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  • Intervention
    What effect does EPA/DHA taken as a fish oil supplement have on triglycerides in hypertriglyceridemic patients who are taking cholesterol lowering medication (statins)?
    • Conclusion

      The triglyceride lowering benefit of EPA/DHA fish oil with HMG-Co A reductase inhibitors (statins) was reported in three studies of varied patient populations. Studies provided 1.68-3.2g EPA/DHA daily for 5-48 weeks in patients receiving statin therapy with diet and lifestyle changes. This resulted in a 0-35% reduction in triglycerides vs. baseline values. Two of the studies found a 32-35% reduction and one study found no reduction in triglycerides. In these three studies there appears to be no dose response. No dietary adherence data were reported.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What effect does EPA/DHA taken as a fish oil supplement have on triglycerides in hypertriglyceridemic patients who are not taking cholesterol lowering medications?
    • Conclusion

      Subjects with elevated triglycerides (mean values ranged 250-919 mg/dL) taking 2.6-3.6g of commercial EPA/DHA fish oil (approximately 48-60% EPA/ 33-40% DHA) with varied dietary intakes without cholesterol lowering medicines, for 6 weeks to 1 year* had 22-45% reductions in triglyceride values compared to baseline values. Lower doses of fish oil (1.72g; 59% EPA/41% DHA) also resulted in 22-25% reductions in triglycerides vs. baseline values after 6 months to 1 year.

      *One study was of 1 year duration and was a 6-month open label extension of a 6 month study.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What effect does EPA/DHA taken as a fish oil supplement have on LDL-cholesterol in hypertriglyceridemic patients?
    • Conclusion

      In studies of patients with high triglycerides, not following specific dietary advice and not on concurrent statin therapy, fish oil was associated with a 8-44% increase in LDL-C. In studies of people taking fish oil capsules and statins, LDL-C decreased 0-20%. 

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What effect does DHA consumed as DHA-enriched eggs have on triglycerides in hypertriglyceridemic patients?
    • Conclusion

      Based on one study (n=150), ten DHA-rich eggs per week (209mg DHA per day) given for 6 weeks did not lower triglycerides and increased LDL-C.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What effect does EPA/DHA taken as a fish oil supplement have on triglycerides in hypertriglyceridemic patients when combined with medical nutrition therapy provided by a Registered Dietitian?
    • Conclusion

      Fish oil capsule intake in addition to MNT according to current evidence-based nutrition practice guidelines provided by an RD has not been evaluated in the hypertriglyceridemic patient.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.