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Omega-3 review: Half a gram needed for heart benefits

By Stephen Daniells , 04-Aug-2009
Last updated on 04-Aug-2009 at 11:44 GMT

The science behind the cardiovascular health benefits of omega-3 fatty acids supports recommended daily levels of 500 mg, according to a ‘state-of-the-art’ review.

“Compelling evidence” from studies involving almost 40,000 participants supports daily EPA plus DHA intakes of at least 500 mg per day for healthy individuals, while people with known heart disease or heart failure should aim for up to 1,000 mg daily, according to a review published in the Journal of the American College of Cardiology.

The recommendations for healthy people are double the recommended levels determined by the European Food Safety Authority’s (EFSA) Panel on Dietetic Products, Nutrition and Allergies (NDA).

EFSA last month determined 250mg should be the labelling reference intake value for long-chain omega-3 fatty acids – most notably eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

“This isn’t just hype; we now have tremendous and compelling evidence from very large studies, some dating back 20 and 30 years, that demonstrate the protective benefits of omega-3 fish oil in multiple aspects of preventive cardiology,” said Carl Lavie, lead author of the review and medical director of Cardiac Rehabilitation and Prevention at the Ochsner Medical Center in New Orleans.

The review is in-line with claims from both industry and academia, and unofficial recommendations from UK and US bodies, for limits close to 500mg per day for EPA and DHA.

While the recent EFSA opinion was largely welcomed by industry, a group of prominent lipid scientists urged the EU to rethink of draft daily reference intake levels for the fatty acids. “Better no regulation than a bad regulation”, they said. To read about their position, click here .

Taking heart from the new review

Dr Lavie and his co-workers noted that the most compelling evidence for the cardiovascular benefits of the fatty acids came from four randomised controlled trials with EPA and DHA, which involved around 40,000 participants.

Following evaluation of evidence from retrospective epidemiologic studies and from large randomised controlled trials, the reviewers recommended that healthy individuals should consume 500 mg daily of omega-3 fish oil containing EPA and DHA, while people with known heart disease or heart failure aim for between 800 and 1,000 mg per day.

“Further studies are needed to determine optimal dosing and the relative ratio of DHA and EPA omega-3 PUFA that provides maximal cardioprotection in those at risk of CV disease as well in the treatment of atherosclerotic, arrhythmic, and primary myocardial disorders,” concluded the researchers.

EFSA’s opinion

EFSA’s draft recommends levels of EPA, DHA and ALA that products must contain if they are to carry either ‘Source of omega-3 fatty acids’ or ‘High in omega-3 fatty acids’ label claims.

Those levels are 300mg of ALA (alpha-linolenic acid) per 100g [and per 100kcal], or 30mg of the sum of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) per 100g/100kcal for the ‘source of’ claim. For the ‘high in’ claim, the levels are double.

These levels are based on a baseline daily intake level of 200mg per day EPA/DHA.

Source: Journal of the American College of Cardiology
Volume 54, Pages 585-594, doi:10.1016/j.jacc.2009.02.084
"Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases"
Authors: C.J. Lavie, R.V. Milani, M.R. Mehra, H.O. Ventura

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