Hearts of granite

8 December 2020

The benefits of fish oil have been known about for many years, but an authoritative new analysis now links increased omega-3 intake to cardioprotection and improved cardiovascular outcomes. Chris Gearheart, director of communications at the Global Organisation for EPA and DHA Omega-3s, explains to Ian Turner the importance of this new study, and how omega-3 can be incorporated into the diet.

According to a new study from Grand View Research, the global omega-3 market size was valued at $2.49bn in 2019 and is expected to expand at a CAGR of 7.7% over the coming years. The industry is driven by rising the penetration of omega-3 in the active pharmaceutical ingredient market. In light of this, Chris Gearheart, director of communications at the Global Organisation for EPA and DHA Omega-3s (GOED), explains the results of his organisation’s latest study.

New analysis links increased omega-3 intake to improved cardiovascular outcomes. Can you tell us about this research?

Chris Gearheart: GOED’s recent meta-analysis published in Mayo Clinic Proceedings [entitled, ‘Effect of omega-3 dosage on cardiovascular outcomes: An updated meta-analysis and meta-regression of interventional trials’] analysed 40 clinical trials on omega-3 intake and cardiovascular health, including the results of more than 135,000 study participants.

EPA and DHA supplementation was associated with statistically significant risks reductions in fatal heart attacks (35%), heart attacks (13%), general coronary heart disease events (10%) and death from coronary heart disease (9%). Notably, this positive effect increased with dosage – each additional gram of EPA and DHA per day resulted in a statistically significant 5.8% reduction in the risk of cardiovascular disease events, and a 9% reduction in the risk of heart attack.

The global value of the omega-3 market in 2019.
Grand View Research

What is the relevance of balancing the omega-6/omega-3 ratio?

Both omega-3s and omega-6s support the health of the body’s cells. However, recent global diet shifts have led to higher consumption of omega-6s through corn, sunflower and vegetable oils in snacks and fried foods. Boosting EPA and DHA intake is one way for consumers to get a healthier balance between the fats.

With demand for fish oil growing, how can we ensure sustainable stocks?

Protecting our oceans and natural resources ensures sustainable growth for the omega-3 industry as a whole. Most of the fisheries from which fish or other marine omega-3 oils come from are sustainably managed, either because of oversight by local governmental research bodies (for example, with Peruvian anchovy and krill), because the fish oil is a by-product of the seafood industry (like salmon oil or tuna oil), or because it is certified by the Marine Stewardship Council (Alaskan pollock and Arctic cod).

The risk reduction of a fatal heart attack if supplemented by EPA and DHA.

Which sources of fish oil are the most effective?

GOED focuses on the importance of EPA and DHA, regardless of the source. Consumers should choose a form – such as algae for vegetarians or krill for those who prefer a smaller pill – that works for them.

The new study, published in Mayo Clinic Proceedings, provides the most comprehensive analysis of the role of omega-3 dosage on cardiovascular prevention to date. The meta-analysis, which is an in-depth review of 40 clinical trials, provides authoritative evidence for consuming more EPA and DHA omega-3 fats. The research concludes that EPA and DHA omega-3 intake is associated with reduced risk of coronary heart disease events, the cause of 7.4 million deaths globally each year, and reduced risk of myocardial infarction (heart attack), including fatal heart attacks.

“The study supports the notion that EPA and DHA intake contributes to cardioprotection, and that whatever patients are getting through the diet, they likely need more,” said co-author Dr Carl Lavie, a cardiologist at Ochsner Health in New Orleans, Louisiana, in support of its release.

Cardiovascular benefits appear to increase with dosage. The researchers found that adding an extra 1,000mg of EPA and DHA per day decreased the risk of cardiovascular disease and heart attack even more: as Gearheart mentioned, the risk of cardiovascular disease events decreased by 5.8%, and the risk of heart attacks decreased by 9.0%. The study looked at dosages of up to 5,500mg a day.

In fact, the new paper is aligned with other studies that make similar or identical claims. GOED’s research corroborates the results of an earlier study from the Harvard School of Public Health, published in the autumn of 2019. That report looked at EPA and DHA dosage using the 13 largest clinical studies.

All told, the body of evidence includes more than 135,000 study participants.

“When separate analyses arrive at similar results, that’s not only validating,” said another co-author, Dr Aldo Bernasconi, vice-president of data science for GOED, “it also underscores the science base needed to inform future intake recommendations. Because this paper included more studies and all dosages, the estimates for a dose-response are more precise and the conclusions stronger.”

Something fishy

EPA and DHA omega-3s are long-chain, marine-based fatty acids. Eating fish, particularly fatty fish such as salmon, anchovies and sardines, is the optimal way to get EPA and DHA omega-3s, since fish also provides other beneficial nutrients. However, most people around the world eat much less than the amount of fish recommended, so supplementing with omega-3s helps to close the gap.

“People should consider the benefits of omega-3 supplements at doses of 1,000 to 2,000mg per day – far higher than what is typical, even among people who regularly eat fish,” added Lavie. “Given the safety and diminished potential for interaction with other medications, the positive results of this study strongly suggest omega-3 supplements are a relatively low-cost, high-impact way to improve heart health with few associated risks, and should be considered as part of a standard preventive treatment for most patients with cardiovascular diseases and those recovering from myocardial infarction.”

WHO still looking to eliminate trans fats by 2023

Two years into WHO’s ambitious effort to eliminate industrially-produced trans fats from the global food supply, it has reported that 58 countries so far have introduced laws that will protect 3.2 billion people from the harmful substance by the end of 2021. But more than 100 countries still need to take actions to remove these harmful substances from their food supplies. Consumption of industrially-produced trans fats are estimated to cause around 500,000 deaths per year due to coronary heart disease.

“In a time when the whole world is fighting the Covid-19 pandemic, we must make every effort to protect people’s health,” said WHO director-general Tedros Adhanom Ghebreyesus. “That must include taking all steps possible to prevent non-communicable diseases that can make them more susceptible to the coronavirus, and cause premature death. Our goal of eliminating trans fats by 2023 must not be delayed.”

The report highlights two encouraging trends. First, when countries do act, they overwhelmingly adopt best practice policies rather than less restrictive ones. New policy measures passed and/or introduced in the past year in Brazil, Turkey and Nigeria all meet WHO’s criteria for best practice policies.

Second, regional regulations that set standards for multiple countries are becoming increasingly popular, emerging as a promising strategy for accelerating progress towards global elimination by 2023. In 2019, the EU passed a best practice policy, and all 35 countries that are part of the WHO American region, the Pan-American Health Organisation, unanimously approved regional plans of action to eliminate industrially produced trans fats by 2025.

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