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Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis.
Cochrane Database Syst Rev 2007; (3):CD006443CD

Abstract

BACKGROUND

Omega-3 fatty acids (n-3, fish oil) have been shown to have anti-inflammatory properties. Therefore, n-3 therapy may be beneficial in chronic inflammatory disorders such as ulcerative colitis.

OBJECTIVES

To systematically review the efficacy and safety of n-3 for maintaining remission in ulcerative colitis (UC).

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 Experts were contacted for unpublished data.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 fish oil for maintenance of remission in UC 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 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 the secondary outcome was frequency of adverse events. Other outcomes to assess efficacy were change in disease activity scores and time to first relapse.

DATA COLLECTION AND ANALYSIS

Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality. Meta-analysis weighted by the Mantel-Haenszel method was performed using RevMan 4.2.8 software. Random or fixed effect models were used according to degree of heterogeneity and subgroup analyses were performed to explore heterogeneity. A sensitivity analysis was performed excluding a study of questionable quality .

MAIN RESULTS

The three studies that were included used different formulation and dosing of n-3 but none used enteric coated capsules. The pooled analysis showed a similar relapse rate in the n-3 treated patients and controls (RR 1.02; 95% CI 0.51 to 2.03; P = 0.96). Combining the studies resulted in virtually no statistical heterogeneity (P = 0.93, I(2) = 0%). Various subgroup and sensitivity analyses showed similar results. However, the total number of patients enrolled in these studies was small (n = 138). No significant adverse events were recorded in any of the studies and not enough data were available to pool the other secondary outcomes for meta-analysis.

AUTHORS' CONCLUSIONS

No evidence was found that supports the use of omega 3 fatty acids for maintenance of remission in UC. Further studies using enteric coated capsules may be justified.

Authors+Show Affiliations

Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Ave.,Toronto, Ontario, Canada, M5G 1X8. dan.turner@sickkids.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17636844

Citation

Turner, D, et al. "Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Ulcerative Colitis." The Cochrane Database of Systematic Reviews, 2007, p. CD006443.
Turner D, Steinhart AH, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007.
Turner, D., Steinhart, A. H., & Griffiths, A. M. (2007). Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. The Cochrane Database of Systematic Reviews, (3), p. CD006443.
Turner D, Steinhart AH, Griffiths AM. Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Ulcerative Colitis. Cochrane Database Syst Rev. 2007 Jul 18;(3)CD006443. PubMed PMID: 17636844.
* 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 ulcerative colitis. AU - Turner,D, AU - Steinhart,A H, AU - Griffiths,A M, Y1 - 2007/07/18/ PY - 2007/7/20/pubmed PY - 2007/10/19/medline PY - 2007/7/20/entrez SP - CD006443 EP - CD006443 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Omega-3 fatty acids (n-3, fish oil) have been shown to have anti-inflammatory properties. Therefore, n-3 therapy may be beneficial in chronic inflammatory disorders such as ulcerative colitis. OBJECTIVES: To systematically review the efficacy and safety of n-3 for maintaining remission in ulcerative colitis (UC). 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 fish oil for maintenance of remission in UC 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 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 the secondary outcome was frequency of adverse events. Other outcomes to assess efficacy were change in disease activity scores and time to first relapse. DATA COLLECTION AND ANALYSIS: Two independent investigators reviewed studies for eligibility, extracted the data and assessed study quality. Meta-analysis weighted by the Mantel-Haenszel method was performed using RevMan 4.2.8 software. Random or fixed effect models were used according to degree of heterogeneity and subgroup analyses were performed to explore heterogeneity. A sensitivity analysis was performed excluding a study of questionable quality . MAIN RESULTS: The three studies that were included used different formulation and dosing of n-3 but none used enteric coated capsules. The pooled analysis showed a similar relapse rate in the n-3 treated patients and controls (RR 1.02; 95% CI 0.51 to 2.03; P = 0.96). Combining the studies resulted in virtually no statistical heterogeneity (P = 0.93, I(2) = 0%). Various subgroup and sensitivity analyses showed similar results. However, the total number of patients enrolled in these studies was small (n = 138). No significant adverse events were recorded in any of the studies and not enough data were available to pool the other secondary outcomes for meta-analysis. AUTHORS' CONCLUSIONS: No evidence was found that supports the use of omega 3 fatty acids for maintenance of remission in UC. Further studies using enteric coated capsules may be justified. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17636844/Omega_3_fatty_acids__fish_oil__for_maintenance_of_remission_in_ulcerative_colitis_ L2 - https://doi.org/10.1002/14651858.CD006443.pub2 DB - PRIME DP - Unbound Medicine ER -