FISH OIL



















  • Reference: AHA website
Fish Omega-3 fatty acids per 3 oz serving
Salmon 1100 - 1900 mg
Flounder or sole 480 mg
Pollock 450 mg
Crabs 270 - 400 mg
Scallops 180 - 340 mg
Catfish 220 - 300 mg
Shrimp 290 mg
Clams 250 mg
Canned tuna 170 - 240 mg
Cod 150 - 240 mg







  • Maximum effect seen after 12 weeks of therapy
  • References [1-7, 33,34,35]
Effect of 3 - 4 grams/day of fish oil on triglycerides
Baseline triglyceride % reduction
> 600 mg/dl 30 - 50%
< 600 mg/dl 20 - 30%



REDUCE-IT trial - Vascepa® vs Mineral Oil for the Prevention of CVD Events, NEJM (2018) [PubMed abstract]
  • The REDUCE-IT trial enrolled 8179 patients with documented CVD or with DM and one additional risk factor for CVD
Main inclusion criteria
  • Established CVD or ≥ 50 years old with DM and one additional risk factor for CVD
  • Fasting triglycerides of 135 - 499 mg/dl
  • LDL 41 - 100 mg/dl
  • Stable statin dose for ≥ 4 weeks
Main exclusion criteria
  • HgA1C > 10%
  • Severe heart failure
  • Severe liver disease
Baseline characteristics
  • Median age 64 years
  • Established CVD - 71%
  • Type two diabetes - 58%
  • Median triglyceride level - 216 mg/dl
  • Median LDL - 75 mg/dl
  • Median HDL - 40 mg/dl
  • Triglyceride distribution: < 150 mg/dl: 10% | 150 - 200 mg/dl: 29% | > 200 mg/dl: 60%
Randomized treatment groups
  • Group 1 (4089 patients) - Vascepa 2 grams twice daily
  • Group 1 (4090 patients) - Mineral oil capsules (placebo) twice daily
  • Non-study fish oil products were prohibited
Primary outcome: Composite of cardiovascular death, nonfatal myocardial infarction (including silent myocardial infarction), nonfatal stroke, coronary revascularization, or unstable angina in a time-to-event analysis
Results

Duration: Median of 4.9 years
Outcome Vascepa Mineral oil Comparisons
Primary outcome 17.2% 22% HR 0.75, 95% CI [0.68 - 0.83], p<0.001
Overall mortality 6.7% 7.6% HR 0.87, 95% CI [0.74 - 1.02]
Fatal or nonfatal MI 6.1% 8.7% HR 0.69, 95% CI [0.58 - 0.81], p<0.001
Fatal or nonfatal Stroke 2.4% 3.3% HR 0.72, 95% CI [0.55 - 0.93], p=0.01
Serious bleeding event 2.7% 2.1% p=0.06
Atrial fibrillation 5.3% 3.9% p=0.003
Hospitalization for A fib/flutter 3.1% 2.1% p=0.004
Peripheral edema 6.5% 5.0% p=0.002
Constipation 5.4% 3.6% p<0.001
Median change in triglycerides at 5 years -38 mg/dl -3 mg/dl p<0.001
Median change in LDL at 5 years -0.8 mg/dl +6.2 mg/dl p<0.001
  • For patients without documented CVD at baseline (primary prevention), there was no significant difference in the primary outcome (8.2% vs 9.8%, HR 0.88, 95%CI [0.70 - 1.10])
  • The observed cardiovascular benefits were similar across baseline levels of triglycerides (<150, ≥150 to <200, and ≥200 mg/dl)

Findings: Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo
STRENGTH trial - Epanova® vs Corn Oil for the Prevention of CVD Events [PubMed abstract]
  • The STRENGTH trial enrolled 13,078 patients with a history of CVD or multiple risk factors for CVD
Main inclusion criteria
  • One of the following:
    • History of CVD
    • Diabetes + 1 risk factor (smoking, hypertension, hs-CRP ≥ 2 mg/L, albuminuria)
    • Age > 50 (60 for women) + 1 risk factor (fam hx of premature CAD, smoking, hypertension, hs-CRP ≥ 2 mg/L, impaired renal function, CAC > 300)
  • Statin therapy for ≥ 4 weeks
  • LDL < 100 mg/dl or taking maximum tolerated statin
  • Triglycerides 180 - 499 mg/dl
  • HDL < 42 mg/dl (47 mg/dl for women)
Main exclusion criteria
  • Consuming > 1 gram of prescription fish oil or supplement
  • CVD event within 30 days
Baseline characteristics
  • Average age 63 years
  • Baseline CVD - 56%
  • Diabetes - 70%
  • Median LDL - 75 mg/dl
  • Median triglyceride - 240 mg/dl
  • Median HDL - 36 mg/dl
Randomized treatment groups
  • Group 1 (6539 patients): Omega-3 carboxylic acid (Epanova) 4 grams/day. Each one gram Epanova capsule contains EPA 550 mg and DHA 200 mg [38]
  • Group 2 (6539 patients): Corn oil 4 capsules/day (placebo)
  • Fibrates and non-study fish oil products were prohibited
Primary outcome: Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, and hospitalization for unstable angina
Results

Duration: After a median of 42 months, the study was stopped early due to futility
Outcome Epanova Corn oil Comparisons
Primary outcome 12% 12.2% p=0.84
Primary outcome (patients with CVD at baseline) 15.6% 16.6% p=0.27
CV death 3.5% 3.2% p=0.37
Nonfatal MI 3.3% 3.5% p=0.77
Nonfatal stroke 2.2% 1.9% p=0.28
Revascularization 6.3% 6.7% p=0.41
Overall mortality 5.7% 5.1% p=0.11
A fib 2.2% 1.3% p<0.001
Median triglyceride at 1 year 191 mg/dl 235 mg/dl N/A
Median LDL at 1 year 76 mg/dl 75 mg/dl N/A

Findings: Among statin-treated patients at high cardiovascular risk, the addition of omega-3 CA, compared with corn oil, to usual background therapies resulted in no significant difference in a composite outcome of major adverse cardiovascular events. These findings do not support use of this omega-3 fatty acid formulation to reduce major adverse cardiovascular events in high-risk patients.
ORIGIN Trial - Fish Oil vs Placebo for Prevention of CVD, NEJM (2012) [PubMed abstract]
  • The ORIGIN trial enrolled 12,536 patients at high risk for cardiovascular events
Main inclusion criteria
  • ≥ 50 years old
  • Diagnosis of early diabetes or impaired glucose tolerance
  • ≥ 1 risk factor for CVD event (e.g. history of MI, stroke, LVH, PVD)
Main exclusion criteria
  • HgA1C > 9%
  • CABG within 4 years
  • Heart failure
Baseline characteristics
  • Average age 64 years
  • History of CVD - 59%
  • Median triglyceride level - 141 mg/dl
  • Average LDL - 112 mg/dl
  • Median HgA1C - 6.4%
  • Taking statin - 54%
  • Median dietary DHA/EPA intake - 210 mg/day
Randomized treatment groups
  • Group 1 (6319 patients) - Fish oil 1000 mg (465 mg of EPA | 375 mg of DHA) once daily
  • Group 1 (6292 patients) - Olive oil 1 gram once daily (placebo)
  • No specific dietary recommendations regarding fish were made
  • Nonstudy supplements containing n-3 fatty acids were discouraged
Primary outcome: Death from cardiovascular causes
Results

Duration: Median of 6.2 years
Outcome Fish oil Olive oil Comparisons
Primary outcome 9.1% 9.3% HR 0.98, 95% CI [0.87 - 1.10], p=0.72
Myocardial infarction (fatal and nonfatal) 5.5% 5.1% HR 1.09, 95% CI [0.93 - 1.27], p=0.28
Stroke (fatal and nonfatal) 5.0% 5.4% HR 0.92, 95% CI [0.79 - 1.08], p=0.32
Revascularization procedure 13.8% 14.3% HR 0.96, 95% CI [0.87 - 1.05], p=0.39
Overall mortality 15.1% 15.4% HR 0.98, 95% CI [0.89 - 1.07], p=0.63
Decrease in triglycerides 23.5 mg/dl 9 mg/dl p<0.001

Findings: Daily supplementation with 1 g of n-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events





  • Reference [33,35]
  • Only reported in Epanova® PI
  • Doses of 4 grams a day
Side effect Fish oil 4 grams/day
Placebo
Belching 3 - 4% 1%
Upset stomach 3 - 5% 2%
Abnormal taste in mouth 4% 1%
Diarrhea 15% 2%

























Lovaza® (Omega-3-acid ethyl esters)

Dosage forms

Capsule
  • 1000 mg
  • Each capsule contains ∼ 465 mg of EPA and 375 mg of DHA

Dosing

Severe hypertriglyceridemia (≥ 500 mg/dl)
  • Dosing: 4000 mg a day
  • Max: 4000 mg a day
  • May take once daily or in 2 divided doses
  • May take without regard to food

Generic / Price

- YES/$ (120 capsules)

Other

  • Do not break, crush, dissolve, or chew capsule
  • In trials, triglyceride levels were rechecked after 6 or 16 weeks

Vascepa® (Icosapent ethyl)

Dosage forms

Capsule
  • 500 mg
  • 1000 mg
  • Vascepa contains only EPA

Dosing

Prevention of CVD
  • Dosing: 2000 mg twice daily with food
  • Max: 2000 mg twice daily
  • May take as four 500 mg capsules twice daily or two 1000 mg capsules twice daily
  • Take with food
Severe hypertriglyceridemia (≥ 500 mg/dl)
  • Dosing: 2000 mg twice daily with food
  • Max: 2000 mg twice daily
  • May take as four 500 mg capsules twice daily or two 1000 mg capsules twice daily
  • Take with food

Generic / Price

- NO/$$$$

Other

  • Do not break, crush, dissolve, or chew capsule
  • In trials, triglyceride levels were rechecked after 12 weeks



Atrial fibrillation

Fish oil vs Placebo to Prevent A fib Recurrence, J Am Coll Cardiol (2014) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=337 | length = average of 271 days) in adults with symptomatic paroxysmal or persistent A fib within 6 months of enrollment
  • Treatment: Fish oil two capsules (EPA 400 mg/DHA 200 mg per capsule) twice daily vs Placebo two capsules (1 gram of safflower) twice daily
  • Primary outcome: Time to first asymptomatic or symptomatic A fib recurrence lasting ≥ 30 seconds. Recurrence of A fib was monitored by weekly trans-telephonic monitor transmissions to detect potentially asymptomatic episodes, whereas symptomatic episodes were assessed by transtelephonic monitor strips, 12-lead electrocardiography or any implanted device
  • Results:
    • Primary outcome: Fish oil - 64.1%, Placebo - 63.2% (p=0.48)
  • Findings: High-dose fish oil does not reduce A fib recurrence in patients with a history of A fib not receiving conventional antiarrhythmic therapy. Furthermore, fish oil does not reduce inflammation or oxidative stress markers in this population, which may explain its lack of efficacy.

Fish oil vs Placebo to Prevent Postoperative Atrial Fibrillation, JAMA (2012) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=1516 | length = 10 days) in adults undergoing cardiac surgery
  • Treatment: Fish oil vs Placebo. Fish oil was given as 1 gram capsules (EPA 465 mg/DHA 375 mg) with a dose of 10 grams over 3 - 5 days before surgery followed by 2 g/day until discharge or postop day 10.
  • Primary outcome: Occurrence of postoperative A fib lasting longer than 30 seconds
  • Results:
    • Primary outcome: Fish oil - 30%, Placebo - 30.7% (p=0.74)
  • Findings: In this large multinational trial among patients undergoing cardiac surgery, perioperative supplementation with n-3-PUFAs, compared with placebo, did not reduce the risk of postoperative atrial fibrillation

Fish oil vs Placebo to Prevent Recurrent A Fib, JAMA (2010) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=663 | length = 24 weeks) in adults with symptomatic paroxysmal or persistent A fib
  • Treatment: Lovaza 1 gram capsule (EPA 465 mg/DHA 375 mg) vs Placebo. Lovaza was dosed at 8 grams/day for the first 7 days followed by 4 grams a day thereafter.
  • Primary outcome: Symptomatic recurrence of A fib (first recurrence) in participants with paroxysmal A fib (N=542). Biweekly transtelephonic monitoring was used to document asymptomatic recurrences of A fib and assess symptomatic events.
  • Results:
    • Primary outcome: Fish oil - 52%, Placebo - 48% (p=0.26)
  • Findings: Among participants with paroxysmal A fib, 24-week treatment with prescription omega-3 compared with placebo did not reduce recurrent A fib over 6 months

Cancer prevention

Fish Oil vs Placebo for the Primary Prevention of Cancer, NEJM (2018) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=25,871; length - 5.3 years) in patients with no history of cancer
  • Treatment: Fish oil (EPA 460 mg / DHA 380 mg) once daily vs Placebo
  • Primary outcome: Invasive cancer of any type
  • Findings: Supplementation with n−3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo

Cardiovascular disease (CVD)

Fish Oil vs Placebo for the Secondary Prevention of CVD in Elderly Patients, Circulation (2020) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=1,027 | length = 2 years) in patients 70 - 82 years old with a history of myocardial infarction
  • Treatment: Fish oil (930 mg EPA and 660 mg DHA) once daily vs Placebo
  • Primary outcome: Composite of non-fatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after two years
  • Results:
    • Primary outcome: Fish oil - 21.4%, Placebo - 20% (p=0.60)
  • Findings: We could not detect reduction in clinical events in our elderly patients with a recent AMI, treated with 1.8 g n-3 PUFAs daily for 2 years

Fish Oil vs Placebo for the Primary Prevention of CVD, NEJM (2018) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=25,871 | length - median of 5.3 years) in patients with no history of cardiovascular disease
  • Treatment: Fish oil (EPA 460 mg / DHA 380 mg) once daily vs Placebo
  • Primary outcome: Composite of myocardial infarction, stroke, and death from cardiovascular causes
  • Results:
    • Primary outcome: Fish oil - 2.98%, Placebo - 3.23% (p=0.24)
  • Findings: Supplementation with n−3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo

Fish Oil vs Placebo to Prevent Cardiovascular Events in Patients with DM or Prediabetes, NEJM (2012) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=12,536 | length - median of 6.2 years) in patients with diabetes or prediabetes
  • Treatment: Fish oil 1 gram once daily vs Placebo
  • Primary outcome: Death from cardiovascular causes
  • Results:
    • Primary outcome: Fish oil - 9.1%, Placebo - 9.3% (p=0.72)
  • Findings: Daily supplementation with 1 gram of n-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events

Fish Oil and ALA vs Placebo for the Secondary Prevention of CVD, NEJM (2010) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=4,837 | length - 40 months) in patients 60 - 80 years old with a history of myocardial infarction in the past 10 years
  • Treatment: Daily intake of 4 different margarines: Margarine with no additional n−3 fatty acids (placebo margarine) vs Margarine with 400 mg of EPA–DHA per day vs Margarine with 2 g of ALA per day vs Margarine with combination of EPA–DHA and ALA
  • Primary outcome: The rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions
  • Results:
    • Primary outcome: During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA-DHA nor ALA reduced this primary end point (hazard ratio with EPA-DHA, 1.01; 95% confidence interval [CI], 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20)
  • Findings: Low-dose supplementation with EPA-DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy

Dementia

Fish oil to prevent dementia in the elderly, JAMA (2015) [PubMed abstract]
  • Design: randomized controlled trial of omega-3 supplements in 3501 elderly patients
  • Findings: Among older persons with age-related macular degeneration, oral supplementation with long-chain polyunsaturated fatty acids or lutein/zeaxanthin had no statistically significant effect on cognitive function

Diabetes

EPA/DHA 1 gram/day vs Placebo for Prevention of Kidney Disease in Diabetes , JAMA (2019) [PubMed abstract]
  • Design: Randomized placebo-controlled trial (N=1312 | length = 5 years) in adults with type 2 diabetes
  • Treatment: EPA 465 mg + DHA 375 mg once daily vs Placebo. The study had another factor that included vitamin D.
  • Primary outcome: Change in glomerular filtration rate estimated from serum creatinine and cystatin C (eGFR) from baseline to year 5
  • Results:
    • Primary outcome (decrease in GFR): EPA/DHA - 12.2 ml/min, Placebo - 13.1 ml/min (p=0.27)
  • Findings: Among adults with type 2 diabetes, supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years. The findings do not support the use of vitamin D or omega-3 fatty acid supplementation for preserving kidney function in patients with type 2 diabetes.

Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus, NEJM (2018) [PubMed abstract]
  • Design: Randomized, placebo-controlled trials (N=15,480; length = 7.4 years) among patients with type 2 diabetes and no history of CVD
  • Treatment: Fish oil (460 mg of EPA + 380 mg DHA) once daily vs Placebo (olive oil)
  • Primary outcomes: First serious vascular event, which was defined as a composite of nonfatal myocardial infarction or stroke (excluding confirmed intracranial hemorrhage), TIA, or vascular death excluding intracranial hemorrhage
  • Results:
    • Primary outcome: Fish oil - 8.9%, Placebo - 9.2% (RR 0.97, 95%CI [0.87 to 1.08], p=0.55)
  • Findings: Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n−3 fatty acid supplementation and those who were assigned to receive placebo.

Dry eyes

n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease, NEJM (2018) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=535, length = 12 months)
  • Treatment: Fish oil 3 grams once daily vs Placebo
  • Primary outcome: Mean change from baseline in the score on the Ocular Surface Disease Index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity)
  • Findings: Among patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n-3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo

Osteoarthritis

Fish oil for knee osteoarthritis, BJM (2016) [PubMed abstract]
  • Design: Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose
  • Findings: In people with symptomatic knee OA, there was no additional benefit of a high-dose fish oil compared with low-dose fish oil. The combination comparator oil appeared to have better efficacy in reducing pain at 2 years, suggesting that this requires further investigation.

Overall health/Physical fitness

Vitamin D, Fish oil, and Exercise for a Variety of Health Outcomes in Elderly Patients, JAMA (2020) [PubMed abstract]
  • Design: Randomized, 2 X 2 X 2 factorial, placebo-controlled trial (N=2157 | length = 3 years) in adults ≥ 70 years old with no major health events in the last 5 years
  • Treatment: Patients were randomly assigned to Vitamin D3 2000 IU/day vs Placebo, Fish oil 1 gram/day vs Placebo, and Strength-training exercise program vs None
  • Primary outcome: The 6 primary outcomes were change in systolic and diastolic blood pressure, Short Physical Performance Battery, Montreal Cognitive Assessment, and incidence rates of nonvertebral fractures and infections over 3 years.
  • Results:
    • Primary outcome: Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years
  • Findings: Among adults without major comorbidities aged 70 years or older, treatment with vitamin D3, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes.

Prenatal / infant development

DHA vs Placebo for Prevention of Bronchopulmonary Dysplasia in Breastfed Preterm Infants, JAMA (2020) [PubMed abstract]
  • Design: Randomized placebo-controlled trial (N=461 | length = up to 36 weeks postmenstrual age) in women who delivered preterm infants before 29 weeks and were breastfeeding
  • Treatment: DHA 1.2 grams/day vs Placebo. The DHA or Placebo was given to the mothers. Treatment was started within 72 hours of delivery and continued to 36 weeks' postmenstrual age.
  • Primary outcome: Bronchopulmonary dysplasia-free survival in infants at 36 weeks' postmenstrual age
  • Results:
    • Primary outcome: DHA - 54.9%, Placebo - 61.6% (p=0.18)
    • Enrollment was stopped early due to concern for harm based on interim data from this trial and from another trial that was published during the course of this study
  • Findings: Among breastfed preterm infants born before 29 weeks of gestation, maternal docosahexaenoic acid supplementation during the neonatal period did not significantly improve bronchopulmonary dysplasia-free survival at 36 weeks' postmenstrual age compared with placebo. Study interpretation is limited by early trial termination.

DHA/EPA vs Placebo for Prevention of Preterm Delivery in Pregnant Women, NEJM (2019) [PubMed abstract]
  • Design: Randomized placebo-controlled trial (N=5517 | length = 9 months) in pregnant women
  • Treatment: DHA 800 mg + EPA 100 mg once daily vs Placebo starting before 20 weeks gestation and continuing until 34 weeks gestation or delivery
  • Primary outcome: Early preterm delivery, defined as delivery before 34 completed weeks of gestation
  • Results:
    • Primary outcome: DHA/EPA - 2.2%, Placebo - 2.0% (p=0.50)
  • Findings: Supplementation with n−3 long-chain polyunsaturated fatty acids from early pregnancy (< 20 weeks of gestation) until 34 weeks of gestation did not result in a lower incidence of early preterm delivery or a higher incidence of interventions in post-term deliveries than control.

Effect of Docosahexaenoic Acid Supplementation vs Placebo on Developmental Outcomes of Toddlers Born Preterm, JAMA Pediatrics (2018) [PubMed abstract]
  • Design: Randomized, placebo-controlled trials (N=377; length = 6 months) among children born < 35 weeks gestation who were 10 - 16 months corrected age
  • Treatment: DHA 200 mg + arachidonic acid 200 mg once daily vs Corn oil (placebo)
  • Primary outcomes: Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), cognitive composite score at 16 to 22 months corrected age
  • Findings: Daily supplementation with 200 mg of DHA and 200 mg of AA for 6 months resulted in no improvement in cognitive development and early measures of executive function vs placebo, and may have resulted in negative effects on language development and effortful control in certain subgroups of children. These findings do not support DHA supplementation in the second year of life for children who are born preterm.

Docosahexaenoic Acid and Bronchopulmonary Dysplasia in Preterm Infants, NEJM (2017) [PubMed abstract]
  • Design: Randomized, controlled trial (N=1273, duration=36 weeks)
  • Primary outcome: Bronchopulmonary dysplasia, defined on a physiological basis (with the use of oxygen-saturation monitoring in selected infants), at 36 weeks of postmenstrual age or discharge home, whichever occurred first
  • Findings: Enteral DHA supplementation at a dose of 60 mg per kilogram per day did not result in a lower risk of physiological bronchopulmonary dysplasia than a control emulsion among preterm infants born before 29 weeks of gestation and may have resulted in a greater risk.

Fish Oil-Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring, NEJM (2016) [PubMed abstract]
  • Design: Randomized, placebo-controlled trial (N=736)
  • Findings: Supplementation with n−3 LCPUFA in the third trimester of pregnancy reduced the absolute risk of persistent wheeze or asthma and infections of the lower respiratory tract in offspring by approximately 7 percentage points, or one third.

Prenatal fish oil for child development and prevention of postpartum depression, JAMA (2010) [PubMed abstract]
  • Design: Randomized controlled trial comparing prenatal fish oil to placebo for child development and preventing postpartum depression
  • Findings: The use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood.