Eicosapentaenoic acid omega-3
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Eicosapentaenoic Acid (EPA) Omega-3: Health Benefits and Clinical Applications
Global Blood Levels of EPA and DHA
A comprehensive global survey has revealed significant variability in blood levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) among healthy adults. Regions such as the Sea of Japan and Scandinavia exhibit high blood levels of EPA and DHA, while North America, Central and South America, Europe, the Middle East, Southeast Asia, and Africa show very low levels. This disparity may contribute to differing risks of chronic diseases worldwide1.
Cardiovascular Health and EPA Supplementation
Prevention of Cardiovascular Disease
Multiple randomized controlled trials (RCTs) have evaluated the role of EPA and DHA supplementation in preventing cardiovascular diseases. While the primary prevention effects in the general population remain unexamined, secondary prevention in high-risk patients, including those with diabetes and coronary heart disease, has been studied extensively. The American Heart Association recommends EPA and DHA supplements for patients with prevalent coronary heart disease and other high-risk conditions based on cumulative evidence from these RCTs2.
Reduction of Serum Triglycerides
EPA and DHA have been shown to dose-dependently reduce fasting serum triglycerides. A review of 15 RCTs established a mathematical model predicting a 3.1% to 7.2% reduction in triglyceride levels with daily intakes of 200-500 mg of long-chain omega-3 fatty acids4. This finding underscores the potential of EPA and DHA in managing hypertriglyceridemia.
Cholesterol Management
A study on the EPA-rich extract from the microalga Nannochloropsis demonstrated significant reductions in very-low-density lipoprotein (VLDL) cholesterol and total cholesterol without increasing low-density lipoprotein (LDL) cholesterol. This suggests that EPA-only formulations can effectively manage cholesterol levels in healthy individuals6.
Mental Health Benefits
Bipolar Spectrum Disorders
A pilot study investigated the efficacy of high EPA/DHA omega-3 fatty acids combined with inositol in treating pediatric bipolar spectrum disorders. The combination treatment significantly reduced symptoms of mania and depression, indicating potential benefits for mood stabilization in children with mild to moderate bipolar disorders3.
Unipolar Depressive Disorder
In patients with recurrent unipolar depressive disorder, the addition of EPA to ongoing antidepressant therapy showed significant benefits by the third week of treatment. This suggests that EPA may augment antidepressant effects or possess independent antidepressant properties8.
Cancer Cachexia and Colorectal Cancer
Cancer Cachexia
EPA has been explored for its potential to alleviate cancer cachexia, a syndrome characterized by severe weight loss in advanced cancer patients. However, current data are insufficient to conclusively determine its effectiveness compared to placebo. Further research is needed to establish optimal dosing and efficacy5.
Colorectal Cancer Recurrence
The EPA for Metastasis Trial 2 (EMT2) is investigating the impact of EPA on colorectal cancer recurrence and survival post-surgery for liver metastases. Preliminary findings suggest potential benefits for disease-free survival, warranting further investigation in this ongoing phase 3 trial7.
Conclusion
Eicosapentaenoic acid (EPA) omega-3 fatty acids offer a range of health benefits, particularly in cardiovascular health, mental health, and potentially in cancer management. While global blood levels of EPA and DHA vary significantly, supplementation has shown promise in reducing triglycerides, managing cholesterol, and supporting mental health. Ongoing research continues to explore the full therapeutic potential of EPA in various clinical settings.
Sources and full results
Most relevant research papers on this topic
Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults.
High EPA+DHA blood levels are found in the Sea of Japan, Scandinavia, and areas with indigenous populations, while very low levels are found in most regions, potentially increasing global risk for chronic disease.
Systematic Review
Highly CitedOmega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association
Omega-3 polyunsaturated fatty acid supplementation may help prevent clinical cardiovascular events in patients with diabetes, prediabetes, and high risk of cardiovascular disease.
Systematic Review
Rigorous JournalHighly CitedA randomized clinical trial of high eicosapentaenoic acid omega-3 fatty acids and inositol as monotherapy and in combination in the treatment of pediatric bipolar spectrum disorders: a pilot study.
The combined treatment of omega-3 fatty acids and inositol reduced symptoms of mania and depression in prepubertal children with mild to moderate bipolar spectrum disorders.
RCTLong-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides.
Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides, with predicted reductions of 3.1 to 7.2% at recommended intakes of 200-500 mg/day.
Systematic ReviewHighly CitedEicosapentaenoic acid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia.
There is insufficient evidence to establish whether oral EPA is better than placebo in improving symptoms of cancer cachexia in advanced cancer patients.
Systematic ReviewHighly CitedOmega-3 Eicosapentaenoic Acid (EPA) Rich Extract from the Microalga Nannochloropsis Decreases Cholesterol in Healthy Individuals: A Double-Blind, Randomized, Placebo-Controlled, Three-Month Supplementation Study
Almega®PL supplementation significantly increases EPA levels and reduces cholesterol levels in healthy individuals without increasing LDL, offering a natural EPA-only option for managing cholesterol levels.
RCT
Very Rigorous JournalRandomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol
Omega-3 fatty acid EPA may improve colorectal cancer outcomes after liver resection surgery for resectable liver metastases.
RCT
Large Human TrialAddition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder.
E-EPA addition to maintenance antidepressant therapy significantly improves depressive episodes in patients with recurrent unipolar depressive disorder, but its role in enhancing antidepressant action remains unclear.
RCTHighly CitedThe ratio of eicosapentaenoic acid to docosahexaenoic acid as a modulator for the cardio-metabolic effects of omega-3 supplements: a meta-regression of randomized clinical trials.
The ratio of EPA to DHA in omega-3 supplements affects the modulation of inflammation and systolic blood pressure, with higher ratios reducing CRP and higher ratios increasing systolic blood pressure.
Meta-AnalysisEfficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.
Omega-3 fatty acid supplements show insufficient evidence of a secondary preventive effect against overall cardiovascular events in patients with a history of cardiovascular disease.
Meta-AnalysisHighly Cited