Omega-3 supplementation offers fall prevention benefits in older adults
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In a cohort of generally healthy, active, vitamin D-replete older adults, supplemental omega-3 fatty acids spurred a modest benefit in reducing falls, data from the DO-HEALTH trial show.
However, daily high-dose vitamin D and a simple home exercise program yielded no significant fall prevention benefit in this population, researchers wrote in The American Journal of Clinical Nutrition.
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“DO-HEALTH is the first trial to show a benefit of supplemental omega-3 on fall prevention,” study coauthor Heike A. Bischoff-Ferrari, MD, DrPH, a professor of geriatrics and aging research at the University of Switzerland, told Healio.
Falls are among one of “the most expensive medical conditions” and can often predict which adults will experience functional decline and require admission to a nursing home, according to Bischoff-Ferrari and colleagues.
The researchers conducted a 2x2x2 factorial design trial of older adults (mean age, 74.9 years; 61.7% women) from five European countries. About 40% had serum 25-hydroxyvitamin D concentration greater than 20 ng/mL — the amount that the NIH considers “adequate” for bone and overall health for most healthy people. Most participants (83%) were at least moderately physically active.
The DO-HEALTH participants had no major health events in the 5 years before they were enrolled in the study. As part of the study’s design, the researchers recruited some participants who experienced a fall in the year before randomization. This subgroup made up 41.9% of the study population.
The researchers randomly assigned the DO-HEALTH participants to:
2,000 IUs of vitamin D3 and 1 g of supplemental omega-3 daily and a simple strength-based exercise program that involved sitting-to-standing, one-leg stance, pull-backs and shoulder rotations with an elastic band and stepping on stairs three times a week for 30 minutes each day (n = 264); vitamin D3 and omega-3 (n = 265); vitamin D3 and the strength-based exercise program (n = 275); vitamin D3 only (n = 272); omega-3s and the strength-based exercise program (n = 275); omega-3s only (n = 269); the strength-based exercise (n = 267); or placebo (n = 270).
“Each participant received two study capsules per day,” Bischoff-Ferrari and colleagues wrote. “Each active omega-3s capsule contained 500 mg of eicosapentaenoic acid and docosahexaenoic acid in a ratio of 1:2; each active vitamin D capsule contained 1,000 IU of vitamin D3 stabilized with dl--tocopherol (vitamin E, 2.5 pro mill); and each placebo capsule contained high oleic sunflower oil.”
The DO-HEALTH participants could only consume 800 IU of vitamin D3 daily, were not allowed to take supplemental omega-3s that were not assigned to them and were followed for a mean of 2.99 years.
During the study period, 3,333 falls occurred among 1,311 study participants. The overall incidence rate of total falls was 0.56 (95% CI, 0.53-0.59) for each person and year, according to the researchers. Regardless of a patient’s baseline vitamin D 25 (OH) level, high-dose daily vitamin D had no significant impact on the incidence rate of total falls (incidence rate ratio [IRR] = 1.03; 95% CI, 0.92-1.14).
The researchers also reported that the simple home exercise program yielded no significant benefit on total falls (IRR=1.1; 95% CI, 0.99-1.22), but may have increased the rate of falls in subgroups of men (IRR=1.23; 95% CI, 1.02-1.48), younger participants (IRR =1.16; 95% CI 1-1.33) and participants who experienced at least one fall prior to enrollment (IRR= 1.17, 95% CI, 1-1.37), when compared with their respective counterparts.
On the contrary, adults who consumed omega-3s experienced 10% fewer falls (IRR = 0.9; 95% CI 0.81-1) compared with those who did not. This benefit was observed among women (IRR = 0.88; 95% CI, 0.77-1), participants aged 75 years and older (IRR = 0.81; 95% CI, 0.69- 0.95), those with higher omega-3 polyunsaturated fat levels at baseline (IRR = 0.83; 95% CI, 0.71-0.97), and those who were more physically active (IRR = 0.84; 95% CI, 0.72-0.97).
In addition, 51.8% of study participants said they experienced a fall that caused injury. The overall incidence rate of this type of fall was 0.36 (95% CI, 0.34-0.38) for each person and year. Overall, the benefits of supplemental omega-3s compared with no omega-3s were not significant for the frequency of falls that caused injury (IRR = 0.91; 95% CI, 0.81-1.01). However, the researchers reported that supplemental omega-3s provided fall prevention benefits among those with baseline polyunsaturated fat levels higher than 100 g per mL (IRR = 0.81; 95% CI, 0.69-0.95) and among the adults who were more physically active at the start of the study (IRR = 0.81; 95% CI, 0.7-0.95). High doses of vitamin D3 had a neutral effect on the rate of injurious falls (IRR = 1.03; 95% CI, 0.92-1.14). The strength-based exercise program did not offer a significant benefit against injurious falls (IRR = 1.08; 95% CI, 0.97-1.21), the researchers reported. Instead, the strength-based exercise program was associated with an increased rate of injurious falls in men (IRR =1.28; 95% CI, 1.05-1.56) and participants aged 75 years and younger (IRR = 1.19; 95% CI, 1.03-1.38).
“Given the limited evidence for fall prevention strategies other than exercise in generally healthy and active older adults, our results may prove relevant for this population, especially as fall reduction benefits of supplemental omega-3 in DO-HEALTH included older adults at the highest physical activity level,” Bischoff-Ferrari said. “While it is still important to avoid vitamin D deficiency in generally healthy older adults for fall and fracture prevention, with current recommendations of daily 800 IU, additional daily high-dose vitamin D supplementation does not contribute to fall prevention based on DO-HEALTH and the recently published large U.S. VITAL trial.”
References:
Bischoff-Ferrari HA, et al. Am J Clin Nutr. 2022;doi:10.1093/ajcn/nqac022.
Bischoff-Ferrari HA, et al. Contemp Clin Trials. 2021;doi:10.1016/j.cct/2020.106124.
Vitamin D for health professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed Feb. 22, 2022.