Gesundheitsökonomie & Qualitätsmanagement 2009; 14(5): 245-252
DOI: 10.1055/s-0028-1109707
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Omega-3-Fettsäuren in Prävention und Therapie: Aspekte der Versorgungsqualität

Omega-3 Fatty Acids in Prevention and Therapy: Aspects of Health Care QualityE. Idelevich1 , C. Hillger1 , W. Kirch1
  • 1Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden
Further Information

Publication History

Publication Date:
22 October 2009 (online)

Zusammenfassung

Omega-3-Fettsäuren (FS) Eicosapentaensäure (EPA) und Docosahexaensäure (DHA) sind wichtige Bestandteile der Nahrung. Gegenwärtig ist jedoch die Aufnahme dieser essenziellen mehrfach ungesättigten Fettsäuren im Rahmen der täglichen Ernährung unzureichend. Es soll daher darauf geachtet werden, dass EPA und DHA dem Organismus in ausreichender Menge, vor allem in Form von Fisch und Fischprodukten, zugeführt werden. Wird eine optimale Versorgung des Körpers durch die normale Nahrungszufuhr nicht sichergestellt, können Supplementationsmöglichkeiten überlegt werden. In der vorliegenden Arbeit wird der Stellenwert von Omega-3-FS für Prävention und Therapie unterschiedlicher Erkrankungen sowie ihre Wirkmechanismen diskutiert. Es wird weiter auf die praktischen Verfahren eingegangen, den individuellen Omega-3-Status zu bestimmen und durch unterschiedliche Maßnahmen eine ausreichende Zufuhr von Omega-3-FS zu gewährleisten.

Abstract

Omega-3 fatty acids (FA) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are important components of nutrition. Unfortunately, the intake of these essential polyunsaturated fatty acids is often insufficient in western countries. Therefore, it is of particular importance, that the organism receives adequate amounts of EPA and DHA from nourishment (fish and fish products). If the optimal intake of Omega-3 FA from nutrition can not be achieved in an individual, supplementation should be considered. In the present review, the role of Omega-3 fatty acids in prevention and therapy of various diseases, as well as their mechanisms of action, are discussed. Furthermore, the paper addresses practical options to determine the individual Omega-3 status and describes different possibilities to assure sufficient intake of Omega-3 FA.

Literatur

  • 1 Bang H O, Dyerberg J, Hjoorne N. The composition of food consumed by Greenland Eskimos.  Acta Med Scand. 1976;  200 69-73
  • 2 Khanapure S P, Garvey D S, Janero D R. et al . Eicosanoids in inflammation: biosynthesis, pharmacology, and therapeutic frontiers.  Curr Top Med Chem. 2007;  7 311-340
  • 3 Simopoulos A P. The importance of the ratio of omega-6 /omega-3 essential fatty acids.  Biomed Pharmacother. 2002;  56 365-379
  • 4 Brenna J T, Salem Jr N, Sinclair A J. et al . alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans.  Prostaglandins Leukot Essent Fatty Acids. 2009;  80 85-91
  • 5 Plourde M, Cunnane S C. Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements.  Appl Physiol Nutr Metab. 2007;  32 619-634
  • 6 Appleton K M, Rogers P J, Ness A R. Is there a role for n-3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials.  Nutr Res Rev. 2008;  21 13-41
  • 7 Brouwer I A. Omega-3 PUFA: good or bad for prostate cancer?.  Prostaglandins Leukot Essent Fatty Acids. 2008;  79 97-99
  • 8 Carpentier Y A, Portois L, Malaisse W J. n-3 fatty acids and the metabolic syndrome.  Am J Clin Nutr. 2006;  83 1499S-1504S
  • 9 Cole G M, Ma Q L, Frautschy S A. Omega-3 fatty acids and dementia.  Prostaglandins Leukot Essent Fatty Acids. 2009;  Jun 10. Epub ahead of print
  • 10 Mayser P, Grimm H, Grimminger F. n-3 fatty acids in psoriasis.  Br J Nutr. 2002;  87 (Suppl 1) S77-S82
  • 11 Turner D, Zlotkin S H, Shah P S. et al . Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease.  Cochrane Database Syst Rev. 2009;  (1) CD006320
  • 12 McKarney C, Everard M, N’Diaye T. Omega-3 fatty acids (from fish oils) for cystic fibrosis.  Cochrane Database Syst Rev. 2007;  (4) CD002201
  • 13 Mehta L R, Dworkin R H, Schwid S R. Polyunsaturated fatty acids and their potential therapeutic role in multiple sclerosis.  Nat Clin Pract Neurol. 2009;  5 82-92
  • 14 Kris-Etherton P M, Grieger J A, Etherton T D. Dietary reference intakes for DHA and EPA.  Prostaglandins Leukot Essent Fatty Acids. 2009;  Jun 12. Epub ahead of print
  • 15 Hoy S M, Keating G M. Omega-3 ethylester concentrate: a review of its use in secondary prevention post-myocardial infarction and the treatment of hypertriglyceridaemia.  Drugs. 2009;  69 1077-1105
  • 16 Cetin I, Koletzko B. Long-chain omega-3 fatty acid supply in pregnancy and lactation.  Curr Opin Clin Nutr Metab Care. 2008;  11 297-302
  • 17 Cicero A F, Ertek S, Borghi C. Omega-3 polyunsaturated Fatty acids: their potential role in blood pressure prevention and management.  Curr Vasc Pharmacol. 2009;  7 330-337
  • 18 Goldberg R J, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.  Pain. 2007;  129 210-223
  • 19 Proudman S M, Cleland L G, James M J. Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility.  Rheum Dis Clin North Am. 2008;  34 469-479
  • 20 Omacor (Omega-3-Säurenethylester 90 1000 mg). Fachinformation. Stand November 2007
  • 21 Albert C M, Campos H, Stampfer M J. et al . Blood levels of long-chain n-3 fatty acids and the risk of sudden death.  N Engl J Med. 2002;  346 1113-1118
  • 22 Burr M L, Fehily A M, Gilbert J F. et al . Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART).  Lancet. 1989;  2 757-761
  • 23 Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial.  Lancet. 1999;  354 447-455
  • 24 Senges J, Schiele R, Schneider S. et al .Randomized trial of omega-3 fatty acids on top of modern therapy after acute myocardial infarction: the OMEGA trial (oral presentation). 58th Annual Scientific Session of the American College of Cardiology 2009 Mar 29 – 31
  • 25 Rauch B, Schiele R, Schneider S. et al . Highly purified omega-3 fatty acids for secondary prevention of sudden cardiac death after myocardial infarction-aims and methods of the OMEGA-study.  Cardiovasc Drugs Ther. 2006;  20 365-375
  • 26 Tavazzi L, Tognoni G, Franzosi M G. et al . Rationale and design of the GISSI heart failure trial: a large trial to assess the effects of n-3 polyunsaturated fatty acids and rosuvastatin in symptomatic congestive heart failure.  Eur J Heart Fail. 2004;  6 635-641
  • 27 Tavazzi L, Maggioni A P, Marchioli R. et al . Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.  Lancet. 2008;  372 1223-1230
  • 28 Back M. Leukotriene signaling in atherosclerosis and ischemia.  Cardiovasc Drugs Ther. 2009;  23 41-48
  • 29 Simopoulos A P. Omega-3 fatty acids in inflammation and autoimmune diseases.  J Am Coll Nutr. 2002;  21 495-505
  • 30 Arterburn L M, Hall E B, Oken H. Distribution, interconversion, and dose response of n-3 fatty acids in humans.  Am J Clin Nutr. 2006;  83 1467S-1476S
  • 31 London B, Albert C, Anderson M E. et al . Omega-3 fatty acids and cardiac arrhythmias: prior studies and recommendations for future research: a report from the National Heart, Lung, and Blood Institute and Office Of Dietary Supplements Omega-3 Fatty Acids and their Role in Cardiac Arrhythmogenesis Workshop.  Circulation. 2007;  116 e320-e335
  • 32 Schacky von C. Omega-3 fatty acids: antiarrhythmic, proarrhythmic or both?.  Curr Opin Clin Nutr Metab Care. 2008;  11 94-99
  • 33 Christensen J H, Schmidt E B. Autonomic nervous system, heart rate variability and n-3 fatty acids.  J Cardiovasc Med. 2007;  8 (Suppl 1) S19-S22
  • 34 Calo L, Bianconi L, Colivicchi F. et al . N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial.  J Am Coll Cardiol. 2005;  45 1723-1728
  • 35 Pratt C M, Reiffel J A, Ellenbogen K A. et al . Efficacy and safety of prescription omega-3-acid ethyl esters for the prevention of recurrent symptomatic atrial fibrillation: a prospective study.  Am Heart J. 2009;  158 163-169 e161-e163
  • 36 Macchia A, Varini S, Grancelli H. et al . The rationale and design of the FORomegaARD Trial: A randomized, double-blind, placebo-controlled, independent study to test the efficacy of n-3 PUFA for the maintenance of normal sinus rhythm in patients with previous atrial fibrillation.  Am Heart J. 2009;  157 423-427
  • 37 Thies F, Garry J M, Yaqoob P. et al . Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial.  Lancet. 2003;  361 477-485
  • 38 Balk E M, Lichtenstein A H, Chung M. et al . Effects of omega-3 fatty acids on coronary restenosis, intima-media thickness, and exercise tolerance: a systematic review.  Atherosclerosis. 2006;  184 237-246
  • 39 Schacky von C, Fischer S, Weber P C. Long-term effects of dietary marine omega-3 fatty acids upon plasma and cellular lipids, platelet function, and eicosanoid formation in humans.  J Clin Invest. 1985;  76 1626-1631
  • 40 Mindrescu C, Gupta R P, Hermance E V. et al . Omega-3 fatty acids plus rosuvastatin improves endothelial function in South Asians with dyslipidemia.  Vasc Health Risk Manag. 2008;  4 1439-1447
  • 41 Wright S A, O’Prey F M, McHenry M T. et al . A randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus.  Ann Rheum Dis. 2008;  67 841-848
  • 42 Goodfellow J, Bellamy M F, Ramsey M W. et al . Dietary supplementation with marine omega-3 fatty acids improve systemic large artery endothelial function in subjects with hypercholesterolemia.  J Am Coll Cardiol. 2000;  35 265-270
  • 43 Ross B M, Seguin J, Sieswerda L E. Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?.  Lipids Health Dis. 2007;  6 21
  • 44 Lin P Y, Su K P. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids.  J Clin Psychiatry. 2007;  68 1056-1061
  • 45 Montgomery P, Richardson A J. Omega-3 fatty acids for bipolar disorder.  Cochrane Database Syst Rev. 2008;  (2) CD005169
  • 46 Raz R, Gabis L. Essential fatty acids and attention-deficit-hyperactivity disorder: a systematic review.  Dev Med Child Neurol. 2009;  51 580-592
  • 47 Peet M, Stokes C. Omega-3 fatty acids in the treatment of psychiatric disorders.  Drugs. 2005;  65 1051-1059
  • 48 Romano C, Cucchiara S, Barabino A. et al . Usefulness of omega-3 fatty acid supplementation in addition to mesalazine in maintaining remission in pediatric Crohn’s disease: a double-blind, randomized, placebo-controlled study.  World J Gastroenterol. 2005;  11 7118-7121
  • 49 Stenson W F, Cort D, Rodgers J. et al . Dietary supplementation with fish oil in ulcerative colitis.  Ann Intern Med. 1992;  116 609-614
  • 50 Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study.  Am J Gastroenterol. 1992;  87 432-437
  • 51 Berbert A A, Kondo C R, Almendra C L. et al . Supplementation of fish oil and olive oil in patients with rheumatoid arthritis.  Nutrition. 2005;  21 131-136
  • 52 Mayser P, Mrowietz U, Arenberger P. et al . Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial.  J Am Acad Dermatol. 1998;  38 539-547
  • 53 Dunstan J A, Mori T A, Barden A. et al . Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial.  J Allergy Clin Immunol. 2003;  112 1178-1184
  • 54 Mayser P, Mayer K, Mahloudjian M. et al . A double-blind, randomized, placebo-controlled trial of n-3 versus n-6 fatty acid-based lipid infusion in atopic dermatitis.  JPEN J Parenter Enteral Nutr. 2002;  26 151-158
  • 55 Turner D, Steinhart A H, Griffiths A M. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis.  Cochrane Database Syst Rev. 2007;  (3) CD006443
  • 56 Soyland E, Funk J, Rajka G. et al . Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.  N Engl J Med. 1993;  328 1812-1816
  • 57 Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis.  Allergy. 2009;  64 840-848
  • 58 Auestad N, Scott D T, Janowsky J S. et al . Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age.  Pediatrics. 2003;  112 e177-e183
  • 59 Fleith M, Clandinin M T. Dietary PUFA for preterm and term infants: review of clinical studies.  Crit Rev Food Sci Nutr. 2005;  45 205-229
  • 60 Koletzko B, Lien E, Agostoni C. et al . The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.  J Perinat Med. 2008;  36 5-14
  • 61 Helland I B, Smith L, Saarem K. et al . Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age.  Pediatrics. 2003;  111 e39-e44
  • 62 Lichtenstein A H, Appel L J, Brands M. et al . Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.  Circulation. 2006;  114 82-96
  • 63 Kris-Etherton P M, Harris W S, Appel L J. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.  Circulation. 2002;  106 2747-2757
  • 64 De Backer G, Ambrosioni E, Borch-Johnsen K. et al . European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.  Eur Heart J. 2003;  24 1601-1610
  • 65 Harris W S. International recommendations for consumption of long-chain omega-3 fatty acids.  J Cardiovasc Med. 2007;  8 (Suppl 1) S50-S52
  • 66 FDA .Substances Affirmed as Generally Recognized as Safe: Menhaden Oil. Federal Register: Volume 69, Number 10. January 15, 2004 http://www.epa.gov/EPA-IMPACT/ 2004 /January/Day-15 /i811.htm
  • 67 Dyerberg J, Bang H O. Haemostatic function and platelet polyunsaturated fatty acids in Eskimos.  Lancet. 1979;  2 433-435
  • 68 Bays H E. Safety considerations with omega-3 fatty acid therapy.  Am J Cardiol. 2007;  99 35C-43C
  • 69 Siscovick D S, Raghunathan T E, King I. et al . Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest.  Jama. 1995;  274 1363-1367
  • 70 Harris W S, Von Schacky C. The Omega-3 Index: a new risk factor for death from coronary heart disease?.  Prev Med. 2004;  39 212-220
  • 71 Harris W S. The omega-3 index as a risk factor for coronary heart disease.  Am J Clin Nutr. 2008;  87 1997S-2002S
  • 72 Harris W S. Omega-3 fatty acids and cardiovascular disease: a case for omega-3 index as a new risk factor.  Pharmacol Res. 2007;  55 217-223
  • 73 Schacky von C. Cardiovascular disease prevention and treatment.  Prostaglandins Leukot Essent Fatty Acids. 2009;  Jun 9. Epub ahead of print
  • 74 Iso H, Kobayashi M, Ishihara J. et al . Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I.  Circulation. 2006;  113 195-202
  • 75 Block R C, Harris W S, Reid K J. et al . EPA and DHA in blood cell membranes from acute coronary syndrome patients and controls.  Atherosclerosis. 2008;  197 821-828
  • 76 Max Rubner-Institut. Bundesforschungsinstitut für Ernährung und Lebensmittel .Nationale Verzehrsstudie II. Ergebnisbericht, Teil 2. 2008
  • 77 Weaver K L, Ivester P, Chilton J A. et al . The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish.  J Am Diet Assoc. 2008;  108 1178-1185
  • 78 USDA National Nutrient Database for Standard Reference (SR 20). US Dept of Agriculture, Agricultural Research Service Web site http://nal.usda.gov/fnic/foodcomp
  • 79 Domingo J L, Bocio A, Falco G. et al . Benefits and risks of fish consumption Part I. A quantitative analysis of the intake of omega-3 fatty acids and chemical contaminants.  Toxicology. 2007;  230 219-226
  • 80 Methyl mercury in fish and fishery products. Information note. European Commission: Health & Consumer Protection Directorate-General. Directorate D – Food Safety: production and distribution chain. Brussels; 12 May 2004
  • 81 Harris W S. n-3 Fatty acid fortification: opportunities and obstacles.  Br J Nutr. 2007;  97 593-595
  • 82 Kirch W, Badura B. Prävention. Heidelberg; Springer 2005
  • 83 Kirch W, Badura B, Pfaff H. Prävention und Versorgungsforschung. Heidelberg; Springer 2007

Evgeny Idelevich

Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden

Fiedlerstraße 27

01307 Dresden

Email: evgeny.idelevich@tu-dresden.de

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