Weighing Up Fish and Omega-3 PUFA Advice with Accurate, Balanced Scales: Stringent Controls and Measures Required for Clinical Trials

Up-Regulation of Mitochondrial Antioxidant Superoxide Dismutase Underpins Persistent Cardiac Nutritional-Preconditioning by Long Chain n-3 Polyunsaturated Fatty Acids in the Rat

“…The present study deliberately used a high DHA fish oil, which does not reflect the composition of most nutritional supplement fish oils, but rather reflects the main LC n -3 PUFA derived from eating fish [ 4 , 40 ]. As the most abundant n -3 PUFA found in myocardium, DHA is also the main fatty acid underpinning the cardiac effects of fish and fish oil [ 4 ].…”

Algal supplementation of vegetarian eating patterns improves plasma and serum docosahexaenoic acid concentrations and omega‐3 indices: a systematic literature review

“…Recently, concern has been expressed for omega‐3 fatty acid controlled trials exploring cardiac outcomes . Much of the criticism surrounds the disparity in study design when comparing standard pharmacological controlled trials to fish oil trials.…”

A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying According to Lipid Membrane Incorporation in Cardiac Surgical Patients

“…The discrepant findings reported from population/observational studies and from RCTs in relation to n-3 PUFA benefit, at least partially reflect the problem of variable participant n-3 PUFA status at study commencement and ongoing ingestion behaviour during the study [15]. In supplementation studies, participants will have variable endogenous background levels of key PUFAs, and the capacity to effect a quantitatively significant intervention by supplementation may be compromised [17].…”

“…The disparity in observational and randomised clinical trial-based findings in relation to n-3 PUFA supplement benefit is perplexing. The key issue and challenge which has been highlighted in the posthoc consideration of this NHFA report on n-3 PUFA efficacy is the difficulty in defining participant groups in randomised trials (or in any study design type) which can be identified as dichotomous treatment categories [17,18]. In dealing with a 'treatment' agent which is present always to a variable extent in background diet and which is readily available in non-prescription, retail supermarket form, the effectiveness of randomisation may be compromised.…”

“…In dealing with a 'treatment' agent which is present always to a variable extent in background diet and which is readily available in non-prescription, retail supermarket form, the effectiveness of randomisation may be compromised. The importance of establishing actual tissue lipid incorporation levels to assess real dichotomy of treatment groups and cardiac endpoints has been emphasized [17,18]. In determining an effect of lipid ingestion intervention on arrhythmic propensity or on protective myocardial signalling pathways, it would seem apparent that knowledge of lipid status of study participants would be essential.…”