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Title: Associations of obesity with triglycerides and C-reactive protein are attenuated in adults with high red blood cell eicosapentaenoic and docosahexaenoic acids

item MAKHOUL, ZEINA - Fred Hutchinson Cancer Research Center
item KRISTAL, ALAN - Fred Hutchinson Cancer Research Center
item GULATI, ROMAN - Fred Hutchinson Cancer Research Center
item LUICK, BRET - University Of Alaska
item BERSAMIN, ANDREA - University Of Alaska
item O'BRIEN, DIANE - University Of Alaska
item HOPKINS, SCARLETT - University Of Alaska
item Stephensen, Charles
item STANHOPE, KIMBER - University Of California
item HAVEL, PETER - University Of California
item BOYER, BERT - University Of Alaska

Submitted to: European Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/21/2011
Publication Date: 3/23/2011
Citation: Makhoul, Z., Kristal, A.R., Gulati, R., Luick, B., Bersamin, A., O'Brien, D., Hopkins, S.E., Stephensen, C.B., Stanhope, K.L., Havel, P.J., Boyer, B. 2011. Associations of obesity with triglycerides and C-reactive protein are attenuated in adults with high red blood cell eicosapentaenoic and docosahexaenoic acids. European Journal of Clinical Nutrition. 65(7):808-817. Available:

Interpretive Summary: Inflammation associated with obesity increases the risk of chronic inflammatory disease, such as cardiovascular disease. High intake of marine fatty acids, such as EPA and DHA found in cold-water fish, can decrease inflammation and the risk of heart disease. Most Americans have low levels of EPA and DHA in their diets and may take supplements to achieve beneficial levels, but Yup’ik Eskimos in Alaska have relatively high intake from their traditional diets. This work showed that low-grade, systemic inflammation was attenuated at high intakes of EPA and DHA by Yup’ik Eskimos from traditional diets, and that these levels were similar to those achieved with supplement use. This information will help inform recommendations for dietary and supplemental intakes of EPA and DHA.

Technical Abstract: Background:N-3 fatty acids are associated with favorable, and obesity with unfavorable, concentrations of chronic disease risk biomarkers.Objective:We examined whether high eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid intakes, measured as percentages of total red blood cell (RBC) fatty acids, modify associations of obesity with chronic disease risk biomarkers.Methods:In a cross-sectional study of 330 Yup'ik Eskimos, generalized additive models (GAM) and linear and quadratic regression models were used to examine associations of BMI with biomarkers across RBC EPA and DHA categories.Results:Median (5th-95th percentile) RBC EPA and DHA were 2.6% (0.5-5.9%) and 7.3% (3.3-8.9%), respectively. In regression models, associations of BMI with triglycerides, glucose, insulin, C-reactive protein (CRP) and leptin differed significantly by RBC EPA and DHA. The GAM confirmed regression results for triglycerides and CRP: at low RBC EPA and RBC DHA, the predicted increases in triglycerides and CRP concentrations associated with a BMI increase from 25 to 35 were 99.5±45.3'mg/dl (106%) and 137.8±71.0'mg/dl (156%), respectively, for triglycerides and 1.2±0.7'mg/l (61%) and 0.8±1.0'mg/l (35%), respectively, for CRP. At high RBC EPA and RBC DHA, these predicted increases were 13.9±8.1'mg/dl (23%) and 12.0±12.3'mg/dl (18%), respectively, for triglycerides and 0.5±0.5'mg/l (50%) and -0.5±0.6'mg/l (-34%), respectively, for CRP.Conclusions:In this population, high RBC EPA and DHA were associated with attenuated dyslipidemia and low-grade systemic inflammation among overweight and obese persons. This may help inform recommendations for n-3 fatty acid intakes in the reduction of obesity-related disease risk.European Journal of Clinical Nutrition advance online publication, 23 March 2011; doi:10.1038/ejcn.2011.39.