Elevated omega-3 levels linked to better quality of life, low exacerbation odds in COPD
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Key takeaways:
- The odds for moderate exacerbations went down by 60% per one standard deviation rise in two omega-3 fatty acids.
- Researchers found a significant reduction in IL-6 concentration with this increase.
Respiratory-specific quality of life and exacerbation odds in former smokers with COPD may improve with elevated omega-3 levels, according to research published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
“Many physicians already counsel their patients on the importance of diet for a host of health reasons, particularly in adults with chronic disease,” Nirupama Putcha, MD, MHS, associate professor of medicine and pulmonary and critical care medicine physician at Johns Hopkins University, told Healio. “These findings support the importance of not just healthy diets but diets high in antioxidants such as omega-3 fatty acids.”
Using data from a prospective cohort study, Hansel and colleagues evaluated 57 former smokers (mean age, 65.28 years; 59.6% women; 49.1% white; mean BMI, 32.63 kg/m2) with moderate to severe COPD to determine how levels of two omega-3 polyunsaturated fatty acids — plasma eicosapentaenoic (EPA) plus docosahexaenoic acid (DHA) — collected at a maximum of three clinic visits impact COPD morbidity.
“Examining plasma omega-3 gives us more accurate data than when examining self-reported dietary intake of omega-3 and helps reduce the burden on study participants to recall their food consumption,” Nadia N. Hansel, MD, MPH, professor of medicine and pulmonary and critical care medicine physician at Johns Hopkins University, said in a press release.
During these visits, researchers also performed spirometry and had patients fill out the St. George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale.
The total cohort provided 133 EPA plus DHA samples, with averages of 14.7 μg/mL of plasma EPA and 40.2 μg/mL of plasma DHA.
In a model adjusted for demographics, lung function, pack-years, comorbidities and neighborhood poverty, researchers observed a significant decrease of 2.7 points (95% CI, –5.2 to –0.2) in SGRQ total score per one standard deviation (~22.2 μg/mL) rise in EPA plus DHA levels.
Additionally, there was a significant link between this increase in EPA plus DHA levels and a reduced likelihood for moderate exacerbations (OR = 0.4; 95% CI, 0.2-0.9).
"Our research group has performed previous work that supported the hypothesis that omega-3 fatty acids in the diet may be associated with improved respiratory health, but previous studies have shown this using self-reported information about diet,” Putcha said.
“This study lends further support and weight to the previous findings by more directly showing that higher levels of omega-3 fatty acids in the blood are associated with improved respiratory health in patients with COPD, while also taking into account many other confounding factors, including social contextual characteristics,” she continued.
In contrast, EPA plus DHA levels were not significantly related to CAT scores, mMRC scores or the odds for severe exacerbations, according to researchers.
Switching to a focus on inflammatory biomarkers, researchers found a significant reduction in IL-6 mean concentration per one standard deviation rise in EPA plus DHA (–14.3%; 95% CI, 1.2%-25.7%). This was the only biomarker with a significant link to plasma EPA plus DHA levels out of the assessed markers (IL-6, IL-8, TNF-alpha, IFN-gamma).
The addition of docosapentaenoic acid (DPA) and alpha-linolenic acid (ALA) to EPA and DHA yielded similar results to the main findings outlined above, with a significant link between an elevated total omega-3 level and decreased SGRQ total score (–2.8 points; 95% CI, –5.3 to –0.3), as well as reduced odds for moderate exacerbations (OR = 0.4; 95% CI, 0.2-0.97).
Researchers wrote that DHA and DPA levels played large parts in these associations.
When assessing inflammatory biomarkers, DHA along with DPA were also the main drivers of the significant relationship between reduced IL-6 concentration and an elevated total omega-3 level (–15.5%; 95% CI, –26.1% to –3.3%).
“Future studies, including a clinical trial ongoing for Hansel’s research team, will test this further by understanding how increasing omega-3 fatty acids in the diet can improve outcomes in COPD to more directly provide evidence for guidelines,” Putcha said.
Reference:
- Increased omega-3 levels may help improve quality of life for people with COPD. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/1984/Increased-Omega-3-Levels-May-Help-Improve-Quality-of-Life-for-People-With-COPD.aspx. Published June 25, 2024. Accessed June 25, 2024.
Perspective
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The findings from this study contribute to the growing body of evidence supporting a beneficial effect of omega-3 fatty acids, especially DHA, on lung health. Importantly, this study highlights a potential utility of DHA in the management of COPD, which could have significant impact given the contribution of chronic lung disease to mortality and morbidities worldwide.
This finding has strong biologic plausibility. Airway inflammation, often attributed to cigarette smoke exposure, is a hallmark characteristic of COPD, and omega-3 fatty acids are widely recognized for their potent anti-inflammatory and immunomodulatory properties. Of note, the effects of cigarette smoking on the lungs can persist after smoking cessation, underscoring the importance of identifying modifiable factors that can help combat the detrimental effects of smoking.
The associations of higher blood DHA with improved respiratory quality of life, reduced risk for exacerbations and reduced inflammatory markers found in this study of former smokers with moderate to severe COPD support this hypothesis. These findings could have significant clinical impact, especially for individuals who have successfully quit smoking. Similar research in current smokers with COPD is warranted to understand whether DHA holds the same potential in that population.
The evidence for DHA as a therapeutic target in the context of COPD is still nascent, and improvements in two key areas are needed before this evidence should inform standard practice. First, additional high-quality studies, including clinical trials of fish intake and/or DHA supplementation, are needed to conclude with any certainty that DHA has a beneficial effect on COPD morbidities. Second, further understanding of the relationship between dietary intake and blood levels of DHA and the other omega-3 fatty acids is needed to establish therapeutic doses and blood target levels of DHA for COPD management.
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