Changes in Total Homocysteine Levels Following Supplementation of Omega-3 Fatty Acid

Aim: Vascular damage and premature atherosclerosis occurs when arterial endothelium is exposed to elevated levels of homocysteine. The purpose of this study was to examine the effect of an over-the-counter (OTC) Omega-3 fatty acid (n-3) supplementation on total homocysteine (tHcy) levels in ESRD patients undergoing chronic hemodialysis. Methods: A permuted-randomized, double-blind and placebo controlled experimental protocol was used. End-Stage-Renal Disease (ESRD) patients (N=69) were followed prospectively while supplementing fish oil (treatment [n-3]) or corn oil (placebo [n-6]) for six months. tHcy was obtained through whole blood analysis at baseline and at six months. Results: The results of this study using regression models revealed differences in age and gender regarding homocysteine levels at the posttest (six months). Study findings contradicted previous published work with the present study findings suggesting that daily administration of n-3 fatty acids containing 160 mg of EPA (0.96 g/day) and 100 mg of DHA (0.6 g/day) had no effect on tHcy levels when compared to control. Conclusion: Published findings regarding the relationship between n-3 supplementation and tHcy have been equivocal and appear to vary based on sample population, n-3 dosage, and study duration. Potential reasons for this non-significant result of this study may be found in a dose-response relationship, as well advancement of disease progression in the sample population. This study did not support the work of previously published study authors who supplemented 4 grams per day with a higher dose of EPA (1.75 grams) and DHA (0.96 grams) using a pharmaceutical grade n-3 possibly creating a smaller dose-response in the present study. Secondly, ESRD patients have progressed morbidity making the lowering of tHcy problematic and may cause patients to not be responsive to a lower dosed OTC n-3 supplement. Hyperhomocysteinemia was elevated for a prolonged period of time in this patient population with supplementation possibly occurring too late in the morbid condition. Future studies should continue to focus on the OTC n-3 supplements to save out of pocket expenses for patients and decrease utilization of pharmaceutical treatments.