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Recommendations of the Spanish Menopause Society on the consumption of omega-3 polyunsaturated fatty acids by postmenopausal women

      Highlights

      • Long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) have antiarrhythmic effects, reduce blood pressure and decrease triglycerides.
      • LCO3-PUFAs improve some rheumatic processes, particularly rheumatoid arthritis.
      • Correction of LCO3-PUFA deficiency appears to improve depressive and psychotic symptoms.
      • LCO3-PUFA intake has not been found to be associated with an increased risk of any type of cancer.
      • We need more data to confirm the benefit of LCO3-PUFAs in the relief of menopause symptoms and osteoporosis.

      Abstract

      The consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) has shown a great variety of beneficial effects, including cardiovascular, metabolic and inflammatory effects, which make them interesting for the postmenopausal woman. Because LCO3-PUFAs could be effective and safe during this period, a panel of experts from the Spanish Menopause Society met to establish a set of recommendations for their use in postmenopausal women based on the best available evidence.
      The decrease in triglycerides is the most consistent effect observed with LCO3-PUFAs (at doses greater than 3 g/day). In addition, LCO3-PUFAs have antiarrhythmic effects, reduce blood pressure, improve depressive and psychotic symptoms, and do not increase the risk of cancer. However, further studies are needed to confirm the benefit of LCO3-PUFAs in the relief of menopause symptoms and osteoporosis.

      Keywords

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      References

        • Bourre J.M.
        Dietary omega-3 fatty acids for women.
        Biomed. Pharmacother. 2007; 61: 105-112
      1. http://cebgrade.mcmaster.ca/.

        • Calder P.C.
        Functional roles of fatty acids and their effects on human health.
        J. Parenter. Enteral. Nutr. 2015; 39: 18S-32S
        • European Food Safety Authority
        Scientific Opinion on the Tolerable Upper Intake Level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA).
        EFSA J. 2012; 10: 2815-2882
        • Ulven S.M.
        • Kirkhus B.
        • Lamglait A.
        • Basu S.
        • Elind E.
        • Haider T.
        • Berge K.
        • Vik H.
        • Pedersen J.I.
        Metabolic effects of krill oil are essentially similar to those of fish oil but at lower dose of EPA and DHA, in healthy volunteers.
        Lipids. 2011; 46: 37-46
        • Al-Khudairy L.
        • Hartley L.
        • Clar C.
        • Flowers N.
        • Hooper L.
        • Rees K.
        Omega 6 fatty acids for the primary prevention of cardiovascular disease.
        Cochrane Database Syst. Rev. 2015; (CD011094): 11
        • Kwak S.M.
        • Myung S.K.
        • Lee Y.J.
        • Seo H.G.
        Korean Metaanalysis Study Group Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double blind, placebocontrolled trials.
        Arch. Intern. Med. 2012; 172: 686-694
        • Roncaglioni M.C.
        • Tombesi M.
        • Avanzini F.
        • Barlera S.
        • Caimi V.
        • Longoni P.
        • et al.
        n-3 Fatty acids in patients with multiple cardiovascular risk factors. Risk and prevention study collaborative group.
        N. Engl. J. Med. 2013; 368: 1800-1808
        • Rizos E.C.
        • Ntzani E.E.
        • Bika E.
        • Kostapanos M.S.
        • Elisaf M.S.
        Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.
        JAMA. 2012; 308: 1024-1033
        • Chowdhury R.
        • Stevens S.
        • Gorman D.
        • Pan A.
        • Warnakula S.
        • Chowdhury S.
        • Ward H.
        • Johnson L.
        • Crowe F.
        • Hu F.B.
        • Franco O.H.
        Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis.
        BMJ. 2012; 345: e6698
        • Enns J.E.
        • Yeganeh A.
        • Zarychanski R.
        • Abou-Setta A.M.
        • Friesen C.
        • Zahradka P.
        • Taylor C.G.
        The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis.
        BMC Cardiovasc. Disord. 2014; 14: 70
        • Zheng T.
        • Zhao J.
        • Wang Y.
        • Liu W.
        • Wang Z.
        • Shang Y.
        • Zhang W.
        • Zhang Y.
        • Zhong M.
        The limited effect of omega-3 polyunsaturated fatty acids on cardiovascular risk in patients with impaired glucose metabolism: a meta-analysis.
        Clin. Biochem. 2014; 47: 369-377
        • Del Gobbo L.C.
        • Imamura F.
        • Aslibekyan S.
        • Marklund M.
        • Virtanen J.K.
        • Wennberg M.
        • et al.
        Cohorts for heart and aging research in genomic epidemiology (CHARGE) fatty acids and outcomes research consortium (FORCe). Ω-3 polyunsaturated fatty acid biomarkers and Coronary heart disease: pooling project of 19 cohort studies.
        JAMA Intern. Med. 2016; 8: 1155-1166
        • Schwingshackl L.
        • Boeing H.
        • Stelmach-Mardas M.
        • Gottschald M.
        • Dietrich S.
        • Hoffmann G.
        • Chaimani A.
        Dietary supplements and risk of cause-Specific death, cardiovascular disease, and cancer: a systematic review and meta-Analysis of primary prevention trials.
        Adv. Nutr. 2017; 8: 27-39
        • Von Schacky C.
        Omega-3 fatty acids in cardiovascular disease–an uphill battle.
        Prostaglandins Leukot. Essent. Fatty Acids. 2015; 92: 41-47
        • Gissi-HF Investigators
        • Tavazzi L.
        • Maggioni A.P.
        • Marchioli R.
        • Barlera S.
        • Franzosi M.G.
        • Latini R.
        • Lucci D.
        • Nicolosi G.L.
        • Porcu M.
        • Tognoni G.
        Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.
        Lancet. 2008; 372: 1223-1230
        • Davidson M.H.
        • Johnson J.
        • Rooney M.W.
        • Kyle M.L.
        • Kling D.F.
        A novel omega-3 free fatty acid formulation has dramatically improved bioavailability during a low-fat diet compared with omega-3-acid ethyl esters: the ECLIPSE (Epanova® compared to Lovaza® in a pharmacokinetic single-dose evaluation) study.
        J. Clin. Lipidol. 2012; 6: 573-584
        • Schuchardt J.P.
        • Hahn A.
        Bioavailability of long-chain omega-3 fatty acids.
        Prostaglandins Leukot. Essent. Fatty Acids. 2013; 89: 1-8
        • Köhler A.
        • Bittner D.
        • Löw A.
        • von Schacky C.
        Effects of a convenience drink fortified with n-3 fatty acids on the n-3 index.
        Br. J. Nutr. 2010; 104: 729-736
        • Langlois K.
        • Ratnayake W.M.
        Omega-3 index of Canadian adults.
        Health Rep. 2015; 26: 3-11
        • Lukaschek K.
        • von Schacky C.
        • Kruse J.
        • Ladwig K.H.
        Cognitive impairment is associated with a low omega-3 index in the elderly: results from the KORA-Age study.
        Dement. Geriatr. Cogn. Disord. 2016; 42: 236-245
        • Von Schacky C.
        • Passow A.
        • Kiefl R.
        Trans-fatty acid levels in erythrocytes in Europe.
        Eur. J. Nutr. 2016; 56: 1719-1723
        • Carlson S.J.
        • Fallon E.M.
        • Kalish B.T.
        • Gura K.M.
        • Puder M.
        The role of the ω-3 fatty acid DHA in the human life cycle.
        JPEN. J. Parenter. Enteral Nutr. 2013; 37: 15-22
        • Sydenham E.
        • Dangour A.D.
        • Lim W.S.
        Omega 3 fatty acid for the prevention of cognitive decline and dementia.
        Cochrane Database Syst. Rev. 2012; 6 (CD005379)
        • Campagnoli C.
        • Abbà C.
        • Ambroggio S.
        • Peris C.
        • Perona M.
        • Sanseverino P.
        Polyunsaturated fatty acids (PUFAs) might reduce hot flushes: an indication from two controlled trials on soy isoflavones alone and with a PUFA supplement.
        Maturitas. 2005; 51: 127-134
        • Reed S.D.
        • Guthrie K.A.
        • Newton K.M.
        • Anderson G.L.
        • Booth-LaForce C.
        • Caan B.
        • Carpenter J.S.
        • Cohen L.S.
        • Dunn A.L.
        • Ensrud K.E.
        • Freeman E.W.
        • Hunt J.R.
        • Joffe H.
        • Larson J.C.
        • Learman L.A.
        • Rothenberg R.
        • Seguin R.A.
        • Sherman K.J.
        • Sternfeld B.S.
        • LaCroix A.Z.
        Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.
        Am. J. Obstet. Gynecol. 2014; 210 (244. e1–11)
        • Cohen L.S.
        • Joffe H.
        • Guthrie K.A.
        • Ensrud K.E.
        • Freeman M.
        • Carpenter J.S.
        • Learman L.A.
        • Newton K.M.
        • Reed S.D.
        • Manson J.E.
        • Sternfeld B.
        • Caan B.
        • Freeman E.W.
        • LaCroix A.Z.
        • Tinker L.F.
        • Booth-Laforce C.
        • Larson J.C.
        • Anderson G.L.
        Efficacy of omega-3 for vasomotor symptoms treatment: a randomized controlled trial.
        Menopause. 2014; 21: 347-354
        • Freeman M.P.
        • Hibbeln J.R.
        • Silver M.
        • Hirschberg A.M.
        • Wang B.
        • Yule A.M.
        • Petrillo L.F.
        • Pascuillo E.
        • Economou N.I.
        • Joffe H.
        • Cohen L.S.
        Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial.
        Menopause. 2011; 18: 279-284
        • Lucas M.
        • Asselin G.
        • Merette C.
        • Poulin M.J.
        • Dodin S.
        Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial.
        Menopause. 2009; 16: 357-366
        • Guthrie K.A.
        • LaCroix A.Z.
        • Ensrud K.E.
        • Joffe H.
        • Newton K.M.
        • Reed S.D.
        • Caan B.
        • Carpenter J.S.
        • Cohen L.S.
        • Freeman E.W.
        • Larson J.C.
        • Manson J.E.
        • Rexrode K.
        • Skaar T.C.
        • Sternfeld B.
        • Anderson G.L.
        Pooled analysis of six pharmacologic and nonpharmacologic interventions for vasomotor symptoms.
        Obstet. Gynecol. 2015; 126: 413-422
        • Stark K.D.
        • Holub B.J.
        Differential eicosapentaenoic acid elevations and altered cardiovascular disease risk factor responses after supplementation with docosahexaenoic acid in postmenopausal women receiving and not receiving hormone replacement therapy.
        Am. J. Clin. Nutr. 2004; 79: 765-773
        • Watkins B.A.
        • Lippman P.M.
        • Le Bouteiller L.
        • et al.
        Bioactive fatty acids: role in bone biology and bone cell function.
        Prog. Lipid Res. 2001; 40: 125-148
        • Kruger M.C.
        • Coetzer H.
        • de Winter R.
        • et al.
        Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis.
        Aging (Milan). 1998; 10: 385-394
        • Orchard T.S.
        • Pan X.
        • Cheek F.
        • Ing S.W.
        • Jackson R.D.
        A systematic review of omega-3 fatty acids and osteoporosis.
        Br. J. Nutr. 2012; 107: S253-60
        • Dong H.
        • Hutchins-Wiese H.
        • Kleppinger A.
        • Annis K.
        • Liva E.
        • Lammi-Keefe C.
        • Durham H.
        • Feinn R.
        • Kenny A.M.
        Effects of omega-3 polyunsaturated fatty acid supplementation on bone turnover in older women.
        Int. J. Vitam. Nutr. Res. 2014; 84: 124-132
        • Lorente-Cebrián S.
        • Costa A.G.
        • Navas-Carretero S.
        • Zabala M.
        • Laiglesia L.M.
        • Martínez J.A.
        • Moreno-Aliaga M.J.
        An update on the role of omega-3 fatty acids on inflammatory and degenerative diseases.
        J. Physiol. Biochem. 2015; 71: 341-349
        • Yokoyama M.
        • Origasa H.
        • Matsuzaki M.
        • et al.
        Japan EPA Lipid Intervention Study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomized open-label, blinded endpoint analysis.
        Lancet. 2007; 9583: 220
        • Tsubura A.
        • Yuri T.
        • Yoshizawa K.
        • Uehara N.
        • Takada H.
        Role of fatty acids in malignancy and visual impairment: epidemiological evidence and experimental studies.
        Histol. Histopathol. 2009; 24: 223-234
        • Gerber M.
        Omega-3 fatty acids and cancers: a systematic update review of epidemiological studies.
        Br. J. Nutr. 2012; 107: S228-39
        • Lenihan-Geels G.
        • Bishop K.S.
        • Ferguson L.R.
        Cancer risk and eicosanoid production interaction between the protective effect of long chain omega-3 polyunsaturated fatty acid intake and genotype.
        J. Clin. Med. 2016; 5 (pii: E25)
        • Iyengar N.M.
        • Hudis C.A.
        • Gucalp A.
        Omega-3 fatty acids for the prevention of breast cancer: an update and state of the science.
        Curr. Breast Cancer Rep. 2013; 5: 247-254
        • Straka S.
        • Lester J.L.
        • Cole R.M.
        • Andridge R.R.
        • Puchala S.
        • Rose A.M.
        • Clinton S.K.
        • Belury M.A.
        • Yee L.D.
        Incorporation of eicosapentaenioic and docosahexaenoic acids into breast adipose tissue of women at high risk of breast cancer: a randomized clinical trial of dietary fish and n-3 fatty acid capsules.
        Mol. Nutr. Food Res. 2015; 59: 1780-1790
        • Zhang Y.F.
        • Gao H.F.
        • Hou A.J.
        • Zhou Y.H.
        Effect of omega- 3 fatty acid supplementation on cancer incidence, nonvascular death, and total mortality: a meta-analysis of randomized controlled trials.
        BMC Public Health. 2014; 14: 204
        • Hopkins M.M.
        • Meier K.E.
        Free fatty acid receptors and cancer: from nutrition to pharmacology.
        Handb. Exp. Pharmacol. 2017; 236: 233-251
        • Zheng J.S.
        • Hu X.J.
        • Zhao Y.M.
        • Yang J.
        • Li D.
        Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies.
        BMJ. 2013; 346: f3706
        • Fabian C.J.
        • Kimler B.F.
        • Hursting S.D.
        Omega-3 fatty acids for breast cancer prevention and survivorship.
        Breast Cancer Res. 2015; 17: 62
        • Haraldsdottir A.
        • Steingrimsdottir L.
        • Valdimarsdottir U.
        • Aspelund T.
        • Tryggvadottir L.
        • Harris T.B.
        • Launer L.
        • Mucci L.A.
        • Giovannucci E.L.
        • Adami H.O.
        • Gudnason V.
        • Torfadottir J.E.
        Early life residence, fish consumption and risk of breast cancer.
        Cancer Epidemiol. Biomark. Prev. 2016; (pii: cebp. 0473. 2016. [Epub ahead of print])
        • Sandhu N.
        • Schetter S.E.
        • Liao J.
        • Hartman T.J.
        • Richie J.P.
        • McGinley J.
        • Thompson H.J.
        • Prokopczyk B.
        • DuBrock C.
        • Signori C.
        • Hamilton C.
        • Calcagnotto A.
        • Trushin N.
        • Aliaga C.
        • Demers L.M.
        • El-Bayoumy K.
        • Manni A.
        Influence of obesity on Breast density reduction by omega-3 fatty acids: evidence from a randomized clinical trial.
        Cancer Prev. Res. (Phila). 2016; 9: 275-282
        • Mansara P.
        • Ketkar M.
        • Deshpande R.
        • Chaudhary A.
        • Shinde K.
        • Kaul-Ghanekar R.
        Improved antioxidant status by omega-3 fatty acid supplementation in breast cancer patients undergoing chemotherapy: a case series.
        J. Med. Case Rep. 2015; 9
        • Hutchins-Wiese H.L.
        • Picho K.
        • Watkins B.A.
        • Li Y.
        • Tannenbaum S.
        • Claffey K.
        • Kenny A.M.
        High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study.
        Nutr. Cancer. 2014; 66: 68-76
        • Bougnoux P.
        • Hajjaji N.
        • Maheo K.
        • Couet C.
        • Chevalier S.
        Fatty acids and breast cancer: sensitization to treatments and prevention of metastatic re-growth.
        Prog. Lipid Res. 2010; 49: 76-86
        • Dewey A.
        • Baughan C.
        • Dean T.
        • Higgins B.
        • Johnson I.
        Eicosapentaenoic acid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia.
        Cochrane Database Syst Rev. 2007; (CD004597)
        • Fabian C.J.
        • Kimler B.F.
        • Phillips T.A.
        • Box J.A.
        • Kreutzjans A.L.
        • Carlson S.E.
        • Hidaka B.H.
        • Metheny T.
        • Zalles C.M.
        • Mills G.B.
        • Powers K.R.
        • Sullivan D.K.
        • Petroff B.K.
        • Hensing W.L.
        • Fridley B.L.
        • Hursting S.D.
        Modulation of Breast cancer risk biomarkers by high-Dose omega-3 fatty acids: phase II pilot study in premenopausal women.
        Cancer Prev. Res. (Phila). 2015; 8: 912-921
        • Pan J.
        • Cheng L.
        • Bi X.
        • Zhang X.
        • Liu S.
        • Bai X.
        • Li F.
        • Zhao A.Z.
        Elevation of ω-3 polyunsaturated fatty acids attenuates PTEN-deficiency induced endometrial cancer development through regulation of COX-2 and PGE2 production.
        Sci. Rep. 2015; 5: 14958
        • Lu X.
        • Ding X.
        • Jing L.
        Effect of mechanism of action of different ω-6/ω-3 polyunsaturated fatty acids ratio on the growth of endometrial carcinoma mice.
        Cell Biochem. Biophys. 2015; 71: 1671-1676
        • Brasky T.M.
        • Neuhouser M.L.
        • Cohn D.E.
        • White E.
        Associations of long-chain (-3 fatty acids and fish intake with endometrial cancer risk in the VITamins And Lifestyle cohort.
        Am. J. Clin. Nutr. 2014; 99: 599-608
        • Terry P.
        • Wolk A.
        • Vainio H.
        • Weiderpass E.
        Fatty fish consumption lowers the risk of endometrial cancer: a nationwide case-control study in Sweden.
        Cancer Epidemiol. Biomark. Prev. 2002; 11: 143-145
        • Arem H.
        • Neuhouser M.L.
        • Irwin M.L.
        • Cartmel B.
        • Lu L.
        • Risch H.
        • Mayne S.T.
        • Yu H.
        Omega-3 and omega-6 fatty acid intakes and endometrial cancer risk in a population-based case-control study.
        Eur. J. Nutr. 2013; 52: 1251-1260
        • Brasky T.M.
        • Sponholtz T.R.
        • Palmer J.R.
        • Rosenberg L.
        • Ruiz-Narváez E.A.
        • Wise L.A.
        Associations of dietary long-chain ω-3 polyunsaturated fatty acids and fish consumption with endometrial cancer risk in the black women's health study.
        Am. J. Epidemiol. 2016; 183: 199-209
        • Brasky T.M.
        • Rodabough R.J.
        • Liu J.
        • Kurta M.L.
        • Wise L.A.
        • Orchard T.S.
        • Cohn D.E.
        • Belury M.A.
        • White E.
        • Manson J.E.
        • Neuhouser M.L.
        Long-chain ω-3 fatty acid intake and endometrial cancer risk in the Women's Health Initiative.
        Am. J. Clin. Nutr. 2015; 101: 824-834
        • Faloppa C.C.
        • Baiocchi G.
        • Cunha I.W.
        • Fregnani J.H.
        • Osorio C.A.
        • Fukazawa E.M.
        • Kumagai L.Y.
        • Badiglian-Filho L.
        • Pinto G.L.
        • Soares F.A.
        NF-κB and COX-2 expression in nonmalignant endometrial lesions and cancer.
        Am. J. Clin. Pathol. 2014; 141: 196-203