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Santurino C, López-Plaza B, Fontecha J, Calvo MV, Bermejo LM, Gómez-Andrés D, Gómez-Candela C. Consumption of Goat Cheese Naturally Rich in Omega-3 and Conjugated Linoleic Acid Improves the Cardiovascular and Inflammatory Biomarkers of Overweight and Obese Subjects: A Randomized Controlled Trial. Nutrients 2020; 12:nu12051315. [PMID: 32380746 PMCID: PMC7285099 DOI: 10.3390/nu12051315] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
This study examines the value of a goat cheese naturally enriched in polyunsaturated fatty acids (PUFA) (n-3 PUFA and conjugated linolenic acid (CLA)) as means of improving cardiovascular and inflammatory health. Sixty-eight overweight and obese subjects (BMI ≥ 27 and <40 kg/m2), with at least two risk factors for cardiovascular disease (CVD) in a lipid panel blood tests, participated in a randomized, placebo-controlled, double-blind, parallel designed study. The subjects consumed for 12 weeks: (1) 60 g/d control goat cheese and (2) 60 g/d goat cheese naturally enriched in n-3 PUFA and CLA. Diet and physical activity were assessed. Anthropometric and dual-energy X-ray absorptiometry (DXA) tests were performed. Blood samples were collected at the beginning and at the end of the study period. Changes in health status, lifestyle and dietary habits, and daily compliance were recorded. The consumption of a PUFA-enriched goat cheese significantly increased plasma high-density lipoprotein (HDL)-cholesterol, as well as in apolipoprotein B, and it significantly decreased high-sensitivity C-reactive protein concentrations compared to the control goat cheese (p < 0.05). The significant improvement of the plasma lipid profile and inflammatory status of people with risk for CVD due to the consumption of PUFA-enriched cheese suggests a potential role of this dairy product as an alternative to develop high nutritional value food in a balanced diet comprising regular exercise.
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Affiliation(s)
- Cristina Santurino
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (C.S.); (L.M.B.); (C.G.-C.)
| | - Bricia López-Plaza
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (C.S.); (L.M.B.); (C.G.-C.)
- Correspondence:
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC), Campus of Autonomous University of Madrid, 28049 Madrid, Spain; (J.F.); (M.V.C.)
| | - María V. Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC), Campus of Autonomous University of Madrid, 28049 Madrid, Spain; (J.F.); (M.V.C.)
| | - Laura M. Bermejo
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (C.S.); (L.M.B.); (C.G.-C.)
| | - David Gómez-Andrés
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- Pediatric Neurology Unit, Hospital Universitari Vall d’Hebron, VHIR, 08035 Barcelona, Spain
| | - Carmen Gómez-Candela
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (C.S.); (L.M.B.); (C.G.-C.)
- Dietetic and Clinical Nutrition Department, La Paz, University Hospital, 28046 Madrid, Spain
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Monoacylglycerol Form of Omega-3s Improves Its Bioavailability in Humans Compared to Other Forms. Nutrients 2020; 12:nu12041014. [PMID: 32272659 PMCID: PMC7230359 DOI: 10.3390/nu12041014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Numerous benefits are attributed to omega-3 fatty acids (OM3) especially in cardiovascular health. However, bioavailability and clinical efficacy depend on numerous factors, including OM3 form, food matrix effects (especially the lipid content of the diet), and metabolic capacity. Here, we show in humans that a "pre-digested" OM3-sn-1(3)-monoacylglycerol lipid structure (OM3-MAG) has a significantly greater absorption at high therapeutic doses (2.9 g/day) than the most commonly OM3-ethyl ester (3.1 g/day) form (used for the treatment of hypertriglyceridemia), and a comparable profile to other pre-digested OM3 free fatty acids (OM3-FFA) structure (3.2 g/day). Nutritional supplement doses of MAG resulted in similar increases in OM3 blood level, compared to OM3 triacylglycerols (OM3-TAG) supplements in obese subjects (1.2 g/day) under low fat diet, and in children with cystic fibrosis (1.0 g/day). These results suggest that both forms of pre-digested OM3-MAG and OM3-FFA are effectively absorbed and re-incorporated effectively into triacylglycerols inside the enterocytes, before being exported into the chylomicrons lipid transport system. The pre-digested OM3-MAG might provide a more effective therapy in severe cardiovascular conditions where high doses of OM3 are required and a low-fat diet is indicated, which limited digestive lipase activity.
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de Freitas MCP, Martins Figueiredo Neto A, Damasceno NR. Nonlinear optical responses of oxidized low-density lipoprotein: Cutoff point for z-scan peak-valley distance. Photodiagnosis Photodyn Ther 2020; 30:101689. [PMID: 32087295 DOI: 10.1016/j.pdpdt.2020.101689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/28/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
The development of new methods to assess biomarkers of cardiovascular disease is currently a subject of scientific research. This article broadens our view of nonlinear optical responses of oxidized low density lipoprotein (LDL) evaluated using the Z-scan peak-valley distance and proposes a cutoff point. We investigated the association of peak-valley distance and some cardiovascular risk factors related with sociodemographic, clinical and anthropometric profiles and plasma biomarkers such as lipid and glucose profile, apolipoprotein, lipoprotein subfractions and omega 3 fatty acids. Z-scan analysis was performed using isolated LDL after ultracentrifugation in human blood samples collected after fasting. Peak-valley distance is a parameter that decreases directly depending on the oxidizability of LDL. As peak-valley distance was associated with relevant biomarkers of cardiovascular risk, we tested cutoff points for categorization and the best results were obtained using percentile < 75 (Lowz-scan) and percentile ≥ 75 (Highz-scan). The regression logistic models tested after establishing the cutoff point for peak-valley distance showed that increased levels of plasma high-density lipoprotein cholesterol, apolipoprotein A-I, large high-density lipoprotein subfractions and docosahexaenoic acid are directly associated with HighZ-scan. Conversely, high levels of small LDL were associated with decreased odds of presenting HighZ-scan. In conclusion, the cutoff point for peak-valley distance was able to identify atherogenic characteristics of LDL and its relationship with some parameters of high-density lipoprotein functionality.
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Affiliation(s)
- Maria Camila Pruper de Freitas
- Department of Nutrition, Faculty of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, 01246-904, Sao Paulo, SP, Brazil.
| | | | - Nágila Raquel Damasceno
- Department of Nutrition, Faculty of Public Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, 01246-904, Sao Paulo, SP, Brazil.
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Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris-Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB, Rodriguez-Leyva D, de Ferranti SD, Welty FK. Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association. Circulation 2019; 140:e673-e691. [PMID: 31422671 DOI: 10.1161/cir.0000000000000709] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertriglyceridemia (triglycerides 200-499 mg/dL) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dL) are far less frequently observed. Both are becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus. In a 2002 American Heart Association scientific statement, the omega-3 fatty acids (n-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2-4 g/d) for reducing triglycerides in patients with elevated triglycerides. Since 2002, prescription agents containing EPA+DHA or EPA alone have been approved by the US Food and Drug Administration for treating very high triglycerides; these agents are also widely used for hypertriglyceridemia. The purpose of this advisory is to summarize the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA) on the basis of new scientific data and availability of n-3 FA agents. In treatment of very high triglycerides with 4 g/d, EPA+DHA agents reduce triglycerides by ≥30% with concurrent increases in low-density lipoprotein cholesterol, whereas EPA-only did not raise low-density lipoprotein cholesterol in very high triglycerides. When used to treat hypertriglyceridemia, n-3 FAs with EPA+DHA or with EPA-only appear roughly comparable for triglyceride lowering and do not increase low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin. In the largest trials of 4 g/d prescription n-3 FA, non-high-density lipoprotein cholesterol and apolipoprotein B were modestly decreased, indicating reductions in total atherogenic lipoproteins. The use of n-3 FA (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT (Reduction of Cardiovascular Events With EPA Intervention Trial), a randomized placebo-controlled trial of EPA-only in high-risk patients treated with a statin. The results of a trial of 4 g/d prescription EPA+DHA in hypertriglyceridemia are anticipated in 2020. We conclude that prescription n-3 FAs (EPA+DHA or EPA-only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents.
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Zgheel F, Perrier S, Remila L, Houngue U, Mazzucotelli JP, Morel O, Auger C, Schini-Kerth VB. EPA:DHA 6:1 is a superior omega-3 PUFAs formulation attenuating platelets-induced contractile responses in porcine coronary and human internal mammary artery by targeting the serotonin pathway via an increased endothelial formation of nitric oxide. Eur J Pharmacol 2019; 853:41-48. [DOI: 10.1016/j.ejphar.2019.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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Sepidarkish M, Morvaridzadeh M, Akbari-Fakhrabadi M, Almasi-Hashiani A, Rezaeinejad M, Heshmati J. Effect of omega-3 fatty acid plus vitamin E Co-Supplementation on lipid profile: A systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:1649-1656. [PMID: 31336536 DOI: 10.1016/j.dsx.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dyslipidemia is linked to chronic inflammation, which in return leads to a set of chronic disorders. Omega-3 fatty acids have been reported to reduce inflammation. Furthermore, Vitamin E is a fat-soluble vitamin which has antioxidant and anti-inflammatory effects. Vitamin E and omega-3 fatty acids co-supplementations may be more effective than the single supplementation in control dyslipidemia. Therefore, we designed and conducted the current systematic review and meta-analysis to investigate the effect of co-supplementation of vitamin E and omega-3 fatty acids on the lipid profile. METHODS A comprehensive search for studies published between January 1990 and July 2018 was performed. The initial search extracted 3015 potentially relevant articles. After studying these publications, 9 RCTs were potentially eligible and retrieved in full text. RESULTS The meta-analysis indicate that on total cholesterol, HDL, LDL and triglyceride individually did not show any significant difference between intervention and control groups, but vitamin E an omega-3 fatty acids co-supplementations significantly reduce VLDL levels. CONCLUSIONS Based on the available evidence, omega-3 fatty acid and vitamin E co-supplementation can reduce VLDL, although its effect on other lipid profile parameters requires more well-designed studies.
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Affiliation(s)
- Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
| | - Mojgan Morvaridzadeh
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Akbari-Fakhrabadi
- Department of Nutrition, School of Public Health, International Campus, Iran University of Medical Sciences, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Heshmati
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Omega 3 fatty acids in cardiovascular disease risk factors: An updated systematic review of randomised clinical trials. Clin Nutr 2017; 37:72-77. [PMID: 28601400 DOI: 10.1016/j.clnu.2017.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/11/2017] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Abstract
Several studies and reviews regarding the supplementation of omega-3 LC-PUFAs have been developed during the last years. Indeed, the evidence states that high doses omega-3 LC-PUFAs produce a small but significant decrease in blood pressure in older and hypertensive subjects. Due to the increasing interest in the benefits of LC-PUFAs, we aimed to evaluate the scientific evidence provided in the past five years (2012-2016) on the effects of the intake of omega-3 LC-PUFAs on cardiovascular risk factors such as inflammation and oxidative stress, through a systematic review in PubMed database. Twenty-eight articles were related to cardiovascular disease (CVD) and are included in this systematic review. The studies included healthy subjects and CVD patients; we included the number of subjects, type of study, type and doses of omega-3 LC-PUFAs, primary outcomes, and results. The use of omega-3 LC-PUFAs for ameliorating CVD risk factors can be recommended. However, the administration of omega-3 does not seem to show any benefit for the management of CVD or associated complications.
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Ellulu MS, Khaza'ai H, Patimah I, Rahmat A, Abed Y. Effect of long chain omega-3 polyunsaturated fatty acids on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Food Nutr Res 2016; 60:29268. [PMID: 26829184 PMCID: PMC4734034 DOI: 10.3402/fnr.v60.29268] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background Obesity is a degree of excess weight that predisposes people to metabolic syndromes via an inflammatory mechanism. Hypertensive and diabetic people have higher risks of developing systemic inflammation. Long chain omega-3 polyunsaturated fatty acids (LC ω-3 PUFAs) can reduce the cardiovascular events and help against inflammation. Objective To identify the effects of LC ω-3 PUFAs on reducing the levels of inflammatory markers on hypertensive and/or diabetic obese adults. Materials and methods Sixty-four patients, who were hypertensive and/or diabetic obese with high levels of inflammatory markers, from primary healthcare centers of Gaza City, Palestine, enrolled in two groups of an open-label, parallel, randomized, controlled trial for 8 weeks. Thirty-three patients were in the control group, and 31 patients were in the experimental group. The experimental group was treated with a daily dose of 300 mg eicosapentaenoic acid and 200 mg of docosahexaenoic acid. Results Treatment with LC ω-3 PUFAs significantly reduced the level of high sensitivity C reactive protein (hs-CRP) [14.78±10.7 to 8.49±6.69 mg/L, p<0.001], fasting blood glucose (FBG) [178.13±58.54 to 157.32±59.77 mg/dL, p=0.024], and triglyceride (TG) [209.23±108.3 to 167.0±79.9 mg/dL, p<0.05] after 8 weeks of treatment, whereas no significant changes appeared in interleukin 6 (IL-6) and total cholesterol (TC). In the control group, significant reduction was detected for FBG [187.15±64.8 to 161.91±37.9 mg/dL, p<0.05] and TG [202.91±107.0 to 183.45±95.82 mg/dL, p<0.05], and no changes for hs-CRP, IL-6, or TC. By comparing the experimental group with the changes of control group at the endpoint, LC ω-3 PUFAs did not reach the clinical significance in treating effectiveness for any of the clinical variables. Conclusion LC ω-3 PUFAs have recommended effects on health; the obtained results can improve the role of LC ω-3 PUFAs as a protective factor on inflammation and metabolic dysregulation. The time allowed or the dose used could be insufficient to achieve full treatment affectivity.
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Affiliation(s)
- Mohammed S Ellulu
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Huzwah Khaza'ai
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia;
| | - Ismail Patimah
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Asmah Rahmat
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Yehia Abed
- Faculty of Public Health, Al Quds University of Gaza, Gaza City, Palestine
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Metherel AH, Stark KD. The stability of blood fatty acids during storage and potential mechanisms of degradation: A review. Prostaglandins Leukot Essent Fatty Acids 2016; 104:33-43. [PMID: 26802940 DOI: 10.1016/j.plefa.2015.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/03/2015] [Accepted: 12/05/2015] [Indexed: 01/28/2023]
Abstract
Fatty acids in blood samples, particularly polyunsaturated fatty acids (PUFAs), are susceptible to degradation through peroxidation reactions during long-term storage. Storage of blood samples is necessary in almost all studies and is crucial for larger clinical studies and in field research settings where it is not plausible for analytical infrastructure. Despite this, PUFA stability during blood storage is often overlooked. This review introduces and discusses lipid peroxidation and popular strategies employed to prevent or minimize peroxidation reactions during fatty acid analysis. Further, an in-depth examination of fatty acid stability during storage of blood is discussed in detail for all blood fractions including plasma/serum, erythrocytes and whole blood stored both in cryovials and on chromatography paper before discussing the associated mechanisms of degradation during storage. To our knowledge this is the first review of its kind and will provide researchers with the necessary information to confidently store blood samples for fatty acid analysis.
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Affiliation(s)
- Adam H Metherel
- University of Waterloo, 200 University Avenue, Waterloo, ON, Canada N2L 3G1
| | - Ken D Stark
- University of Waterloo, 200 University Avenue, Waterloo, ON, Canada N2L 3G1.
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Jackowski SA, Alvi AZ, Mirajkar A, Imani Z, Gamalevych Y, Shaikh NA, Jackowski G. Oxidation levels of North American over-the-counter n-3 (omega-3) supplements and the influence of supplement formulation and delivery form on evaluating oxidative safety. J Nutr Sci 2015; 4:e30. [PMID: 26688721 PMCID: PMC4678768 DOI: 10.1017/jns.2015.21] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/23/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to evaluate the oxidation status of North American n-3 (omega-3) PUFA nutritional supplements commercially available in Canada and evaluate the influence of product formulation and delivery form on oxidative safety. A total of 171 North American over-the-counter n-3 PUFA nutritional supplements were analysed for oxidation safety. Primary and secondary oxidation and total oxidation (TOTOX) were determined using the American Oil Chemists' Society (AOCS) procedures. Comparisons between supplements' final forms, oil source and n-3 PUFA concentration quartiles, as measures of product formulations and delivery forms, were compared using ANOVA. Of the products successfully tested, 50 % exceeded the voluntary recommended levels for markers of oxidation. Another 18 % of products were approaching the limits with 1-3 years before expiration. Encapsulated products without flavour additives had significantly lower secondary and TOTOX levels than bulk oils and flavoured products (P < 0·05). Children's products had significantly higher primary, secondary and TOTOX levels compared with all other products (P < 0·05). Markers of oxidation did not differ between oil sources (P > 0·05), with the exception of krill oil products having higher secondary oxidation levels than plant-based products (P > 0·05). Markers of oxidation did not differ between n-3 PUFA supplement concentration quartiles. Consumers may be at risk of exposure to higher levels of oxidative products. New regulatory mandates need to be introduced to ensure that all n-3 PUFA products, used as nutritional supplements, regardless of their formulation or delivery form, can be tested for oxidative safety and compliance.
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Affiliation(s)
- Stefan A Jackowski
- University of Saskatchewan , Saskatoon , SK , Canada ; Pivotal Therapeutics Inc. , Woodbridge , ON , Canada
| | - Azhar Z Alvi
- Pivotal Therapeutics Inc. , Woodbridge , ON , Canada
| | | | - Zahabia Imani
- Pivotal Therapeutics Inc. , Woodbridge , ON , Canada
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Shaikh NA, Tappia PS. Why are there inconsistencies in the outcomes of some omega-3 fatty acid trials for the management of cardiovascular disease? ACTA ACUST UNITED AC 2015. [DOI: 10.2217/clp.15.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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