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1.
Psychiatr Danub ; 32(1): 55-59, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303030

RESUMEN

BACKGROUND: Anorexia nervosa (AN) is a serious mental disorder with a high mortality rate and often a chronic course. In contrast to many other common mental disorders, there is no drug therapy approved for AN. METHODS: We performed a narrative literature review to consider whether a choline-containing molecule, such as phosphatidylcholine (PC), with an omega (ω)-3 long chain polyunsaturated fatty acid (LCPUFA) could be a potential future medicinal treatment for AN. RESULTS: Choline and LCPUFAs have individually shown benefit for mental health. Case series and pilot studies suggest ω-3 LCPUFAs may be effective in eating disorders. However, pharmacodynamic and pharmacokinetic considerations suggest a greater benefit from the combination of both components. CONCLUSION: The combination of a choline-containing molecule with an ω-3 LCPUFA may be clinically effective and well tolerated. This idea is supported by the current literature on the role of inflammation, the microbiome, the gut-brain-axis, hormonal, neurotransmitter and intracellular signalling, and on the structure and fluidity of nerve cells membranes in patients with AN.


Asunto(s)
Anorexia Nerviosa/tratamiento farmacológico , Ácidos Grasos Omega-3/química , Ácidos Grasos Omega-3/uso terapéutico , Fosfatidilcolinas/uso terapéutico , Anorexia Nerviosa/metabolismo , Anorexia Nerviosa/patología , Encéfalo/metabolismo , Encéfalo/patología , Humanos , Inflamación/metabolismo , Inflamación/patología , Fosfatidilcolinas/química
2.
PLoS One ; 15(2): e0228315, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32045421

RESUMEN

OBJECTIVE: To evaluate the effects of omega-3 long-chain polyunsaturated fatty acids on proteinuria, estimated glomerular filtration rate (eGFR) and metabolic biomarkers among patients with diabetes. STUDY DESIGN: Meta-analysis of randomized controlled clinical trials (RCTs). SETTING & SUBJECTS: Patients with diabetes. SELECTION CRITERIA FOR STUDIES: We conducted electronic searches in PubMed, Embase and Cochrane Central Register of Controlled Trials from January 1960 to April 2019 to identify RCTs, which examined the effects of omega-3 fatty acids on proteinuria, eGFR and metabolic biomarkers among diabetic patients. RESULTS: Ten RCTs with 344 participants were included in our meta-analysis. Omega-3 fatty acids reduced the amount of proteinuria among type 2 diabetes mellitus (type 2 DM) and type 1 diabetes mellitus (type 1 DM). This association was only significant among type 2 DM (SMD = -0.29 (95% CI: -0.54, -0.03; p = 0.03). Only studies with duration of intervention of 24 weeks or longer demonstrated a significant lower proteinuria among omega-3 fatty acids compared to control group (SMD = -0.30 (95% CI: -0.58, -0.02; p = 0.04). There was a higher eGFR for both type 1 and type 2 DM groups among omega-3 fatty acids compared to control group, however, the effect was not statistically significant. Regarding serum total cholesterol, LDL-cholesterol and HbA1C, there was no significant difference comparing omega-3 fatty acids to control group. There was a non-significant systolic blood pressure reduction in the omega-3 fatty acids supplementation group compared to control. CONCLUSION: Omega-3 fatty acids could help ameliorate proteinuria among type 2 DM who received omega-3 supplementation for at least 24 weeks without adverse effects on HbA1C, total serum cholesterol and LDL-cholesterol.


Asunto(s)
Diabetes Mellitus Tipo 1/patología , Ácidos Grasos Omega-3/uso terapéutico , Proteinuria/tratamiento farmacológico , Biomarcadores/metabolismo , Colesterol/sangre , LDL-Colesterol/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Tasa de Filtración Glomerular , Hemoglobina A Glucada/análisis , Humanos , Proteinuria/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto
3.
PLoS One ; 15(1): e0227695, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31951599

RESUMEN

BACKGROUND: Endometriosis is defined by the presence of endometrial-like tissue (lesions) outside the uterus, commonly on the pelvic peritoneum. It affects 6-10% of women and is associated with debilitating pelvic pain. Current management options are often unsatisfactory. Omega-3 polyunsaturated fatty acids (O-PUFA) have the potential to reduce the painful symptoms associated with endometriosis, reduce lesion size, preserve the patient's ability to conceive, and have minimal side effects. We performed a two-arm, parallel double-blinded randomised controlled trial to inform the planning of a future multicentre randomised controlled trial to evaluate the efficacy of O-PUFA for endometriosis-associated pain. OBJECTIVES: The primary objectives of the trial were to assess recruitment and retention rates. The secondary objectives were to determine the acceptability to women of the proposed methods of recruitment, randomisation, treatments and questionnaires, to estimate the variability in the proposed primary endpoints to inform the sample size calculation and to refine the research methodology for the future definitive trial. METHODS: We recruited women with endometriosis from June 2016 to June 2017 and randomised them to eight weeks of treatment with O-PUFA or olive oil. Pain scores and quality of life questionnaires were collected at baseline and eight weeks. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to eight weeks. Acceptability questionnaires were used to evaluate women's experiences of the trial. RESULTS: The proportion of eligible participants who were randomised was 45.2% (33/73) and 81.8% (27/33) completed the study. The majority of participants described their overall trial experience favourably and there were no adverse events in either group. CONCLUSION: Our pilot trial supports the feasibility of a future larger trial to definitively evaluate the efficacy of O-PUFA for endometriosis-associated pain. TRIAL REGISTRATION: The trial was registered on the ISRCTN registry (registration number ISRCTN44202346).


Asunto(s)
Endometriosis/tratamiento farmacológico , Endometriosis/fisiopatología , Ácidos Grasos Omega-3/uso terapéutico , Dolor Pélvico/tratamiento farmacológico , Adulto , Método Doble Ciego , Endometriosis/complicaciones , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Cooperación del Paciente , Selección de Paciente , Dolor Pélvico/etiología , Dolor Pélvico/fisiopatología , Proyectos Piloto , Calidad de Vida , Encuestas y Cuestionarios , Adulto Joven
4.
Int J Vitam Nutr Res ; 90(1-2): 67-83, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30932776

RESUMEN

Omega-3 fatty acids and vitamin D3 have beneficial effects on different blood, cardiovascular parameters and physical performance. However, the effect of low-dose omega-3 fatty acid supplementation remains unclear. 84 office workers aged 40-60 years, participated in a 16-week open, randomized, placebo-controlled, parallel-group study. The experimental group received 330 mg of omega-3 fatty acid and 0.005 mg (200 IU) of vitamin D3 per day and the control group received placebo. Anthropometric, biochemical blood and respiratory indices were measured at 12 and 16 weeks. Body mass (BM) and body mass index (BMI) significantly reduced in both the experimental (BM from 74.4 ± 13.04 to 73.2 ± 13.02 kg, p < 0.001; BMI from 25.8 ± 4.1 to 25.4 ± 4.3 kg/m2, p < 0.001) and the placebo groups (BM from 69.5 ± 11. to 68.7 ± 11.4 kg, p < 0.05; BMI from 24.1 ± 4.0 to 23.8 ± 4.2 kg/m2, p < 0.05). Omega-3 fatty acid supplementation significantly improved glucose (from 5.12 ± 0.55 to 4.97 ± 0.62 mmol/l; p = 0.05), total cholesterol (from 5.86 ± 1.0 to 5.32 ± 1.55 mmol/l; p = 0.003), and vitamin D levels (from 35.07 ± 21.65 to 68.63 ± 25.94 nmol/l; p = 0.000). Maximal oxygen consumption (from 33.7 ± 2.4 to 36.6 ± 3.2 ml/kg/min, p = 0.035), forced vital capacity (from 3.5 ± 0.6 to 3.9 ± 0.9 l, p = 0.044), forced expiratory volume (from 3.2 ± 0.6 to 3.5 ± 0.7 l, p = 0.014), and peak expiratory flow (from 6.7 ± 1.4 to 7.5 ± 1.6 l/s, p = 0.019) also slightly improved in the omega-3 fatty acid group. Daily supplementation of 330 mg of omega-3 fatty acids had a slight positive impact on total cholesterol and glucose level, while there was no effect on low and high density lipoproteins, and triglycerides levels. Therefore, dose of 330 mg per day seems as insufficient.


Asunto(s)
Colecalciferol/sangre , Ácidos Grasos Omega-3 , Vitamina D , Adulto , Suplementos Dietéticos , Método Doble Ciego , Ácidos Grasos Omega-3/uso terapéutico , Humanos , Persona de Mediana Edad , Vitamina D/uso terapéutico
5.
Expert Opin Pharmacother ; 21(1): 47-61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31693423

RESUMEN

Introduction: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions diverge. Together with these factors, the complexity of BPD generates uncertainty in day-to-day practice. This narrative review aims to provide an overview of advances in BPD treatment and posit a critical opinion based on clinical evidence and practice.Areas covered: The authors review the clinical trials concerning the efficacy of the main classes of drugs in BPD: antidepressants, mood stabilizers, first-, second-, and third-generation antipsychotics, and other agents (opiate antagonists, clonidine, oxytocin, omega-3 fatty acids). They also include in this review studies on combinations of drugs and psychotherapies.Expert opinion: An individualized, tailored pharmacotherapy for BPD that targets the prominent symptom clusters can improve relevant aspects of the clinical picture. However, no medication is indicated to treat the global psychopathology of BPD. Polypharmacy should be avoided or strictly limited. To date, pharmacotherapy alone does not suffice to manage the complexity of BPD. Combining medication with psychotherapy may improve specific BPD symptom dimensions. In particular, it may help those aspects that respond slowly or not at all to monotherapy.


Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Psicoterapia/métodos , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Ácidos Grasos Omega-3/uso terapéutico , Humanos , Polifarmacia
6.
Expert Opin Pharmacother ; 21(1): 107-120, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31738617

RESUMEN

Introduction: Hypertriglyceridemia is associated with both the development of cardiovascular disease (CVD) when mild-to-moderate and high risk of pancreatitis when more severe. The residual CVD risk after low-density lipoprotein cholesterol (LDL-C) lowering is, in part, attributed to high triglyceride (TG) levels. Therefore, there appears to be a need for effective TG-lowering agents.Areas covered: This review presents the most recent advances in hypertriglyceridemia treatment; specifically, it discusses the results of clinical trials and critically comments on apolipoprotein C-III inhibitors, angiopoietin-like 3 inhibitors, alipogene tiparvovec, pradigastat, pemafibrate and novel formulations of omega-3 fatty acids.Expert opinion: In the era of extreme lowering of LDL-C levels with several agents, there seems to be space for novel therapeutic options to combat parameters responsible for residual CVD risk, among which are elevated TGs. Furthermore, a significant number of individuals have very high TG levels and encounter the risk of acute pancreatitis. The most recently developed TG-lowering drugs appear to have a role in both conditions; the choice is mainly based on baseline TG levels. Dyslipidemia guidelines are likely to change in the near future to include some of these agents. Of course, long-term data regarding their safety and efficacy in terms of CVD outcomes and pancreatitis are warranted.


Asunto(s)
Hipertrigliceridemia/tratamiento farmacológico , Hipolipemiantes/administración & dosificación , Enfermedad Aguda , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Ácidos Grasos Omega-3/uso terapéutico , Humanos , Pancreatitis/prevención & control , Triglicéridos/sangre
7.
Cochrane Database Syst Rev ; 12: CD011016, 2019 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-31847055

RESUMEN

BACKGROUND: Polyunsaturated fatty acid (PUFA) supplements, involving omega-3 and/or omega-6 components, have been proposed as a therapy for dry eye. Omega-3 PUFAs exist in both short- (alpha-linolenic acid [ALA]) and long-chain (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) forms, which largely derive from certain plant- and marine-based foods respectively. Omega-6 PUFAs are present in some vegetable oils, meats, and other animal products. OBJECTIVES: To assess the effects of omega-3 and omega-6 polyunsaturated fatty acid (PUFA) supplements on dry eye signs and symptoms. SEARCH METHODS: CENTRAL, Medline, Embase, two other databases and three trial registries were searched in February 2018, together with reference checking. A top-up search was conducted in October 2019, but the results have not yet been incorporated. SELECTION CRITERIA: We included randomized controlled trials (RCTs) involving dry eye participants, in which omega-3 and/or omega-6 supplements were compared with a placebo/control supplement, artificial tears, or no treatment. We included head-to-head trials comparing different forms or doses of PUFAs. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods and assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 34 RCTs, involving 4314 adult participants from 13 countries with dry eye of variable severity and etiology. Follow-up ranged from one to 12 months. Nine (26.5%) studies had published protocols and/or were registered. Over half of studies had high risk of bias in one or more domains. Long-chain omega-3 (EPA and DHA) versus placebo or no treatment (10 RCTs) We found low certainty evidence that there may be little to no reduction in dry eye symptoms with long-chain omega-3 versus placebo (four studies, 677 participants; mean difference [MD] -2.47, 95% confidence interval [CI] -5.14 to 0.19 units). We found moderate certainty evidence for a probable benefit of long-chain omega-3 supplements in increasing aqueous tear production relative to placebo (six studies, 1704 participants; MD 0.68, 95% CI 0.26 to 1.09 mm/5 min using the Schirmer test), although we did not judge this difference to be clinically meaningful. We found low certainty evidence for a possible reduction in tear osmolarity (one study, 54 participants; MD -17.71, 95% CI -28.07 to -7.35 mOsmol/L). Heterogeneity was too substantial to pool data on tear break-up time (TBUT) and adverse effects. Combined omega-3 and omega-6 versus placebo (four RCTs) For symptoms (low certainty) and ocular surface staining (moderate certainty), data from the four included trials could not be meta-analyzed, and thus effects on these outcomes were unclear. For the Schirmer test, we found moderate certainty evidence that there was no intergroup difference (four studies, 455 participants; MD: 0.66, 95% CI -0.45 to 1.77 mm/5 min). There was moderate certainty for a probable improvement in TBUT with the PUFA intervention relative to placebo (four studies, 455 participants; MD 0.55, 95% CI 0.04 to 1.07 seconds). Effects on tear osmolarity and adverse events were unclear, with data only available from a single small study for each outcome. Omega-3 plus conventional therapy versus conventional therapy alone (two RCTs) For omega-3 plus conventional therapy versus conventional therapy alone, we found low certainty evidence suggesting an intergroup difference in symptoms favoring the omega-3 group (two studies, 70 participants; MD -7.16, 95% CI -13.97 to -0.34 OSDI units). Data could not be combined for all other outcomes. Long-chain omega-3 (EPA and DHA) versus omega-6 (five RCTs) For long-chain omega-3 versus omega-6 supplementation, we found moderate certainty evidence for a probable improvement in dry eye symptoms (two studies, 130 participants; MD -11.88, 95% CI -18.85 to -4.92 OSDI units). Meta-analysis was not possible for outcomes relating to ocular surface staining, Schirmer test or TBUT. We found low certainty evidence for a potential improvement in tear osmolarity (one study, 105 participants; MD -11.10, 95% CI -12.15 to -10.05 mOsmol/L). There was low level certainty regarding any potential effect on gastrointestinal side effects (two studies, 91 participants; RR 2.34, 95% CI 0.35 to 15.54). AUTHORS' CONCLUSIONS: Overall, the findings in this review suggest a possible role for long-chain omega-3 supplementation in managing dry eye disease, although the evidence is uncertain and inconsistent. A core outcome set would work toward improving the consistency of reporting and the capacity to synthesize evidence.


Asunto(s)
Síndromes de Ojo Seco/tratamiento farmacológico , Ácidos Grasos Omega-3/uso terapéutico , Ácidos Grasos Omega-6/uso terapéutico , Humanos , Gotas Lubricantes para Ojos/administración & dosificación , Soluciones Oftálmicas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Life Sci ; 239: 117038, 2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31730868

RESUMEN

AIM: Disturbed placentation results in pregnancy complications like preeclampsia. Placental development is influenced by apoptosis during trophoblast differentiation and proliferation. Increased oxidative stress upregulates placental apoptosis. We have earlier reported increased oxidative stress, lower omega-3 fatty acids and vitamin E levels in women with preeclampsia. Current study examines effect of maternal omega-3 fatty acids and vitamin E supplementation on apoptotic markers across gestation in a rat model of preeclampsia. MAIN METHODS: Pregnant Wistar rats were randomly assigned to control; early onset preeclampsia (EOP); late onset preeclampsia (LOP); early onset preeclampsia + omega-3 fatty acid + vitamin E supplementation (EOP + O + E) and late onset preeclampsia + omega-3 fatty acid + vitamin E supplementation (LOP + O + E) groups. Animals (Control, EOP, EOP + O + E) were sacrificed at d14 and d20 of gestation while animals (LOP, LOP + O + E) were sacrificed at d20 to collect blood and placentae. Protein and mRNA levels of apoptotic markers were analyzed by ELISA and RT-PCR respectively. KEY FINDINGS: Protein levels of proapoptotic markers like Bcl-2 associated X-protein (BAX) (p < 0.05), caspase-8 and 3 (p < 0.01 for both) and malondialdehyde (p < 0.01) were higher only in the EOP group as compared to control. However, the antiapoptotic marker, B cell lymphoma 2 (Bcl-2) protein levels were lower in both the subtypes of preeclampsia (p < 0.01 for both). SIGNIFICANCE: Our findings suggest that supplementation was beneficial in reducing the caspase-8 and 3 in early onset preeclampsia but did not normalize BAX and Bcl-2 levels. This has implications for reducing placental apoptosis in preeclampsia.


Asunto(s)
Ácidos Grasos Omega-3/uso terapéutico , Preeclampsia/dietoterapia , Vitamina E/uso terapéutico , Animales , Apoptosis/fisiología , Biomarcadores/metabolismo , Caspasa 3/análisis , Caspasa 3/sangre , Caspasa 8/análisis , Caspasa 8/sangre , Suplementos Dietéticos , Modelos Animales de Enfermedad , Ácidos Grasos Omega-3/metabolismo , Femenino , Masculino , Fenómenos Fisiológicos de la Nutrición/fisiología , Estrés Oxidativo/fisiología , Placenta/metabolismo , Preeclampsia/metabolismo , Embarazo , Efectos Tardíos de la Exposición Prenatal/metabolismo , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Vitamina E/metabolismo , Proteína X Asociada a bcl-2/análisis , Proteína X Asociada a bcl-2/sangre
9.
Methodist Debakey Cardiovasc J ; 15(3): 171-178, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31687095

RESUMEN

Three recent clinical trials have demonstrated the benefits of marine omega-3 fatty acids on cardiovascular disease end points. In the Vitamin D and Omega-3 Trial (VITAL), 840 mg/d of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) resulted in a 28% reduced risk for heart attacks, 50% reduced risk for fatal heart attacks, and 17% reduced risk for total coronary heart disease events. In the ASCEND trial (A Study of Cardiovascular Events in Diabetes), cardiovascular disease death was significantly reduced by 19% with 840 mg/d of EPA and DHA. However, the primary composite end points were not significantly reduced in either study. In REDUCE-IT (the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), there was a 25% decrease in the primary end point of major cardiovascular events with 4 g/d EPA (icosapent ethyl) in patients with elevated triglycerides (135-499 mg/dL) who also were taking a statin drug. For clinical practice, we now have compelling evidence of the cardiovascular benefits of omega-3 fatty acids. The findings of REDUCE-IT provide a strong rationale for prescribing icosapent ethyl for patients with hypertriglyceridemia who are on a statin. For primary prevention, the goal is to increase the population intake of omega-3 fatty acids to levels currently recommended, which translates to consuming at least one to two servings of fish/seafood per week. For individuals who prefer taking omega-3 fatty acid supplements, recent findings from clinical trials support the benefits for primary prevention.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Ácidos Grasos Omega-3/uso terapéutico , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Ensayos Clínicos como Asunto , Quimioterapia Combinada , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Medicina Basada en la Evidencia , Ácidos Grasos Omega-3/efectos adversos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Prevención Primaria , Factores de Riesgo , Prevención Secundaria , Resultado del Tratamiento
10.
Cochrane Database Syst Rev ; 2019(11)2019 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-31689359

RESUMEN

BACKGROUND: Psychosis is a serious mental condition characterised by a loss of contact with reality. There may be a prodromal period or stage of psychosis, where early signs of symptoms indicating onset of first episode psychosis (FEP) occur. A number of services, incorporating multimodal treatment approaches (pharmacotherapy, psychotherapy and psychosocial interventions), developed worldwide, now focus on this prodromal period with the aim of preventing psychosis in people at risk of developing FEP. OBJECTIVES: The primary objective is to assess the safety and efficacy of early interventions for people in the prodromal stage of psychosis. The secondary objective is, if possible, to compare the effectiveness of the various different interventions. SEARCH METHODS: We searched Cochrane Schizophrenia's study-based Register of studies (including trials registers) on 8 June 2016 and 4 August 2017. SELECTION CRITERIA: All randomised controlled trials (RCTs) evaluating interventions for participants older than 12 years, who had developed a prodromal stage of psychosis. DATA COLLECTION AND ANALYSIS: Review authors independently inspected citations, selected studies, extracted data, and assessed study quality. MAIN RESULTS: We included 20 studies with 2151 participants. The studies analysed 13 different comparisons. Group A comparisons explored the absolute effects of the experimental intervention. Group B were comparisons within which we could not be clear whether differential interactive effects were also ongoing. Group C comparisons explored differential effects between clearly distinct treatments. A key outcome for this review was 'transition to psychosis'. For details of other main outcomes please see 'Summary of findings' tables. In Group A (comparisons of absolute effects) we found no clear difference between amino acids and placebo (risk ratio (RR) 0.48 95% confidence interval (CI) 0.08 to 2.98; 2 RCTs, 52 participants; very low-quality evidence). When omega-3 fatty acids were compared to placebo, fewer participants given the omega-3 (10%) transitioned to psychosis compared to the placebo group (33%) during long-term follow-up of seven years (RR 0.24 95% CI 0.09 to 0.67; 1 RCT, 81 participants; low-quality evidence). In Group B (comparisons where complex interactions are probable) and in the subgroup focusing on antipsychotic drugs added to specific care packages, the amisulpiride + needs-focused intervention (NFI) compared to NFI comparison (no reporting of transition to psychosis; 1 RCT, 102 participants; very low-quality evidence) and the olanzapine + supportive intervention compared to supportive intervention alone comparison (RR 0.58 95% CI 0.28 to 1.18; 1 RCT, 60 participants; very low-quality evidence) showed no clear differences between groups. In the second Group B subgroup (cognitive behavioural therapies (CBT)), when CBT + supportive therapy was compared with supportive therapy alone around 8% of participants allocated to the combination of CBT and supportive therapy group transitioned to psychosis during follow-up by 18 months, compared with double that percentage in the supportive therapy alone group (RR 0.45 95% CI 0.23 to 0.89; 2 RCTs, 252 participants; very low-quality evidence). The CBT + risperidone versus CBT + placebo comparison identified no clear difference between treatments (RR 1.02 95% CI 0.39 to 2.67; 1 RCT, 87 participants; very low-quality evidence) and this also applies to the CBT + needs-based intervention (NBI) + risperidone versus NBI comparison (RR 0.75 95% CI 0.39 to 1.46; 1 RCT, 59 participants; very low-quality evidence). Group C (differential effects) also involved six comparisons. The first compared CBT with supportive therapy. No clear difference was found for the 'transition to psychosis' outcome (RR 0.74 95% CI 0.28 to 1.98; 1 RCT, 72 participants; very low-quality evidence). The second subgroup compared CBT + supportive intervention was compared with a NBI + supportive intervention, again, data were equivocal, few and of very low quality (RR 6.32 95% CI 0.34 to 117.09; 1 RCT, 57 participants). In the CBT + risperidone versus supportive therapy comparison, again there was no clear difference between groups (RR 0.76 95% CI 0.28 to 2.03; 1 RCT, 71 participants; very low-quality evidence). The three other comparisons in Group C demonstrated no clear differences between treatment groups. When cognitive training was compared to active control (tablet games) (no reporting of transition to psychosis; 1 RCT, 62 participants; very low quality data), family treatment compared with enhanced care comparison (RR 0.54 95% CI 0.18 to 1.59; 2 RCTs, 229 participants; very low-quality evidence) and integrated treatment compared to standard treatment comparison (RR 0.57 95% CI 0.28 to 1.15; 1 RCT, 79 participants; very low-quality evidence) no effects of any of these approaches was evident. AUTHORS' CONCLUSIONS: There has been considerable research effort in this area and several interventions have been trialled. The evidence available suggests that omega-3 fatty acids may prevent transition to psychosis but this evidence is low quality and more research is needed to confirm this finding. Other comparisons did not show any clear differences in effect for preventing transition to psychosis but again, the quality of this evidence is very low or low and not strong enough to make firm conclusions.


Asunto(s)
Antipsicóticos/uso terapéutico , Terapia Cognitivo-Conductual , Ácidos Grasos Omega-3/uso terapéutico , Trastornos Psicóticos/prevención & control , Humanos , Síntomas Prodrómicos , Trastornos Psicóticos/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
Pediatrics ; 144(5)2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31586029

RESUMEN

CONTEXT: Dietary interventions such as restrictive diets or supplements are common treatments for young people with autism spectrum disorder (ASD). Evidence for the efficacy of these interventions is still controversial. OBJECTIVE: To assess the efficacy of specific dietary interventions on symptoms, functions, and clinical domains in subjects with ASD by using a meta-analytic approach. DATA SOURCES: Ovid Medline, PsycINFO, Embase databases. STUDY SELECTION: We selected placebo-controlled, double-blind, randomized clinical trials assessing the efficacy of dietary interventions in ASD published from database inception through September 2017. DATA EXTRACTION: Outcome variables were subsumed under 4 clinical domains and 17 symptoms and/or functions groups. Hedges' adjusted g values were used as estimates of the effect size of each dietary intervention relative to placebo. RESULTS: In this meta-analysis, we examined 27 double-blind, randomized clinical trials, including 1028 patients with ASD: 542 in the intervention arms and 486 in the placebo arms. Participant-weighted average age was 7.1 years. Participant-weighted average intervention duration was 10.6 weeks. Dietary supplementation (including omega-3, vitamin supplementation, and/or other supplementation), omega-3 supplementation, and vitamin supplementation were more efficacious than the placebo at improving several symptoms, functions, and clinical domains. Effect sizes were small (mean Hedges' g for significant analyses was 0.31), with low statistical heterogeneity and low risk of publication bias. LIMITATIONS: Methodologic heterogeneity among the studies in terms of the intervention, clinical measures and outcomes, and sample characteristics. CONCLUSIONS: This meta-analysis does not support nonspecific dietary interventions as treatment of ASD but suggests a potential role for some specific dietary interventions in the management of some symptoms, functions, and clinical domains in patients with ASD.


Asunto(s)
Trastorno del Espectro Autista/dietoterapia , Suplementos Dietéticos , Ácidos Grasos Omega-3/uso terapéutico , Vitaminas/uso terapéutico , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
N Engl J Med ; 381(11): 1035-1045, 2019 09 12.
Artículo en Inglés | MEDLINE | ID: mdl-31509674

RESUMEN

BACKGROUND: Previous studies have suggested that maternal supplementation with n-3 long-chain polyunsaturated fatty acids may reduce the incidence of preterm delivery but may also prolong gestation beyond term; however, more data are needed regarding the role of n-3 long-chain polyunsaturated fatty acids in pregnancy. METHODS: We performed a multicenter, double-blind, randomized trial in which women who were pregnant with single or multiple fetuses were assigned to receive either fish-oil capsules that contained 900 mg of n-3 long-chain polyunsaturated fatty acids (n-3 group) or vegetable-oil capsules that contained trace n-3 long-chain polyunsaturated fatty acids (control group) daily, beginning before 20 weeks of gestation and continuing to 34 weeks of gestation or delivery, whichever occurred first. The primary outcome was early preterm delivery, defined as delivery before 34 completed weeks of gestation. Other pregnancy and neonatal outcomes were also assessed. RESULTS: A total of 5544 pregnancies in 5517 women were randomly assigned at six centers in Australia; 5486 pregnancies were included in the primary analysis. Early preterm delivery occurred in the case of 61 of 2734 pregnancies (2.2%) in the n-3 group and 55 of 2752 pregnancies (2.0%) in the control group; the between-group difference was not significant (adjusted relative risk, 1.13; 95% confidence interval [CI], 0.79 to 1.63; P = 0.50). There were no significant differences between the groups in the incidence of interventions in post-term (>41 weeks of gestation) deliveries, in adverse events, or in other pregnancy or neonatal outcomes, except that a higher percentage of infants born to women in the n-3 group than in the control group were very large for gestational age at birth (adjusted relative risk, 1.30; 95% CI, 1.02 to 1.65). Percentages of serious adverse events did not differ between the groups. Minor gastrointestinal disturbances were more commonly reported in the n-3 group than in the control group. CONCLUSIONS: Supplementation with n-3 long-chain polyunsaturated fatty acids from early pregnancy (<20 weeks of gestation) until 34 weeks of gestation did not result in a lower incidence of early preterm delivery or a higher incidence of interventions in post-term deliveries than control. (Funded by the Australian National Health and Medical Research Council and the Thyne Reid Foundation; ORIP Australian New Zealand Clinical Trials Registry number, ACTRN12613001142729.).


Asunto(s)
Suplementos Dietéticos , Ácidos Grasos Omega-3/uso terapéutico , Nacimiento Prematuro/prevención & control , Adulto , Método Doble Ciego , Femenino , Macrosomía Fetal , Edad Gestacional , Humanos , Incidencia , Recién Nacido , Análisis de Intención de Tratar , Aceites Vegetales/uso terapéutico , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Atención Prenatal , Insuficiencia del Tratamiento
14.
Int J Mol Sci ; 20(17)2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31480294

RESUMEN

A nutritional approach could be a promising strategy to prevent or slow the progression of neurodegenerative diseases such as Parkinson's and Alzheimer's disease, since there is no effective therapy for these diseases so far. The beneficial effects of omega-3 fatty acids are now well established by a plethora of studies through their involvement in multiple biochemical functions, including synthesis of anti-inflammatory mediators, cell membrane fluidity, intracellular signaling, and gene expression. This systematic review will consider epidemiological studies and clinical trials that assessed the impact of supplementation or dietary intake of omega-3 polyunsaturated fatty acids on neurodegenerative diseases such as Parkinson's and Alzheimer's diseases. Indeed, treatment with omega-3 fatty acids, being safe and well tolerated, represents a valuable and biologically plausible tool in the management of neurodegenerative diseases in their early stages.


Asunto(s)
Ensayos Clínicos como Asunto , Ácidos Grasos Omega-3/uso terapéutico , Enfermedades Neurodegenerativas/tratamiento farmacológico , Humanos , Estudios Observacionales como Asunto
15.
Int J Mol Sci ; 20(15)2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31374840

RESUMEN

BACKGROUND: Although it has been previously demonstrated that acute inflammation can promote the tumor growth of a sub-tumorigenic dose of melanoma cells through of 5-lipoxygenase inflammatory pathway and its product leukotriene B4, and also that the peritumoral treatment with eicosapentaenoic acid and its product, leukotriene B5, reduces the tumor development, the effect of the treatment by gavage with omega-3 and omega-6 in the tumor microenvironment favorable to melanoma growth associated with acute inflammation has never been studied. METHODS: C57BL/6 mice were coinjected with 1 × 106 apoptotic cells plus 1 × 103 viable melanoma cells into the subcutaneous tissue and treated by gavage with omega-3-rich fish oil or omega-6-rich soybean oil or a mixture of these oils (1:1 ratio) during five consecutive days. RESULTS: The treatment by gavage with a mixture of fish and soybean oils (1:1 ratio) both reduced the melanoma growth and the levels of leukotriene B4 (LTB4), prostaglandin E2 (PGE2), PGE2/prostaglandin E3 (PGE3) ratio, and CXC ligand 1 (CXCL1) and increased the levels of interleukin 10 (IL-10) to IL-10/CXCL1 ratio in the melanoma microenvironment. CONCLUSION: The oral administration of a 1:1 mixture of fish oil and soybean oil was able to alter the release of inflammatory mediators that are essential for a microenvironment favorable to the melanoma growth in mice, whereas fish oil or soybean oil alone was ineffective.


Asunto(s)
Ácidos Grasos Omega-3/uso terapéutico , Ácidos Grasos Omega-6/uso terapéutico , Inflamación/tratamiento farmacológico , Melanoma/tratamiento farmacológico , Microambiente Tumoral/efectos de los fármacos , Animales , Antiinflamatorios/uso terapéutico , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Aceites de Pescado/uso terapéutico , Inflamación/inmunología , Inflamación/patología , Melanoma/inmunología , Melanoma/patología , Ratones , Ratones Endogámicos C57BL , Aceite de Soja/uso terapéutico
16.
Transl Psychiatry ; 9(1): 190, 2019 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-31383846

RESUMEN

We conducted this meta-analysis of double-blind randomized placebo-controlled trials to estimate the efficacy of omega-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), in the improvement of depression. We applied a systematic bibliographic search in PubMed and EMBASE for articles published prior to 20 December 2017. This meta-analysis was performed using RevMan 5.3 and R 3.4.3, and means and standard deviations were calculated in fixed- or random-effects models based on the results of the Q-test. A sensitivity analysis was also conducted to evaluate the stability of the results, and publication bias was evaluated by a funnel plot and Egger's linear regression analysis. Our search resulted in 180 articles; we analyzed 26 studies, which included 2160 participants. The meta-analysis showed an overall beneficial effect of omega-3 polyunsaturated fatty acids on depression symptoms (SMD = -0.28, P = 0.004). Compared with placebo, EPA-pure (=100% EPA) and EPA-major formulations (≥60% EPA) demonstrated clinical benefits with an EPA dosage ≤1 g/d (SMD = -0.50, P = 0.003, and SMD = -1.03, P = 0.03, respectively), whereas DHA-pure and DHA-major formulations did not exhibit such benefits.Current evidence supports the finding that omega-3 PUFAs with EPA ≥ 60% at a dosage of ≤1 g/d would have beneficial effects on depression. Further studies are warranted to examine supplementation with omega-3 PUFAs for specific subgroups of subjects with inflammation, severity of depression, and the dose response for both EPA and DHA supplementation.


Asunto(s)
Trastorno Depresivo/tratamiento farmacológico , Ácidos Grasos Omega-3/uso terapéutico , Método Doble Ciego , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
17.
Int J Mol Sci ; 20(16)2019 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-31426560

RESUMEN

Heart failure (HF) is a rapidly growing global public health problem. Since HF results in high mortality and re-hospitalization, new effective treatments are desired. Although it remains controversial, omega 3 polyunsaturated fatty acids (n-3 PUFAs), such as the eicosapentaenoic acid and docosahexaenoic acid, have been widely recognized to have benefits for HF. In a large-scale clinical trial regarding secondary prevention of HF by n-3 PUFA (GISSI-HF trial), the supplementation of n-3 PUFA significantly reduced cardiovascular mortality and hospitalization. Other small clinical studies proposed that n-3 PUFA potentially suppresses the ventricular remodeling and myocardial fibrosis, which thereby improves the ventricular systolic and diastolic function both in ischemic and non-ischemic HF. Basic investigations have further supported our understanding regarding the cardioprotective mechanisms of n-3 PUFA against HF. In these reports, n-3 PUFA has protected hearts through (1) anti-inflammatory effects, (2) intervention of cardiac energy metabolism, (3) modification of cardiac ion channels, (4) improvement of vascular endothelial response, and (5) modulation of autonomic nervous system activity. To clarify the pros and cons of n-3 PUFA on HF, we summarized recent evidence regarding the beneficial effects of n-3 PUFA on HF both from the clinical and basic studies.


Asunto(s)
Cardiotónicos/uso terapéutico , Ácidos Grasos Omega-3/metabolismo , Insuficiencia Cardíaca/prevención & control , Animales , Ensayos Clínicos como Asunto , Ácidos Grasos Omega-3/química , Ácidos Grasos Omega-3/uso terapéutico , Insuficiencia Cardíaca/metabolismo , Humanos
18.
BMJ ; 366: l4697, 2019 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-31434641

RESUMEN

OBJECTIVE: To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism. DESIGN: Systematic review and meta-analyses. DATA SOURCES: Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews. ELIGIBILITY CRITERIA: Randomised 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 SYNTHESIS: Statistical 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. RESULTS: 83 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. CONCLUSIONS: This 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 REGISTRATION: PROSPERO CRD42017064110.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/prevención & control , Grasas Insaturadas en la Dieta/uso terapéutico , Prevención Primaria/métodos , Prevención Secundaria/métodos , Adulto , Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Suplementos Dietéticos , Ayuno/sangre , Ácidos Grasos Omega-3/uso terapéutico , Ácidos Grasos Omega-6/uso terapéutico , Ácidos Grasos Insaturados/uso terapéutico , Femenino , Hemoglobina A Glucada/análisis , Humanos , Insulina/sangre , Resistencia a la Insulina , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
G Ital Cardiol (Rome) ; 20(7): 431-438, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-31320765

RESUMEN

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the most important long-chain polyunsaturated fatty acids of the n-3 series (n-3 PUFA). Recent studies have clarified that EPA and DHA have different tissue distribution and influence target organs in a distinct way. In addition to the main effect of reducing triglycerides (TG), they exert antithrombotic, antiarrhythmic, anti-inflammatory, anti-atherogenic, and hemodynamic effects. The different action of PUFA n-3 depends on the dosage and duration of treatment: the effect on TG requires high doses and a few weeks/months of treatment.Several epidemiological studies have shown a relationship between hypertriglyceridemia and cardiovascular risk, confirmed by post-hoc analysis of statin trials and by recent genetic linkage studies. Moreover in secondary prevention, the evidence of a significant "residual risk", even in the presence of an adequate control of LDL-cholesterol, has led the scientific community to consider further intervention objectives in the context of the individual lipid profile, the most promising of which is certainly hypertriglyceridemia.The recent landmark REDUCE-IT study is the first major lipid intervention study to demonstrate a benefit deriving from an approach not based on the LDL target, focusing on a determinant factor of residual risk such as hypertriglyceridemia and treating it with high doses of n-3 PUFA (4 g/day).Overall, the "lipid residual risk" approach involves two integrated actions: (i) the achievement of the LDL-cholesterol target (<70 mg/dl) by using statins, ezetimibe, PCSK9 inhibitors; (ii) checking TG levels in order to start n-3 PUFA in case of TG values >150 mg/dl, at an initial dosage of 2-3 g/day (up to 4 g/day after 10-12 weeks).


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Ácidos Grasos Omega-3/uso terapéutico , Algoritmos , Enfermedades Cardiovasculares/etiología , Colesterol/sangre , Humanos , Factores de Riesgo , Triglicéridos/sangre
20.
Ulus Travma Acil Cerrahi Derg ; 25(4): 324-330, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31297772

RESUMEN

BACKGROUND: Oils from marine organisms have a different fatty acid composition. Fish oil (FO) has a high content of eicosapentaenoic and docosahexaenoic acids esterified to triacylglycerols; while in krill oil (KO), fatty acids are primarily esterified to phospholipids. This study aimed to compare the efficacy of two different, marine-derived omega-3 fatty acid sources in the wound healing of colon anastomoses rat model. METHODS: For the study, we used 42 male Wistar albino rats. The rats were divided into six groups with seven rats in each group-CO3: left colonic anastomosis (control group), sacrificed on the third day; KO3: left colonic anastomosis + oral KO, sacrificed on the third day; FO3: left colonic anastomosis + oral FO, sacrificed on the third day; CO7: left colonic anastomosis (control group), sacrificed on the seventh day; KO7: left colonic anastomosis + oral KO, sacrificed on the seventh day; FO7: left colonic anastomosis + oral FO, sacrificed on the seventh day. Peritoneal adhesions, anastomotic bursting pressures, hydroxyproline levels, and histological examination of the anastomotic tissue were evaluated. RESULTS: On day 7, bursting pressure and hydroxyproline measurements of the KO group was significantly higher than the FO group (p=0.012; p=0.002, respectively). Also, on day 7, a statistically significant difference was observed between the groups according to inflammatory cell infiltration, fibroblast activity, neoangiogenesis, and collagen deposition in favor of the KO group (p=0.023; p=0.028; p=0.016; p=0.012, respectively). CONCLUSION: Both KO and FO supplementation in patients before colorectal surgery may reduce some risk of anastomotic leakage; and KO might be a better alternative and excellent omega-3 source.


Asunto(s)
Colon/cirugía , Euphausiacea/química , Ácidos Grasos Omega-3/uso terapéutico , Aceites de Pescado/química , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/tratamiento farmacológico , Fuga Anastomótica/patología , Animales , Colectomía/efectos adversos , Colon/patología , Ácidos Grasos Omega-3/farmacología , Humanos , Hidroxiprolina/análisis , Masculino , Presión , Distribución Aleatoria , Ratas , Ratas Wistar , Herida Quirúrgica/tratamiento farmacológico
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