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Meta-Analysis
. 2008 Jan 23;2008(1):CD003205.
doi: 10.1002/14651858.CD003205.pub2.

Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus

J Hartweg  1 , R Perera, V Montori, S Dinneen, H A W Neil, A Farmer
Affiliations
Meta-Analysis

Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus

J Hartweg et al. Cochrane Database Syst Rev. .

Abstract

Background: People with type 2 diabetes mellitus are at increased risk from cardiovascular disease. Dietary omega-3 polyunsaturated fatty acids (PUFAs) are known to reduce triglyceride levels, but their impact on cholesterol levels, glycemic control and vascular outcomes are not well known.

Objectives: To determine the effects of omega-3 PUFA supplementation on cardiovascular outcomes, cholesterol levels and glycemic control in people with type 2 diabetes mellitus.

Search strategy: We carried out a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, bibliographies of relevant papers and contacted experts for identifying additional trials.

Selection criteria: All randomised controlled trials were included where omega-3 PUFA supplementation or dietary intake was randomly allocated and unconfounded in people with type 2 diabetes. Authors of large trials were contacted for missing information.

Data collection and analysis: Trials were assessed for inclusion. Authors were contacted for missing information. Data was extracted and quality assessed independently in duplicate. Fixed-effect meta-analysis was carried out.

Main results: Twenty three randomised controlled trials (1075 participants) were included with a mean treatment duration of 8.9 weeks. The mean dose of omega-3 PUFA used in the trials was 3.5 g/d. No trials with vascular events or mortality endpoints were identified. Among those taking omega-3 PUFA triglyceride levels were significantly lowered by 0.45 mmol/L (95% confidence interval (CI) -0.58 to -0.32, P < 0.00001) and VLDL cholesterol lowered by -0.07 mmol/L (95% CI -0.13 to 0.00, P = 0.04). LDL cholesterol levels were raised by 0.11 mmol/L (95% CI 0.00 to 0.22, P = 0.05). No significant change in or total or HDL cholesterol, HbA1c, fasting glucose, fasting insulin or body weight was observed. The increase in VLDL remained significant only in trials of longer duration and in hypertriglyceridemic patients. The elevation in LDL cholesterol was non-significant in subgroup analyses. No adverse effects of the intervention were reported.

Authors' conclusions: Omega-3 PUFA supplementation in type 2 diabetes lowers triglycerides and VLDL cholesterol, but may raise LDL cholesterol (although results were non-significant in subgroups) and has no statistically significant effect on glycemic control or fasting insulin. Trials with vascular events or mortality defined endpoints are needed.

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Conflict of interest statement

None known.

Figures

1
1
1.1
1.1. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 1 Triglycerides (mmol/l).
1.2
1.2. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 2 Total cholesterol (mmol/l).
1.3
1.3. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 3 HDL cholesterol (mmol/l).
1.4
1.4. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 4 LDL cholesterol (mmol/l).
1.5
1.5. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 5 VLDL cholesterol (mmol/l).
1.6
1.6. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 6 HbA1c (%).
1.7
1.7. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 7 Fasting glucose (mmol/l).
1.8
1.8. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 8 Fasting insulin (pmol/l).
1.9
1.9. Analysis
Comparison 1 Omega‐3 versus placebo, Outcome 9 Weight (kg).
2.1
2.1. Analysis
Comparison 2 Fish oil versus placebo (subgroups triglyceride levels), Outcome 1 Triglycerides (mmol/l).
2.2
2.2. Analysis
Comparison 2 Fish oil versus placebo (subgroups triglyceride levels), Outcome 2 LDL cholesterol (mmol/l).
2.3
2.3. Analysis
Comparison 2 Fish oil versus placebo (subgroups triglyceride levels), Outcome 3 VLDL cholesterol (mmol/l).
3.1
3.1. Analysis
Comparison 3 Fish oil versus placebo (subgroups dose), Outcome 1 Triglycerides (mmol/l).
3.2
3.2. Analysis
Comparison 3 Fish oil versus placebo (subgroups dose), Outcome 2 LDL cholesterol (mmol/l).
3.3
3.3. Analysis
Comparison 3 Fish oil versus placebo (subgroups dose), Outcome 3 VLDL cholesterol (mmol/l).
4.1
4.1. Analysis
Comparison 4 Fish oil versus placebo (subgroups study duration), Outcome 1 Triglycerides (mmol/l).
4.2
4.2. Analysis
Comparison 4 Fish oil versus placebo (subgroups study duration), Outcome 2 LDL Cholesterol (mmol/l).
4.3
4.3. Analysis
Comparison 4 Fish oil versus placebo (subgroups study duration), Outcome 3 VLDL cholesterol (mmol/l).
5.1
5.1. Analysis
Comparison 5 Sensitivity, Outcome 1 HbA1c (%).
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References

References to studies included in this review

Alekseeva 2000 {published and unpublished data}
    1. Alekseeva RI, Sharafetdinov K, Plotnikova OA, Meshcheriakova VA, Mal'tsev GI, Kulakova SN. Effects of diet therapy including eiconol on clinical and metabolic parameters in patients with type 2 diabetes mellitus. Vopr Pitan 2000;69:36‐9. - PubMed
    1. Meshcheriakova VA, Plotnikova OA, Sharafetdinov KH, Alekseeva RI, Mal'tsev GI, Kulakova SN. Comparative study of effects of diet therapy including eiconol or linseed oil on several parameters of lipid metabolism in patients with type 2 diabetes mellitus. Vopr Pitan 2001;70(28):28‐31. - PubMed
Annuzzi 1991 {published data only}
    1. Annuzzi G, Rivellese A, Capaldo B, Marino L, Iovine C, Marotta G, et al. A controlled study on the effects of n‐3 fatty acids on lipid and glucose metabolism in non‐insulin‐dependent diabetic patients. Atherosclerosis 1991;87:65‐73. - PubMed
Axelrod 1994 {published data only}
    1. Axelrod L, Camuso J, Williams E, Kleinman K, Briones E, Schoenfeld D. Effects of a small quantity of omega‐3 fatty acids on cardiovascular risk factors in NIDDM. A randomized, prospective, double‐blind, controlled study. Diabetes Care 1994;17:37‐44. - PubMed
Boberg 1992 {published data only}
    1. Boberg M, Pollare T, Siegbahn A, Vessby B. Supplementation with n‐3 fatty acids reduces triglycerides but increases PAI‐1 in non‐insulin‐dependent diabetes mellitus. European Journal of Clinical Investigation 1992;22:645‐50. - PubMed
Borkman 1989 {published data only}
    1. Borkman M, Chisholm DJ, Furler SM, Storlien LH, Kraegen EW, Simons LA, et al. Effects of fish oil supplementation on glucose and lipid metabolism in NIDDM. Diabetes 1989;38:1314‐9. - PubMed
Connor 1993 {published data only}
    1. Connor WE, Prince MJ, Ullmann D, Riddle M, Hatcher L, Smith FE, et al. The hypotriglyceridemic effect of fish oil in adult‐onset diabetes without adverse glucose control. Annals of the New York Academy of Sciences 1993;683:337‐40. - PubMed
Goh 1997 {published data only}
    1. Goh YK, Jumpsen JA, Ryan EA, Clandinin MT. Effect of omega 3 fatty acid on plasma lipids, cholesterol and lipoprotein fatty acid content in NIDDM patients. Diabetologia 1997;40:45‐52. - PubMed
Hendra 1990 {published data only}
    1. Hendra TJ, Britton ME, Roper DR, Wagaine‐Twabwe D, Jeremy JY, Dandona P, et al. Effects of fish oil supplements in NIDDM subjects. Controlled study. Diabetes Care 1990;13:821‐9. - PubMed
Jain 2002 {published and unpublished data}
    1. Jain S, Gaiha M, Bhattacharjee J, Anuradha S. Effects of low‐dose omega‐3 fatty acid substitution in type‐2 diabetes mellitus with special reference to oxidative stress‐‐a prospective preliminary study. Journal of the Association of Physicians of India 2002;50:1028‐33. - PubMed
Luo 1998 {published data only}
    1. Luo J, Rizkalla SW, Vidal H, Oppert JM, Colas C, Boussairi C, et al. Moderate intake of n‐3 fatty acids for 2 months has no detrimental effect on glucose metabolism and could ameliorate the lipid profile in type 2 diabetic men. Results of a controlled study. Diabetes Care 1998;21:717‐24. - PubMed
McGrath 1996 {published data only}
    1. McGrath LT, Brennan GM, Donnelly JP, Johnston GD, Hayes JR, McVeigh GE. Effect of dietary fish oil supplementation on peroxidation of serum lipids in patients with non‐insulin dependent diabetes mellitus. Atherosclerosis 1996;121:275‐83. - PubMed
    1. McVeigh G, Brennan G, Hayes R, Johnston D. Primary nitrate tolerance in diabetes mellitus. Diabetologia 1994;37:115‐7. - PubMed
    1. McVeigh GE, Brennan GM, Cohn JN, Finkelstein SM, Hayes RJ, Johnston GD. Fish oil improves arterial compliance in non‐insulin‐dependent diabetes mellitus. Arteriosclerosis and Thrombosis 1994;14:1425‐9. - PubMed
    1. McVeigh GE, Brennan GM, Johnston GD, McDermott BJ, McGrath LT, Henry WR, et al. Dietary fish oil augments nitric oxide production or release in patients with type 2 (non‐insulin‐dependent) diabetes mellitus. Diabetologia 1993;36:33‐8. - PubMed
McManus 1996 {published data only}
    1. McManus RM, Jumpson J, Finegood DT, Clandinin MT, Ryan EA. A comparison of the effects of n‐3 fatty acids from linseed oil and fish oil in well‐controlled type II diabetes. Diabetes Care 1996;19:463‐7. - PubMed
Morgan 1995 {published data only}
    1. Morgan WA, Raskin P, Rosenstock J. A comparison of fish oil or corn oil supplements in hyperlipidemic subjects with NIDDM. Diabetes Care 1995;18:83‐6. - PubMed
Mostad 2006 {published data only}
    1. Mostad IL, Bjerve KS, Bjorgaas MR, Lydersen S, Grill V. Effects of n‐3 fatty acids in subjects with type 2 diabetes: reduction of insulin sensitivity and time‐dependent alteration from carbohydrate to fat oxidation [published erratum appears in The American journal of clinical nutrition 2007;85(6):1668]. The American journal of clinical nutrition 2006;84(3):540‐50. - PubMed
Pelikanova 1992 {published data only}
    1. Pelikanova T, Kohout M, Valek J, Kazdova L, Base J. Metabolic effects of omega‐3 fatty acids in type 2 (non‐insulin‐dependent) diabetic patients. Annals of the New York Academy of Sciences 1993;683:2722‐8. - PubMed
    1. Pelikanova T, Kohout M, Valek J, Kazdova L, Karasova L, Base J, et al. The effect of fish oil on the secretion and effect of insulin in patients with type II diabetes. Casopis Lekaru Ceskych 1992;131:668‐72. - PubMed
Petersen 2002 {published and unpublished data}
    1. Pedersen H, Petersen M, Major‐Pedersen A, Jensen T, Nielsen NS, Lauridsen ST, et al. Influence of fish oil supplementation on in vivo and in vitro oxidation resistance of low‐density lipoprotein in type 2 diabetes. European Journal of Clinical Nutrition 2003;57:713‐20. - PubMed
    1. Petersen M, Pedersen H, Major‐Pedersen A, Jensen T, Marckmann P. Effect of fish oil versus corn oil supplementation on LDL and HDL subclasses in type 2 diabetic patients. Diabetes Care 2002;25:1704‐8. - PubMed
Puhakainen 1995 {published data only}
    1. Puhakainen I, Ahola I, Yki‐Jarvinen H. Dietary supplementation with n‐3 fatty acids increases gluconeogenesis from glycerol but not hepatic glucose production in patients with non‐insulin‐dependent diabetes mellitus. American Journal of Clinical Nutrition 1995;61:121‐6. - PubMed
Schectman 1988 {published data only}
    1. Schectman G, Kaul S, Kissebah AH. Effect of fish oil concentrate on lipoprotein composition in NIDDM. Diabetes 1988;37:1567‐73. - PubMed
Silvis 1990 {published data only}
    1. Silvis N, Vorster HH, Mollentze WF, Jager JD, Huisman HW. Metabolic and Haemostatic Consequences of Dietary Fibre and N‐3 Fatty Acids in Black Type 2 (NIDDM) Diabetic Subjects: A Placebo Controlled Study. International Clinical Nutrition Review 1990;10:362‐80.
Sirtori 1997 {published data only}
    1. Maffettone A. Long‐term effects (six months) of omega‐3 polyunsaturated fatty acids on insulin sensitivity and lipid metabolism in patients with type 2 diabetes and hypertriglycaeridemia. Giornale Italiano di Diabetologia 1996;16:185‐93.
    1. Patti L, Maffetone A, Iovine C, Marino L, Annuzzi G, Raccardi G, et al. Long‐term effects of fishoil on lipoprotein subfractions and low density lipoprotein size in non‐insulin‐dependent diabetic patients with hypertriglyceridemia. Atherosclerosis 1999;146:361‐7. - PubMed
    1. Rivellese AA, Maffettone A, Iovine C, Marino L, Annunzi G, Mancini M, et al. Long‐term effects of fish oil on insulin resistance and plasma lipoproteins in NIDDM patients with hypertriglyceridemia. Diabetes Care 1996;19:1207‐13. - PubMed
    1. Sirtori CR, Paoletti R, Mancini M, Crepaldi G, Manzato E, Rivellese A et al on behalf of the Italian Fish Oil Multicenter Study. N‐3 fatty acids do not lead to an increased diabetic risk in patients with hyperlipidemia and abnormal glucose tolerance. Italian Fish Oil Multicenter Study. American Journal of Clinical Nutrition 1997;65:1874‐81. - PubMed
Vessby 1990 {published data only}
    1. Vessby B, Boberg M. Dietary supplementation with n‐3 fatty acids may impair glucose homeostasis in patients with non‐insulin‐dependent diabetes mellitus. Journal of Internal Medicine 1990;228:165‐71. - PubMed
Westerveld 1993 {published data only}
    1. Westerveld HT, Graaf JC, Breugel HH, Akkerman JWN, Sixma JJ, Erkelens DW, et al. Effects of low‐dose EPA‐E on glycemic control, lipid profile, lipoprotein(a), platelet aggregation, viscosity, and platelet and vessel wall interaction in NIDDM. Diabetes Care 1993;16:683‐8. - PubMed
Woodman 2002 {published and unpublished data}
    1. Mori TA, Woodman RJ, Burke V, Puddey IB, Croft KD, Beilin LJ. Effect of eicosapentaenoic acid and docosahexaenoic acid on oxidative stress and inflammatory markers in treated‐hypertensive type 2 diabetic subjects. Free Radical Biological Medicine 2003;35:772‐81. - PubMed
    1. Woodman RJ, Mori TA, Burke V, Puddey IB, Barden A, Watts GF, et al. Effects of purified eicosapentaenoic acid and docosahexaenoic acid on platelet, fibrinolytic and vascular functino in hypertensive type 2 diabetic patients. Atherosclerosis 2003;166:85‐93. - PubMed
    1. Woodman RJ, Mori TA, Burke V, Puddey IB, Watts GF, Beilin LJ. Effects of purified eicosapentaenoic and docosahexaenoic acids on glycemic control, blood pressure, and serum lipids in type 2 diabetes with treated hypertension. Clinical Nutrition 2002;76:1007‐15. - PubMed

References to studies excluded from this review

Adler 1994 {published data only}
    1. Adler AI, Boyko EJ, Schraer CD, Murphy NJ. Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska Natives. Diabetes Care 1994;17:1498‐501. - PubMed
Bonnema 1995 {published data only}
    1. Bonnema SJ, Jespersen LT, Marving J, Gregersen G. Supplementation with olive oil rather than fish oil increases small arterial compliance in diabetic patients. Diabetes, Nutrition and Metabolism Clinical and Experimental 1995;8:81‐7.
Das 1994a {published data only}
    1. Das UN, Kumar KV, Mohan IK. Lipid peroxides and essential fatty acids in patients with diabetes mellitus and diabetic nephropathy. Journal of Nutritional Medicine 1994;4:149‐55.
Das 1994b {published data only}
    1. Das UN, Kumar KV, Ramesh G. Essential fatty acid metabolism in south Indians. Prostaglandins leukotrienes and essential fatty acids 1994;50:253‐5. - PubMed
Das 1995 {published data only}
    1. Das UN. Essential fatty acid metabolism in patients with hypertension, diabetes mellitus and coronary heart disease. Prostaglandins, leukotrienes and essential fatty acids 1995;52:387‐91. - PubMed
Dunstan 1997 {published data only}
    1. Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, et al. The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. A randomized controlled study. Diabetes Care 1997;20:913‐21. - PubMed
Eritsland 1994 {published data only}
    1. Eritsland J, Seljeflot I, Abdelnoor M, Arnesen H, Torjesen PA. Long‐term effects of n‐3 fatty acids on serum lipids and glycaemic control. Scandinavian Journal of Clinical & Laboratory Investigation 1994;54:273‐80. - PubMed
Fasching 1991 {published data only}
    1. Fasching P, Ratheiser K, Waldhausl W, Rohac M, Osterode W, et al. Metabolic effects of fish‐oil supplementation in patients with impaired glucose tolerance. Diabetes 1991;40:583‐9. - PubMed
Friedberg 1998 {published data only}
    1. Friedberg CE, Janssen M, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes: A meta‐analysis. Diabetes Care 1998;21:494‐500. - PubMed
Hamazaki 1990 {published data only}
    1. Hamazaki T, Takazakura E, Osawa K, Urakaze M, Yano S. Reduction in microalbuminuria in diabetics by eicosapentaenoic acid ethyl ester. Lipids 1990;25:541‐5. - PubMed
Herrmann 1992 {published data only}
    1. Herrmann W, Biermann J, Ratzmann KP, Lindhofer HG. Effect of fish oil concentrate on the lipoprotein profile of patients with type II diabetes mellitus. Medizinische Klinik 1992;87:12‐5. - PubMed
Holler 1996 {published data only}
    1. Holler C, Auinger M, Ulberth F, Irsigler K. Eicosanoid precursors: potential factors for atherogenesis in diabetic CAPD patients?. Peritoneal Dialysis International 1996;16:S250‐3. - PubMed
Howard 1993 {published data only}
    1. Howard WJ. Is it time for a clinical trial of dietary fish oil supplementation in individuals with NIDDM?. Annals of the New York Academy of Sciences 1993;683:341‐2. - PubMed
Kasim 1988 {published data only}
    1. Kasim SE, Stern B, Khilnani S, McLin P, Bacioowski S, Jen K‐LC. Effects of omega‐3 fish oils on lipid metabolism, glycemic control and blood pressure in type II diabetic patients. Journal of Clinical Endocrinology and Metabolism 1988;67:1‐4. - PubMed
Lee 1994 {published data only}
    1. Lee R. Fish oil, essential fatty acids, and hypertension. Canadian Journal of Physiology & Pharmacology 1994;72:945‐953. - PubMed
Lungershausen 1997 {published data only}
    1. Lungershausen YK, Howe PR, Clifton PM, Hughes CR, Philips P, Graham JJ, et al. Evaluation of an omega‐3 fatty acid supplement in diabetics with microalbuminuria. Annals of the New York Academy of Sciences 1997;827:369‐81. - PubMed
Mackness 1994 {published data only}
    1. Mackness MI, Bhatnagar D, Durrington PN, Prais H, Haynes B, Morgan J, et al. Effects of a new fish oil concentrate on plasma lipids and lipoproteins in patients with hypertriglyceridaemia. European Journal of Clinical Nutrition 1994;48:859‐65. - PubMed
Malasanos 1991 {published data only}
    1. Malasanos TH, Stacpoole PW. Biological effects of omega‐3 fatty acids in diabetes mellit. Diabetes Care 1991;14:1160‐79. - PubMed
Morris 1995 {published data only}
    1. Morris MC, Manson JE, Rosner B, Buring JE, Willett WC, Hennekens CH. Fish consumption and cardiovascular disease in the physicians' health study: a prospective study. American Journal of Epidemiology 1995;142:166‐75. - PubMed
Okuda 1992 {published data only}
    1. Okuda Y, Mizutani M, Tanaka K, Isaka M, Yamashita K. Beneficial effects of eicosapentaenoic acid for diabetic patients with arteriosclerosis obliterans [1]. Diabetes Research and Clinical Practice 1992;18:139‐40. - PubMed
Okuda 1996 {published data only}
    1. Okuda Y, Mitzutani M, Ogawa M. Long term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. Journal of Diabetes and its Complications 1996;10:280‐7. - PubMed
Prince 1997 {published data only}
    1. Prince MJ, Deeg MA. Do n‐3 fatty acids improve glucose tolerance and lipaemia in diabetics. Current Opinion in Lipidology 1997;8:280‐7. - PubMed
Rossing 1996 {published data only}
    1. Rossing P, Hansen BV, Nielsen FS, Myrup B, Holmer G, Parving HH. Fish oil in diabetic nephropathy. Diabetes Care 1996;19:1214‐9. - PubMed
Schaap 1991 {published data only}
    1. Schaap GH, Bilo HJG, Beukhof JR, Gans ROB, Popp‐Snijders C, Donker AJM. The effects of short‐term omega‐3 polyunsaturated fatty acid supplementation in patients with chronic renal insufficiency. Current Therapeutic Research, Clinical and Experimental 1991;49:1061‐70.
Semplicini 1994 {published data only}
    1. Semplicini A, Valle R. Fish oils and their possible role in the treatment of cardiovascular disorders. Pharmacology and Therapeutics 1994;61:385‐97. - PubMed
Sheehan 1997 {published data only}
    1. Sheehan JP, Wei IW, Ulchaker M, Tserng KY. Effects of high fiber intake in fish‐oil treated patients with non‐insulin‐dependent diabetes mellitus. American Journal of Clinical Nutrition 1997;66:1183‐7. - PubMed
Shimizu 1993 {published data only}
    1. Shimizu H, Sato N, Tanaka Y, Kashima K, Ohtani K‐I, Mori M. Effect of eicosapentaenoic acid ethyl on urine albumin excretion in NIDDM. Diabetes Care 1993;16:1406‐7. - PubMed
Shimizu 1995 {published data only}
    1. Shimizu H, Ohtani K, Tanak Y, Sato N, Mori M, Shimomura Y. Long term effect of eicosapentaenoic acid ethyl (EPA‐E) on albuminuria of non‐insulin dependent diabetic patients. Diabetes Research and Clinical Practice 1995;28:35‐40. - PubMed
Shunto 1992 {published data only}
    1. Shunto S, Takahashi K, Negishi K, Suzuki M, Moritani S, Itabashi A, et al. Effects of eicosapentaenoic acid on glycemic control and lipid metabolism in healthy and NIDDM subjects. Seraputikku Risachi 1992;13:257‐65.
Silva 1996 {published data only}
    1. Silva JM, Souza I, Silva R, Tavares P, Teixeira F, Silva PS. The triglyceride lowering effect of fish oils is affected by fish consumption. International Journal of Cardiology 1996;57:75‐80. - PubMed
Sirtori 1998 {published data only}
    1. Sirtori CR, Crepaldi G, Manzato E, Mancini M, Rivellese A, Paoletti R, et al. One year treatment with ethyl‐esthers of n‐3 fatty acids in patients with hypertriglyceridemia and glucose intolerance reduced triglyceridemia, total cholessterol and increased HDL‐C without glycemic alterations. Atherosclerosis 1998;137:419‐27. - PubMed
Stacpoole 1989 {published data only}
    1. Stacpoole PW, Alig J, Ammon L, Crockett SE. Dose response effects of dietary marine oil on carbohydrate and lipid metabolism in normal subjects and patients with hypertriglyceridemia. Metabolism: Clinical and Experimental 1989;38:946‐56. - PubMed
Stender 1990 {published data only}
    1. Stender S, Jensen T, Deckert T. Experience with fish oil treatment with special emphasis on diabetic nephropathy. Journal of Diabetic Complications 1990;4:70‐1. - PubMed
Tonstad 1997 {published data only}
    1. Tonstad S. Drug therapy of hyperlipidaemia ‐ unanswered questions. Tidsskrift for Den Norske Laegeforening 1997;117:674‐7. - PubMed
Urano 1991 {published data only}
    1. Urano S, Hoshi‐Hashizume M, Tochigi N, Matsuo M, Ito H. Vitamin E and the susceptibility of erythrocytes and reconstituted liposomes to oxidative stress in aged diabetics. Lipids 1991;26:58‐61. - PubMed
Yamada 1995 {published data only}
    1. Yamada Y, Fushimi H, Inoue T. Effect of eicosapentaenoic acid and docosahexaenoic acid on diabetic osteopenia. Diabetes Research and Clinical Practice 1995;30:37‐42. - PubMed
Zak 1996 {published data only}
    1. Zak A, Zeman M, Tvrzicka E, Stolba P. Effects of fish oils in patients with type 2 diabetes with associated dyslipidaemia. Casopis Lekaru Ceskych 1996;135:354‐9. - PubMed
Zambon 1992 {published data only}
    1. Zambon S, Friday KE, Childs MT, Fujimoto WY, Bierman EL, Ensinck JY. Effects of glyburide and omega 3 fatty acid dietary supplements on glucose and lipid metabolism in patients with non insulin dependent diabetes mellitus. American Journal of Clinical Nutrition 1992;56:447‐54. - PubMed

References to ongoing studies

AFORRD 2004 {published data only}
    1. The AFORRD Trial. Atorvastatin in factorial with omega‐3 risk reduction in diabetes) (Abstract) Register for Randomised Controlled Trials. http://www.controlled‐trials.com/isrctn/trial/0‐76737502.html 2004.
ASCEND 2005 {published data only}
    1. The ASCEND Trial (Abstract). Oxford Clinical Trials Service Unit. http://www.ctsu.ox.ac.uk/ascend/ 2005.
Galan 2003 {published data only}
    1. Galan P, Bree A, Mennen L, Courcy P, Preziozi P, Bertrais S, Castetbon K, Hercberg S. Background and rationale of the SU.FO.LOM3 study: double blind placebo‐controlled secondary prevention trial to test the impact with supplementation with folate, vitamin B6 and B12 and/or omega‐3 fatty acids on the prevention of recurrent ischemic events in subjects with artherosclerosis in the coronary or cerebral arteries. Journal of Nutrion, Health and Aging 2003;7(6):428‐35. - PubMed
ORIGIN 2005 {published data only}
    1. The ORIGIN Trial. Outcome Reduction with Initial Glargine Intervention (Abstract) Clinical Trials.gov Identifier: NCT00069784. http://www.controlledtrials.com/mrct/trial/OMEGA%2D3%7CDIABETES/1059/616... 2005.

Additional references

ADA 1998
    1. American Diabetes Association. Management of Dyslipidemia in Adults with Diabetes. Diabetes Care. Diabetes Care 1998;21(Suppl 1):S36‐9. - PubMed
Balk 2004
    1. Balk E, Chung M, Lichtenstein A, Kupelnick B, Lawrence A, Vine D, et al. Effects of omega‐3 fatty acids on cardiovascular risk factors and intermediate markers of cardiovascular disease. Prepared by Tufts New England Medical Center Evidence‐based Practice Center, Rockville, MD.. Agency for Health Care Research and Quality; Evidence Report/Technology Assessment No. 93 2004. - PMC - PubMed
Bang 1976
    1. Bang HO, Dyerberg J, Hjorne N. The composition of food consumed by Greenland Eskimos. Acta Medica Scandanavica 1976;200:69‐73. - PubMed
Bucher 2002
    1. Bucher, HC, Hengstler, P, Schindler C, Meier G. N‐3 polyunsaturated fatty acids in coronary heart disease: a meta‐analysis of radomized controlled trials. American Journal of Medicine 2002;112:298‐304. - PubMed
Burr 1989
    1. Burr ML, Gilbert JF, Holliday RM, Elwood PC, Fehily AM, Rogers S, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1999;354:757‐61. - PubMed
Burr 2003
    1. Burr ML, Ashfield‐Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. European Journal of Clinical Nutrition 2003;57:193‐200. - PubMed
Connor 2000
    1. Connor WE. Importance of n‐3 fatty acids in health and disease. American Journal of Clinical Nutrition 2000;71:171‐5S. - PubMed
Dickersin 1994
    1. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. British Medical Journal 1994;309:1286‐91. - PMC - PubMed
Egger 1997
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. British Medical Journal 1997;315:629‐34. - PMC - PubMed
Elkeles 1998
    1. Elkeles RS, Diamond JR, Poulter C, Dhanjil S, Nicolaides AN, Mahmood S, et al. Cardiovascular outcomes in type 2 diabetes: a double blind placebo‐controlled study of bezafibrate: the St. Mary's, Ealing, Northwick Park Diabetes Cardiovascular Prevention (SENDCAP) Study. Diabetes Care 1998;21:641‐8. - PubMed
Farmer 2001
    1. Farmer A, Montori V, Dinneen S, Clar C. Fish oin in people with type 2 diabetes. Cochrane Database of Systematic Reviews 2001, Issue 3. - PubMed
Fasching 1996
    1. Fasching P, Rohac M, Liener K, Schneider B, Nowotny P, Waldhausl W. Fish oil supplementation versus gemfibrozil treatment in hyperlipidemic NIDDM: a randomized crossover study. Hormone and Metabolism Research 1996;28:230‐6. - PubMed
Fisher 1998
    1. Fisher WR, Zech LA, Stacpoole PW. Apolipoprotein B metabolism in hypertriglyceridemic patients administered either a fish oil‐ or vegetable oil‐enriched diet. Journal of Lipid Research 1998;39:388‐401. - PubMed
Friday 1989
    1. Friday KE, Childs MT, Tsunehara C, Fujimoto WY, Bierman EL, Ensinck JW. Elevated plasma glucose and lowered triglyceride levels from omega‐3 fatty acid supplementation in type II diabetes. Diabetes Care 1989;12:276‐81. - PubMed
Garg 1990
    1. Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidaemia in non‐insulin dependent diabetes mellitus. JAMA 1990;264:2994‐6. - PubMed
GISSI 1999
    1. GISSI‐Prevenzione Investigators. Dietary supplementation with n‐3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI‐Prevenzione trial. Lancet 1999;354:447‐55. - PubMed
Glauber 1988
    1. Glauber H, Wallace P, Griver K, Brechtel G. Adverse metabolic effect of omega‐3 fatty acids in non‐insulin dependent diabetes mellitus. Annals of Internal Medicine 1988;108:663‐8. - PubMed
Hooper 2004
    1. Hooper L, Thompson R, Harrison R, Summerbell C, Moore H, Worthington H, et al. Omega‐3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database of Systematic Reviews 2004, Issue 4. - PMC - PubMed
Howard 1987
    1. Howard BV. Lipoprotein metabolism in diabetes mellitus. Journal of Lipid Research 1987;28:613‐28. - PubMed
Jadad 1996
    1. Jadad AR, Moore RA, Carrol D, Jenkinson C, Reynolds DJM, Gavaghan DJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Kratz 1998
    1. Kratz A, Lewandrowski KB. Normal reference laboratory values. New England Journal of Medicine 1998;339(15):1063‐72. - PubMed
Lindsey 1992
    1. Lindsey S, Pronczuk A, Hayes KC. Low density lipoprotein from humans supplemented with n‐3 fatty acids depresses both LDL receptor activity and LDLr mRNA abundance in HepG2 cells. Journal of Lipid Research 1992;33:647‐58. - PubMed
Minihane 2000
    1. Minihane AM, Khan S, Leigh‐Firbank EC, Talmud P, Wright JW, Murphy MC, et al. Apo E polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype. Arteriosclerosis, Thrombosis and Vascular Biology 2000;20:1990‐7. - PubMed
Montori 2000
    1. Montori VM, Farmer A, Wollan PC, Dinneen SF. Fish oil supplementation in type 2 diabetes. Diabetes Care 2000;23:1407‐15. - PubMed
Mori 2000
    1. Mori TA, Burke V, Puddey IB, Watts GF, O'Neal DN, Best JD, et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. American Journal of Clinical Nutrition 2000;71:1085‐94. - PubMed
Mouraoff 1967
    1. Mouratoff GJ, Carroll NV, Scott EM. Diabetes mellitus in eskimos. Journal of the American Medical Association 1967;199:107‐12. - PubMed
Nutall 1998
    1. Nutall FQ. Comparison of percent total GHb with percent HbA1c in people with and without known diabetes. Diabetes Care 1998;21:1475‐80. - PubMed
Ouguerram 2006
    1. Ouguerram K, Maugeais C, Gardette J, Margot T, Krempf M. Effect of n‐3f fatty acids on metabolism of apoB100‐containing lipoproteins in type 2 diabetic subjects. British Journal of Nutrition 2006;96(1):100‐6. - PubMed
Pyorala 1997
    1. Pyorala K, Pedersen TR, Kjiekshus J, Faergeman O, Olsson AG, Thorgeirsson G. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a sub‐group analysis of the Scandinavian Simvastatin Survival Study. Diabetes Care 1997;20:614‐20. - PubMed
Rice 1995
    1. Rice JA. Mathematical Statistics and Data Analysis. California, USA: Duxbury Press, 1995.
Schectman 1996
    1. Schectman G, Boerboom LE, Hannah J, Howard BV, Mueller RA, Kissebah AH. Dietary fish oil decreases low‐density‐lipoprotein clearance in non‐human primates. American Journal of Clinical Nutrition 1996;64:215‐21. - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Surette 1992
    1. Surette, Whelan J, Lu GP, Broughton KS, Kinsella JE. Dependence on dietary cholesterol for n‐3 polyunsaturated fatty acid‐induced changes in plasma cholesterol in the Syrian hamster. Journal of Lipid Research 1992;33:263‐71. - PubMed
Suzukawa 1995
    1. Suzukawa M, Abbey M, Howe PR, Nestel PJ. Effects of fish oil fatty acids on low density lipoprotein size, oxidizability, and uptake by macrophages. Journal of Lipid Research 1995;36:473‐84. - PubMed
Theobald 2004
    1. Theobald HE, Chowienczyk PJ, Whittall R, Humphries SE, Sanders TA. LDL cholesterol‐raising effect of low‐dose docosahexaenoic acid in middle‐aged men and women. American Journal of Clinical Nutrition 2004;79(4):558‐63. - PubMed
Tramer 1997
    1. Tramer Mr, Reynolds DJ, Moore RA, McQuay HJ. Impact of covert duplicate publication on meta‐analysis: a case study. BMJ 1997;315:635‐40. - PMC - PubMed

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