The Omega-3 Index is defined as erythrocyte eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and represents an individual's status in these two marine omega-3 fatty acids. A target range of 8 to 11% has been suggested, because values below predispose to cardiovascular events, especially sudden cardiac death, as well as to suboptimal brain function, like prolonged reaction times or even depression. Compared with the general population, elite athletes have an increased incidence of sudden death. The Omega-3 Index has not yet been investigated in elite athletes. In an exploratory approach, we determined the Omega-3 Index in 106 consecutive German national elite winter endurance athletes presenting for preparticipation screening, using a well-established analytical procedure (HS-Omega-3 Index). Surprisingly, only one athlete had a value within the target range, but all others had values <8%. We conclude that we have identified a deficiency of EPA and DHA in these elite athletes. This deficiency presents a potential option for prevention of cardiovascular events such as sudden cardiac death, and improving aspects of brain function. It will be important to scrutinize our finding by more thorough epidemiologic studies and appropriate intervention trials.

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A 34-year-old para V woman was referred to our centre at 35+1 weeks of gestation for an assumed fetal malformation with prenatal renal impairment and anhydramnios. Prenatal ultrasound demonstrated unilateral renal agenesis; the bladder was not detectable. The baby was born by caesarian section at 36+2 weeks of gestation because of placental insufficiency. Postnatal adaptation was uneventful, but the newborn presented external stigmas of trisomy 21 and progressive renal impairment with anuria. Nevertheless, the postnatal ultrasound showed two enlarged kidneys in loco typico with impaired perfusion but without signs of malformations. In the lower abdomen, a rosette-shaped structure of unknown origin was noted. Its origin could not be cleared by imaging including voiding cystourethrography and colon contrast radiography. Explorative laparotomy identified the structure as a persistent urachal cyst with secondary obstruction of the upper urinary tract. After removal of the urachus with reconstruction of the bladder dome, renal function recovered completely while urine was drained continuously via suprapubic catheter. A voiding cystourethrogram 3 weeks later showed a posterior urethral valve as an additional unexpected diagnosis. The valve was slit at the age of 6 months without complications, the renal function remained stable in the further course. In retrospect, the main cause for the renal failure remains unclear. It appears to be the obstruction due to the space-consuming character of the urachal cyst, especially because the megacystis typically associated with urethral valve was not viewable. Alternatively, the additional proximal stenosis may have only masked the typical findings of PUV.