Omega-3s for Baby Boomers: a review of the science and recommendations for stakeholders
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Omega-3s for Baby Boomers:
a review of the science and
recommendations for stakeholders
Wendy Morgan
Nutrition Advisor, The Omega-3 Centre &
Director, innovations & solutions
Agenda
Ω What is The Omega-3 Centre?
Ω Who are the Baby Boomers?
Ω Why a Consensus workshop?
Ω What were the outcomes of the workshop?
– Findings
– Recommendations
The Omega-3 Centre Inc.
• Executive Director
– Ms Monique Cashion
• Management Committee
• Executive team
• Scientific advisors
• Communications advisors
The Omega-3 Centre Inc
• Established 2006
• Aims to improve health status of Australians and
New Zealanders by:
Communicating Building a conducive
the health benefits environment
of omega-3s
LONG De-mystifying & Facilitating &
CHAIN !
translating the science promoting R&D
Hg
Identifying & Ensuring sound science
addressing barriers as the basis
ACTION !
• Talk/write/engage the media
• Literature reviews – monthly
• Expert workshops
• Conferences, meetings
• Website/newsletters/updates/
notices/submissions
• And more ........................
SunHerald
Baby Boomers • Born 1946 to 1965 • Post-World War II baby boom • Record rates of increase in the population aged 65+ between 2011 and 2021 • 12% pop in 1997 (2.2 million people) • 18% pop in 2021 (4.0 million) • 24-26% in 2051 (6.0–6.3 million) • →Huge implications for health expenditure Source: AIHW, 2004
Role of long chain omega-3s in health maintenance and chronic diseases... ...brain, eye, heart, joints, weight, diabetes
Omega-3s and Baby Boomers Scientific
Consensus workshop
The experts:
Ω Dr Wendy Hunter, Deakin University
Ω Professor Andrew J Sinclair, Deakin University
Ω Dr Victoria Flood, University of Sydney
Ω Professor Peter Howe, University of South Australia
Ω Professor Les Cleland, Royal Adelaide Hospital
Ω A/Professor David Colquhoun, University of Queensland
Ω Dr Michelle Keske, University of Tasmania
Ω Professor Linda Tapsell, University of Wollongong
Ω Ms Wendy Morgan, The Omega-3 Centre & innovations & solutions
Facilitator: Dr David Roberts
Chronic diseases – Baby Boomers
(approx figures)
• 54% overweight or obese
• 12% reported having diabetes
• 20% 50+ died from ischaemic heart disease
• 10% died from strokes
• 29% died from cancer
• over 1.5 million people in Australia affected by
osteoarthritis
• 1 in 100 people have rheumatoid arthritis
Source: Hunter W 2008 from ABS 2006 & AIHW 2008
Chronic diseases – Baby Boomers: Living longer and more of them! Not only do these conditions have detrimental effects on individual’s ability to perform daily activities and quality of life, they also substantially contribute to health care costs (AIHW 2008).
Number of participants who were on different types of diets in the three
months prior to they survey
40
35
Percentage of participants
30
Low fat
25 Low fat/sugar
Low salt
20
Vegetarian/vegan
Medical diet
15
Other diets
10
5
0
Source: Hunter W et al 2008Long chain omega-3 intakes low mg/day Source: Howe et al 2006, NHMRC 2006
Contribution of major dietary sources to
intakes of long chain omega-3s
%
Source: Howe et al 2006% persons consuming fish and meats
aged 45 – 64 y
Source: ABS 1999% persons consuming fish and seafood
dishes by age and gender
Source: ABS 1999The brain
• DHA – a fundamental role in brain structure
and function
• Long chain O3s and depression
– Epidemiological, cross sectional studies
– Plausible mechanisms:
• reductions in prostaglandins derived from AA leading to
decreased brain derived neurotrophic factor (BDNF)
levels and/or alterations in blood flow to the brain.
• Mood & cognition - observational studies promising
• Need intervention studies% PUFA in brain grey matter Source: Tassoni D & Sinclair AJ 2008
The eyes
• DHA - high proportion of retina and macular
composition
• Increased dietary intakes of omega-3s and regular
fish consumption protect against the
development and progression of AMD
– supported by epidemiological studies and meta-
analysis (Chong et al 2008)
• A plausible mechanism:
– long chain omega-3s promote healthy ocular tissue by
regulating inflammatory and immune responses in the
retina, thereby reducing the risk of AMDWeight maintenance
• Mainly short term studies (3 – 12 w)
• Around 1.5kg decrease weight or body fat
• Little long term evidence
• ? EPA or DHA
Despite these limitations, in a large proportion of
overweight individuals at risk of metabolic
syndrome, the multifaceted health benefits of
long chain omega-3s supplementation, both
cardiovascular and metabolic, provide strong
justification for this weight management
approach (Howe 2008)Effects on weight & body composition
2.0
1.0
Change FO fish oil (HiDHA® tuna oil)
in body 0.0
FOX tuna oil + exercise
weight -1.0
SO sunflower oil
-2.0 SOX sunflower oil + exercise
p = 0.06
kg -3.0
FO FOX SO SOX
2.0
1.0
Change in
fat mass 0.0
-1.0
kg -2.0
p < 0.05
-3.0 *
FO FOX SO SOX
Source: Hill A et al 2007Effects on CV risk factors
0.0
Change in TG FO fish oil (HiDHA® tuna oil)
mmol/L -0.2
SO sunflower oil
p < 0.05
-0.4 *
FO 0.4 SO
Change in HDL
0.2 *
mmol/L
p < 0.05
0.0
0.016
FMD
0.012
Change in arterial
diameter 0.008
p = 0.05
(mm) 0.004
0.000
Source: Hill A et al 2007 FO SOInflammation & rheumatoid arthritis • Long chain O3s benefit RA, lupus, IgA nephropathy, Crohn’s disease, psoriasis • Need 3g or more long chain O3 for 3 months for improvement in RA symptoms • Similar pain reduction as analgesic type anti- inflammatory drugs
Comparative effects : NSAIDs v. Fish Oil
Effects NSAIDs Fish Oil
NSAID sparing no Yes (PGE2)
Serious CV Events increased reduced
Blood pressure increased reduced
TNF & IL-1 increased reduced
Upper GI increased ? (?reduced)
Bleeding
Mortality increased reduced
Time to effect prompt delayed
From: Cleland, James, Proudman - Fish oil: what the prescriber needs to know
http://arthritis-research.com/content/8/1/202Practical feasibility of fish oil as an
alternative to NSAIDs
• Convenient to ingest
– 2.7g omega-3s equivalent to 9 standard fish oil capsules
daily or 10ml bottled fish oil
• Affordable
– However, fish oil capsules can be expensive at higher doses
• Free of toxins
– Toxins are removed in processing (eg PCBs, dioxins, heavy
metals)
• Compatibility with other medications
– Including warfarinCardiovascular disease • Investigated extensively – evidence convincing • Fish and fish oil reduce risk CVD • Consumption DHA, EPA and ALA improve cardiovascular outcomes • The Omega-3 Index a useful tool • Strong evidence for lowering TG levels • NHFA position paper on omega-3s
Heart Foundation recommendations
All adult Australians
To lower their risk of coronary heart disease
(CHD), all Australians should:
1. Consume about 500 mg/d DHA and EPA through a
combination of the following:
• two or three serves (150 g serve) of oily fish per week
• fish oil capsules or liquid
• food and drinks enriched with marine omega-3s.
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Heart Foundation recommendations
All adult Australians (cont’d)
2. Consume at least 2 g/d ALA.
3. Follow government advice on fish consumption
regarding local safety issues.
4. Discuss healthy eating and concerns about
nutrition with an Accredited Practising Dietitian or
a doctor.
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Heart Foundation recommendations
Health professionals should advise adult
Australians with documented CHD to:
1. Consume about 1000 mg/d DHA and EPA through a
combination of the following:
• two or three serves (150 g serve) of oily fish per week
• fish oil capsules or liquid
• food and drinks enriched with marine omega-3s.
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Heart Foundation recommendations
Health professionals should advise adult
Australians with documented CHD to:
2. Consume at least 2 g/d of ALA.
3. Follow government advice on fish consumption
regarding local safety issues.
4. Discuss healthy eating and concerns about
nutrition with an Accredited Practising Dietitian or
a doctor.
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Heart Foundation recommendations
Health professionals should advise adults
with elevated TGs to take fish oil capsules or
liquid and marine omega-3 enriched foods and
drink as first-line therapy by:
• starting with a dose of 1200 mg/d DHA and EPA; and
if appropriate
• increasing the dose to 4000 mg/d of DHA and EPA
and checking patient’s response every 3 to 4 weeks
when the dose is changed, until target TG levels are
reached.
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Heart Foundation recommendations
Great information available on Heart
Foundation website!
– Eating plans with many options
– Omega-3 content of various fish and seafood
– Q&As for health professionals and the general public
www.heartfoundation.org.au/Professional
_Information/Lifestyle_Risk/Nutrition.htm
From NHFA Position statement Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008Ranking of current level of evidence
Ranking Meaning Area Evidence strength Dose/dietary intake
+1 Interesting Mental health:
evidence
- Depression Interesting, Not possible to
possible define at this time
- Mood Weak evidence to
- Cognition date, important to
- Dementia, follow up
Alzheimer’s disease
Obesity Interesting but Not possible to
insufficient define at this time
evidence to date
Metabolic health Possible Not possible to
define at this time
+2 Positive Visual health Possible Not possible to
evidence,
define at this time
no harmRanking of current level of evidence
Ranking Meaning Area Evidence strength Dose/dietary intake
+3 Some good Vision: age-related Probable (no 1-2 serves fish/w
evidence
macular intervention trials
degeneration at this stage)
+4 Conclusive Long term Convincing 3g/d EPA + DHA
evidence
analgesia -useful alternative
associated with to NSAIDS
rheumatoid
arthritis
CVD: 0.5g/d EPA + DHA =
- prevention Convincing 2 oily fish/w
- management of Convincing 1g/d EPA + DHA
existing disease
- blood Convincing 1.2-4g/d EPA + DHA
triglycerides (or DHA alone)Key recommendations • 500 mg per day of DHA + EPA • Adequate Intakes (AI) levels reflect the current low intakes of long chain omega-3s in the Australian population
Calls to action for baby boomers • 500 mg per day of DHA + EPA from – 2 or more serves of oily fish per week and/or – foods enriched with long chain omega-3s and/or – dietary supplements of fish oil – within the context of an energy-balanced diet. • People with disease conditions such as RA and CVD may benefit from higher levels of long chain omega-3s and should seek medical advice
Communication to health professionals
• New NHFA recommendations
• Recommended intakes for rheumatoid arthritis
• Help us gain understanding, acceptance and support
for The Omega-3 Index
• Understand difference between ALA and EPA, DPA &
DHA
• Able to provide clear guidance on how to achieve
desired levels of long chain omega-3s
– Specific information on amount and type of appropriate
food sources, including fish varieties is also requiredGovernment and policy makers
• Be part of the process to develop a strategy for
the acceptance and support of The Omega-3
Index
• There is sufficient evidence for FSANZ to permit
health claims on foods containing long chain
omega-3s in the proposed Nutrition, health and
related claims standard
• A key role:
– To revise nutrition policy to take account of the key
role of long chain omega-3s
– To encourage Baby Boomers to have an optimal intake
of long chain omega-3sGovernment and policy makers
• A key role (cont):
– To fund omega-3 research (see next slide)
– To ensure that food choices available in government
institutions supply adequate long chain omega-3s
• Messages to government:
– The SDTs should be used in determining policy on food
and nutrition. The levels set for Adequate Intakes of
long chain omega-3s for adults are unhelpful
– Need for a cost benefit analysis to assess the potential
contribution of an optimal intake of long chain
omega-3s on health status and healthcare costs.Research recommendations Intakes and status • Urgent need for a National Food and Nutrition Survey • Simplified food frequency questionnaire • Input to future studies to examine evidence for links between intakes of long chain omega-3s, omega-3 status and disease risk Roles of omega-3s • Roles of individual long chain omega-3s (EPA, DHA and DPA) to help elucidate their mechanisms of action in the body • Roles and mechanisms of action of omega-3s in mental health • Intervention trials on visual benefits - epidemiological evidence is highly supportive
Research recommendations National database • To monitor RBC omega-3 levels in adults in Australia/NZ Food analyses • Standardisation and harmonisation Cost benefit analyses • Healthcare costs vs benefits re omega-3s Consumer research • Barriers causing Baby Boomers’ resistance to enriched foods and dietary supplements providing long chain omega-3s. • Understanding the impact of the shift to cheaper foods and brands by Baby Boomers on omega-3 status.
Thank you to the experts who participated in
the workshop for their volunteered time and
tremendous effort and thank you to the
International Life Sciences Institute (ILSI) and
the International Society of the Study of Fatty
Acids and Lipids (ISSFAL) for sponsoring the
scientific consensus workshop.
www.omega-3centre.comHere’s to happy, healthy Baby Boomers!
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