Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study☆

Borges, Mariane Curado; Santos, Fabiana de Miranda Moura dos; Telles, Rosa Weiss; Andrade, Marcus Vinícius Melo de; Correia, Maria Isabel Toulson Davisson; Lanna, Cristina Costa Duarte

doi:10.1016/j.rbre.2016.09.014

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Revista Brasileira de Reumatologia

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Original articles • Rev. Bras. Reumatol. 57 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.rbre.2016.09.014 copy

Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study^☆ ☆ Study conducted at Unidade de Reumatologia, Hospital das Clínicas; Faculdade de Medicina, Departamentos de Sistema Locomotor, Cirurgia e Medicina Interna, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Studies have shown that omega-3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C-reactive protein (CRP) and other inflammatory mediators.

Objective:

To investigate the effects of omega-3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE).

Methods:

Experimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega-3 group (daily intake of 1080 mg EPA + 200 mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega-3 group were compared using Wilcoxon test. U-Mann-Whitney test was used to compare variations of measured variables [ΔV = pre-treatment (T0) − post-treatment (T1) concentrations] between groups. p < 0.05 was considered significant.

Results:

The median (interquartile range - IQR) of age was 37 (29-48) years old, of disease duration was 7 (4-13) years, and of SLEDAI-2K was 1 (0-2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega-3 group while there was an increase in control group (p = 0.008). The serum concentrations of IL-6 and IL-10, leptin and adiponectin did not change after a 12 week treatment.

Conclusions:

Supplementation with omega-3 had no impact on serum concentrations of IL-6, IL-10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega-3 may impact total and LDL-cholesterol.

Keywords:
Omega 3; Cytokines; Adipokines; C reactive protein; Systemic lupus erythematosus

	Total n = 49	Omega-3 group n = 22	Control group n = 27	p ^c c Pearson's Chi-square, Fisher's exact or U-Mann-Whitney test.
Mucocutaneous disorders^a a N (%).	20 (40.8)	9 (40.9)	11 (40.7)	0.829
Arthritis^a a N (%).	3 (6.1)	1 (4.5)	2 (7.4)	0.724
Hematological disorders^a a N (%).	27 (55.1)	13 (59.1)	14 (51.9)	0.340
Lymphopenia^a a N (%).	26 (53.1)	13 (59.1)	13 (48.1)	0.233
Leukopenia^a a N (%).	10 (20.4)	3 (13.6)	7 (25.9)	0.390
Thrombocytopenia^a a N (%).	1 (2.0)	0	1 (3.7)	0.390
Nephritis^a a N (%).	11 (22.4)	5 (22.7)	6 (22.2)	0.861
Low C3^a a N (%).	9 (18.0)	2 (9.1)	7 (25.0)	0.146
Low C4^a a N (%).	10 (20.4)	3 (14.3)	3 (11.1)	0.102
Positive double strand antiDNA^a a N (%).	6 (12.5)	3 (14.3)	3 (11.1)	0.741
Current steroid dose (mg)^b b Median (interquartil range).	5.0 (2.5-10.0)	5.0 (0.6-10.0)	5.0 (3.5-8.1)	0.745
Cumulative steroid dose (g)^b b Median (interquartil range).	20.0 (12.2-37.8)	22.0 (12.7-56.7)	19.1 (12.1-30.5)	0.178
SLEDAI-2K^b b Median (interquartil range).	1 (0-2)	0 (0-2)	2 (0-4)	0.072
BMI (kg/m²2 Bhangle S, Kolasinski SL. Fish oil in rheumatic diseases. Rheum Dis Clin North Am. 2011;37:77-84.)^b b Median (interquartil range).	28.4 (25.7-30.9)	29.0 (25.7-30.7)	28.1 (25.2-31.4)	0.805
Body fat %^b b Median (interquartil range).	36.9 (33.7-41.1)	37.7 (33.2-41.9)	36.0 (33.1-38.8)	0.512
Obesity^a a N (%).	17 (34.7)	8 (36.4)	9 (33.3)	0.689
Current immunosuppressor use^a a N (%).	33 (64.7)	13 (59.1)	20 (69.0)	0.465

	Omega-3 group n = 22 Median (IQR)	Control group n = 27 Median (IQR)	p ^e e U-Mann-Whitney test.
IL-6 (pg/mL)	0.57 (0.40-2.90)^a a n = 21.	1.09 (0.52-1.98)^b b n = 26.	0.692
IL-10 (pg/mL)	19.05 (9.88-40.87)^c c n = 14.	21.41 (6.72-51.64)^d d n = 21.	0.699
Leptin (ng/mL)	80.03 (63.21-129.40)	58.12 (36.65-109.20)	0.067
Adiponectin (µg/mL)	42.30 (24.88-58.01)	40.08 (27.69-59.47)	0.817
Glucose (mg/dL)	77.5 (75.2-82.8)	78.0 (71.0-86.0)	0.958
Cholesterol (mg/dL)	168.0 (151.0-194.0)	182.0 (155.5-192.2)	0.899
LDL-c (mg/dL)	95.0 (80.0-116.0)	100.0 (84.5-111.8)	0.926
HDL-c (mg/dL)	52.0 (38.0-57.0)	53.0 (37.8-63.2)	0.498
Triglycerides (mg/dL)	88.0 (64.0-124.0)	79.5 (59.5-114.0)	0.311
CRP (mg/dL)	5.0 (4.9-8.1)	6.4 (4.9-11.6)	0.370

Variable	Omega 3 group N=22			Control group N=27
	T0 Median (IQR)	T1 Median (IQR)	p ^a a Nonparametric paired Wilcoxon.	T0 Median (IQR)	T1 Median (IQR)	p ^a a Nonparametric paired Wilcoxon.
IL-6 (pg/mL)^b b IL-6, Omega 3 Group n = 21; control group n = 26; IL-10, Omega 3 Group n = 14; control group n = 21.	0.57 (0.40-2.90)	1.10 (0.60-2.80)	0.821	1.09 (0.52-1.98)	0.88 (0.33-2.08)	0.946
IL-10 (pg/mL)^b b IL-6, Omega 3 Group n = 21; control group n = 26; IL-10, Omega 3 Group n = 14; control group n = 21.	19.05 (9.88-40.87)	29.90 (9.80-56.30)	0.363	21.41 (6.72-51.64)	26.08 (11.38-47.54)	0.332
Leptin (ng/mL)	80.03 (63.21-129.40)	93.20 (54.80-153.40)	0.506	58.12 (36.65-109.20)	77.20 (50.00-103.00)	0.416
Adiponectin (µg/mL)	42.30 (24.88-58.01)	44.9 (23.90-57.20)	0.465	40.08 (27.69-59.47)	44.50 (20.00-59.00)	0.462
Glucose (mg/dL)	77.5 (75.2-82.8)	83.0 (75.0-87.0)	0.043	78.0 (71.0-86.0)	77.5 (72.2-85.0)	0.354
Cholesterol (mg/dL)	168.0 (151.0-194.0)	188.0 (162.0-214.5)	0.012	182.0 (155.5-192.2)	176.0 (152.0-199.8)	0.067
LDL-c (mg/dL)	95.0 (80.0-116.0)	115.5 (90.0-129.2)	0.003	100.0 (84.5-111.8)	98.0 (76.0-125.0)	0.019
HDL-c (mg/dL)	52.0 (38.0-57.0)	53.0 (47.0-67.0)	0.537	53.0 (37.8-63.2)	53.5 (45.5-59.0)	0.857
Triglycerides (mg/dL)	88.0 (64.0-124.0)	70.0 (57.0-98.5)	0.520	79.5 (59.5-114.0)	87.0 (63.2-128.0)	0.657
CRP (mg/dL)	5.0 (4.9-8.1)	4.9 (4.9-7.2)	0.230	6.4 (4.9-11.6)	5.0 (4.9-11.6)	0.009

	Omega-3 group Median (IQR)	Control group Median (IQR)	p ^e e U-Mann-Whitney test.
ΔV IL-6 (pg/mL)	0.12 (-1.19 to 1.45)^a a n = 21.	-0.05 (-0.57 to 0.58)^b b n = 26.	0.915
ΔV IL-10 (pg/mL)	1.32 (-8.94 to 18.80)^c c n = 14.	1.04 (-7.17 to 12.19)^d d n = 21.	0.920
ΔV Adiponectin (µg/mL)	0.6 (-3.2 to 11.8)	-3.4 (-6.6 to 5.8)	0.171
ΔV Leptin (ng/mL)	3.4 (-18.2 to 22.6)	0.0 (-16.3 to 28.0)	0.924
ΔV CRP (mg/dL)	0.0 (-1.5 to 0.0)	0.0 (0.0 to 1.5)	0.008
ΔGlucose (mg/dL)	-4.0 (-8.0 to 0.0)	-1.0 (-8.0 to 4.0)	0.496
ΔCholesterol (mg/mL)	14.0 (-2.5 to 27.2)	4.5 (-8.5 to 23.8)	0.477
ΔLDL-c (mg/dL)	17.0 (3.0 to 27.0)	10.5 (-2.5 to 20.8)	0.288
ΔHDL-c (mg/dL)	0.0 (-4.5 to 12.5)	-0.5 (-7.0 to 5.0)	0.536
ΔTriglycerides (mg/dL)	-1.0 (-39.2 to 22.8)	-4.5 (-17.8 to 16.8)	0.867

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[1] * Corresponding author. duartelanna@gmail.com (C.C. Lanna).