(n-3) Fatty Acids and Cardiovascular Health: Are Effects of EPA and DHA Shared or Complementary?
(n-3) Fatty Acids and Cardiovascular Health: Are Effects of EPA and DHA Shared or Complementary?
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DOI：
10.3945/jn.111.149633
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发表时间：
2012-03-01
影响因子：
4.2
通讯作者：
Wu, Jason H. Y.
中科院分区：
文献类型：
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作者：
Mozaffarian, Dariush;Wu, Jason H. Y.
相当多的研究支持从鱼或鱼油中摄入omega-3 PUFA（也称为（n-3）PUFA）的心血管益处。单个长链（n-3）PUPA是否具有共享或互补效应尚未完全确定。我们回顾了EPA [20：5（n-3）]、二十二碳五烯酸[DPA，22：5（n-3）]和DHA [22：6（n-3）]的饮食和内源性来源以及对生物途径、生理风险因素和临床终点的心血管效应的证据。DHA需要直接从饮食中摄入，很少合成或逆转化为DPA或EPA。虽然EPA也主要来自直接消费，但EPA也可以少量从植物（n-3）前体合成，特别是十八碳四烯酸。相比之下，DPA似乎主要来源于EPA的内源性延伸，并且DPA也可以经历逆转化回到EPA。在实验和动物模型中，EPA和DHA都调节几种相关的生物途径，有证据表明它们具有一些不同的益处。在人类中，两种脂肪酸都能降低TG水平，并且根据更有限的研究，对心脏舒张期充盈、动脉顺应性以及炎症和氧化应激的一些指标产生有利影响。所有三种（n-3）PUFA都能减少离体血小板聚集，DHA也能适度增加LDL和HDL颗粒大小;这些发现的临床相关性尚不确定。EPA+DHA或DPA+DHA的组合水平与致死性心脏事件的风险较低相关，DHA与房颤的风险较低相关，表明DHA对心律失常有直接或间接的益处（尽管不排除EPA或DPA的类似益处）。相反，在一些研究中，EPA和DPA（而不是DHA）与非致命性心血管终点的风险降低相关，在一项大型临床试验中，纯化的EPA降低了非致命性冠状动脉综合征的风险。总体而言，对于许多心血管通路和结局，已确定的个体（n-3）PUFA研究相对有限，尤其是DPA。尽管如此，目前的证据表明，EPA和DHA具有共同和互补的益处。根据目前的证据，增加其中任何一种的消费都比很少或不消费有利。考虑到可能产生的互补效应，以及现有更有力的文献表明，鱼或鱼油的合并消费对心血管有益，因此，关注其合并消费仍然是最谨慎的做法。J. Nutr. 142：614S-625S，2012.
Considerable research supports cardiovascular benefits of consuming omega-3 PUFA, also known as (n-3) PUFA, from fish or fish oil. Whether individual long-chain (n-3) PUPA have shared or complementary effects is not well established. We reviewed evidence for dietary and endogenous sources and cardiovascular effects on biologic pathways, physiologic risk factors, and clinical endpoints of EPA [20:5(n-3)], docosapentaenoic acid [DPA, 22:5(n-3)], and DHA [22:6(n-3)]. DHA requires direct dietary consumption, with little synthesis from or retroconversion to DPA or EPA. Whereas EPA is also largely derived from direct consumption, EPA can also be synthesized in small amounts from plant (n-3) precursors, especially stearidonic acid. In contrast, DPA appears principally derived from endogenous elongation from EPA, and DPA can also undergo retroconversion back to EPA. In experimental and animal models, both EPA and DHA modulate several relevant biologic pathways, with evidence for some differential benefits. In humans, both fatty acids lower TG levels and, based on more limited studies, favorably affect cardiac diastolic filling, arterial compliance, and some metrics of inflammation and oxidative stress. All three (n-3) PUFA reduce ex vivo platelet aggregation and DHA also modestly increases LDL and HDL particle size; the clinical relevance of such findings is uncertain. Combined EPA+DHA or DPA+DHA levels are associated with lower risk of fatal cardiac events and DHA with lower risk of atrial fibrillation, suggesting direct or indirect benefits of DHA for cardiac arrhythmias (although not excluding similar benefits of EPA or DPA). Conversely, EPA and DPA, but not DHA, are associated with lower risk of nonfatal cardiovascular endpoints in some studies, and purified EPA reduced risk of nonfatal coronary syndromes in one large clinical trial. Overall, for many cardiovascular pathways and outcomes, identified studies of individual (n-3) PUFA were relatively limited, especially for DPA. Nonetheless, the present evidence suggests that EPA and DHA have both shared and complementary benefits. Based on current evidence, increasing consumption of either would be advantageous compared to little or no consumption. Focusing on their combined consumption remains most prudent given the potential for complementary effects and the existing more robust literature on cardiovascular benefits of their combined consumption as fish or fish oil for cardiovascular benefits. J. Nutr. 142: 614S-625S, 2012.