Supplementation with long-chain n-3 fatty acids in non-insulin-dependent diabetes mellitus (NIDDM) patients leads to the lowering of oleic acid content in serum phospholipids.

BACKGROUND: The dietary supplementation with EPA (eicosapentaenoic acid; 20:5n3) and DHA (docosahexaenoic acid; 22:6n3) has been recommended because of their favourable effects on the cardiovascular system (including complications of NIDDM). Oleic acid (18:1n9) from olive oil has some analogous and complementary effects. Potential competitive relations between long-chain n-3 fatty acids (FAs) and the oleic acid would therefore mean a problem. AIM OF THE STUDY: We focused primarily on the oleic acid changes in serum phospholipids (SPL) after a supplementation with EPA and DHA. METHODS: Thirty-five patients with type 2 diabetes mellitus (NIDDM) were supplemented for 28 days with 1.7 g of EPA plus 1.15 g of DHA/day (as Maxepa capsules, Seven Seas, U. K.). After that, a 3-month wash-out control period with 21 patients followed. A fatty acid composition of serum phospholipids (SPL) was determined by capillary gas-chromatography. Values were calculated as relative percentages of all FAs. RESULTS: After the supplementation with the Maxepa capsules, there was a very strong increase in EPA, docosapentaenoic acid (22:5n3) and DHA content in SPL. It was followed by a strong decrease after the wash-out (all p < 0.0001). The oleic acid SPL content after the intervention significantly decreased from 10. 105 +/- 0.307% (mean +/- S. E. M.) to 9.082 +/- 0.276 % (p < 0.0003). During the wash-out, the change was in the opposite direction (p < 0.0001). When the intervention and the wash-out periods were taken together, changes in the oleic acid were inversely correlated with changes in EPA, docosapentaenoic acid and DHA (r = -0.729; r = -0.552; r = -0.629, respectively; p < 0.0001; n = 56). On the background of the overall n-6 FA reduction, the decline in the arachidonic acid after the supplementation (p < 0.0001) and its rise after the wash-out (p < 0.0003) were similar. There were no significant changes in the saturated FA spectrum. CONCLUSIONS: Supplementation with long-chain n-3 FAs in NIDDM patients leads to the lowering of oleic acid SPL content. Whereas the reduction of the arachidonic acid may have some desirable aspects (e. g. suppression of thromboxane TxA2 or 4 series leukotriene production), the decline of the former is to be regarded as a potential problem. Therefore, the search for optimally balanced blends of n-3 polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) seems to be more promising than a supplementation with only one type of FA.

[Importance of certain hemostatic indicators as cardiovascular risk factors in type 2 diabetes]. / Význam niektorých hemostatických ukazovatelvov ako kardiovaskulárnych rizík u diabetikov 2. typu.

BACKGROUND: Abnormal levels of some hemostatic factors in patients with type 2 diabetes mellitus are associated with increased risk of severe cardiovascular complications. OBJECTIVES: For the purpose of clinical practice it is necessary to specify most relevant coagulation factor abnormalities pertaining to a particular patient's risk profile (e.g. diabetes duration, his/her lipoprotein profile), since a routine examination to their full extent is in common ambulatory practice hardly manageable. This information is also needed for aiming the efforts to influence them purposefully. METHODS: The investigated group included 42 out-patients with type 2 diabetes mellitus. Selected hemostatic factors and lipoproteins were measured with standard methods. Patients were stratified into terciles based on supposedly causative factors (diabetes duration for vWF and lipoproteins for F VII), these relations being also examined in the whole group using regression analysis. MAIN RESULTS AND CONCLUSIONS: vWF (antigen) plasma concentration mean value in the whole group (in % of reference plasma: 149.917; 95% CI 134.296 to 165.538) was on the upper limit of the normal value reference range (56 to 140), exceeding it distinctly in the tercile III with the longest diabetes duration (vWF mean was 180.115; 95% CI 151.961 to 208.270). The mean in this tercile was also by 42.187 (95% CI of diff. 10.231 to 74.142; sign. level 0.012) higher than in the tercile I with the shortest diabetes duration. These 2 variables significantly correlated (r = 0.345; p = 0.025) also in the whole group. F VII plasma concentration mean values in terciles III with highest triacylglycerol (TAG) or total cholesterol (TCH) serum levels (in %: 129.286, 95% CI 121.117 to 137.455 or 121.071, 95% CI 109.228 to 132.915, respectively; the normal value reference range being 70 to 130) clearly surpassed the analogous values in tercile I by 35.0 (95% CI of diff. 22.793 to 47.207; sign. level < 10(-5)) or by 26.0 (95% CI of diff. 10.815 to 41.185; sign. level 0.002), respectively. There were also positive significant correlations between lipoproteins (TAG, TCH or LDL) and F VII in the whole group (r = 0.697, r = 0.580, r = 0.397; p < 0.0001, p < 0.0001, p = 0.018, respectively). Therefore the estimation of vWF seems to be useful in all diabetic patients and most elevated values are to be expected in long-duration-diabetics. F VII should be cared for especially in patients with concomitantly elevated TAG, TCH or LDL-cholesterol serum levels. (Tab. 6, Fig. 4, Ref. 24.)

Oleic acid serum phospholipid content is linked with the serum total- and LDL-cholesterol in elderly subjects.

INTRODUCTION: Increased dietary intake of the olive oil has been found to lower several cardiovascular risk factors. Aim of our study was to check if there is any link between the oleic acid (OL-18:1n9) serum phospholipid (SPL) content and some of these factors in subjects living relatively far from the Mediterranean region and in habitual conditions, i.e. without any dietary intervention. MATERIAL AND METHODS: The investigated group included 62 out-patients older than 51 yr. Serum lipids were measured using standard hospital laboratory methods, the LDL-cholesterol was calculated using Friedewald's formula. Gas chromatography was used for estimation of fatty acids (FA) in SPL, their values were calculated as relative percentages of all FA. RESULTS: There was a statistically significant inverse correlation between the OL SPL content and the serum total cholesterol (TCHOL) in all 62 patients (r = -0.294; p = 0.020). Analogous correlation was marginally significant for the LDL (r = -0.245; p = 0.055). After a division into 2 groups based on the median of the OL, the group with OL higher than median had significantly lower both TCHOL and LDL (p = 0.014; p = 0.033, respectively). OL correlated positively with the alpha-linolenic acid (18:3n3; r = 0.281; p = 0.027) but inversely with the stearic acid (18:0; r = -0.303; p = 0.017). CONCLUSION: The subjects with less OL in their SPL had higher TCHOL and LDL serum levels and also their fatty acid SPL spectrum showed some other features which may be characterized as undesirable. This is an independent argument emphasizing the need for enhancing OL dietary intake.

[The effect of n-3 fatty acid administration on selected indicators of cardiovascular disease risk in patients with type 2 diabetes mellitus]. / Vplyv podávania n-3 mastných kyselín na vybrané ukazovatele kardiovaskulárnych rizík u pacientov s diabetom mellitus II. typu.

BACKGROUND: Serum triacylglycerols (TG), VLDL, HDL, fatty acid and eicosanoid spectrum are among the factors determining the risk of cardiovascular complications in NIDDM. N-3 polyunsaturated fatty acids (PUFA) are expected to have beneficial effects on these factors. In NIDDM patients there have however been previously reported (late 1980s) some adverse effects. OBJECTIVES: Our aim was to verify the effects of n-3 PUFA in NIDDM patients using relatively low dosage. METHODS: The investigated group included 21 NIDDM patients with dyslipoproteinemia type IV. The patients were treated for 28 days with 1.7 g EPA (eicosapentaenoic acid) + 1.15 g DHA (docosahexaenoic acid)/day (10 capsules/day of MAXEPA, Seven Seas U.K.). The lipoproteins were measured using the BIO-LACHEMA kits, the fatty acid spectrum in phospholipids was determined by gas chromatography and prostanoids (after their separation) were measured by RIA methods. MAIN RESULTS AND CONCLUSIONS: After the MAXEPA treatment there has been a strong decrease in TG (p < 0.005) and VLDL (p < 0.002) serum levels, accompanied by a significant increase in HDL (p < 0.02). The final-to-baseline TG ratio in individual patients negatively correlated with the relative percentage of EPA in phospholipids after the treatment (p < 0.03; r = -0.474). There was no significant change in serum total cholesterol, fasting glycaemia and glycosylated hemoglobin. There was a slight, but statistically already significant (p < 0.05), rise in LDL. The relative percentage of EPA, docosapentaenoic acid and DHA in serum phospholipids increased sharply (p < 0.001, p < 0.001, p < 0.001). The increase of n-3 PUFA in individual patients was linked with the decrease in n-6 PUFA (p < 0.001; r = -0.686). The spectrum of the latter has changed also very markedly. The prostacyclin PGI2-to-thromboxane TxA2 ratio increased significantly (p < 0.001). Beneficial effects of n-3 fatty acids have prevailed and this kind of treatment seems very encouraging also in NIDDM patients. The results are logically compatible with other authors' results pattern formed in 1990s. A slight rise in serum LDL needs a more detailed discussion since only its phenotype B ("small dense LDL particles") has been recently found to be atherogenic. (Tab. 2, Fig. 5, Ref. 15.)