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August 5, 1988, Vol 260, No. 5 >
ARTICLE | August 5, 1988

Clinical Applications of Fish Oils FREE

Jack Zeev Yetiv, MD, PhD
[+] Author Affiliations

Reprints not available.


JAMA. 1988;260(5):665-670. doi:10.1001/jama.1988.03410050085035
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References

Fish oil supplements are currently being nationally advertised, and many physicians are being queried about their clinical utility. Epidemiologic studies reveal a low incidence of cardiovascular disease in people, such as the Eskimos, who eat large amounts of seafood. Cardiovascular health may be improved because fish and fish oil supplements lower plasma lipid levels (especially triglycerides), inhibit platelet aggregation, and may decrease blood pressure and viscosity and increase high-density lipoprotein (HDL) levels. Preliminary observations also suggest a potential future role for fish oils in the treatment of some autoimmune diseases, such as atopic dermatitis, psoriasis, and rheumatoid arthritis. Patients with serum triglyceride levels greater than 5.64 mmol/L and/or cholesterol levels greater than 7.75 mmol/L refractory to dietary management may benefit from a medically supervised trial of fish oil supplements. Data currently available are insufficient to recommend fish oil supplements for the general public, or for patients with other diseases, and side effects must also be considered. These include occasional adverse lipid changes, potential for bleeding and vitamin E deficiency, and, with some preparations, vitamin A and D toxicity.

(JAMA 1988;260:665-670)

REFERENCES

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Goodnight SH, Harris WS, Connor WE, et al:  Polyunsaturated fatty acids, hyperlipidemia, and thrombosis . Arteriosclerosis 1982;;2:87-113.
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Walker ARP:  Fish, fish oils and coronary heart disease . S Afr Med J 1985;;68:1-2.
5 +
Neutze JM, Starling MB:  Fish oils and coronary heart disease . NZ Med J 1986;;99:581-583.
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Herrold PM, Kinsella JE:  Fish oil consumption and decreased risk of cardiovascular disease: A comparison of findings from animal and human feeding trials . Am J Clin Nutr 1986;;43:566-598.
7 +
Von Schacky C:  Prophylaxis of atherosclerosis with marine omega-3 fatty acids: A comprehensive strategy . Ann Intern Med 1987;;107:890-899.
8 +
Leaf A, Weber PC:  Cardiovascular effects of n-3 fatty acids . N Engl J Med 1988;;318:549-557.
9 +
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10 +
Arthaud JB:  Cause of death in 339 Alaskan natives as determined by autopsy . Arch Pathol Lab Med 1970;;90:433-438.
11 +
Kromhout D, Bosschieter EB, Coulander CL:  The inverse relation between fish consumption and 20-year mortality from heart disease . N Engl J Med 1985;;312:1205-1209.
12 +
Shekelle RB, Paul 0, Shryock AM, et al:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:820.
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Norell SE, Ahlbom A, Feychting M, et al:  Fish consumption and mortality from coronary heart disease . Br Med J 1986;;293:426.
14 +
Vollset SE, Heuch I, Bjelke E:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:820-821.
15 +
Curb JD, Reed DM:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:821.
16 +
Kromann N, Green A:  Epidemiological studies in the Upernavik district, Greenland . Acta Med Scand 1980;;208:401-406.
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Hamberg M, Svensson J, Samuelsson B:  Thromboxanes: A new group of biologically active compounds derived from prostaglandin endoperoxides . Proc Nat Acad Sci USA 1975;;72:2994-2998.
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Moncada S, Higgs EA, Vane JR:  Human arterial and venous tissues generate prostacyclin (prostaglandin X), a potent inhibitor of platelet aggregation . Lancet 1977;;1:18-21.
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Vane JR:  Prostaglandins and the cardiovascular system . Br Heart J 1983;;49:405-409.
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Hamazaki T, Nakazawa R, Tateno S, et al:  Effects of fish oil rich in eicosapentaenoic acid on serum lipid in hyperlipidemic hemodialysis patients . Kidney Int 1984;;26:81-84.
22 +
Singer P, Wirth M, Berger I, et al:  Influence in serum lipids, lipoproteins and blood pressure of mackerel and herring diet in patients with type IV and V hyperlipoproteinemia . Atherosclerosis 1985;;56:111-116.
23 +
Simons LA, Hickie JB, Balasubramaniam S:  On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidemia . Atherosclerosis 1985;;54:75-88.
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Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Gunby P:  It's not fishy: Fruit of the sea may foil cardiovascular disease . JAMA 1982;;247:729-731.
2 +
Harris WS:  Health effects of omega-3 fatty acids . Contemp Nutr 1985;;10:1-2.
3 +
Goodnight SH, Harris WS, Connor WE, et al:  Polyunsaturated fatty acids, hyperlipidemia, and thrombosis . Arteriosclerosis 1982;;2:87-113.
4 +
Walker ARP:  Fish, fish oils and coronary heart disease . S Afr Med J 1985;;68:1-2.
5 +
Neutze JM, Starling MB:  Fish oils and coronary heart disease . NZ Med J 1986;;99:581-583.
6 +
Herrold PM, Kinsella JE:  Fish oil consumption and decreased risk of cardiovascular disease: A comparison of findings from animal and human feeding trials . Am J Clin Nutr 1986;;43:566-598.
7 +
Von Schacky C:  Prophylaxis of atherosclerosis with marine omega-3 fatty acids: A comprehensive strategy . Ann Intern Med 1987;;107:890-899.
8 +
Leaf A, Weber PC:  Cardiovascular effects of n-3 fatty acids . N Engl J Med 1988;;318:549-557.
9 +
 Eskimo diets and diseases , editorial. Lancet 1983;;1:1139-1141.
10 +
Arthaud JB:  Cause of death in 339 Alaskan natives as determined by autopsy . Arch Pathol Lab Med 1970;;90:433-438.
11 +
Kromhout D, Bosschieter EB, Coulander CL:  The inverse relation between fish consumption and 20-year mortality from heart disease . N Engl J Med 1985;;312:1205-1209.
12 +
Shekelle RB, Paul 0, Shryock AM, et al:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:820.
13 +
Norell SE, Ahlbom A, Feychting M, et al:  Fish consumption and mortality from coronary heart disease . Br Med J 1986;;293:426.
14 +
Vollset SE, Heuch I, Bjelke E:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:820-821.
15 +
Curb JD, Reed DM:  Fish consumption and mortality from coronary heart disease . N Engl J Med 1985;;313:821.
16 +
Kromann N, Green A:  Epidemiological studies in the Upernavik district, Greenland . Acta Med Scand 1980;;208:401-406.
17 +
Hamberg M, Svensson J, Samuelsson B:  Thromboxanes: A new group of biologically active compounds derived from prostaglandin endoperoxides . Proc Nat Acad Sci USA 1975;;72:2994-2998.
18 +
Moncada S, Higgs EA, Vane JR:  Human arterial and venous tissues generate prostacyclin (prostaglandin X), a potent inhibitor of platelet aggregation . Lancet 1977;;1:18-21.
19 +
Vane JR:  Prostaglandins and the cardiovascular system . Br Heart J 1983;;49:405-409.
20 +
Imaichi K, Michaels GD, Gunning B, et al:  Studies with the use of fish oil fractions in human subjects . Am J Clin Nutr 1963;;13:158-168.
21 +
Hamazaki T, Nakazawa R, Tateno S, et al:  Effects of fish oil rich in eicosapentaenoic acid on serum lipid in hyperlipidemic hemodialysis patients . Kidney Int 1984;;26:81-84.
22 +
Singer P, Wirth M, Berger I, et al:  Influence in serum lipids, lipoproteins and blood pressure of mackerel and herring diet in patients with type IV and V hyperlipoproteinemia . Atherosclerosis 1985;;56:111-116.
23 +
Simons LA, Hickie JB, Balasubramaniam S:  On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidemia . Atherosclerosis 1985;;54:75-88.
24 +
Raz A, Minkes MS, Needleman P:  Endoperoxides and thromboxanes: Structural determinants for platelet aggregation and vasoconstriction . Biochim Biophys Acta 1977;;488:305-311.
25 +
Needleman P, Raz A, Minkes M, et al:  Triene prostaglandins: Prostacyclin and thromboxane biosynthesis and unique biological properties . Proc Natl Acad Sci USA 1979;;76:944-948.
26 +
Samuelsson B:  Leukotrienes: Mediators of immediate hypersensitivity reactions and inflammation . Science 1983;;220:568-575.
27 +
Mullane KM, Salmon JA, Kraemer R:  Leukocyte-derived metabolites of arachidonic acid in ischemia-induced myocardial injury . Fed Proc 1987;;46:2422-2433.
28 +
Terano T, Salmon JA, Moncada S:  Biosynthesis and biological activity of leukotriene B5 . Prostaglandins 1984;;27:217-232.
29 +
Strasser TH, Fischer S, Weber PC:  Leukotriene B5 is formed in human neutrophils after dietary supplementation with eicosapentaenoic acid . Proc Natl Acad Sci USA 1985;;82:1540-1543.
30 +
Hilditch TP: The Chemical Constitution of Natural Fats , ed 3. New York, John Wiley & Sons Inc, 1956;, pp 376-377,402.
31 +
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To understand the clinical management of acute heart failure syndromes.
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