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Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease.
Cochrane Database Syst Rev 2009; (1):CD006320CD

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 maintenance of 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 Experts were contacted for unpublished data.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 the relapse rate and secondary outcomes included 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-analyses were 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 in an attempt to explore possible sources of heterogeneity.

MAIN RESULTS

Six studies were eligible for inclusion. There was a marginal significant benefit of n-3 therapy for maintaining remission (RR 0.77 0.; 95%CI 0.61 to 0.98; P = 0.03). However, the studies were both clinically and statistically heterogeneous (P = 0.03, I(2) = 58%). Two large studies showed negative results. When considering the estimated rather than the observed 1-year relapse rate of these two studies, the benefit was no longer statistically significant (RR 0.59; 95% CI 0.34 to 1.03; P=0.06). A funnel plot suggested publication bias. No serious adverse events were recorded in any of the studies but in a pooled analyses there was a significantly higher rate of diarrhea (RR 1.36 95% CI 1.01 to 1.84) and symptoms of the upper gastrointestinal tract (RR 1.98 95% CI 1.38 to 2.85) in the n-3 treatment group.

AUTHORS' CONCLUSIONS

Omega 3 fatty acids are safe but probably ineffective for maintenance of remission in CD. The existing data do not support routine maintenance treatment of Crohn's disease with omega 3 fatty acids.

Authors+Show Affiliations

Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, P.O.B 3235, Jerusalem, Israel, 91031. turnerd@szmc.org.ilNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19160277

Citation

Turner, Dan, et al. "Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Crohn's Disease." The Cochrane Database of Systematic Reviews, 2009, 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. 2009.
Turner, D., Zlotkin, S. H., Shah, P. S., & Griffiths, A. M. (2009). Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. The Cochrane Database of Systematic Reviews, (1), p. CD006320. doi:10.1002/14651858.CD006320.pub3.
Turner D, et al. Omega 3 Fatty Acids (fish Oil) for Maintenance of Remission in Crohn's Disease. Cochrane Database Syst Rev. 2009 Jan 21;(1)CD006320. PubMed PMID: 19160277.
* 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,Dan, AU - Zlotkin,Stanley H, AU - Shah,Prakeshkumar S, AU - Griffiths,Anne Marie, Y1 - 2009/01/21/ PY - 2009/1/23/entrez PY - 2009/1/23/pubmed PY - 2009/3/20/medline SP - CD006320 EP - CD006320 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 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 maintenance of 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 the relapse rate and secondary outcomes included 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-analyses were 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 in an attempt to explore possible sources of heterogeneity. MAIN RESULTS: Six studies were eligible for inclusion. There was a marginal significant benefit of n-3 therapy for maintaining remission (RR 0.77 0.; 95%CI 0.61 to 0.98; P = 0.03). However, the studies were both clinically and statistically heterogeneous (P = 0.03, I(2) = 58%). Two large studies showed negative results. When considering the estimated rather than the observed 1-year relapse rate of these two studies, the benefit was no longer statistically significant (RR 0.59; 95% CI 0.34 to 1.03; P=0.06). A funnel plot suggested publication bias. No serious adverse events were recorded in any of the studies but in a pooled analyses there was a significantly higher rate of diarrhea (RR 1.36 95% CI 1.01 to 1.84) and symptoms of the upper gastrointestinal tract (RR 1.98 95% CI 1.38 to 2.85) in the n-3 treatment group. AUTHORS' CONCLUSIONS: Omega 3 fatty acids are safe but probably ineffective for maintenance of remission in CD. The existing data do not support routine maintenance treatment of Crohn's disease with omega 3 fatty acids. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19160277/Omega_3_fatty_acids__fish_oil__for_maintenance_of_remission_in_Crohn's_disease_ L2 - https://doi.org/10.1002/14651858.CD006320.pub3 DB - PRIME DP - Unbound Medicine ER -