Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials

Paige E Miller, Mary Van Elswyk, Dominik D Alexander, Paige E Miller, Mary Van Elswyk, Dominik D Alexander

Abstract

Background: Although a large body of literature has been devoted to examining the relationship between eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and blood pressure, past systematic reviews have been hampered by narrow inclusion criteria and a limited scope of analytical subgroups. In addition, no meta-analysis to date has captured the substantial volume of randomized controlled trials (RCTs) published in the past 2 years. The objective of this meta-analysis was to examine the effect of EPA+DHA, without upper dose limits and including food sources, on blood pressure in RCTs.

Methods: Random-effects meta-analyses were used to generate weighted group mean differences and 95% confidence intervals (CIs) between the EPA+DHA group and the placebo group. Analyses were conducted for subgroups defined by key subject or study characteristics.

Results: Seventy RCTs were included. Compared with placebo, EPA+DHA provision reduced systolic blood pressure (-1.52 mm Hg; 95% confidence interval (CI) = -2.25 to -0.79) and diastolic blood pressure (-0.99 mm Hg; 95% CI = -1.54 to -0.44) in the meta-analyses of all studies combined. The strongest effects of EPA+DHA were observed among untreated hypertensive subjects (systolic blood pressure = -4.51 mm Hg, 95% CI = -6.12 to -2.83; diastolic blood pressure = -3.05 mm Hg, 95% CI = -4.35 to - 1.74), although blood pressure also was lowered among normotensive subjects (systolic blood pressure = -1.25 mm Hg, 95% CI = -2.05 to -0.46; diastolic blood pressure = -0.62 mm Hg, 95% CI = -1.22 to -0.02).

Conclusions: Overall, available evidence from RCTs indicates that provision of EPA+DHA reduces systolic blood pressure, while provision of ≥2 grams reduces diastolic blood pressure.

Keywords: blood pressure; docosahexaenoic acid; eicosapentaenoic acid; fish oil; hypertension; meta-analysis; omega-3; randomized controlled trials; systematic review.

© The Author 2014. Published by Oxford University Press on behalf of the American Journal of Hypertension.

Figures

Figure 1.
Figure 1.
Flow diagram of literature search and selection of randomized controlled trials (RCTs) for meta-analysis of eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and blood pressure.
Figure 2.
Figure 2.
Results from meta-analyses of randomized controlled trials examining eicosapentaenoic and docosahexaenoic acids (EPA+DHA) provision and (a) systolic blood pressure and (b) diastolic blood pressure among hypertensive subjects. The squares represent average change in blood pressure in individual randomized controlled trials, or individual trial strata, with 95% confidence intervals (CIs). The diamond represents the pooled summary estimate. Knapp (a) is a higher-dose subgroup, and Knapp (b) is a lower-dose subgroup.
Figure 3.
Figure 3.
Results from meta-analyses of randomized controlled trials examining eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and (a) systolic blood pressure and (b) diastolic blood pressure by EPA+DHA dose category. The circle represents the pooled summary estimate across all studies within each dose category, with 95% confidence intervals (CIs). n indicates the number of data points in each dose category, which may be greater than the number of individual studies.

References

    1. Centers for Disease Control and Prevention. Vital signs: prevalence, treatment, and control of hypertension—United States, 1999–2002 and 2005–2008. MMWR Morbid Mortal Wkly Rep 2011; 60:103–108.
    1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125:e2–e220.
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, Roccella EJ. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560–2572.
    1. Cabo J, Alonso R, Mata P. Omega-3 fatty acids and blood pressure. Br J Nutr 2012; 107:S195–S200.
    1. Hartweg J, Farmer AJ, Holman RR, Neil HAW. Meta-analysis of the effects of n-3 polyunsaturated fatty acids on haematological and thrombogenic factors in type 2 diabetes. Diabetologia 2007; 50:250–258.
    1. Xin W, Wei W, Li X. Effect of fish oil supplementation on fasting vascular endothelial function in humans: a meta-analysis of randomized controlled trials. PLoS One 2012; 7:e46028.
    1. Campbell F, Dickinson HO, Critchley JA, Ford GA, Bradburn M. A systematic review of fish-oil supplements for the prevention and treatment of hypertension. Eur J Prev Cardiol 2013; 20:107–120.
    1. Rothstein H, Sutton A, Borenstein M, eds. Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments. John Wiley and Sons: Chichester, England, 2005.
    1. Trials of Hypertension Prevention Collaborative Research Group (THPCRG). The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. JAMA 1992; 267:1213–1220.
    1. Armstrong P, Kelley DS, Newman JW, Staggers FE, Sr, Hartiala J, Allayee H, Stephensen CB. Arachidonate 5-lipoxygenase gene variants affect response to fish oil supplementation by healthy African Americans. J Nutr 2012; 142:1417–1428.
    1. Atar MJH, Hajianfar H, Bahonar A. The effects of omega-3 on blood pressure and the relationship between serum visfatin level and blood pressure in patients with type II diabetes. ARYA Atheroscler 2012; 8:27–31.
    1. Bach R, Schmidt U, Jung F, Kiesewetter H, Hennen B, Wenzel E, Schieffer H, Bette L, Heyden S. Effects of fish oil capsules in two dosages on blood pressure, platelet functions, haemorheological and clinical chemistry parameters in apparently healthy subjects. Ann Nutr Metab 1989; 33:359–367.
    1. Barcelo-Coblijn G, Murphy EJ, Othman R, Moghadasian MH, Kashour T, Friel JK. Flaxseed oil and fish-oil capsule consumption alters human red blood cell n-3 fatty acid composition: A multiple-dosing trial comparing 2 sources of n-3 fatty acid. Am J Clin Nutr 2008; 88:801–809.
    1. Bønaa KH, Bjerve KS, Straume B, Gram IT, Thelle D. Effect of eicosapentaenoic and docosahexaenoic acids on blood pressure in hypertension. A population-based intervention trial from the Tromsø study. N Engl J Med 1990; 795–801.
    1. Browning LM, Krebs JD, Moore CS, Mishra GD, O’Connell MA, Jebb SA. The impact of long chain n-3 polyunsaturated fatty acid supplementation on inflammation, insulin sensitivity and CVD risk in a group of overweight women with an inflammatory phenotype. Diabetes Obes Metab 2007; 9:70–80.
    1. Buckley JD, Burgess S, Murphy KJ, Howe PRC. DHA-rich fish oil lowers heart rate during submaximal exercise in elite Australian Rules footballers. J Sci Med Sport 2009; 12:503–507.
    1. Carter JR, Schwartz CE, Yang H, Joyner MJ. Fish oil and neurovascular control in humans. Am J Physiol Heart Circ Physiol 2012; 303:H450–H456.
    1. Cazzola R, Russo-Volpe S, Miles EA, Rees D, Banerjee T, Roynette CE, Wells SJ, Goua M, Wahle KWJ, Calder PC, Cestaro B. Age- and dose-dependent effects of an eicosapentaenoic acid-rich oil on cardiovascular risk factors in healthy male subjects. Atherosclerosis 2007; 193:159–167.
    1. Chin JP, Gust AP, Nestel PJ, Dart AM. Marine oils dose-dependently inhibit vasoconstriction of forearm resistance vessels in humans. Hypertension 1993; 21:22–28.
    1. Cobiac L, Clifton PM, Abbey M, Belling GB, Nestel PJ. Lipid, lipoprotein, and hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males. Am J Clin Nutr 1991; 53:1210–1216.
    1. Conquer JA, Cheryk LA, Chan E, Gentry PA, Holub BJ. Effect of supplementation with dietary seal oil on selected cardiovascular risk factors and hemostatic variables in healthy male subjects. Thromb Res 1999; 96:239–250.
    1. Croset M, Vericel E, Rigaud M, Hanss M, Courpron P, Dechavanne M, Lagarde M. Functions and tocopherol content of blood platelets from elderly people after low intake of purified eicosapentaenoic acid. Thromb Res 1990; 57:1–12.
    1. Demke DM, Peters GR, Linet OI, Metzler CM, Klott KA. Effects of a fish oil concentrate in patients with hypercholesterolemia. Atherosclerosis 1988; 70:73–80.
    1. Derosa G, Cicero AFG, Fogari E, D’Angelo A, Bonaventura A, Romano D, Maffioli P. Effects of n-3 PUFAs on postprandial variation of metalloproteinases, and inflammatory and insulin resistance parameters in dyslipidemic patients: evaluation with euglycemic clamp and oral fat load. J Clin Lipid 2012; 6:553–564.
    1. Derosa G, Maffioli P, D’Angelo A, Salvadeo SAT, Ferrari I, Fogari E, Gravina A, Mereu R, Randazzo S, Cicero AFG. Effects of long chain omega-3 fatty acids on metalloproteinases and their inhibitors in combined dyslipidemia patients. Expert Opin Pharmacother 2009; 10:1239–1247.
    1. Deslypere JP. Influence of supplementation with N-3 fatty acids on different coronary risk factors in men—a placebo controlled study. Verh K Acad Geneeskd Belg 1992; 54:189–216.
    1. Dewell A, Marvasti FF, Harris WS, Tsao P, Gardner CD. Low- and high-dose plant and marine (n-3) fatty acids do not affect plasma inflammatory markers in adults with metabolic syndrome. J Nutr 2011; 141:2166–2171.
    1. Dyerberg J, Eskesen DC, Andersen PW, Astrup A, Buemann B, Christensen JH, Clausen P, Rasmussen BF, Schmidt EB, Tholstrup T, Toft E, Toubro S, Stender S. Effects of trans- and n-3 unsaturated fatty acids on cardiovascular risk markers in healthy males. An 8 weeks dietary intervention study. Eur J Clin Nutr 2004; 58:1062–1070.
    1. Finnegan YE, Minihane AM, Leigh-Firbank EC, Kew S, Meijer GW, Muggli R, Calder PC, Williams CM. Plant- and marine-derived n-3 polyunsaturated fatty acids have differential effects on fasting and postprandial blood lipid concentrations and on the susceptibility of LDL to oxidative modification in moderately hyperlipidemic subjects. Am J Clin Nutr 2003; 77:783–795.
    1. Flaten H, Hostmark AT, Kierulf P, Lystad E, Trygg K, Bjerkedal T, Osland A. Fish-oil concentrate: effects on variables related to cardiovascular disease. Am J Clin Nutr 1990; 52:300–306.
    1. Geelen A, Zock PL, Swenne CA, Brouwer IA, Schouten EG, Katan MB. Effect of n-3 fatty acids on heart rate variability and baroreflex sensitivity in middle-aged subjects. Am Heart J 2003; 146:E4.
    1. Ginty AT, Conklin SM. Preliminary evidence that acute long-chain omega-3 supplementation reduces cardiovascular reactivity to mental stress: a randomized and placebo controlled trial. Biol Psychol 2012; 89:269–272.
    1. Grimsgaard S, Bonaa KH, Hansen JB, Myhre ES. Effects of highly purified eicosapentaenoic acid and docosahexaenoic acid on hemodynamics in humans. Am J Clin Nutr 1998; 68:52–59.
    1. Gustafsson IB, Ohrvall M, Ekstrand B, Vessby B. Moderate amounts of n-3 fatty acid enriched seafood products are effective in lowering serum triglycerides and blood pressure in healthy subjects. J Hum Nutr Diet 1996; 9:135–145.
    1. Hallund J, Madsen BO, Bugel SH, Jacobsen C, Jakobsen J, Krarup H, Holm J, Nielsen HH, Lauritzen L. The effect of farmed trout on cardiovascular risk markers in healthy men. Br J Nutr 2010; 104:1528–1536.
    1. Harris WS, Lemke SL, Hansen SN, Goldstein DA, DiRienzo MA, Su H, Nemeth MA, Taylor ML, Ahmed G, George C. Stearidonic acid-enriched soybean oil increased the omega-3 index, an emerging cardiovascular risk marker. Lipids 2008; 43:805–811.
    1. Hellsten G, Boman K, Saarem K, Hallmans G, Nilsson TK. Effects on fibrinolytic activity of corn oil and a fish oil preparation enriched with omega-3-polyunsaturated fatty acids in a long-term study. Curr Med Res Opin 1993; 13:133–139.
    1. Hill AM, Buckley JD, Murphy KJ, Howe PRC. Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors. Am J Clin Nutr 2007; 85:1267–1274.
    1. Hughes GS, Ringer TV, Watts KC, DeLoof MJ, Francom SF, Spillers CR. Fish oil produces an atherogenic lipid profile in hypertensive men. Atherosclerosis 1990; 84:229–237.
    1. Kelley DS, Siegel D, Vemuri M, Mackey BE. Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr 2007; 86:324–333.
    1. Knapp HR, FitzGerald GA. The antihypertensive effects of fish oil. A controlled study of polyunsaturated fatty acid supplements in essential hypertension. N Engl J Med 1989; 320:1037–1043.
    1. Landmark K, Thaulow E, Hysing J, Mundal HH, Eritsland J, Hjermann I. Effects of fish oil, nifedipine and their combination on blood pressure and lipids in primary hypertension. J Hum Hypertens 1993; 7:25–32.
    1. Levinson PD, Iosiphidis AH, Saritelli AL, Herbert PN, Steiner M. Effects of n-3 fatty acids in essential hypertension. Am J Hypertens 1990; 3:754–760.
    1. Lofgren RP, Wilt TJ, Nichol KL, Crespin L, Pluhar R, Eckfeldt J. The effect of fish oil supplements on blood pressure. Am J Pub Health 1993; 83:267–269.
    1. Mackness MI, Bhatnagar D, Durrington PN, Prais H, Haynes B, Morgan J, Borthwick L. Effects of a new fish oil concentrate on plasma lipids and lipoproteins in patients with hypertriglyceridaemia. Eur J Clin Nutr 1994; 48:859–865.
    1. Maki KC, Reeves MS, Farmer M, Griinari M, Berge K, Vik H, Hubacher R, Rains TM. Krill oil supplementation increases plasma concentrations of eicosapentaenoic and docosahexaenoic acids in overweight and obese men and women. Nutr Res 2009; 29:609–615.
    1. McVeigh GE, Brennan GM, Cohn JN, Finkelstein SM, Hayes RJ, Johnston GD. Fish oil improves arterial compliance in non-insulin-dependent diabetes mellitus. Arterioscler Thromb 1994; 14:1425–1429.
    1. Meland E, Fugelli P, Laerum E, Ronneberg R, Sandvik L. Effect of fish oil on blood pressure and blood lipids in men with mild to moderate hypertension. Scand J Prim Health Care 1989; 7:131–135.
    1. Mills DE, Mah M, Ward RP, Morris BL, Floras JS. Alteration of baroreflex control of forearm vascular resistance by dietary fatty acids. Amer J Physiol 1990; 259:R1164–R1171.
    1. Mills DE, Prkachin KM, Harvey KA, Ward RP. Dietary fatty acid supplementation alters stress reactivity and performance in man. J Hum Hypertens 1989; 3:111–116.
    1. Monahan KD, Wilson TE, Ray CA. Omega-3 fatty acid supplementation augments sympathetic nerve activity responses to physiological stressors in humans. Hypertension 2004; 44:732–738.
    1. Mori TA, Bao DQ, Burke V, Puddey IB, Beilin LJ. Docosahexaenoic acid but not eicosapentaenoic acid lowers ambulatory blood pressure and heart rate in humans. Hypertension 1999; 34:253–260.
    1. Mortensen JZ, Schmidt EB, Nielsen AH, Dyerberg J. The effect of N-6 and N-3 polyunsaturated fatty acids on hemostasis, blood lipids and blood pressure. Thromb Haemost 1983; 50:543–546.
    1. Mundal HH, Gjesdal K, Landmark K. The effect of N-3 fatty acids and nifedipine on platelet function in hypertensive males. Thromb Res 1993; 72:257–262.
    1. Murphy KJ, Meyer BJ, Mori TA, Burke V, Mansour J, Patch CS, Tapsell LC, Noakes M, Clifton PA, Barden A, Puddey IB, Beilin LJ, Howe PRC. Impact of foods enriched with n-3 long-chain polyunsaturated fatty acids on erythrocyte n-3 levels and cardiovascular risk factors. Br J Nutr 2007; 97:749–757.
    1. Neff LM, Culiner J, Cunningham-Rundles S, Seidman C, Meehan D, Maturi J, Wittkowski KM, Levine B, Breslow JL. Algal docosahexaenoic acid affects plasma lipoprotein particle size distribution in overweight and obese adults. J Nutr 2011; 141:207–213.
    1. Nestel P, Shige H, Pomeroy S, Cehun M, Abbey M, Raederstorff D. The n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid increase systemic arterial compliance in humans. Am J Clin Nutr 2002; 76:326–330.
    1. Nordoy A, Hansen JB, Brox J, Svensson B. Effects of atorvastatin and omega-3 fatty acids on LDL subfractions and postprandial hyperlipemia in patients with combined hyperlipemia. Nutr Metab Cardiovas 2001; 11:7–16.
    1. Noreen EE, Brandauer J. The effects of supplemental fish oil on blood pressure and morning cortisol in normotensive adults: a pilot study. J Compl Integr Med 2012; 9:1–16.
    1. Passfall J, Philipp T, Woermann F, Quass P, Thiede M, Haller H. Different effects of eicosapentaenoic acid and olive oil on blood pressure, intracellular free platelet calcium, and plasma lipids in patients with essential hypertension. Clin Investigator 1993; 71:628–633.
    1. Prisco D, Paniccia R, Bandinelli B, Filippini M, Francalanci I, Giusti B, Giurlani L, Gensini GF, Abbate R, Neri Serneri GG. Effect of medium-term supplementation with a moderate dose of n-3 polyunsaturated fatty acids on blood pressure in mild hypertensive patients. Thromb Res 1998; 91:105–112.
    1. Radack K, Deck C, Huster G. The effects of low doses of n-3 fatty acid supplementation on blood pressure in hypertensive subjects. A randomized controlled trial. Arch Intern Med 1991; 151:1173–1180.
    1. Ramel A, Martinez JA, Kiely M, Bandarra NM, Thorsdottir I. Moderate consumption of fatty fish reduces diastolic blood pressure in overweight and obese European young adults during energy restriction. Nutrition 2010; 26:168–174.
    1. Ryu J, Lerner J, Sullivan JM. Unresponsiveness of forearm hemodynamics to omega-3 polyunsaturated fatty acids and aspirin. Prostaglandins 1990; 39:339–347.
    1. Sagara M, Njelekela M, Teramoto T, Taguchi T, Mori M, Armitage L, Birt N, Birt C, Yamori Y. Effects of docosahexaenoic acid supplementation on blood pressure, heart rate, and serum lipids in scottish men with hypertension and hypercholesterolemia. Int J Hypertens 2011; 2011:1–7.
    1. Sanders TA, Gleason K, Griffin B, Miller GJ. Influence of an algal triacylglycerol containing docosahexaenoic acid (22:6n-3) and docosapentaenoic acid (22:5n-6) on cardiovascular risk factors in healthy men and women. Br J Nutr 2006; 95:525–531.
    1. Sjoberg NJ, Milte CM, Buckley JD, Howe PRC, Coates AM, Saint DA. Dose-dependent increases in heart rate variability and arterial compliance in overweight and obese adults with DHA-rich fish oil supplementation. Br J Nutr 2010; 103:243–248.
    1. Stark KD, Holub BJ. Differential eicosapentaenoic acid elevations and altered cardiovascular disease risk factor responses after supplementation with docosahexaenoic acid in postmenopausal women recieving and not receiving hormon replacement therapy. Am J Clin Nutr 2004; 79:765–773.
    1. Steiner A, Oertel R, Battig B, Pletscher W, Weiss B, Germinger P, Vetter W. Effect of fish oil on blood pressure and serum lipids in hypertension and hyperlipidaemia. J Hypertens 1989; 7:S73–S76.
    1. Theobald HE, Goodall AH, Sattar N, Talbot DCS, Chowienczyk PJ, Sanders TAB. Low-dose docosahexaenoic acid lowers diastolic blood pressure in middle-aged men and women. J Nutr 2007; 137:973–978.
    1. Toft I, Bonaa KH, Ingebretsen OC, Nordoy A, Jenssen T. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. A randomized, controlled trial. Ann Intern Med 1995; 123:911–918.
    1. Vakhapova V, Richter Y, Cohen T, Herzog Y, Korczyn AD. Safety of phosphatidylserine containing omega-3 fatty acids in non-demented elderly: a double-blind placebo-controlled trial followed by an open-label extension. BMC Neurol 2011; 11:79.
    1. Vandongen R, Mori TA, Burke V, Beilin LJ, Morris J, Ritchie J. Effects on blood pressure of omega 3 fats in subjects at increased risk of cardiovascular disease. Hypertension 1993; 22:371–379.
    1. Vericel E, Calzada C, Chapuy P, Lagarde M. The influence of low intake of n-3 fatty acids on platelets in elderly people. Atherosclerosis 1999; 147:187–192.
    1. von Houwelingen R, Nordoy A, van der Beek E, Houtsmuller U, de Metz M, Hornstra G. Effect of a moderate fish intake on blood pressure, bleeding time, hematology, and clincical chemistry in healthy males. Am J Clin Nutr 1987; 46:424–436.
    1. Walser B, Stebbins CL. Omega-3 fatty acid supplementation enhances stroke volume and cardiac output during dynamic exercise. Eur J Appl Physiol 2008; 104:455–461.
    1. Wang S, Ma AQ, Song SW, Quan QH, Zhao XF, Zheng XH. Fish oil supplementation improves large arterial elasticity in overweight hypertensive patients. Eur J Clin Nutr 2008; 62:1426–1431.
    1. Lindqvist HM, Langkilde AM, Undeland I, Sandberg AS. Herring (Clupea harengus) intake influences lipoproteins but not inflammatory and oxidation markers in overweight men. Br J Nutr 2009; 101:383–390.
    1. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24:215–233.
    1. Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation 1993; 88:523–533.
    1. Geleijnse JM, Giltay EJ, Grobbee DE, Donders AR, Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens 2002; 20:1493–1499.
    1. Mozaffarian D. Fish, n-3 fatty acids, and cardiovascular haemodynamics. J Cardiovasc Med (Hagerstown) 2007; 8:S23––S26.
    1. Wang Q, Liang X, Wang L, Lu X, Huang J, Cao J, Li H, Gu D. Effect of omega-3 fatty acids supplementation on endothelial function: a meta-analysis of randomized controlled trials. Atherosclerosis 2012; 221:536–543.
    1. Egert S, Stehle P. Impact of n-3 fatty acids on endothelial function: results from human interventions studies. Curr Opin Clin Nutr Metab Care 2011; 14:121–131.
    1. Appel LJ, American Society of Hypertension Writing Group, Giles TD, Black HR, Izzo JL, Jr, Materson BJ, Oparil S, Weber MA. ASH position paper: dietary approaches to lower blood pressure. J Clin Hypertens (Greenwich) 2009; 11:358–368.
    1. Appel LJ, Miller ER, 3rd, Seidler AJ, Whelton PK. Does supplementation of diet with “fish oil” reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med 1993; 153:1429–1438.
    1. Ruxton CHS. The benefits of fish consumption. Nutr Bull 2011; 36:6–19.
    1. Adophus K, Biac S. Oily fish consumption in young adults: current intakes, knowledge, barriers and motivations. J Hum Nutr Diet 2011; 24:375.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren