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

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

Author de Borst, Martin H. Google Scholar
Baia, Leandro C. Autor UNIFESP Google Scholar
Hoogeveen, Ellen K. Google Scholar
Giltay, Erik J. Google Scholar
Navis, Gerjan Google Scholar
Bakker, Stephan J. L. Google Scholar
Geleijnse, Johanna M. Google Scholar
Kromhout, Daan Google Scholar
Soedamah-Muthu, Sabita S. Google Scholar
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 m(2) (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
xmlui.dri2xhtml.METS-1.0.item-coverage Basel
Language English
Sponsor Netherlands Heart Foundation]
US National Institutes of Health (NIH/NHLBI)
US National Institutes of Health (ODS)
Unilever RD, Vlaardingen
Royal Netherlands Academy of Arts and Sciences (KNAW)
Royal Netherlands Academy of Arts and Sciences
Dutch Kidney Foundation
Grant number Netherlands Heart Foundation: 2000T401
US National Institutes of Health (ODS): R01HL-076200
Dutch Kidney Foundation: PV41
Date 2017
Published in Nutrients. Basel, v. 9, n. 11, p. -, 2017.
ISSN 2072-6643 (Sherpa/Romeo, impact factor)
Publisher Mdpi Ag
Extent -
Origin http://dx.doi.org/10.3390/nu9111233
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000416547200071
URI https://repositorio.unifesp.br/handle/11600/58233

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