Effects of marine omega-3 fatty acids supplementation on biochemical, anthropometric, and inflammatory outcomes in subjects living with HIV on antiretroviral therapy: review and clinical trial.

Author(s)

Julicristie Machado de Oliveira

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2011-02-15

Examining board members

Patricia Helen de Carvalho Rondo; Denise Pimentel Bergamaschi; Inar Alves de Castro; Nágila Raquel Teixeira Damasceno; Sigrid de Sousa dos Santos

• Advisor: Patricia Helen de Carvalho Rondo

Abstract

Background: Although the antiretroviral therapy (ART) revolutionized the care of HIV-infected subjects, it has been associated with metabolic abnormalities and increased risk of cardiovascular diseases. Aims: To review the effects of marine omega-3 fatty acids on lipid profile, insulin resistance and inflammatory markers in subjects living with HIV on ART. Methods: Paper 1. Thirty three articles were found in a PubMed search; six met the inclusion criteria; and four of them were considered of adequate quality and included. Meta-analysis with fixed effects was performed and weighted mean differences (WMD (95 per cent CI)) were described. Paper 2 and 3. The study was conducted in an HIV/Aids care centre affiliated to the Medical School, University of Sao Paulo. This was a randomized controlled trial that assessed the effects of 3g fish oil/day (900mg of omega-3 fatty acids) or 3g soy oil/day (placebo). A hundred and twenty subjects aged between 19 and 64 years were recruited. The statistical analyses were performed in Stata 9. Results: Paper 1. Data from 83 subjects were included in the analyses. The overall reduction on triglyceride concentrations after 8-16 weeks of treatment with 900-3360mg of omega-3/day was WMD=-80.34mg/dL (95 per cent CI: -129.08 to -31.60). The pooled result of studies with mean triglyceride > 300 mg/dL at baseline and 1800-2900mg omega-3/day was WMD=-129.72mg (95 per cent CI: -206.54 to -52.91). Paper 2 and 3. Multilevel analyses revealed no statistically significant relationships between fish oil supplementation and the longitudinal changes in triglyceride (p= 0.335), LDL-C (p= 0.078), HDL-C (p= 0.383), total cholesterol (p=0.072), apo B (p= 0.522), apo A1 (p=0.420), LDL-C/apo B ratio (p=0.107), homa-2 IR index (p=0.387), BMI (p=0.068), waist circumference (p=0.128), waist/hip ratio (p=0.359), hs-CRP (p=0.918), fibrinogen (p=0.148), and VIII factor (p=0.073). Conclusions: Paper 1. Different doses of omega-3 fatty acids reduced significantly triglyceride concentrations confirming the potential applicability of this nutrient on the management of hypertriglyceridemia in HIV-infected subjects on ART. Paper 2 and 3. A relatively low dose of fish oil for HIV subjects on ART did not change lipid profile, insulin resistance, body fat distribution, and inflammatory markers. Further investigations should considerer the assessment of higher doses and more sensitivity inflammatory markers (AU)