COMMENTARY

Omega-3: Fishing Out the Recent Evidence

JoAnn E. Manson, MD, DrPH

Disclosures

June 04, 2013

In This Article

What Should We Recommend to Our Patients?

First, these randomized trials of fish oil do not cast out on the recommendation to have at least 2 servings of dietary fish per week. That is a recommendation from the American Heart Association and many other professional societies, and many studies suggest benefit. Some of the benefit may be because dietary fish is replacing other foods that could increase risk, such as red meat or foods high in saturated fat. Do recommend at least 2 servings of fish per week, particularly the darker fatty fish such as salmon and mackerel.

Second, in patients who are candidates for prescription omega-3 fatty acids, those who have very high triglyceride levels, these findings do not cast doubt on that indication for use. That would still be an appropriate use. In patients who are taking fish oil and are doing very well on it and feel strongly that the fish oil is helping their symptoms or are a benefit to them, there is no strong basis from these studies for encouraging them to stop, because there were no major risks associated with fish oil found in the studies.

Trials in Primary Prevention and Other Outcomes

We need primary-prevention trials of omega-3 fatty acids in usual-risk general populations. We are doing such a trial, the VITAL (VITamin D and OmegA-3 TriaL) trial, at Brigham and Women's Hospital.[4] It is a nationwide trial with more than 20,000 men and women, testing omega-3 fatty acids in primary prevention. We also need to look at other health outcomes where omega-3 fatty acids may be promising. Many of these outcomes will be looked at in the VITAL trial, including prevention of cognitive decline, depression, autoimmune diseases, diabetes, and eye diseases such as macular degeneration and dry eye syndrome.

But at present, the focus should be on increasing dietary fish intake. Thank you very much for your attention. This is JoAnn Manson.

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