Javed Choudhury
July 23, 2024
TOPLINE:
The regular use of fish oil supplements and high circulating levels of omega-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid (DHA), are associated with a lower risk for vascular complications in patients with type 2 diabetes (T2D).
METHODOLOGY:
Fish oils, rich in omega-3 PUFAs, are beneficial supplements for the vascular health of the general population, but similar studies in patients with T2D are scarce, despite their higher risk of developing vascular disease.
This prospective cohort study evaluated the association between fish oil supplementation and the risks for vascular complications in 20,338 patients with T2D (median age, 60 years; 39.7% women) with complete supplementation usage data from the UK Biobank, as well as 4874 participants with T2D possessing plasma PUFA data.
The regular use of fish oil supplementation was assessed by an electronic questionnaire at baseline between 2006 and 2010; blood samples were tested for omega-3 fatty acids between June 2019 and April 2020.
Study outcomes were diabetic macrovascular complications (coronary heart disease, heart failure, peripheral artery disease, and stroke) and microvascular complications (diabetic kidney disease, diabetic retinopathy, and diabetic neuropathy).
Blood samples collected at recruitment were assessed for biomarkers related to cardiovascular disease.
TAKEAWAY:
Over a median follow-up of 13.2 years, 5396 patients developed macrovascular and 4868 developed microvascular complications.
The use of fish oil supplementation vs no use was associated with a 10% [adjusted hazard ratio (HR), 0.90; 95% CI, 0.85-0.97] and 11% [HR, 0.89; 95% CI, 0.83-0.95] lower risk for composite macrovascular and microvascular complications, respectively, and also with individual complications except for heart failure or stroke.
Higher levels of plasma total n-3 PUFA, especially DHA, were associated with lower risk for composite macrovascular and microvascular complications in a nonlinear dose-response manner (P overall < .05; P for nonlinearity < .05), as well as with habitual fish oil supplement use.
The researchers identified seven biomarkers, including lipid profile and inflammation, that collectively explained 54.4% and 63.1% of the association between plasma levels of DHA and the risk for composite macrovascular complications and coronary heart disease, respectively.
IN PRACTICE:
“In individuals with T2D, habitual use of fish oil and higher plasma omega-3 PUFA levels, especially DHA, were associated with lower risks of both macrovascular and microvascular complications. In addition, the favorable associations of plasma DHA with diabetic complications were partially mediated through improving biomarkers of lipid profile and inflammation,” the authors wrote.
SOURCE:
This study, led by Shufan Tian and Tianyu Guo, Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
This observational study could not establish any causal relationship because of its observational nature. The detailed information on the dosage, composition, and duration of fish oil use was lacking. The study was restricted to total omega-3 PUFAs and DHA only.
DISCLOSURES:
This study was supported by the National Nature Science Foundation of China, Hubei Province Science Fund for Distinguished Young Scholars, and Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.
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