Lipid, lipoprotein, and hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males13 Lynne

Cobiac,

Peter

ABSTRACT

The

mostasis,

and

blood

perlipidemic

(EPA)

M Clifton,

men

plus

effects

subjects

served

triglycerides

20%

protein

(VLDL)

cholesterol increased by creases in the proportion respectively. lipoprotein

and

significantly

different

lowered

from

fibrinogen

KEY

WORDS

lipids,

plasma

dition, fish oil appears (17) and protect against

acid

for 5 wk. Six

and

N-3

P

(all

(HDL)

rise

The

fish

fish

oil

produced

but

only the Nutr l99l;53:

J C/in n-3

comparable

fatty acids,

lipoproteins,

lipid

fish improved 12 10-16.

plasma

fatty fatty

and

hemostatic

acids

fish and

fish may

health

benefits

of fish

the observations extended

been

effects

It is therefore oil and

content. We men in whom plus

DHA

were

compared.

in Eskimos.

correlated

with

the Eskimos’

have

played

that

have

other

a role high

(3).

(1) highlighted

large

of whale

lifestyle

showed

disease

(4)

of Japanese

popula-

a similar

reduced

and

as little as 30 g lean fish/d may development of heart disease (5). Nevertheless, sumption

and

not

to

(1 1). n-3 fatty

acids

sahexaenoic responsible (3, flesh 1210

reportedly

fatty lower

more

are likely biological

reported

coronary fish

fish con-

(6, 7) whereas

study

heart

or

eicosapentaenoic

acid (DHA) for the many

12, 1 3). N-3

clinical

eat

suggested against the prospective

between

risk

intervention

with

advised

it was

protect some

an association

heart-disease

A recent

in patients

been

ments The

showed

reduced

(8-10).

mortality had

studies

were

intake

even

epidemiologic

findings

of the Eskimos’

of fish

heart

the

lipid profile,

These

Investigations

intakes

of coronary

aspects

investigated

favorable

time

may

did

differ

In ad-

EPA (19)

ar-

either

other

the

fatty

or con-

acids.

EPA-DHA

and

DHA

were

effects

differences

such study in mildly on lipids and hemostatic

supplied

that

and

the

account

flesh

biological

give

reported

(20) and hemostasis

to compare into

fish

in their

because

on lipid metabolism

report one the effects

extract

produce with

metabolites

to take

g EPA

(eg,

may It is possible

may

important

also

forms

in conjunction

consideration

to have different

Subjects

hemostasis

widely

Dyerberg

disease,

bleeding

tions

prevalence

have

and

heart

seal fat (2) although

that

oils

of Bang

ofcoronary

subsequently

and

(16).

atherosclerosis ventricular

as fatty

offish

with

in fatty

acid

hyperlipidemic factors of 4.5

fish

or as a fish-oil

and methods

Subjects

low prevalence and

(15). act

eicosanoid

Thirty-one since

in different

the oils consumed

an important

(21).

actions

supplements)

magnitudes

in the

to different

fish

supplied offish-oil

of various

ratio,

antithrombotic

to prevent experimental experimentally induced

fish, fish oil, plasma acids,

Introduction The

produce

forms

stituents

LDL cholesterol, apofish and fish oil were not diet.

fatty

effects

The

and

(18).

the various

respectively

for the control

(15),

rhythmias

fish oil lowered

and thromboxane (10.5%) and in(10.8%) (P < 0.05 compared with control).

changes,

Am

profiles

(15.7%)

bleeding time fatty fish and

lipoprotein factors.

changes

J Nestel

he-

9%, with 34% and 32% inparticles for fish and fish oil,

Changes in total cholesterol, B, and blood pressure with

Paul

hy-

very-bow-density-lipo52%,

and

lipids,

High-density-lipoprotein

10% and of HDL2

Beiing,

in 25 mildly

oil on

daily

and

42%

G Bryan

g eicosapentaenoic Fish

28%

with control).

fish

(DHA)

as controls.

triglycerides

0.05 compared

and

4.5

acid and

Abbey,

compared

received

plasma

creased Eating

were

docosahexaenoic

additional


20

Committee South

at

Australia.

participant.

who

suppleand

doco-

constituents of fish ascribed to the oils

blood

mmol/L, pressure

excessive

aged

(plasma cholesterol 6.7 ± 0. 1 1 mmol/L, I 5.8-8.0 mmol/L; plasma triglycerides 1.9 ± 0.14

reduced

fish-oil (EPA)

men

hyperlipidemic ± SEM) range

fish oil or fish plasma

Am J C/in Nutr

lipid 1991;53:1210-16.

Downloaded from https://academic.oup.com/ajcn/article-abstract/53/5/1210/4731818 by Denise Hannibal user on 03 June 2018

I From the CSIRO Division Australia. 2 Supported by the National

of Human Heart

Nutrition,

Foundation

Address reprint requests to L Cobiac, CSIRO Nutrition, P0 Box 10041 Gouger Street, Adelaide Received June 27, 1990. Accepted for publication October 31, 1990. 3

Printed

in USA.

© 1991 American

Society

Adelaide,

South

of Australia. Division of Human SA 5000, Australia.

for Clinical

Nutrition

n-3

Study

ACIDS

AND

design

The

study

each

consisted

subject

supplement

of a 3-wk

adapted

and

a 5-wk period,

to the

maintaining

of their

systolic

and

baseline

a constant

blood

for all three

allocated

to receive

treatment. group

(n

groups.

(SBP

Two

and

A third

matched

6). The

interventions

=

separate

parallel

fish with

fish oil, a small

to monitor

possible

larger

the fish (n

either

groups.

DBP,

were

Although

allocated therefore

ofcontrol

background

carried

out

globulin

(8.50

(4.08

nm),

the

acid

perchloric

of

study.

Hewlett

Packard

Each

subject’s

samples

and blood

on 3 consecutive

days

pressure

at the end

measurements

ofthe

baseline

were taken

and

intervention

phases.

were

by transesterification

prepared chloride/L

tercurrent

illnesses

were

monitored

alcohol for medications,

routinely

the 24 h and in-

throughout

the

study. Blood

samples

taming

for lipid

sodium

EDTA,

analyses placed

fuged

at 600

X g for 10 mm

were

frozen

at -20

analyses

for

carried Nutley,

out together NJ) with

Mannheim, containing syth, end

phase. for

VLDL

PEG

6000

triglyceride

period

and

was prepared

by

so that

rotor

were

once

from

plasma

(Beckman

using

Kil-

once

ofthe

Alto,

(LDL) cholesterol of the Friedewald

a modification

was equa-

(22).

Apolipoproteins

were

using dards

Boehringer (Hyland

trifugal For

analyzer determination

measured

antisera Diagnostics, (Cobas

(Boehringer) Malvern,

Bio, of LDL

ples ofplasma

from individuals

yielding

pools:

three

separated

from

control,

duplicate

by immunoturbidimetry and Hyland Ortho PA) on an automated

in each dietary

samples

and

Polyacrylamide slab gradient

gradient-gel gels (Gradient

Acrylamide HDL samples

gels

and

ofeach

(0.03

particles, mL)

were

and

plasma

2-16%

respectively. mixed

with

group

equal

sam-

were pooled

pool

used

Duplicate 0.01

mL

10 mm

and

assay

by

Klaus

method for clotting

Simplate

at the end

ofthe

Ifthe

difference

a third

bleeding

phases. mm, were

taken

on both the

there

was

bleeding > 30

taken

pressure

was

X

varied

according

the guidelines was ignored,

taken

was

between

model

been

sitting

DBP

five to six occasions

taken with

1 mm the

apart.

before

the

procedure.

intervention

All

was > 1

measurements bleeding

times

average

< 30 s

of the then

time.

The

subjects

were

two.

the

If

greater had

willing

an automated Critikon,

of the

ceased

were

two,

for

the

Belgium)

the

845XT,

Blood

and

2 consecutive

at which

with

(Roche).

is ±0. 1 gIL.

ofthe

and

quietly

to the diameter

Diagnostica

Fibro

at least

If these

demonstrated

measured

#{176}C) for

automated

is added

end

by was

measurements

time

noted.

given by the manufacturers. and a maximum offour

to separate

Downloaded from https://academic.oup.com/ajcn/article-abstract/53/5/1210/4731818 by Denise Hannibal user on 03 June 2018

was

and

of bleeding and

had

subjects

The

a poly-

(-20 an

kit,

measured.

was

5 difference

frozen

Turnhout,

on

the two

was

nurse.

time

explained

Blood

subjects

time

as a measure

technique ticipate.

period

between

incisions

ter

sucrose!

baseline

then

separated

Accuracy

times

and

supernatant

using

Teknika,

bleeding

by one clinic parallel

apart,

(Organon

to measure

was the

of thrombin

is measured.

II templates

used

days

to occur

was

using

on the Cobas

amount

for

serum

thromboxane

(Fibri-Prest

France)

a fixed

50.3 g.

technique

Asnieres-Sur-Seine,

lipoprotein of 40%

a functional

(Dinamap

was performed with Sydney, Australia). were

x g for

In this

incubated

10 mm

plasma

at 8000

manometer

by a single

citrated

recentrifuged Von

(30

B3 (24).

and

were

of 1 .21 kg/L in the for 17 h at 1 50 000

electrophoresis Laboratories,

of 2.5-27%

LDL

size,

fish oil. Lipoproteins

centrifugation at a background density rotor (of a Beckman ultracentrifuge)

stancen-

B2 and 10 mm

Stago,

silica

The

by radioimmunoassay

fibrinogen,

by

was

stimulated

X g for

was

Roche) (23). and HDL particle fish,

by

blood

Maximal

to thromboxane

analysis

were

(Hewlett-Packard)

X g for

at 600

analysis.

was determined measuring

hy-

esters

a vitreous

waterbath.

at 300

were CA)

whole

centrifugation

at the

intervention Palo

For

methyl

column

agitating

centrifugation #{176}C) until

antibody

time

by ultracentrifugation

Instruments,

by (-20

modified

B)

(VLDL)

measured

at the end

separated frozen

acids

gas.

thromboxane,

#{176}C in a slowly

batch

cholesterol

Chemicals,

as carrier

measuring

1 h at 37

all

B-(apo

(BDH

hydrogen

butylated offatty

50 g anhydrous

ofthe

FFAP

chloroform-

esters

by using

id) cross-linked

oc-

at the

compliance.

with 0.005%

with

Analysis

again

dietary zL)

Methyl

by gas chromatography

For

cbonal

were

ofapolipoprotein

x g. Low-density-lipoprotein

at 1 50 000 calculated

study

methanol.

mm

production

centrisamples

Very-low-density-lipoprotein

VLDL

baseline

17 h in a 50.3

tion

with

Australia). and

ofthe

and

con-

concentrations

(HDL)

precipitation

lipoproteins

cholesterol

ice,

Plasma

of the

triglyceride

High-density-lipoprotein

after

Victoria,

on

the plasma.

completion

and

in tubes

in a centrifugal analyzer (Cobas-Bio, Roche, standard enzymatic test kits (Boehringer,

FRO).

was determined

collected

immediately

to isolate

#{176}C until

cholesterol

were

and

as antioxidant.

a

on two

and

1) containing

(BHT)

m X 0.53

fasted for 12 h and avoided each clinic visit. Alcohol intake,

(4:2:

(2202 by using

measured period

(100

in were

PA).

to determine

hydroxytoluene

performed

Subjects preceding

HC1/L

0-250 Gels

densitometer

were

plasma

Fine sulfosal-

acid.

quantified

baseline

from

a high-

Coomassie

and

acids

phase

extracted 1 mob

drogen

Measurements

fatty

from

in 10%

(Avondale,

ofthe

intervention

fixed

a laser

integrator

plasma

nm)

in 5% acetic

with

cal-

kit (Pharmacia

were

Sweden)

at the end

were

Gels

track)

3390a

once

of the

per

were

of thyro-

dehydrogenase

(3.55

calibration

Bromma,

radii

lactate

Elecof Tris

standards

nm),

destained

gel.

buffer

for 4 h in 0.4%

and

scans

LKB,

to the

Stokes’

albumin

Sweden).

1 h, stained

(two

Ultrascan,

Lipids

(6.10

serum

acid,

methanol-0.

Blood

femtin

bovine

for

directly

V. The

electrophoresis

3.5%

end

course

applied

in a nondenaturing

to coelectrophoresed

Uppsala,

casions,

and

17 h at 160

nm),

and

icylic

in

was included

during

reference

scanned 13)

=

was to compare

subjects

changes

(n

as a control

the objective

8.35,

by

respectively),

randomly

for

pH

Chemicals,

were

performed

culated

triglycerides,

This ensured that matched as closely

groups

was

by

blue

was

borate,

molecular-weight

12) or the fish-oil

=

group

number

followed

of the baseline groups on the

of plasma

pressure

during

1211

RISK

bromophenol

trophoresis

a liquid

fat intake,

At the end three dietary

mass index, and plasma cholesterol. values of these characteristics were

as possible

period,

ofconsuming

measurements

diastolic

age, body the mean

baseline

routine

dietary-intervention phase. subjects were stratified into

basis

CARDIOVASCULAR 0.01%

8-wk

which

the

FATTY

the

to par-

sphygmo-

Tampa,

5 mm.

Cuff

subject’s

arm

FL) sizes

af-

were

following

The first measurement measurements ofSBP and pressure

the intervention

was began

measured to familiarize

on

1212

COBIAC

Dietary

diets

were

requirements structed was

designed

and

dietary

to consume

given

to accommodate preferences.

30%

to enable

in addition

subjects

intake

to a daily

liquid

for

the

ratio

hydrate,

Table

of total

fatty energy,

sodium,

There which

was

all subjects

and

ham

plus

ture

of palm

powder; flavoring

the

5-wk

supplements.

tinuation

with

salmon

steak,

chicken

breast,

period

The

diet

for the control

diet.

The

(1 kg raw

that

contained

oil;

added

potassium;

test

the

three

a mixskim

milk

emulsifiers;

groups

and

consumed

subjects

fish group

weight/wk)

groups.

supplements. during

olive

and

three

the

period

lean

and

to carbo-

dietary

supplement oil,

of the baseline

Atlantic

a variety

fat,

the

from

baseline

cholesterol; sodium agents (Table 1).

During ferent

for

intake

supplied

safflower

Meat or fish meals each

protein,

dif-

was

a con-

was provided

and

Norwegian

sugar

The

fish-oil

a fish-oil bourne,

to match group

preparation, Australia),

a daily

average

tamed

no added

oil,

total

MaxEPA

carbohydrate

continued MaxEPA was of 4.6

intake

meats (105

supplied g EPA

cholesterol, (4.80

with

g/wk;

in the plus

a small

RP

The

added

flavoring agents. Table 2 shows the distribution the salmon, sardines, and fish-oil preparation centage of total fatty acids of edible portion).

a

4.4 16.8 5.6 4.3 22.6 3.4 1.4 1.5

of supplements

(daily

Mel-

to provide conand

0.8 6.1 4.2 3.6 17.4 of total

Protein (g) Fat (g) Carbohydrate (g) Energy(MJ) Sodium (mmol) Potassium (mmol) Cholesterol (mg) Polyunsaturated fatty acids (g) Monounsaturated fatty acids (g) Saturated fatty acids (g) EPA + DHA EPA:DHA

of fatty (expressed

Dietary

a

Fish comprised

I kg Atlantic

salmon

and acids in as per-

Controlf

42 27 12 1.94 14 24.7 183 6.9 8.5

41 27 12 1.90 16.3 23.5 17S 7.2 9.0 6.6

7.7

4.6 2:1

plus

-

150 g sardines

in sild oil

f Mixture oflipids

(I 5 g/d; RP Scherer,

chosen to approximate

to monounsaturated to saturated § EPA, eicosapentaenoic acid;

Melbourne,

Australia).

the ratio of polyunsaturated

fatty acids. DHA, docosahexaenoic

in edible

food

inventories

were

portion.

collected

days and on 3 consecutive for a further 1 wk during

days during the intervention

subjects were were checked

to monitor compliance.

Statistical

encouraged for dietary

on

the

specified

single

baseline period phase. In addition

daily

fat intake.

and the

Records

analyses

The values used for analysis were the average of 3 consecutive days’ measurements for plasma lipids, lipoprotein lipids (except VLDL), bleeding time, and blood pressure. Other variablesVLDL

fibrinogen,

three

and

acid.

Downloaded from https://academic.oup.com/ajcn/article-abstract/53/5/1210/4731818 by Denise Hannibal user on 03 June 2018

groups

lipids,

plasma

fatty

thromboxane-were

phase and A one-way by using

acids,

HDL

measured

particle

once

at the

once at the end of the dietary-interanalysis of variance compared

intraindividual

changes

from

the

baseline

to

end of intervention phase (5 wk). Schefle tests of contrast were performed where appropriate. A paired Student’s t test was used to determine the significance of changes from baseline to end of the

intervention

period.

SPSS/PC

with

(SF55,

Statistical Inc,

analyses

were

performed

Chicago).

Results The

baseline

subjects) There the two Total but

per week.

t 105 g MaxEPA/wk

present

0.2 1.0 20.5 0.8 2.1 11.6

records

end of baseline vention phase.

Fish oilt

41 28 12 1.89 16.3 23.5 175 7.2 8.9 6.9 4.5 1:2

fatty acids

-

olive

sodium,

average)

Fish*

8.3 0.3 0.1 0.3 10.4 8.1 0.6 12.1

-

size, 1 composition

-

-

Percent

9.4 19.3 11.2 3.1 12.4 1.6 0.8 4.2 0.1 1.7

-

6.9

apolipoproteins, TABLE Nutrient

6.2 17.9 9.5 2.1 20.8 1.8 1.1

-

Weighed but

Scherer,

of palm

some

14:0 16:0 16:1 18:0 18:1 18:2 18:3 18:4 20:0 20:1 20:2 20:3 20:4 20:5 22:1 22:5 22:6

flavoring.

supplement

amount

%*

with

baseline

supplement

DHA.

g cholesterol/L),

and

as during

Fish oil

sardines

in sild oil (150 g/wk). This provided a daily average of 4.5 g EPA plus DHA. The liquid supplement contained substantially less oil, some added cholesterol, no skim milk powder, and some added

salmon,

Sardines

fat

monounsaturated

potassium

the milk-based oil,

to

daily 3-wk

were

Salmon

total

containing

cholesterol,

and

a common

estimate

Atlantic

in-

supplements were designed to energy as fat and were matched

(P:M:S),

the average

was

Information

vegetable oils. and two smaller

polyunsaturated

acids

1 shows

and

supplement

energy

subject

as fat.

to monitor

of oils. These foods and liquid supply an average of 10% oftotal saturated

Each

of energy

intake and to avoid polyunsaturated was provided for five larger meals week

individual

AL

TABLE 2 Fatty acid composition of farmed Tasmanian Norwegian sardines in sild oil, and fish oil

interventions

All

ET

characteristics

experimental

cholesterol

the fish-oil and the nificant

groups decreased

to a lesser

triglycerides

of each

are shown in Tables were no significant

extent were

and

changes

equally

significantly

the fish groups.

three

in plasma

compared

in the

of the

groups

(31

3 and 4. with

in the control

fish-oil

group.

reduced The

fish-oil group, by 28%. Both these compared with the control-group

and

(Table

from

fish group

cholesterol

the control

baseline decreased

reductions reduction.

in group.

fish groups 3). Plasma in both by 20% were Both

sigthe

n-3 TABLE 3 Effects of fish, fish-oil,

FATTY

ACIDS

AND

CARDIOVASCULAR fish and

and control

diets on plasma

lipids,

lipoproteins,

the fish-oil

cholesterol

and apolipoproteins* Baseline

Intervention

Change

and

(5 1% and

did

show

not

6.99 ± 0.23 6.77 ± 0.21 6.82 ± 0.25 1.93 ± 0.24 2.03 ± 0.21 1.59±0.19

Fish Fish oil Control Lipoproteins

a

SEM.

± 0.10

-0.39 -0.57

± 0.lOf

+0.21

±0.12

± 0.23f

triglycerides

occurred

component

where

seen

fish

1.23 ± 0.08t 1.12 ± 0.07t 1.41 ± 0.33

+0.1 1 ± 0.03t +0.09 ± 0.04f -0.03 ± 0.02

± 0.09

0.27 ± 0.08t 0.25 ± 0.03t 0.42 ± 0.10

-0.28 -0.43 +0.02

0.68 ± 0.10 0.40 ± 0.10 5.07 ± 0.24 4.95 ± 0.22 4.76 ± 0.47

4.76 ± 0.22t 4.98 ± 0.15 4.30 ± 0.45t

-0.31 +0.03 -0.46

1.35 ± 0.18 1.43 ± 0.21 0.96 ± 0.20

0.78 ± 0.18t 0.67 ± 0.08t 1.12 ± 0.24

-0.57 -0.76 +0.16

the in the

respectively.

This

± 0.0Sf

significant (P with a reduction

± 0.1 lf

group,

and

± 0.04

ratios

of apo

± 0.09

16%

in the

± 0.12

significant

when

± 0.l4f

fish-oil

group

B were

not

was

± 0.23f

LDL particle unchanged

± SD)

control

(P

oftotal

HDL

particles

0.29 0.30 0.36

± 0.02

of particles

± 0.01

to 36.7

± 0.07

-0.08 -0.07 -0.04

± 0.02

The plasma from baseline

1.00 ± 0.04 0.99 ± 0.03 0.97 ± 0.07

0.95 ± 0.04 1.0 1 ± 0.03 0.93 ± 0.08

-0.05 +0.02 -0.04

± 0.06

daily addition of 1 5 g fish-oil produced the greatest change

3.22 ± 0.19 3.19±0.24 3.41 ± 0.21

3.83 ± 0.23t 3.59±0.26t 3.55 ± 0.29

19 ± S 13±4 4 ± 8

I .20 ± 0.06 1.18 ± 0.04 1.40±0.26

1 . 16 ± 0.06 1.08 ± 0.OSt 1.36±0.32

-2 ± 2 -8 ± 3 -3±3

± 0.02t ± 0.03t

± 0.03 ± 0.02

0.93 ± 0.03 0.88 ± 0.02 1.06 ± 0.09 =

HDL-C,

1 . 1 1 ± 0.04t 1.03 ± 0.03t 1 . 1 1 ± 1 .08t

12; for fish oil, n

=

high-density-lipoprotein

different from baseline fil Significantly different from control § Change given as percent change.

values, change:

n

P < 0.05. fP < 0.05,

lIP

=

was

of the

in the

extent.

The

A-I to apo

gel electrophoresis However, HDL altered

(P

± 6.9%

no significant

HDL2

EPA

EPA

the

s, or Table SBP

and

size

DHA

level

increase

in control

by both

fish

of particles 32.4 ± 5.6% < 0.01)

of (1

in subjects

proportion

(34.0

± 3.9%

fish

and

EPA

fish

compared

with

fell by (all

and

DBP

P

10.8%,
4.4

1 . I 1 ± 0.04t 1.09 ± 0.04t 1.26 ± 0.l7t

± 0.02

19%

groups

size as assessed by gradient by dietary supplementation.

I .20 ± 0.04 1 . 17 ± 0.04 1.35 ± 0.16

± 0.02

three

fish groups

0. 1). Changes

=

to apo A-I rose by

fish and

with

fish-oil

7% (Table

-

fell in all three groups, group, 22% in the fish

group

and

distribution

and fish-oil HDL2 size

± 0.02

the

and

by

groups,

in the

compared

fish

cholesterol

among

A-Il

were changes

significant.

particle-size

± 0.09

in the

fish-oil

fish-oil

A-I to apo

Both

groups

0.002). Apo A-Il also of 10% in the control

=

fell by 4% in the

± 0.15

of HDL

difference

0.5 1 mmol/L

3).

cholesterol

and

did in total

VLDL-triglycende

and

in all three

ratio fish

cholesterol

respectively.

(Table

cholesdecreases

reduction

in the

groups,

fell equally

3). Consequently

B

For fish, n

A-I

significantly

not

fish-oil

the

LDL

of 0.33

different

in LDL

3). The

entirely

at P < 0.05 rises in HDL

were significant Despite the apo

almost

group

3).

mirrored

(Table

reductions and

changes

By contrast

group

control

(Table

not significantly

the

fish groups

cholesterol.

in the fish-oil

in the

were

However, the

respecconcen-

the

cholesterol

cholesterol

and

in total

not change

ratios A-Il

Apo, apolipoprotein;

t Significantly

observed

± 0.13

1.12 ± 0.06 1.03 ± 0.05 1.44 ± 0.32 0.55

Control Apo B

HDL-C:apo Fish Fish oil Control

± 0.10

control

whereas

in VLDL

groups.

in HDL9%,

in VLDL-cholesterol

respectively),

in LDL

increase

( 10% and

baseline

reduction

63%,

three

in the

groups,

Fish Fish oil Control Apolipoproteins Apo A-I Fish Fish oil Control Apo A-Il Fish Fish oil

Control Apo A-I:apo Fish Fish oil Control

1.54 ± 0.21t 1.46 ± 0.07t 1.80±0.18

-0.41 -0.10 -0.41

(mmol/L)

HDL cholesterol Fish Fish oil Control VLDL cholesterol Fish Fish oil Control LDL cholesterol Fish Fish oil Control VLDL triglyceride

Fish Fish oil Control Apolipoprotein Apo A-I:apo Fish Fish oil

6.58 ± 0.22t 6.67 ± 0.18 6.41 ± 0.21t

the

a significant

from

a change

changes

among terol

showed

a significant

tration The Lipids (mmol/L) Cholesterol Fish Fish oil Control Triglycerides

groups

concentrations

tively)

1213

RISK

the The

in fibrinogen, fell by 5.7%, increased control decreases

by 38 group; in SBP

from baseline to end of the interbut were not significantly different DBP

dropped

from

baseline

in the

1214

COBIAC

TABLE Effects

blood

4

Discussion

of fish, fish-oil, pressurea

and control

diets

on hemostatic

Baseline Fibrinogen

variables

Intervention

and

As expected the greatest effect was on plasma triglycerides nitude of the falls in triglycerides

Change

2.65

Control(n=6)

1.96±0.14

±

0.15

2.49 ± 0.12 2.73 ± 0.18 2.14±0.10

2.35 ± 0.20

-0.15

± O.12t

+0.38

± 0.19

+0.18±0.17

Thromboxane (ig/L)

107.3

Fish Fish oil

Control time

6.9

95.8

± 5.1

85.0 ± 13.3

90.0

± 9.1

68.6±

85.7±

±

10.9

-1 1.6 ± 6.3t +5.2 ± 10.0 +17.1 ±8.5

11.6

(s)

Fish

348.7

±

Fish oil

365.2

± 23.3

20.1

Control Systolic blood

327.2

± 29.4

386.4

± 28.1

+37.7

± 19.4t

364.3 294.6

± 21.4

-0.9

± 14.4

± 26.1

-32.6

Diastolic

2.3

127.5

±

127.9

± 3.5

127.2

± 4.7

122.4 ± 1.8f

-5.1

± 1.7

123.6 ± 2.4t 123.5 ± 2.3

-4.3

±

-3.7

±

2.0 3.0

0.5

Hg) ±

1.7

79.5

±

l.8f

-2.8

±

80.1 77.5

± 1.7

78.9

±

1.4

-1.2

±

1.4

3.3

75.0

±

2.9f

-2.5

±

0.9

SEM.

s+

t Significantly

t

82.3

±

Significantly

different different

from from

control baseline

change, value,

the

and the fish groups but there the groups (Table 4).

between There groups

was

no significant

did experience

change

rich

P < 0.05. P < 0.05.

an average

to end of the intervention

difference

dose

DHA

in some studies DHA appeared

of fish

oil tended

However,

ofO.5

kg from

of our

compared but

increase

plus

is consistent

with

other

oil given,

EPA and DHA were to have the greater

simultaneous

changes

equipotent inhibitory

in dietary

sat-

to raise

LDL

cholesterol

whereas

the DHA-rich

fish did not. However, the effect of the fish was no greater than the background drift shown by the control group. The interpre-

was no significant in weight.

g EPA

urated fatty acids, and the underlying lipid disorder (3). It is generally agreed that fish oils are beneficial in hypertriglyceridemia but less useful for individuals with combined hyperlipidemia in whom LDL cholesterol may increase with fish oil (3). A recent report by Childs et al (20) showed that fish oil rich in DHA lowered LDL-cholesterol concentrations whereas fish oil rich in EPA did not. This is consistent with our findings in which EPA-

tation

control

of 4.5

(3, 15). Mechanisms for the fall in plasma triglycerides a reduction in hepatic VLDL lipoprotein lipid synthesis

effect on triglyceride secretion by hepatocytes (26). Changes in plasma cholesterol as a result of fish-oil supplementation have been more variable and appear to be related to

blood

(mm

intake

studies include

(3, 15). Although (25), in others

pressure

Fish Fish oil Control

daily

± 17.8

pressure

(mm Hg) Fish Fish oil Control

of consuming 4.5 g n-3 fatty and VLDL lipids. The mag(both plasma and VLDL triglycerides) were similar with fish and fish oil, suggesting that the fish oil may have reduced triglycerides to a greater extent. Reductions in plasma and VLDL triglycerides with either fish or fish oil have been widely reported. The decrease in VLDL triglyceride in the range of 42-52% seen in this study with a acids

(gIL)

Fish (n = 12) Fish oil (n = 13)

Bleeding

ET AL

not

nonspecific

baseline

the overall outcome

must

with

the type

all three

phase.

data

fish

fish

of fatty

changes

effects with

take oils acid;

such

on LDL

the EPA-rich

two that

factors were

second,

as regression

cholesterol

into

account:

matched the control

first,

we

for the

amount

group

defined

to the mean. Nevertheless, do suggest a less desirable

fish oil than

with

the DHA-rich

fish.

TABLE S Plasma fatty acidsa Control

Fish

Baseline

Intervention

Baseline

Fi sh oil Intervention

Baseline

Intervention

%

14:0 16:0 16:1 18:0 18:1 18:2n-6 l8:3n-3 20:3n-6 20:4n-6 20:Sn-3 22:Sn-3 22:6n-3

1.3±0.1 23.5 ± 0.7 2.8 ± 0.2 8.3 ± 0.3 20.9 ± 0.5 30.3 ± 1.1 0.6 ± 0.1 2.0 ± 0.2 7.3 ± 0.6 1.0±0.1 0.7 ± 0.1 1.4 ± 0.1

1.3±0.2 23.7 ± 0.8 2.9 ± 0.2 8.3 ± 0.3 21.2 ± 0.6 29.4 ± 1.0 0.7 ± 0.1 1.9 ± 0.2 7.9 ± 0.8 0.8±0.1 0.8 ± 0.1 1.2 ± 0.1

1.4±0.1 24.1 ± 0.6 3.1 ± 0.2 8.0 ± 0.3 21.9 ± 0.5 29.0 ± 1.1 0.7 ± 0.1 2.3 ± 0.2 6.2 ± 0.4 1.0±0.2 0.7 ± 0.1 1.5 ± 0.1

a±SEM

t Significantly f Significantly

different different

from baseline, P < 0.05. from control, P < 0.04.

§ Significantly

different

from

fish, P