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Effect of omega-3 fatty acid supplementation on plasma fibroblast growth factor 23 levels in post-myocardial infarction patients with chronic kidney disease: The alpha omega trial
De Borst,Martin Baia,Leandro Hoogeveen,Ellen Giltay,Erik Navis,Gerjan Bakker,Stephan Geleijnse,Johanna Kromhout,Daan Soedamah-Muthu,S.S.
De Borst,Martin
Baia,Leandro
Hoogeveen,Ellen
Giltay,Erik
Navis,Gerjan
Bakker,Stephan
Geleijnse,Johanna
Kromhout,Daan
Soedamah-Muthu,S.S.
Abstract
Fibroblast growth factor 23 (FGF23) is an independent risk factor for cardiovascular mortality in chronic kidney disease. Omega-3 (n-3) fatty acid consumption has been inversely associated with FGF23 levels and with cardiovascular risk. We examined the effect of marine n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and plant-derived alpha-linolenic acid (ALA) on plasma FGF23 levels in post-myocardial infarction patients with chronic kidney disease. In the randomized double-blind Alpha Omega Trial, 4837 patients with a history of myocardial infarction aged 60–80 years (81% men) were randomized to one of four trial margarines supplemented with a targeted additional intake of 400 mg/day EPA and DHA, 2 g/day ALA, EPA-DHA plus ALA, or placebo for 41 months. In a subcohort of 336 patients with an eGFR < 60 mL/min/1.73 m2 (creatinine-cystatin C-based CKD-EPI formula), plasma C-terminal FGF23 was measured by ELISA at baseline and end of follow-up. We used analysis of covariance to examine treatment effects on FGF23 levels adjusted for baseline FGF23. Patients consumed 19.8 g margarine/day on average, providing an additional amount of 236 mg/day EPA with 158 mg/day DHA, 1.99 g/day ALA or both, in the active intervention groups. Over 79% of patients were treated with antihypertensive and antithrombotic medication and statins. At baseline, plasma FGF23 was 150 (128 to 172) RU/mL (mean (95% CI)). After 41 months, overall FGF23 levels had increased significantly (p < 0.0001) to 212 (183 to 241) RU/mL. Relative to the placebo, the treatment effect of EPA-DHA was indifferent, with a mean change in FGF23 (95% CI) of −17 (−97, 62) RU/mL (p = 0.7). Results were similar for ALA (36 (−42, 115) RU/mL) and combined EPA-DHA and ALA (34 (−44, 113) RU/mL). Multivariable adjustment, pooled analyses, and subgroup analyses yielded similar non-significant results. Long-term supplementation with modest quantities of EPA-DHA or ALA does not reduce plasma FGF23 levels when added to cardiovascular medication in post-myocardial patients with chronic kidney disease. Keywords: n-3 polyunsaturated fatty acids; fibroblast growth factor 23; myocardial infarction; chronic kidney disease; cardiovascular
Description
Date
2017
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Volume Title
Publisher
Research Projects
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Keywords
SDG 3 - Good Health and Well-being
Citation
De Borst, M, Baia, L, Hoogeveen, E, Giltay, E, Navis, G, Bakker, S, Geleijnse, J, Kromhout, D & Soedamah-Muthu, S S 2017, 'Effect of omega-3 fatty acid supplementation on plasma fibroblast growth factor 23 levels in post-myocardial infarction patients with chronic kidney disease : The alpha omega trial', Nutrients, vol. 9, no. 11, 1233. https://doi.org/10.3390/nu9111233
License
info:eu-repo/semantics/openAccess