A Double-Blind Randomized Trial of Fish Oil to Lower Triglycerides and Improve Cardiometabolic Risk in Adolescents
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Objectives To determine the efficacy of 4 g/day fish oil to lower triglycerides and impact lipoprotein particles, inflammation, insulin resistance, coagulation, and thrombosis.Study design Participants (n = 42, age 14 ± 2 years) with hypertriglyceridemia and low-density lipoprotein (LDL) cholesterol <160 mg/dL were enrolled in a randomized, double-blind, crossover trial comparing 4 g of fish oil daily with placebo. Treatment interval was 8 weeks with a 4-week washout. Lipid profile, lipoprotein particle distribution and size, glucose, insulin, high-sensitivity C-reactive protein, interleukin-6, fibrinogen, plasminogen activator inhibitor-1, and thrombin generation were measured.Results Baseline lipid profile was total cholesterol 194 (5.4) mg/dL (mean [SE]), triglycerides 272 (21) mg/dL, high-density lipoprotein cholesterol 39 (1) mg/dL, and LDL cholesterol 112 (3.7) mg/dl. LDL particle number was 1614 (60) nmol/L, LDL size was 19.9 (1.4) nm, and large very low-density lipoprotein/chylomicron particle number was 9.6 (1.4) nmol/L. Triglycerides decreased on fish oil treatment but the difference was not significant compared with placebo (-52 ± 16 mg/dL vs -16 ± 16 mg/dL). Large very low-density lipoprotein particle number was reduced (-5.83 ± 1.29 nmol/L vs -0.96 ± 1.31 nmol/L; P < .0001). There was no change in LDL particle number or size. There was a trend towards a lower prothrombotic state (lower fibrinogen and plasminogen activator inhibitor-1; .10 > P > .05); no other group differences were seen.Conclusions In children, fish oil (4 g/day) lowers triglycerides slightly and may have an antithrombotic effect but has no effect on LDL particles.
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Prescription doses of omega-3 fatty acids appear as safe for managing elevated triglycerides in adolescents and children as young as 10 years as for adults.
“Prescription doses of n-3 FA appear to be as safe for the management of elevated triglycerides in adolescents and children as young as 10 years of age as they are for adults.78,79”
From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [79]
The Methods section enrolled adolescents eligible from ages 10–17 with elevated triglycerides, and the Results section says 4 g/day fish oil was well tolerated, with medication-related adverse events that were mild to moderate. The paper does not compare safety with adults, and eligibility from age 10 does not establish that a 10-year-old participant received treatment. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThose pediatric trials used lower doses (less than 2 g/d EPA+DHA) or had small sample sizes (fewer than 20 participants per arm), sometimes including patients with only mildly elevated triglycerides.
“However, these trials used lower doses (<2 g/d EPA+DHA) 81 or had relatively small sample sizes (<20 participants per study arm) 79,81 that in some cases included patients with only mildly elevated triglycerides.81”
From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [79]
The Methods report 42 adolescents in a crossover trial, supporting the description of a relatively small study, but the available passages do not establish fewer than 20 participants per study arm. The Methods also specify at least 1.5 g DHA plus 1.86 g EPA daily—more than 2 g combined, contrary to the dose attributed to this trial. Enrollment allowed triglycerides from 150 mg/dL, but the Results describe the groups overall as having severely increased triglycerides; they do not establish that participants had only mildly elevated levels. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe few studies of omega-3 fatty acid supplementation in children and adolescents with hypertriglyceridemia have not shown a significant triglyceride-lowering effect.
“the few studies of n-3 FA supplementation in children/ adolescents with HTG have not shown a significant triglyceride-lowering effect.78,79,81”
From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [79]
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Pepper-Yowell, A. R. (2014) · ThinkTech (Texas Tech University) · Cited by 2 · see citing works
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Dyslipidemia in the Pediatric Population
Sunil, B., & Ashraf, A. P. (2020) · Springer eBooks · doi:10.1007/978-3-030-52215-5_57
- Authors
- Gidding, S. S., Prospero, C., Hossain, J., Zappalla, F., Balagopal, P. (., Falkner, B., & Kwiterovich, P.
- Affiliations
- Alfred I. duPont Hospital for Children (US)
- Mayo Clinic (US)
- Thomas Jefferson University (US)
- Johns Hopkins University (US)
- Corresponding author
- Gidding, Samuel S.
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 165
- Issue
- 3
- Pages
- 497-503.e2
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC5646219
- OpenAlex
- W2021411634
- Cited by
- 56
- References
- 37
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 7 · 2021: 7 · 2020: 5 · 2019: 6 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 1
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Medicine Forum (submittedVersion)
- Funders
- National Institute of General Medical Sciences (U54GM104941)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- fish oil, omega-3 fatty acids, hypertriglyceridemia, triglyceride lowering, adolescents, LDL cholesterol, lipoprotein particle size, cardiometabolic risk, inflammation, insulin resistance, thrombosis, fibrinogen, plasminogen activator inhibitor-1, thrombin generation
- MeSH terms
- Adolescent, Blood Coagulation, Double-Blind Method, Female, Fish Oils, Heart Diseases, Humans, Inflammation, Insulin Resistance, Cholesterol, LDL, Male, Metabolic Diseases, Risk Factors, Thrombosis, Triglycerides, Hypertriglyceridemia, Cross-Over Studies
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