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Læknablaðið - 15.03.2003, Page 33

Læknablaðið - 15.03.2003, Page 33
FRÆÐIGREINAR / FJÖLÓMETTAÐAR FITUSÝRUR OG LÆKNINGAR góður kostur við meðferð hárrar blóðþéttni þríglýs- eríða, iktsýki, IgA nýrnameins og eftir hjartadrep. Notkun í öðrum sjúkdómum þarf frekari rannsókna við og sérstaklega þarf að kanna nánar misræmi í nið- urstöðum rannsókna á sumum sjúkdómum, til dæmis háþrýstingi og endurmyndun þrengsla eftir krans- æðavíkkanir. Mögulegar orsakir geta legið í mismun- andi skammtastærðum og mismunandi líkamsbirgð- um þátttakenda af ómega-3 fjölómettuðum fitusýr- um, E-vítamíni og snefilefnunum zinki og selen sem eru nauðsynleg fyrir efnahvörf sem leiða til nýmynd- unar langra fjölómettaðra fitusýra (42,136). Pá geta náttúruleg uppspretta fitusýranna og hvaða kolefnis- frumeind í glýserólsameind þríglýseríða fitusýrurnar tengjast líka skipt máli varðandi frásog og þéttni þeirra í vefjum líkamans (169). Einnig er brýnt að svara spurningum um skammtastærðir en skammtar hafa verið á bilinu 1 til 10 g í þeim klínísku rannsókn- um sem hér hefur verið fjallað um (tafla II). Loks er heldur ekki ljóst hvort EPA og DHA séu jafngildar eða hafi mismunandi klíníska þýðingu (170-172). Þó ýmsum spurningum sé þannig ósvarað hlýtur hin lága tíðni aukaverkana að gera ómega-3 fjölómettaðar fitusýrur að fýsilegum kosti við meðferð sjúkdóma þar sem sýnt þykir að þær komi að gagni. Heimildir 1. Dyerberg J, Bang HO. A hypothesis on the development of acute myocardial infarction in Greenlanders. Scand J Clin Lab Invest Suppl 1982; 161: 7-13. 2. O'Keefe JHJ, Harris WS. From Inuit to implementation: omega-3 fatty acids come of age. Mayo Clin Proc 2000; 75:607-14. 3. Das UN. BeneFicial effect(s) of n-3 fatty acids in cardiovascular diseases: but, why and how? Prostagl Leukotrien Ess Fatty Acids 2000; 63: 351-62. 4. Calder PC. n-3 polyunsaturated fatty acids and cytokine production in health and disease. Ann Nutr Metabol 1997; 41:203-34. 5. Heird WC. The role of polyunsaturated fatty acids in term and preterm infants and breastfeeding mothers. Ped Clin N Amer 2001; 48:173-88. 6. Uauy R, Peirano P, Hoffman D, Mena P, Birch D, Birch E. Role of essential fatty acids in the function of the developing nervous system. Lipids 1996; 31 Suppl: S167-S176. 7. De Caterina R, Endres S, Kristensen SD, Schmidt EB. n-3 fatty acids and renal diseases. Am J Kidney Dis 1994; 24:397-415. 8. Donadio JV Jr, Grande JP. Immunoglobulin A Nephropathy: A Clinical Perspective. J Am Soc Nephrol 1997; 1324-32. 9. Crawford MA. Background to essential fatty acids and their prostanoid derivatives. Br Med Bull 1983; 39: 210-3. 10. Fischer S, Weber PC. Prostaglandin 13 is formed in vivo in man after dietary eicosapentaenoic acid. Nature 1984; 307:165-8. 11. Fischer S, Weber PC. Thromboxane A3 (TXA3) is formed in human platelets after dietary eicosapentaenoic acid (C20: 5 omega 3). Biochem Biophys Res Commun 1983; 116:1091-9. 12. Lee TH, Mencia-Huerta J-M, Corey EJ, Lewis RA, Austen KF. Effects of exogenous arachidonic, eicosapentaenoic, and docosahexaenoic acids on the generation of 5-lipoxygenase pathway products by ionophore-activated human neutrophils. J Clin Invest 1984; 74:1922-33. 13. Weaver BJ, Holub BJ. Health effects and metabolism of dietary eicosa- pentaenoic acid. Prog Food Nutr Sci 1988; 12:111-50. 14. Endres S, Ghorbani R, Kelley VE, Georgilis K, Lonnemann G, van der Meer JWM, et al. The effect of dietary supplementation of n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mono- nuclear cells. N Engl J Med 1989; 320:265-71. 15. Calder PC, Bond JA, Harvey DJ. Gordon S, Newsholme EA. Uptake of saturated and unsaturated fatty acids into macrophage lipids and their effect upon macrophage adhesion and phagocytosis. Biochem J 1990; 269:807-14. 16. Hughes DA, Pinder AC, Piper Z, Johnson IT, Lund EK. Fish oil supplemen- tation inhibits the expression of major histocompatibility complex class II molecules and adhesion molecules on human monocytes. Am J Clin Nutr 1996; 63:267-72. 17. Lee TH, Hoover RL, Williams JD. Sperling RI. Ravalese J, Spur BW, et al. Effects of dietary enrichment with EPA and DHA on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med 1985;312:1217-24. 18. Kromhout D, Bosschieter EB, de Lezenne C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985;312:1205-9. 19. Daviglus ML, Stamlcr J. Orencia AJ, Dyer AR, Liu K, Greenland P, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med 1997; 336:1046-53. 20. Albert CM, Hennekens CH, O'Donnell CJ, Ajani UA, Carey VJ, Willett WC, et al. Fish consumption and risk of sudden cardiac death. JAMA 1998; 279:23-8. 21. Albert CM, Campos H, Stampfer MJ, Ridker PM, Manson JE, Willett WC, et al. Ðlood levels of long-chain n-3 fatty acids and the risk of sudden death. N EnglJMed 2002;346:1113-8. 22. Hu FB, Bronner L, Willett WC, Stampfer MJ, Rexrode KM, Albert CM, et al. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002; 287:1815-21. 23. Lapidus L, Andersson H, Bengtsson C, Bosaeus I. Dietary habits in relation to incidence of cardiovascular disease and death in women: a 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Am J Clin Nutr 1986; 44:444-8. 24. Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, WiIIett WC. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med 1995; 332: 977-82. 25. Morris MC, Manson JE, Rosner B, Buring JE, Willett WC, Hennekens CH. Fish consumption and cardiovascular disease in the physicians' health study: a prospective study. Am J Epidemiol 1995; 142:166-75. 26. Orencia AJ, Daviglus ML, Dyer AR, Shekelle RB, Stamler J. Fish consump- tion and stroke in men. 30-year findings of the Chicago Western Electric Study. Stroke 1996; 27: 204-9. 27. Pietinen P, Ascherio A, Korhonen P, Hartman AM, Willett WC, Albanes D, et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 1997; 145:876-87. 28. Oomen CM, Feskens EJ, Rasanen L, Fidanza F, Nissinen AM, Menotti A, et al. Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands. Am J Epidemiol 2000; 151: 999-1006. 29. Marckmann P, Gronbaek M. Fish consumption and coronary heart disease mortality. A systematic review of prospective cohort studies. Eur J Clin Nutr 1999; 53: 585-90. 30. Harris WS. n-3 fatty acids and lipoproteins: comparison of results from human and animal studies. Lipids 19%; 31:243-52. 31. Harris WS, Ginsberg HN, Arunakul N, Shachter NS, Windsor SL, Adams M, et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J Cardiovasc Risk 1997; 4: 385-91. 32. Harris WS, Lu G. Rambjor GS, Walen AI, Ontko JA, Cheng Q, et al. Influence of n-3 fatty acid supplementation on the endogenous activities of plasma lipases. Am J Clin Nutr 1997; 66:254-60. 33. Ikeda I, Kumamaru J, Nakatani N, Sakono M, Murota I, Imaizumi K. Re- duced hepatic triglyceride secretion in rats fed docosahexaenoic acid-rich fish oil suppresses postprandial hypertriglyceridemia. J Nutr 2001; 131:1159-64. 34. Harris WS, Connor WE, Illingworth DR, Rothrock DW, Foster DM. Effects of fish oil on VLDL triglyceride kinetics in humans. J Lipid Res 1990; 31:1549-58. 35. Anonymous. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hyper- tension Prevention, Phase I. [erratum appears in JAMA 1992 May 6; 267: 2330.] JAMA 1992; 267:1213-20. 36. Abeywardena MY, Head RJ. Longchain n-3 polyunsaturated fatty acids and blood vessel function. Cardiovasc Res 2001; 52:361-71. 37. Kenny D, Warltier DC, Pleuss JA, Hoffmann RG, Goodfriend TL, Egan BM. Effect of omega-3 fatty acids on the vascular response to angiotensin in normotensive men. Am J Cardiol 1992; 70:1347-52. 38. Goode GK, Garcia S, Heagerty AM. Dictary supplementation with marine fish oil improves in vitro small artery endothelial function in hypercholesterolemic patients: a double-blind placebo-controlled study. Circulation 1997; %: 2802-7. 39. McVeigh GE, Brennan GM, Cohn JN, Finkelstein SM, Hayes RJ, Johnston GD. Fish oil improves arterial compliance in non-insulin-depcndent diabetes mellitus. Arterioscler Thrombosis 1994; 14; 1425-9. 40. Grossman E, Peleg E, Shiff E, Rosenthal T. Hemodynamic and neurohumoral effects of fish oil in hypertensive patients. Am J Hypert 1993; 6:1040-5. 41. Kothny W, Angerer P, Stork S, von Schacky C. Short term effects of omega-3 fatty acids on the radial artery of patients with coronary artery disease. Atherosclerosis 1998; 140:181-6. 42. Bonaa KH, Bjerve KS, Straume B, Gram IT, Thelle D. Effect of eicosa- pentaenoic and docosahexaenoic acids on blood pressure in hypertension. A population-based intervention trial from the Tromsö study. N Engl J Med 1990; 322:795-801. 43. Knapp HR, Fitzgerald GA. The antihypertensive effects of fish oil. A controlled study of polyunsaturated fatty acid supplements in essential hypertension. N Engl J Med 1989; 320:1037-43. 44. Lofgren RP, Wilt TJ, Nichol KL, Crespin L, Pluhar R, Eckfeldt J. The effect of fish oil supplements on blood pressure. Am J Publ Heaith 1993; 83:267-9. 45. Appel LJ, Miller ER, Seidler AJ, Whelton PK. Does supplementation of diet with 'fish oil' reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Int Med 1993; 153:1429-38. 46. Bach R, Schmidt U, Jung F, Kiesewetter H, Hennen B, Wenzel E, et al. Effects of fish oil capsules in two dosages on blood pressure, platelet functions, haemorheological and clinical chemistry parameters in apparently healthy subjects. Ann Nutr Metabol 1989; 33: 359-67. 47. Weincr BH, Ockene IS, Levine PH, Cuenoud HF, Fisher M, Johnson BF, et al. Inhibition of atherosclerosis by cod-liver oil in a hyperlipidemic swine model. N Engl J Med 1986; 315:841-6. 48. Davis HR. Bridenstine RT, Vesselinovitch D, Wissler RW. Fish oil inhibits deve- lopment of atherosclerosis in rhesus monkeys. Arteriosclerosis 1987; 7:441-9. 49. Rich S, Miller JF, Charous S, Davis HR, Shanks P, Glagov S, et al. Develop- ment of atherosclerosis in genetically hyperlipidemic rabbits during chronic fish-oil ingestion. Arteriosclerosis 1989; 9:189-94. 50. Anonymous. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GlSSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocar- dico. Lancet 1999; 354:447-55. 51. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial re- infarction: diet and reinfarction trial (DART). Lancet 1989; 2: 757-61. 52. Singh RB. Niaz MA, Sharma JP, Kumar R. Rastogi V. Moshiri M. Rando- mized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival--4. Cardiovasc Drugs Ther 1997; 11: 485-91. 53. von Schacky C, Angerer P, Kothny W, Theisen K, Mudra H. The effect of die- tary omega-3 fatty acids on coronary atherosclerosis. A randomized, double- blind, placebo-controlled trial. Ann Int Med 1999; 130:554-62. Læknablaðið 2003/89
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