Personalized Omega-3 Testing:  Background

An extremely large body of evidence-based publications from controlled clinical trials throughout the human lifecycle support the beneficial impact of ingesting the long-chain omega-3 fatty acids (EPA-eicosapentaenoic acid and DHA-docosahexaenoic acid) from fish sources and/or nutritional supplements. Just as routine measurements of blood cholesterol levels are used to assess, treat, and to monitor the risk for cardiovascular disease, personalized omega-3 testing for optimizing health management and disease prevention has recently become available to healthcare professionals and the general public.

Personalized Omega-3 Testing: Rationale

It is well recognized that increasing EPA/DHA omega-3 fatty acid intakes, through dietary sources such as fish/seafood or nutritional supplements containing EPA/DHA, can be fully expected to elevate the levels of EPA/DHA in the circulating blood and in the breast milk of lactating mothers. Such elevations in these biomarkers for omega-3 fatty acid status in the body are associated with corresponding increases in long-chain omega-3 fatty acid levels in various tissues such as nerve and heart. Numerous publications in leading medical (eg., New England Journal of Medicine) and nutrition (eg., American Journal of Clinical Nutrition) journals have established that the omega-3  fatty acid levels, as a percent of total fatty acids, in blood samples can be recognized as novel ‘risk factors’ for pregnancy outcomes in terms of both infant health and development, sudden cardiac death, all-cause mortality, and age-related cognitive deterioration, as well mental and visual development during infancy in the case of omega-3 levels in breast milk from lactating mothers.

A number of factors, in addition to the ingested amounts of EPA/DHA, can have a significant impact on the circulating and breast milk levels of EPA/DHA. These factors include the effect of an individual’s genetic architecture,  the timing of the daily omega-3 fatty acid intake, the duration of omega-3 intakes, the forms of supplemental EPA/DHA (triglyceride, ethyl ester, phospholipid, free fatty acid), as well as others contributors.  With the large differences in EPA/DHA amounts across diverse fish/seafood sources, and the absence of food labelling to inform on the EPA/DHA amounts per serving, it is very difficult to guess at the omega-3  fatty acid status in the body. Thus, direct measurement of the EPA/DHA omega-3 fatty acid levels as a key part of personalized omega-3 evaluations provides an effective means of monitoring their status in the body and, as needed, to employ dietary and/or supplemental strategies to ensure, via follow-up testing, that the ‘low risk’ zones for various health outcomes have been reached and maintained. (Am J Clin Nutr. 2018 Aug 1;108(2):211-227. doi: 10.1093/ajcn/nqy089. Best practices for the design, laboratory analysis, and reporting of trials involving fatty acids.  Brenna JT, Plourde M, Stark KD, Jones PJ, Lin YH.)

Personalized Omega-3  Testing: Description

Nutritional Fundamentals for Health has partnered with Lipid Analytical Laboratories (LAL) at the University of Guelph Research Park in Guelph, Ontario to offer a validated paper spot system for blood or breast milk, for  omega-3 assessments and reporting of the results and associated risk zones.  After requesting the omega-3 collection kit which provides the simple instructions, specialized paper strip, and lancet, a few drops of blood from a simple finger prick or from a breast milk sample are spotted onto the paper strip and then mailed to the lab at the University of Guelph. After a complete fatty acid analyses via high-performance capillary gas-liquid chromatography, results are then reported along with the resulting risk zones from high through to low and released. usually via an email attachment or direct mail if so requested, for discussion with your patient.

The following personalized omega-3 fatty acid tests are available:

1. OmegaScore™ – Pregnancy and the Risk of Preterm Birth (Blood spot testing during pregnancy and the risk of preterm birth)

Higher levels of the sum of the (EPA + DHA) as a % age of total fatty acids (at least 2.04 % or more) as derived from the circulating plasma levels (Olsen, S. F. et al., EBioMedicine, 35: 325-333, 2018) is associated with a 90 % lower risk of preterm birth relative to the lowest levels. The sum % age of (EPA+DHA) is referred to as the ‘OmegaScore’. Various international organizations have recommended minimal intakes of DHA of at least 200-300 mgs/day during pregnancy (with or without EPA). Such is expected to readily ensure attaining a level of at least 2.04 % of total fatty acids as (EPA + DHA) in whole blood within two weeks. DHA is metabolized to EPA (via retroconversion) in the body to some degree as well such that both DHA + EPA levels in the blood will rise with supplemental DHA intakes.

2. OmegaScore™ – Breast Milk DHA and AA (Breast milk spot testing during lactation in support of infant cognitive and visual development)

Higher levels of DHA in breast milk than are typically provided for breast-fed infants in North America have been reported to better support optimal cognitive and visual development in full-term infants by providing this physiologically essential nutrient to the brain and retina of the eye, respectively. Levels of 0.32 – 0.35 % of total milk fat fatty acids as DHA would provide at least 100 mgs/infant.day as recommended by various international organizations (Hoffman, D. R. et al., PLEFA, 81: 151-158, 2009).  Testing for the breast milk DHA OmegaScore supports dietary and nutritional supplement approaches to ensure entry into the target DHA levels. Minimal maternal intakes of 200-300 mgs DHA/day during lactation can be expected to meet target levels in the vast majority of mothers within 10 days.  Re-testing can ensure that such targets are fulfilled.

3. OmegaScore™ – Whole Blood (Blood spot testing in adults for the OmegaScore and the risk of sudden cardiac death, all-cause mortality, and age-related cognitive deterioration)

Ground breaking clinical research from the Harvard Medical School in Boston as published in The New England Journal of Medicine (Albert, C. et al.,346: 1113-1118 2002) reported that the summed levels of the long-chain omega-3 polyunsaturated fatty acids (EPA + DHA + DPA) as a percent of the total fatty acids in the blood was very closely related to the risk of dying from sudden cardiac death. This summed % value is referred to as the OmegaScore.. This study, which followed apparently healthy subjects after their blood omega-3 testing for a period of 17 years, found that those subjects with the highest OmegaScores (at least 6.1 % or more) had a 90 % lower risk of sudden cardiac death as compared to those subjects with the lowest scores who were at very high risk. Daily Supplementation with at least 900 mgs of (EPA + DHA) can be expected to move almost all the subjects into the lowest row risk zone within two weeks. This can be confirmed if desired by repeat blood spot testing. It is noted that the OmegaScore values (sum % of EPA + DHA + DPA in whole blood spots) are essentially identical to the Omega-3 Index values (sum of the EPA + DHA % in the red blood cells) if the former are converted by equation to the latter.

Results from the Framingham Heart Study (Harris, W. et al., J. Clin. Lipidol.,12: 718-727, 2018) indicated that higher levels of circulating EPA + DHA levels as a percent of total fatty acids were inversely associated with all-cause mortality including cardiovascular disease. Those who had higher levels of these long-chain omega-3  fatty acids (at least 5.6 % or more of total fatty acids as EPA + DHA) based on whole blood equivalent levels were at a considerably lower risk as compared to those subjects with the lowest levels.

The measured levels of (EPA + DHA +DPA) as % of total fatty acids in the blood spot test (the OmegaScore) are also inversely related to the risk of age-related cognitive deterioration in elderly subjects based on a published study from Germany (Lukaschek, K. et al., Dement. Geriatr. Cogn. Discord., 42: 236-245, 2016). An OmegaScore value of 6.8% or above was associated with a 81 % lower risk of early cognitive aging as compared to those with levels below 5.65%.

It is noted that daily supplementation with at least 900 mgs (EPA + DHA) daily or more can be expected to move almost all subjects into the ‘low risk’ zone for all three of the above adult health outcomes within 10 – 14 days.