systematic review and meta-analysis of randomised controlled trials found little or no association of n -3, n -6 and total PUFA on skeletal muscle outcomes, largely due to insufficient evidence of high quality (16) .…”

Section: Role Of Fat Intake and Metabolism On Age-related Muscle Lossmentioning

confidence: 99%

The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

Hayhoe

Cameron

2019

Proc. Nutr. Soc.

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Skeletal muscle is integral to the metabolism and utilisation of macronutrients; however, substantial muscle loss and morphological changes occur with ageing. These are associated with loss of muscle function and accelerate rapidly from the age of 60 years, leading to the conditions of sarcopenia and frailty. As the relationship between muscle ageing and macronutrient metabolism and utilisation has seen limited research to date, this review focuses on the interactions between skeletal muscle changes during ageing, metabolism and utilisation of fat, carbohydrates and overall energy expenditure.Skeletal muscle contributes less to resting energy expenditure during ageing, potentially contributing to onset of obesity from middle age. Age-related changes to skeletal muscle lead to glucose dysregulation, with consequent reduction in glycaemic control, increased insulin resistance and ultimately onset of type-2 diabetes. Recent studies indicate that high total fat and SFA intake are detrimental to skeletal muscle, while higher intakes of PUFA are protective. Age-associated changes in skeletal muscle may also reduce total fatty acid utilisation.In conclusion, further research is needed to understand the relationships between macronutrient metabolism and utilisation and age-related changes to skeletal muscle. No dietary recommendations exist specifically for skeletal muscle health during ageing, but we advise individuals to follow healthy eating guidelines, by consuming sufficient protein, fruit and vegetables, and limited SFA and to maintain physically active lifestyles. Clinicians responsible for managing type-2 diabetes need to be aware of growing evidence relating age-related skeletal muscle changes to diabetes onset and progression.

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Section: Role Of Fat Intake and Metabolism On Age-related Muscle Lossmentioning

confidence: 99%

The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

Hayhoe

Cameron

2019

Proc. Nutr. Soc.

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“…The full set of reviews assesses effects of PUFA on cardiovascular disease, cancers, inflammatory bowel disease, neurocognitive outcomes, musculoskeletal and functional outcomes, and depression 2933 34 35 36 37 38…”

Section: Introductionmentioning

confidence: 99%

Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials

Brown¹,

Brainard²,

Song

et al. 2019

BMJ

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205

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ObjectiveTo assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.DesignSystematic review and meta-analyses.Data sourcesMedline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews.Eligibility criteriaRandomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).Data synthesisStatistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.Results83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes (relative risk 1.00, 95% confidence interval 0.85 to 1.17; 58 643 participants, 3.7% developed diabetes) or measures of glucose metabolism (HbA1c mean difference −0.02%, 95% confidence interval −0.07% to 0.04%; plasma glucose 0.04, 0.02 to 0.07, mmol/L; fasting insulin 1.02, −4.34 to 6.37, pmol/L; HOMA-IR 0.06, −0.21 to 0.33). A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.ConclusionsThis is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.Systematic review registrationPROSPERO CRD42017064110.

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“…This systematic review and meta-analysis is part of a series of systematic reviews commissioned by the World Health Organization (WHO) assessing health effects of omega-3, omega-6 and total PUFA. [15][16][17][18][19][20][21][22][23] Its protocol was registered (International Prospective Register of Systematic Reviews identifier: CRD42017056092). Specific methods for this review are discussed below, and detailed methods for the review series are reported elsewhere, including detailed search strategies, list of variables data extracted and the wider database of trials.…”

Section: Methodsmentioning

confidence: 99%

“…We assessed Cochrane risk-of-bias domains, 25 and also assessed risk from adherence problems and attention bias specifically for our reviews. [15][16][17][18][19][20][21][22][23] Included trials were judged at low summary risk of bias where randomisation, allocation concealment, blinding of participants, personnel and outcome assessors were adequate (all other trials were at moderate or high risk of bias).…”

Section: Assessment Of Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…We have formally systematically reviewed effects of omega-3, omega-6 and total PUFA on cancer, diabetes, cognition, inflammatory bowel disease, cardiovascular disease, functional outcomes, mortality, adiposity and lipids in sister reviews, so these outcomes are not reported here. [15][16][17][18][19][20][21][22][23] Discussion GRADE assessment of our meta-analytic data suggests that increasing LCn3 probably has little or no effect on risk of depression or anxiety symptoms in those without depression or anxiety at baseline (moderate-quality evidence), but effects on depression severity and risk of remission in depression were unclear. Increasing ALA may increase risk of depression symptoms very slightly (1000 people would need to increase their ALA intake for one additional 10.7 3.5 Fig.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Omega-3 and polyunsaturated fat for prevention of depression and anxiety symptoms: systematic review and meta-analysis of randomised trials

et al. 2019

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BackgroundThere is strong public belief that polyunsaturated fats protect against and ameliorate depression and anxiety.AimsTo assess effects of increasing omega-3, omega-6 or total polyunsaturated fat on prevention and treatment of depression and anxiety symptoms.MethodWe searched widely (Central, Medline and EMBASE to April 2017, trial registers to September 2016, ongoing trials updated to August 2019), including trials of adults with or without depression or anxiety, randomised to increased omega-3, omega-6 or total polyunsaturated fat for ≥24 weeks, excluding multifactorial interventions. Inclusion, data extraction and risk of bias were assessed independently in duplicate, and authors contacted for further data. We used random-effects meta-analysis, sensitivity analyses, subgrouping and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment.ResultsWe included 31 trials assessing effects of long-chain omega-3 (n = 41 470), one of alpha-linolenic acid (n = 4837), one of total polyunsaturated fat (n = 4997) and none of omega-6. Meta-analysis suggested that increasing long-chain omega-3 probably has little or no effect on risk of depression symptoms (risk ratio 1.01, 95% CI 0.92–1.10, I2 = 0%, median dose 0.95 g/d, duration 12 months) or anxiety symptoms (standardised mean difference 0.15, 95% CI 0.05–0.26, I2 = 0%, median dose 1.1 g/d, duration 6 months; both moderate-quality evidence). Evidence of effects on depression severity and remission in existing depression were unclear (very-low-quality evidence). Results did not differ by risk of bias, omega-3 dose, duration or nutrients replaced. Increasing alpha-linolenic acid by 2 g/d may increase risk of depression symptoms very slightly over 40 months (number needed to harm, 1000).ConclusionsLong-chain omega-3 supplementation probably has little or no effect in preventing depression or anxiety symptoms.Declaration of interestL.H. and A.A. were funded to attend the World Health Organization Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health meetings and present review results. The authors report no other conflicts of interest.

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The Relationship Between Omega-3, Omega-6 and Total Polyunsaturated Fat and Musculoskeletal Health and Functional Status in Adults: A Systematic Review and Meta-analysis of RCTs

Cited by 46 publications

References 74 publications

The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials

Omega-3 and polyunsaturated fat for prevention of depression and anxiety symptoms: systematic review and meta-analysis of randomised trials

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