A Pilot Study to Examine the Effects of an Anti-inflammatory Supplement on Eicosanoid Derivatives in Patients with Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease (CKD) is a progressive disease with an inverse relationship between kidney function and levels of inflammation and oxidative stress. Curcumin and Boswellia serrata have been reported to exert anti-inflammatory effects on the cyclooxygenase and lipoxygenase pathways. Therefore, the purpose of this study was to study the effects of a supplement containing curcumin and B. serrata on eicosanoid derivatives in early stage CKD patients who had not initiated hemodialysis. METHODS: Sixteen patients with stage 2 and stage 3 CKD (56.0 ± 16.0 years, 171.4 ± 11.9 cm, 99.3 ± 20.2 kg) were randomized into a treatment group with curcumin and B. serrata or a placebo group. The dependent variables prostaglandin E2 (PGE2), 5-hydroxyicosatetraenoic acid, 12-hydroxyicosatetraenoic acid, 15-hydroxyicosatetraenoic acid, and 13-hydroxyoctadecadienoic acid were measured both before and after 8 weeks of supplementation. Results were analyzed by using a repeated-measures analysis of covariance for compliance and body-mass index. RESULTS: A significant group effect (p = 0.05), and a trend for Group × Time interaction (p = 0.056) were detected for PGE2. No significant differences were observed for any other variables. CONCLUSIONS: This is the first article of baseline levels of the dependent variables in early stage CKD, and the first article to show a significant effect of these supplements on PGE2 in early stage CKD. Further studies are needed to determine whether curcumin and B. serrata may be effective means to reduce inflammation in patients with CKD.

Effects of Fish Oil Supplementation on Postresistance Exercise Muscle Soreness.

The aim of this study was to examine the effects of fish oil supplementation on the magnitude and time-course of postresistance exercise muscle soreness. This study was a randomized, placebo-controlled, double-blind trial. Nonresistance trained females were randomized into one of two groups: fish oil supplementation (6 g/day; 5:1 eicosapentaenoic acid to docosahexaenoic acid (EPA:DHA)) or placebo (6 g/day corn/soy oil). After consuming the supplements for one week, participants underwent a single bout of resistance exercise consisting of 10 sets to failure of elbow flexion and leg extension machines. Muscle soreness was measured daily over the next week via grounded visual analog scale while participants continued to consume their assigned supplement. At 48 hours and one week postexercise, soreness during functional movements and limb circumferences were measured. The fish oil group perceived less static and functional muscle soreness than placebo, although the differences were not statistically significant. Effect sizes for resistance exercise-induced static and functional soreness responses were 33 to 42% lower in fish oil versus placebo without changes in upper arm and thigh circumferences. Supplementing the diet with 6 g per day of fish oil may alleviate muscle soreness experienced after resistance training in young untrained females.

Cassia Cinnamon Supplementation Reduces Peak Blood Glucose Responses but Does Not Improve Insulin Resistance and Sensitivity in Young, Sedentary, Obese Women.

Cassia cinnamon has been suggested to lower blood glucose (BG) and serum insulin (SI) due to an improvement in insulin resistance (IR) and sensitivity (IS). This study compared the effects Cassia cinnamon had on calculated IR and IS values and BG and SI in response to an oral glucose tolerance test (OGTT) in young, sedentary, and obese women. On three separate days, 10 women had a fasted venous blood sample obtained. Participants were given 5 g of encapsulated placebo (PLC) or 5 g of encapsulated Cassia cinnamon bark (CASS). Three hours after the initial blood sample, another blood sample was obtained to calculate values for IS and IR. The participants then completed an OGTT by consuming a 75 g glucose solution. Blood was obtained 30, 60, 90, and 120 min following glucose ingestion. IS and IR were not significantly different between placebo and Cassia (p > .05). The peak BG concentration in response to the OGTT was significantly lower at the 30 min time point for CASS, as compared to PLC (140 ± 5.8 and 156 ± 5.2 mg/dL, p = .025); however, there was no significant difference between treatments for SI (p > .05). The area-under-the-curve responses for BG and SI were not significantly different between PLC and CASS (p > .05). This study suggests that a 5 g dose of Cassia cinnamon may reduce the peak BG response and improve glucose tolerance following an OGTT, but with no improvement in IS and IR in young, sedentary, obese women.

The use of an anti-inflammatory supplement in patients with chronic kidney disease.

Chronic kidney disease (CKD) is characterized by a continuous reduction in kidney function, increased inflammation, and reduced antioxidant capacity. The objective of this study was to assess the effects of a herbal supplement on systemic inflammation and antioxidant status in non-dialysis CKD patients. Sixteen patients with CKD (56.0±16.0 yrs, 171.4±11.9 cm, 99.3±20.2 kg) were randomly chosen to receive a herbal supplement composed of Curcuma longa and Boswellia serrata, or placebo. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), glutathione peroxidase (GPx), and serum C-reactive protein (CRP) were measured at baseline and 8 weeks. Baseline data demonstrated elevated inflammation and low antioxidant levels. A significant time effect (p=0.03) and time x compliance interaction effect (p=0.04) were observed for IL-6. No significant differences were observed for any other variables. This study demonstrates that mild and moderate CKD is associated with chronic inflammation and low antioxidant activity. Systemic inflammation and impaired antioxidant status may be greater in CKD populations with multiple comorbidities. Curcumin and Boswellia serrata are safe and tolerable and helped to improve the levels of an inflammatory cytokine.

The effects of fish oil supplementation on markers of inflammation in chronic kidney disease patients.

OBJECTIVE: One prevalent characteristic of all stages of chronic kidney disease (CKD) is excessive production of proinflammatory cytokines. Fish oil (FO) supplementation has been reported to lower levels of proinflammatory cytokines. The benefits of FO for an extensive range of populations and a variety of health concerns are apparent, yet the anti-inflammatory benefits for nondialysis CKD patients are not as well documented. Therefore, the purpose of this study was to investigate the effects of the daily consumption of FO (1,400 mg eicosapentaenoic acid + 1,000 mg docosahexaenoic acid) on interleukin 1ß (IL-1ß), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) for 8 weeks in nondialysis CKD patients. DESIGN, SETTING, AND SUBJECTS: In this double-blind, randomized, placebo-controlled intervention, the effect of 8 weeks of FO administration on IL-1ß, IL-6, and TNF-α levels in nondialysis CKD patients were evaluated. INTERVENTION: Thirty-one nondialysis CKD patients (17 = FO; 14 = placebo) randomly received either FO dietary supplementation 2.4 g/day (1,400 mg eicosapentaenoic acid + 1,000 mg docosahexaenoic acid) or placebo (safflower oil) for 8 weeks. MAIN OUTCOME MEASURES: IL-1ß, IL-6, and TNF-α were all measured as markers of inflammation. RESULTS: One-way analysis of variance revealed no significant differences in IL-6 (P = .06), IL-1ß (P = .18), and TNF-α (P = .20) between groups in pretest values. Additionally, no pretest differences existed between groups for age (P = .549), weight (P = .324), waist circumference (P = .086), gender (P = .591), and ethnicity (P = .875). Covariance was calculated using compliance, age, gender, ethnicity, body weight, and waist circumference as covariates. No significant differences were discovered between groups after FO supplementation for IL-6 (P = .453) and TNF-α (P = .242). A significant difference was discovered for IL-1ß (P = .050) with lower levels in the FO group. CONCLUSIONS: The results of this study are in agreement with some previous studies that suggest that FO supplementation has no effect on plasma proinflammatory cytokines TNF-α or IL-6, but does have an effect on IL-1ß in nondialysis CKD patients.

Effect of over-the-counter fish-oil administration on plasma Lp(a) levels in an end-stage renal disease population.

OBJECTIVE: This study sought to examine the effect of n-3 supplementation on lipoprotein(a) (Lp(a)) levels in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. DESIGN: The present study was conducted using a double-blind, permuted-randomized, controlled experimental protocol. SETTING: This study took place at the Central Texas Nephrology Associates Dialysis Clinic (Waco, TX). PATIENTS: Patients with ESRD and associated with the Central Texas Nephrology Associates who were undergoing chronic hemodialysis participated in this study. INTERVENTION: Patients with ESRD were followed prospectively while receiving supplements of fish oil (treatment, eicosapentaenoic acid, 0.96g/day, and docosahexaenoic acid, 0.6g/day) or corn oil (control subjects) for 6 months. After a 12-hour fast, participants donated 12mL of blood for analysis of Lp(a) at baseline and at 6 months. MAIN OUTCOME MEASURE: The comparison of Lp(a) concentration by group at 6 months was the primary outcome measure of the study. RESULTS: Our study suggests that fish-oil supplementation did not decrease levels of Lp(a) (P=.66), compared with control subjects. CONCLUSION: We failed to show a significant effect of 6 months of over-the-counter fish-oil supplementation on Lp(a) status in an ESRD population, although results from this study support findings from other studies suggesting that African Americans have higher Lp(a) concentrations than persons of Caucasian decent.

Effects of omega-3 fatty acid supplementation on lipid levels in endstage renal disease patients.

OBJECTIVE: Our purpose was to determine if over-the-counter fish oil improves the cardiovascular-disease risk profile of endstage renal disease patients. DESIGN: This study used a double-blind, permuted-block, randomized, placebo-controlled design. The experimental intervention consisted of fish-oil concentrate supplementation, whereas corn-oil capsules were used as a control. Compliance follow-ups were performed 3 times per week. SETTING: Patients of Central Texas Nephrology Associates clinics were eligible for this study. PATIENTS: Exclusion criteria comprised a life-expectancy of less than 6 months, pregnancy, a history of hemodialysis or medication noncompliance, or age below 18 years. The final sample size was 87 patients. The attrition rate was 9%. INTERVENTION: Participants in the experimental group consumed six 1-g soft-gel capsules of fish-oil concentrate each day for 6 months. The control group consumed corn-oil capsules, following the same protocol. Venous blood samples were acquired before and after the intervention. MAIN OUTCOME MEASURE: We assessed a number of serum lipid indicators. RESULTS: There were significant supplement/time interactions in low-density lipoprotein cholesterol (LDL) levels (P = .0001) and LDL particle number (P = .0001). Repeated-measures analysis of variance revealed significant time trends in high-density lipoprotein cholesterol (P = .012) and LDL (P = .001). High-density lipoprotein cholesterol levels significantly decreased in the control group, and increased in the fish-oil group, at 6 months, and LDL levels increased significantly in both groups. CONCLUSIONS: The analysis indicates mixed results with respect to cardiovascular disease risk. Further research is needed to assess the benefits of an over-the-counter fish-oil supplement in the renal population.

Fish oil supplementation lowers C-reactive protein levels independent of triglyceride reduction in patients with end-stage renal disease.

BACKGROUND: Inflammation has been identified as a marker for cardiovascular disease. The purpose of this study is to examine the effects of fish oil fatty acid supplementation on C-reactive protein (CRP) levels. METHODS: The study uses a double-blind, permuted-randomized, and placebo-controlled experimental protocol. Patients are randomly placed into a fish oil group or a control group. Thirty-three patients in the experimental and control groups ingest 2 soft-gel pills (1 g each) of fish oil supplements containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo at each meal. Patients follow the supplementation protocol for 6 months. Analysis of variance (ANOVA) is used to measure pretest and posttest differences in the variable of interest. A Kolmogorov-Smirnov test for normality is used to test whether CRP levels are normally distributed. RESULTS: The Kolmogorov-Smirnov test for CRP finds a P value of .273 (KS = .997), revealing that the distribution is normal. ANOVA reveals no statistically significant difference between groups at baseline for CRP (F = 4.118, P = .053). ANOVA reveals a significant main effect (F = 4.29, P = .048) for CRP, with the EPA/DHA group having a significant change in values from pretest (16 mg/dL, standard deviation [SD] = 13.80) to posttest (10.22 mg/dL, SD = 7.87). The placebo group's CRP levels do not change significantly from pretest (13.37, standard deviation [SD] = 7.94) to posttest (13.67, SD = 7.07). An observed power calculation using Cohen's D with a computed alpha of .05 is .588. CONCLUSIONS: The study demonstrates that consuming 960 mg/d of EPA and 600 mg/d of DHA can lower CRP.

Omega-3 fatty acid supplementation and total homocysteine levels in end-stage renal disease patients.

AIM: Elevated total homocysteine (tHcy) levels are commonplace among end-stage renal disease (ESRD) patients increasing risk for poor cardiovascular outcomes. Specifically, when plasma levels become significantly elevated, tHcy levels appear to contribute to vascular damage and premature atherosclerosis. The purpose of this study was to examine the effect of an over-the-counter omega-3 (n-3) fatty acid supplementation on tHcy levels in ESRD patients undergoing chronic haemodialysis. METHODS: The present study was conducted using a double-blind, permuted-randomized and placebo-controlled experimental protocol. ESRD patients were followed prospectively while supplementing n-3 or corn oil (n-6) prospectively for 6 months. PATIENTS: Sixty-nine patients were recruited that had previously demonstrated compliance with dialysis and medication. Following a 12 h fast, participants donated 12 mL of blood for analysis of tHcy at baseline and at 6 months. RESULTS: The results of this study using regression models revealed no differences in age and gender regarding homocysteine levels at the post-test with P-values of 0.6818, 0.6709 and 0.3331 for each regression model. The study findings also revealed that daily administration of 6 g of n-3 fatty acids containing 160 mg of eicosapentaenic acid (0.96 g/day) and 100 mg of docosahexaenoic acid (0.6 g/day) had no effect on tHcy levels when compared with control. CONCLUSION: Potential reasons for this non-significant result may be found in a dose-response relationship, advancement of disease progression in our sample population, or potentially the lack of a significant relationship between fish oil and tHcy. Future studies should address whether a dose-response relationship between n-3 fatty acid supplementation and tHcy levels exists, and how stage of disease progression affects intervention success or failure.

Effects of omega-3 fatty acid supplementation on vascular access thrombosis in polytetrafluorethylene grafts.

OBJECTIVE: The purpose of this study was to investigate the effects of orally administered over-the-counter omega-3 (n-3) fatty acid supplements on primary patency of polytetrafluoroethylene (PTFE) grafts. DESIGN: This study was conducted with a triple-blind, permuted-block, randomized, placebo-controlled experimental design. SETTING: Dialysis clinics with patients who, in accordance with physician diagnosis, needed a new PTFE graft. PATIENTS AND OTHER PARTICIPANTS: Patients on long-term hemodialysis with newly placed PTFE grafts who were unable to receive a native arteriovenous fistula. INTERVENTION: Patients were followed prospectively for 8 months after they had been placed into an n-3 fatty acid or control group and were monitored for primary patency. MAIN OUTCOME VARIABLE: Primary patency of the PTFE graft. RESULTS: The n-3 fatty acid group had a mean PTFE graft primary patency rate of 254.2 days (SEM = 51.8), and the control group had a mean PTFE graft primary patency rate of 254.1 days (SEM = 34.6), revealing no significant difference in survival time between groups. CONCLUSIONS: No significant differences in primary patency rates were noted in the experimental and control groups.

Effects of calcium pyruvate supplementation during training on body composition, exercise capacity, and metabolic responses to exercise.

OBJECTIVE: We evaluated the effects of calcium pyruvate supplementation during training on body composition and metabolic responses to exercise. METHODS: Twenty-three untrained females were matched and assigned to ingest in a double blind and randomized manner either 5 g of calcium pyruvate (PYR) or a placebo (PL) twice daily for 30 d while participating in a supervised exercise program. Prior to and following supplementation, subjects had body composition determined via hydrodensiometry; performed a maximal cardiopulmonary exercise test; and performed a 45-min walk test at 70% of pre-training VO2 max in which fasting pre- and post exercise blood samples determined. RESULTS: No significant differences were observed between groups in energy intake or training volume. Univariate repeated measures ANOVA revealed that subjects in the PYR group gained less weight (PL 1.2 +/- 0.3, PYR 0.3 +/- 0.3 kg, P = 0.04), lost more fat (PL 1.1 +/- 0.5; PYR -0.4 +/- 0.5 kg, P = 0.03), and tended to lose a greater percentage of body fat (PL 1.0 +/- 0.7; PYR -0.65 +/- 0.6%, P = 0.07), with no differences observed in fat-free mass (PL 0.1 +/- 0.5; PYR 0.7 +/- 0.3 kg, P = 0.29). However, these changes were not significant when body composition data were analyzed by MANOVA (P = 0.16). There was some evidence that PYR may negate some of the beneficial effects of exercise on HDL values. No significant differences were observed between groups in maximal exercise responses or metabolic responses to submaximal walking. CONCLUSIONS: Results indicate that PYR supplementation during training does not significantly affect body composition or exercise performance and may negatively affect some blood lipid levels.