Exp Clin Endocrinol Diabetes 2018; 126(04): 222-228
DOI: 10.1055/s-0043-119751
Article

The Effects of Flaxseed Oil Omega-3 Fatty Acids Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

Golara Mirmasoumi
1   Department of Biochemistry, Shahreza Branch, Islamic Azad University, Shahreza, Isfahan, I.R. Iran
,
Mohammad Fazilati
1   Department of Biochemistry, Shahreza Branch, Islamic Azad University, Shahreza, Isfahan, I.R. Iran
2   Department of Biology, Pyamenoor University, Tehran, Iran
,
Fatemeh Foroozanfard
3   Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
,
Zahra Vahedpoor
3   Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
,
Samaneh Mahmoodi
3   Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
,
Mohsen Taghizadeh
4   Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
,
Nazanin Kazemi Esfeh
4   Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
,
Maryam Mohseni
4   Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
,
Hassan Karbassizadeh
5   Barij Medicinal Plants Research Center, Kashan, I.R. Iran
,
Zatollah Asemi
4   Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
› Author Affiliations

Abstract

Objective This study was conducted to evaluate the effects of flaxseed oil omega-3 fatty acids supplementation on metabolic status of patients with polycystic ovary syndrome (PCOS).

Methods This randomized double-blind, placebo-controlled trial was conducted on 60 women with PCOS according to the Rotterdam criteria aged 18–40 years old. Participants were randomly assigned into two groups to receive either 1,000 mg flaxseed oil omega-3 fatty acids (n=30) or placebo (n=30) twice a day for 12 weeks. Metabolic, endocrine, inflammatory factors were quantified at baseline and after the 12-week intervention.

Results After the 12-week intervention, compared to the placebo, flaxseed oil omega-3 supplementation significantly decreased insulin values (−2.6±7.7 vs.+1.3±3.9 µIU/mL, P=0.01), homeostasis model of assessment-estimated insulin resistance (−0.7±1.7 vs.+0.3±0.9, P=0.01), mF-G scores (−1.2±1.7 vs. -0.1±0.4, P=0.001), and increased quantitative insulin sensitivity check index (+0.01±0.02 vs. −0.01±0.02, P=0.01). In addition, supplementation with flaxseed oil omega-3 resulted in significant decreases in serum triglycerides (−5.1±20.9 vs.+9.7±26.1 mg/dL, P=0.01), VLDL-cholesterol (−1.0±4.2 vs.+1.9±5.2 mg/dL, P=0.01) and high-sensitivity C-reactive protein (hs-CRP) (−1.6±3.1 vs.+0.2±1.5 mg/L, P=0.004) compared to the placebo. We did not see any significant effect of flaxseed oil omega-3 supplementation on hormonal and other lipid profiles, and plasma nitric oxide levels.

Conclusions Overall, flaxseed oil omega-3 supplementation for 12 weeks in women with PCOS had beneficial effects on insulin metabolism, mF-G scores, serum triglycerides, VLDL-cholesterol and hs-CRP levels, but did not affect hormonal and other lipid profiles, and plasma nitric oxide levels.



Publication History

Received: 08 June 2017
Received: 12 September 2017

Accepted: 14 September 2017

Article published online:
08 November 2017

© 2018. Thieme. All rights reserved.

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  • References

  • 1 Trikudanathan S. Polycystic ovarian syndrome. Med Clin North Am 2015; 99: 221-235
  • 2 Vagi SJ, Azziz-Baumgartner E, Sjodin A. et al. Exploring the potential association between brominated diphenyl ethers, polychlorinated biphenyls, organochlorine pesticides, perfluorinated compounds, phthalates, and bisphenol A in polycystic ovary syndrome: a case-control study. BMC Endocr Disord 2014; 14: 86
  • 3 Pourghassem Gargari B, Houjeghani S, Farzadi L. et al. Relationship between serum leptin, ghrelin and dietary macronutrients in women with polycystic ovary syndrome. Int J Fertil Steril 2015; 9: 313-321
  • 4 Macut D, Bjekic-Macut J, Savic-Radojevic A. Dyslipidemia and oxidative stress in PCOS. Front Horm Res 2013; 40: 51-63
  • 5 Schmidt J, Weijdegard B, Mikkelsen AL. et al. Differential expression of inflammation-related genes in the ovarian stroma and granulosa cells of PCOS women. Mol Hum Reprod 2014; 20: 49-58
  • 6 Jalilian A, Kiani F, Sayehmiri F. et al. Prevalence of polycystic ovary syndrome and its associated complications in Iranian women: A meta-analysis. Iran J Reprod Med 2015; 13: 591-604
  • 7 Rafraf M, Mohammadi E, Asghari-Jafarabadi M. et al. Omega-3 fatty acids improve glucose metabolism without effects on obesity values and serum visfatin levels in women with polycystic ovary syndrome. J Am Coll Nutr 2012; 31: 361-368
  • 8 Prasad K. Flaxseed and cardiovascular health. J Cardiovasc Pharmacol 2009; 54: 369-377
  • 9 Nasri K, Hantoushzadeh S, Aghadavod E. et al. The effects of omega-3 fatty acids supplementation on gene expression involved in the insulin and lipid signaling pathway in patients with polycystic ovary syndrome. Horm Metab Res 2017; 49: 446-451
  • 10 Cunnane SC, Hamadeh MJ, Liede AC. et al. Nutritional attributes of traditional flaxseed in healthy young adults. Am J Clin Nutr 1995; 61: 62-68
  • 11 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25
  • 12 Oner G, Muderris II. Efficacy of omega-3 in the treatment of polycystic ovary syndrome. J Obstet Gynaecol 2013; 33: 289-291
  • 13 Fulghesu AM, Romualdi D, Di Florio C. et al. Is there a dose-response relationship of metformin treatment in patients with polycystic ovary syndrome? Results from a multicentric study. Hum Reprod 2012; 27: 3057-3066
  • 14 Hatch R, Rosenfield RL, Kim MH. et al. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981; 140: 815-830
  • 15 Pisprasert V, Ingram KH, Lopez-Davila MF. et al. Limitations in the use of indices using glucose and insulin levels to predict insulin sensitivity: Impact of race and gender and superiority of the indices derived from oral glucose tolerance test in African Americans. Diabetes Care 2013; 36: 845-853
  • 16 Tatsch E, Bochi GV, Pereira Rda S. et al. de Campos MM, et al. A simple and inexpensive automated technique for measurement of serum nitrite/nitrate. Clin Biochem 2011; 44: 348-350
  • 17 Zheng SH, Li XL. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrinol 2016; 32: 177-183
  • 18 Hyderali BN, Mala K. Oxidative stress and cardiovascular complications in polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol 2015; 191: 15-22
  • 19 Escobar-Morreale HF, Luque-Ramirez M, Gonzalez F. Circulating inflammatory markers in polycystic ovary syndrome: A systematic review and metaanalysis. Fertil Steril 2011; 95: 1048-1058 e1-2
  • 20 Mohammadi E, Rafraf M, Farzadi L. et al. Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome. Asia Pac J Clin Nutr 2012; 21: 511-518
  • 21 Navas-Carretero S, Perez-Granados AM, Schoppen S. et al. An oily fish diet increases insulin sensitivity compared to a red meat diet in young iron-deficient women. Br J Nutr 2009; 102: 546-553
  • 22 Eritsland J, Seljeflot I, Abdelnoor M. et al. Long-term effects of n-3 fatty acids on serum lipids and glycaemic control. Scand J Clin Lab Invest 1994; 54: 273-280
  • 23 Rasic-Milutinovic Z, Perunicic G, Pljesa S. et al. Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Ren Fail 2007; 29: 321-329
  • 24 Hutchins AM, Brown BD, Cunnane SC. et al. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutr Res 2013; 33: 367-375
  • 25 Sadeghi A, Djafarian K, Mohammadi H. et al. Effect of omega-3 fatty acids supplementation on insulin resistance in women with polycystic ovary syndrome: Meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2017; 11: 157-162
  • 26 Legro RS. Polycystic ovary syndrome and cardiovascular disease: A premature association?. Endocr Rev 2003; 24: 302-312
  • 27 Cassar S, Teede HJ, Harrison CL. et al. Biomarkers and insulin sensitivity in women with PCOS: Characteristics and predictive capacity. Clin Endocrinol (Oxf) 2015; 83: 50-58
  • 28 Bellenger J, Bellenger S, Bataille A. et al. High pancreatic n-3 fatty acids prevent STZ-induced diabetes in fat-1 mice: Inflammatory pathway inhibition. Diabetes 2011; 60: 1090-1099
  • 29 Cussons AJ, Watts GF, Mori TA. et al. Omega-3 fatty acid supplementation decreases liver fat content in polycystic ovary syndrome: A randomized controlled trial employing proton magnetic resonance spectroscopy. J Clin Endocrinol Metab 2009; 94: 3842-3828
  • 30 Vargas ML, Almario RU, Buchan W. et al. Metabolic and endocrine effects of long-chain versus essential omega-3 polyunsaturated fatty acids in polycystic ovary syndrome. Metabolism 2011; 60: 1711-1718
  • 31 Oh R. Practical applications of fish oil (Omega-3 fatty acids) in primary care. J Am Board Fam Pract 2005; 18: 28-36
  • 32 Woodman RJ, Mori TA, Burke V. et al. Effects of purified eicosapentaenoic and docosahexaenoic acids on glycemic control, blood pressure, and serum lipids in type 2 diabetic patients with treated hypertension. Am J Clin Nutr 2002; 76: 1007-1015
  • 33 Fakhrzadeh H, Ghaderpanahi M, Sharifi F. et al. The effects of low dose n-3 fatty acids on serum lipid profiles and insulin resistance of the elderly: A randomized controlled clinical trial. Int J Vitam Nutr Res 2010; 80: 107-116
  • 34 Jump DB. N-3 polyunsaturated fatty acid regulation of hepatic gene transcription. Curr Opin Lipidol 2008; 19: 242-247
  • 35 Qi K, Fan C, Jiang J. et al. Omega-3 fatty acid containing diets decrease plasma triglyceride concentrations in mice by reducing endogenous triglyceride synthesis and enhancing the blood clearance of triglyceride-rich particles. Clin Nutr 2008; 27: 424-430
  • 36 Tsitouras PD, Gucciardo F, Salbe AD. et al. High omega-3 fat intake improves insulin sensitivity and reduces CRP and IL6, but does not affect other endocrine axes in healthy older adults. Horm Metab Res 2008; 40: 199-205
  • 37 Li H, Ruan XZ, Powis SH. et al. EPA and DHA reduce LPS-induced inflammation responses in HK-2 cells: Evidence for a PPAR-gamma-dependent mechanism. Kidney Int 2005; 67: 867-874
  • 38 Rossi A, Kapahi P, Natoli G. et al. Anti-inflammatory cyclopentenone prostaglandins are direct inhibitors of IkappaB kinase. Nature 2000; 403: 103-108
  • 39 Wu D, Han SN, Meydani M. et al. Effect of concomitant consumption of fish oil and vitamin E on production of inflammatory cytokines in healthy elderly humans. Ann N Y Acad Sci 2004; 1031: 422-424