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Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease.

Abstract

BACKGROUND

The anti-inflammatory effects of n-3 (omega-3 fatty acids, fish oil) have been suggested to be beneficial in chronic inflammatory disorders such as inflammatory bowel disease.

OBJECTIVES

To systematically review the efficacy and safety of n-3 for maintaining remission in Crohn's disease (CD).

SEARCH STRATEGY

The following databases were searched from their inception without language restriction: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Healthstar, PubMed, and ACP journal club. Experts were contacted for unpublished data.

SELECTION CRITERIA

Randomized placebo-controlled trials (RCT) of n-3 for maintenance of remission in CD were included. Studies must have enrolled patients of any age group, who were in remission at the time of recruitment, and were followed for at least six months. The intervention must have been fish oil or n-3 given in pre-defined dosage. Co-interventions were allowed only if they were balanced between the study groups. The primary outcome was relapse rate and secondary outcomes were change in disease activity scores, time to first relapse and adverse events.

DATA COLLECTION AND ANALYSIS

Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality using Jadad's criteria. Meta-analysis was performed using RevMan 4.2 software, weighted by the Mantel-Haenszel method. Random or fixed effect models were used according to degree of heterogeneity and subgroup analyses were performed to address heterogeneity.

MAIN RESULTS

Four studies were eligible for inclusion. There was a non statistically significant benefit of n-3 therapy for maintaining remission (RR 0.64; 95%CI 0.4 to 1.03; P = 0.07). However, the studies were both clinically and statistically heterogeneous (P = 0.01, I(2) = 72%). Three studies used enteric coated capsules (positive effects) and one ordinary gelatin capsules (no advantage). Subgroup analyses of studies which used enteric coated capsules revealed a statistically significant benefit for maintenance of remission (RR 0.49; 95% CI 0.35 to 0.69; RD 0.31; 95% CI 0.19 to 0.43); number needed to treat to prevent relapse in 1 year was 3 (95% CI 2 to 5; I(2) = 19%). However, the total number of patients enrolled in these studies was small (n = 166). No significant adverse events were recorded in any of the studies and not enough data were available to analyze the other secondary outcomes.

AUTHORS' CONCLUSIONS

Omega 3 fatty acids are safe and may be effective for maintenance of remission in CD when used in enteric coated capsules. However, there are not sufficient data to recommend the routine use of n-3 for maintenance of remission in CD. The small number of patients in the included studies warrants further larger RCTs.

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  • Authors+Show Affiliations

    ,

    Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Ave., Toronto, Ontario, CANADA, M5G 1X8. dan.turner@sickkids.ca

    , ,

    Source

    MeSH

    Adult
    Child
    Crohn Disease
    Fatty Acids, Omega-3
    Humans
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    17443620

    Citation

    Turner, D, et al. "Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Crohn's Disease." The Cochrane Database of Systematic Reviews, 2007, p. CD006320.
    Turner D, Zlotkin SH, Shah PS, et al. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2007.
    Turner, D., Zlotkin, S. H., Shah, P. S., & Griffiths, A. M. (2007). Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. The Cochrane Database of Systematic Reviews, (2), p. CD006320.
    Turner D, et al. Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Crohn's Disease. Cochrane Database Syst Rev. 2007 Apr 18;(2)CD006320. PubMed PMID: 17443620.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. AU - Turner,D, AU - Zlotkin,S H, AU - Shah,P S, AU - Griffiths,A M, Y1 - 2007/04/18/ PY - 2007/4/20/pubmed PY - 2007/7/18/medline PY - 2007/4/20/entrez SP - CD006320 EP - CD006320 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: The anti-inflammatory effects of n-3 (omega-3 fatty acids, fish oil) have been suggested to be beneficial in chronic inflammatory disorders such as inflammatory bowel disease. OBJECTIVES: To systematically review the efficacy and safety of n-3 for maintaining remission in Crohn's disease (CD). SEARCH STRATEGY: The following databases were searched from their inception without language restriction: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Healthstar, PubMed, and ACP journal club. Experts were contacted for unpublished data. SELECTION CRITERIA: Randomized placebo-controlled trials (RCT) of n-3 for maintenance of remission in CD were included. Studies must have enrolled patients of any age group, who were in remission at the time of recruitment, and were followed for at least six months. The intervention must have been fish oil or n-3 given in pre-defined dosage. Co-interventions were allowed only if they were balanced between the study groups. The primary outcome was relapse rate and secondary outcomes were change in disease activity scores, time to first relapse and adverse events. DATA COLLECTION AND ANALYSIS: Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality using Jadad's criteria. Meta-analysis was performed using RevMan 4.2 software, weighted by the Mantel-Haenszel method. Random or fixed effect models were used according to degree of heterogeneity and subgroup analyses were performed to address heterogeneity. MAIN RESULTS: Four studies were eligible for inclusion. There was a non statistically significant benefit of n-3 therapy for maintaining remission (RR 0.64; 95%CI 0.4 to 1.03; P = 0.07). However, the studies were both clinically and statistically heterogeneous (P = 0.01, I(2) = 72%). Three studies used enteric coated capsules (positive effects) and one ordinary gelatin capsules (no advantage). Subgroup analyses of studies which used enteric coated capsules revealed a statistically significant benefit for maintenance of remission (RR 0.49; 95% CI 0.35 to 0.69; RD 0.31; 95% CI 0.19 to 0.43); number needed to treat to prevent relapse in 1 year was 3 (95% CI 2 to 5; I(2) = 19%). However, the total number of patients enrolled in these studies was small (n = 166). No significant adverse events were recorded in any of the studies and not enough data were available to analyze the other secondary outcomes. AUTHORS' CONCLUSIONS: Omega 3 fatty acids are safe and may be effective for maintenance of remission in CD when used in enteric coated capsules. However, there are not sufficient data to recommend the routine use of n-3 for maintenance of remission in CD. The small number of patients in the included studies warrants further larger RCTs. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17443620/Omega_3_fatty_acids__fish_oil__for_maintenance_of_remission_in_Crohn's_disease_ L2 - https://doi.org/10.1002/14651858.CD006320.pub2 DB - PRIME DP - Unbound Medicine ER -