The effect of omega-3 and vitamin E on oxidative stress and inflammation: Systematic review and meta-analysis of randomized controlled trials
Abstract
Abstract.Background: Several studies have investigated the effect of omega-3 fatty acids and vitamin E on oxidative stress and inflammation, but their findings are inconsistent. The aim of this meta-analysis is to elucidate the overall effects of co-supplementation with omega-3 fatty acids and vitamin E on oxidative stress and inflammation. Methods: We searched titles, abstracts, and keywords of relevant articles indexed in PubMed, ISI, Scopus, and Google Scholar databases up to December 2018 to identify eligible RCT studies. Random effects model was used to estimate the pooled effect of co-supplementation with omega-3 fatty acids and vitamin E on oxidative stress and inflammation. Results: Overall, 7 RCTs with 504 participants were included in this meta-analysis. We found that co-supplementation with omega-3 fatty acids and vitamin E decreased hs-CRP (weighed mean difference (WMD) = −2.15 mg/L; 95% CI: −3.40, −0.91 mg/L; P < 0.001) concentrations and increased total antioxidant capacity (TAC) (WMD = 92.87 mmol/L; 95% CI: 31.97, 153.77 mmol/L; P = 0.03), and nitric oxide levels (NO) (WMD: 6.95 μmol/L; 95% CI: 3.86, 10.04, P < 0.001) compared with control group. Omega-3 fatty acids and vitamin E had no significant effect on malondialdehyde (MDA) (WMD: 1.54 mmol/L; 95% CI: −1.29, 4.36; P = 0.196), and glutathione (GSH) (WMD: 20.87 mmol/L; 95% CI: −20.04, 61.6, P = 0.31) levels. Conclusion: The present meta-analysis found that omega-3 fatty acids and vitamin E co-supplementation significantly decreased hs-CRP and increased NO and TAC, although it had no significant effect on MDA and GSH.
References
1 (2000) What is oxidative stress? Oxidative stress and vascular disease, pp. 1–8. Springer.
2 (2000) What is oxidative stress? JMAJ. 45 (7): 271–6.
3 (2010) Some current insights into oxidative stress. Physiol Res. 59 (4).
4 (2010) Oxidative stress, inflammation, and cancer: how are they linked? Free Radic Biol Med. 49 (11): 1603–16.
5 (1995) Oxygen radicals, nitric oxide and human inflammatory joint disease. Ann Rheum Dis. 54 (6): 505.
6 (1997) Oxidative stress and cardiovascular disease. Can J Cardiol. 13 (11): 1021–5.
7 (2014) Oxidative stress and mitochondrial dysfunction in Alzheimer’s disease. Biochim Biophys Acta Journal. 1842 (8): 1240–7.
8 (2017) Data associated with “Retinal oxidative stress at the onset of diabetes determined by synchrotron FTIR widefield imaging: towards diabetes pathogenesis” and “Temporal diabetes-induced biochemical changes in distinctive layers of mouse retina”. Analyst.
9 (2017) Role of dietary antioxidants in the preservation of vascular function and the modulation of health and disease. Front Cardiovasc Med. 4, 64.
10 (2017) Protective role for antioxidants in acute kidney disease. Nutrients. 9 (7): 718.
11 (2017) Long-Term Effects of Vitamins C, E, Beta-Carotene and Zinc on Age-Related Macular Degeneration. AREDS Report No. 35.
12 (2016) Oxidative stress and inflammation: what polyphenols can do for us? Oxidative Med. Cell. Longev.
13 (2005) Vitamin E, oxidative stress, and inflammation. Annu Rev Nutr. 25, 151–74.
14 (2015) Marine omega-3 fatty acids and inflammatory processes: effects, mechanisms and clinical relevance. Biochim Biophys Acta. 1851 (4): 469–84.
15 (2018) The effects of omega-3 and vitamin E co-supplementation on parameters of mental health and gene expression related to insulin and inflammation in subjects with polycystic ovary syndrome. J Affect Disord. 229, 41–7.
16 (2016) Beneficial effects of omega-3 and vitamin E coadministration on gene expression of SIRT1 and PGC1alpha and serum antioxidant enzymes in patients with coronary artery disease. Nutrition, metabolism, and cardiovascular diseases. Nutr. Metab. Cardiovasc Dis. 26 (6): 489–94.
17 (2017) The effects of omega-3 fatty acids and vitamin E co-supplementation on gene expression of lipoprotein (a) and oxidized low-density lipoprotein, lipid profiles and biomarkers of oxidative stress in patients with polycystic ovary syndrome. Mol Cell Endocrinol. 439, 247–55.
18 (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 4 (1): 1.
19 (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 17 (1): 1–12.
20 (2003) Measuring inconsistency in meta-analyses. BMJ. 327 (7414): 557.
21 (2016) Effects of omega-3 fatty acid plus alpha-tocopherol supplementation on malnutrition-inflammation score, biomarkers of inflammation and oxidative stress in chronic hemodialysis patients. Int Urol Nephrol. 48 (11): 1887–95.
22 (2018) The Effects of Omega-3 and Vitamin E Co-supplementation on Carotid Intima-media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome. Oman Medical Journal. 33 (6): 473–9.
23 (2017) Metabolic response to omega-3 fatty acids and vitamin e co-supplementation in patients with fibrocystic breast disease: A randomized, double-blind, placebo-controlled trial. Arch Iran Med. 20 (8): 466.
24 (2017) The effects of omega-3 fatty acids and vitamin E co-supplementation on clinical and metabolic status in patients with Parkinson’s disease: A randomized, double-blind, placebo-controlled trial. Neurochem Int. 108, 183–9.
25 (2017) A Randomized Controlled Clinical Trial Investigating the Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Biomarkers of Oxidative Stress, Inflammation and Pregnancy Outcomes in Gestational Diabetes. Can J Diabetes. 41 (2): 143–9.
26 (2011) C-reactive protein in various disease condition–an overview. Asian J Pharm Clin Res. 4 (1): 9–13.
27 (1998) Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. Jama. 279 (18): 1477–82.
28 (2008) Critical appraisal of CRP measurement for the prediction of coronary heart disease events: new data and systematic review of 31 prospective cohorts. Int J Epidemiol. 38 (1): 217–31.
29 (2014) Association of red blood cell n-3 polyunsaturated fatty acids with plasma inflammatory biomarkers among the Quebec Cree population. Eur J Clin Nutr. 68 (9): 1042.
30 (2015) Vitamin E supplementation is associated with lower levels of C-reactive protein only in higher dosages and combined with other antioxidants: The Cooperative Health Research in the Region of Augsburg (KORA) F4 study. Br J Nutr. 113 (11): 1782–91.
31 (2000) Role of reactive aldehyde in cardiovascular diseases. Free Radic Biol Med. 28 (12): 1685–96.
32 (2016) The effects of high-dose vitamin E supplementation on biomarkers of kidney injury, inflammation, and oxidative stress in patients with diabetic nephropathy: a randomized, double-blind, placebo-controlled trial. J Clin Lipidol. 10 (4): 922–9.
33 (2017) Effect of Omega-3 Fatty Acids on Serum Lipid Profile and Oxidative Stress in Pediatric Patients on Regular Hemodialysis: A Randomized Placebo-Controlled Study. J Ren Nutr. 27 (3): 169–74.
34 (2007) Changes in oxidant-antioxidant status in young diabetic patients from clinical onset onwards. J Cell Mol Med. 11 (6): 1352–66.
35 (1998) Glutathione. an overview of biosynthesis and modulation. Chem- Biol Interact. 111, 1–14.
36 (2015) Measurement of antioxidant activity. J Funct Foods. 18, 757–81.
37 (1997) Understanding Parkinson’s disease. Sci Am. 276 (1): 52–9.
38 (1989) Systemic glutathione deficiency in symptom-free HIV-seropositive individuals. Lancet. 334 (8675): 1294–8.
39 (2002) S-Adenosyl-L-methionine and mitochondrial reduced glutathione depletion in alcoholic liver disease. Alcohol. 27 (3): 179–83.
40 (2001) Rethinking cystic fibrosis pathology: the critical role of abnormal reduced glutathione (GSH) transport caused by CFTR mutation. Free Radic Biol Med. 30 (12): 1440–61.
41 (2002) Irreversible thiol oxidation in carbonic anhydrase III: protection by S-glutathiolation and detection in aging rats. Biol Chem. 383 (3–4): 649–62.
42 (2004) Understanding the association between dietary antioxidants, redox status and disease: is the total antioxidant capacity the right tool? Redox Report. 9 (3): 145–52.
43 (2004) Decreased total and corrected antioxidant capacity in patients with inflammatory bowel disease. Dig Dis Sci. 49 (9): 1433–7.
44 (1998) Arginine metabolism: nitric oxide and beyond. Biochem J. 336 (Pt 1): 1–17.
45 (2008) Nitric oxide in the vasculature: where does it come from and where does it go? A quantitative perspective. Antioxid Redox Signal. 10 (7): 1185–98.
46 (2015) Omega-3 fatty acids supplementation improves endothelial function and maximal oxygen uptake in endurance-trained athletes. Eur J Sport Sci. 15 (4): 305–14.
47 (2010) Regulation of nitric oxide production in health and disease. Curr Opin Clin Nutr Metab Care. 13 (1): 97.
48 (2002) Regulation of nitric oxide synthesis by dietary factors. Annu Rev Nutr. 22 (1): 61–86.
49 (2012) Omega-3 polyunsaturated fatty acids antagonize macrophage inflammation via activation of AMPK/SIRT1 pathway. PloS One. 7 (10): e45990.
50 (2003) Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation. 108 (2): 155–60.
51 (2010) Macrophage α1-AMP-activated protein kinase (α1AMPK) antagonizes fatty acid-induced inflammation through SIRT1. J Biol Chem. 285, 19051–19059.
52 (2007) SIRT1 promotes endothelium-dependent vascular relaxation by activating endothelial nitric oxide synthase. Proc Natl Acad Sci USA. 104 (37): 14855–60.
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.- Personal login
- Register for access
- Claim
-
Restore content access
This functionality works only for purchases made as a guest