Using High-Dose Omega-3 Fatty Acid Supplements to Lower Triglyceride Levels in 10- to 19-Year-Olds

Abstract

Background Omega-3 fatty acids (FA) supplements lower triglyceride (TG) levels in adults; little pediatric information is available. We evaluated their effect in hypertriglyceridemic adolescents. Methods 25 patients ages 10–19 years with TG levels 150–1000 mg/dL were randomized to 6 months double-blind trial of Lovaza [∼3360 mg docosahexaenoic acid + eicosapentaenoic acid/day] vs. Placebo. Results Baseline mean TG levels were 227 mg/dl (SD 49). TG levels declined at 3 months in the Lovaza group by 54 ± 27 mg/dL [mean ± standard error (SE)] (p=0.02) and by 34 ± 26 mg/dL (p=0.16) in the Placebo group. The difference in TG lowering between groups was not significant (p=0.52). There were no between-group differences in endothelial function, blood pressure, body mass index, C-reactive protein or side effects. Conclusions High dose omega-3 FA supplements are well tolerated in adolescents. However, declines in TG levels did not differ significantly from Placebo in this small study.

Combined dyslipidemia in childhood

“…[173][174][175] Two recently published randomized controlled trials of omega-3 fish oil in adolescents showed a minimal decrease in TG levels but no change in LDL particle number or size, suggesting no significant benefit of fish oil treatment in children with CDO. 176,177 In adults, fibrates have been used effectively and safely to lower TG levels, alone and in combination with statins. [178][179][180][181] Fibrates are peroxisome proliferatoractivated receptors agonists and act in the liver to reduce cholesterol synthesis, reduce secretion of very low-VLDLs and increase the removal of VLDLs from the blood, consequently lowering plasma TGs (by 30%-50%) and, to a lesser extent, LDL-C (reduction of 0%-30%).…”

“…There have been rare cases of myositis and rhabdomyolysis, but these have almost always occurred when fibrates are combined with statin therapy. 177,179,180 In children, treatment with fibrates in a single small randomized trial (n 5 14) and 3 case series (n 5 7, n 5 17, and n 5 47) documents significant TG lowering by as much as 54% with an associated 17% increase in HDL-C. [186][187][188][189] One child in a case series was thought to have myositis on clinical grounds with no reported laboratory changes. 188 There were mild, transient elevations in alanine aminotransferase and aspartate aminotransferase (AST) in 2 subjects in another case series.…”

A randomized control trial of the impact of LCPUFA‐ω3 supplementation on body weight and insulin resistance in pubertal children with obesity

“…However, results from intervention studies are variable. While some have found small decreases in HOMA or fasting insulin in children with obesity or IR, another study reported borderline effects on insulin sensitivity but only in girls, and others report no effects even after using high doses of ω3 . Interestingly, none of these intervention studies used any blood measurements of PUFA to evaluate adherence to intervention, proposing that the inconsistency of published results may be due to the lack of adherence to supplementation.…”

Lipid-lowering medications for children and adolescents

“…High dose omega-3 fatty acid supplementation was evaluated by de Ferranti and colleagues, but ultimately they found no statistically significant improvement in triglycerides when compared to placebo. 54 • Despite their ability to effectively reduced cholesterol levels, bile acid sequestrants continue to pose challenges for pediatric patients due to their unpalatability.…”