Effects of N-3 PUFAs Supplementation on Insulin Resistance and Inflammatory Biomarkers in Hemodialysis Patients

Abstract

Aims/Hypothesis. It was suggested that polyunsaturated n-3 fatty acids (n-3 PUFAs) could improve insulin sensitivity and have an anti-inflammatory effects in overall population. This study investigates a possible effect of n-3 PUFAs supplementation on the insulin sensitivity and some inflammatory markers; hence, patients with chronic renal failure (CRF) on maintenance hemodialysis (MHD) are presented with insulin resistance. Methods. This study explored the ratio between red blood cells (RBC) phospholipid long chain fatty acids (LC FAs) and components of metabolic syndrome (MeS) in 35 patients (mean age 54.50 ± 11.99 years) with CRF on MHD. Furthermore, the effects of omega-3 FA eight-week's supplementation (EPA+DHA, 2.4g/d) on the MeS features and inflammatory markers TNF-alpha, IL 6, and hsCRP were examined. Results. Supplementation increased EPA and DHA levels in RBCs (p = 0.009 for EPA and p = 0.002 for DHA). Total n-6 PUFAs: n-3 PUFAs ratio tended to be lower after supplementation (p = 0.31), but not significantly. Data revealed a significant decrease of saturated FAs (SFA) (p = 0.01) as well as total SFA: n-3 PUFAs ratio during the treatment (p = 0.04). The values of serum insulin and calculated IR index-IR HOMA were reduced after supplementation (p = 0.001 for both).There was a significant decrease in the levels of all inflammatory markers (p = 0.01 for TNF alpha, p = 0.001 for IL 6, p = 0.001 for hsCRP, and p = 0.01 for ferritin). In multivariate regression analysis, only the changes in n-6 PUFAs: n-3 PUFAs ratio independently contributed to 40% of the variance in IR HOMA. The impact of changes in PUFAs level in RBCs membrane phospholipid fatty acids on inflammation markers was also registered. The changes in n-6: n-3 PUFAs ratio independently contributed to 18% of the variance in TNF alpha. Conclusion. It was concluded that the EPA and DHA moderate dose administration in the patients with CRF on MHD had a beneficial effect on insulin resistance decrease. The anti-inflammatory effects of the supplemented PUFAs were also presented.

Eicosapentaenoic acid improves insulin sensitivity and blood sugar in overweight type 2 diabetes mellitus patients: a double-blind randomised clinical trial

“…(11) One of the major putative mechanisms that could account for the possible beneficial effects of n-3 PUFAs on insulin resistance is the anti-inflammatory properties of n-3 PUFAs, which have been previously reported. (22,23) In conclusion, our study showed that a diet supplemented with 2 g of EPA daily can improve the indices of glycaemic control, namely FPG, serum insulin, HbA1c and HOMA-IR, in T2DM patients. While the complete mechanism of action of EPA has yet to be elucidated, it is well known that an increase in n-3 PUFAs intake causes an increase in the fluidity of the skeletal muscle membrane.…”

The differential effects of EPA and DHA on cardiovascular risk factors

“…Another hypothesis for the cardioprotective effects of fish oil supplementation is the inhibition of cytokine production, as measured directly in plasma or ex vivo, and studies have been published that support and challenge the hypothesis that n-3 LCP inhibit cytokine and CRP production (102,103,(140)(141)(142)(143)(144)(145)(146)(147)(148)(149)(150) . In their recent meta-analysis including twenty-one trials, Balk et al (151) concluded that the effect of n-3 LCP, including EPA and DHA, on CRP levels in human subjects was unconvincing.…”

Kronik Böbrek Hastalığında Renal İnflamasyon ve Bazı Güncel Diyet Bileşenleri İlişkisi

“…KBH kohortlarını içeren çalışmalar kısıtlıdır, ancak mevcut çalışmalarda özellikle de diyaliz tedavisi alan veya böbrek transplantasyonu yapılmış son evre böbrek yetmezliği hastalarında, PUFA suplementasyonunun CRP ile ölçülen inflamasyonu azaltabildiği ve IL-6 ve TNF-α düzeylerinde düşüş ile sonuçlanabileceği gösterilmiştir. Bu nedenle, böbrek hasarı açısından risk altında olan, özellikle de yaşlı bireylerde, n-3 yağ asitlerinden zengin bir diyet tüketiminin koruyucu olabileceği düşünülmektedir (22,47,48).…”

“…Yapılan bir çalışmada, hemodiyaliz tedavisi alan son evre böbrek yetmezliği hastalarında, 8 hafta boyunca günde 2.4 g EPA+DHA suplemantasyonu yapılmış ve sonuç olarak hastalarda insülin direncinin azaldığı ve yüksek duyarlı CRP (hs-CRP), TNF-α ve IL-6 gibi inflamatuvar parametrelerin anlamlı oranda düştüğü gösterilmiştir (47). Başka bir çalışmada hemodiyaliz tedavisi alan son evre böbrek yetmezliği hastalarında 2 ay süresince 2.4 g/gün n-3 yağ asitleri suplemantasyonu yapılmış ve tedavi sonucunda EPA düzeyinin anlamlı oranda yükseldiği ve IL-6 ve TNF-α düzeylerinin anlamlı oranda düştüğü gösterilmiştir (50).…”