The fatty acid composition of chylomicron remnants influences their propensity to oxidate

BACKGROUND AND AIM: Although the replacement of saturated with unsaturated dietary fat has been advocated as a means of reducing the risk of cardiovascular disease, diets high in polyunsaturated fatty acids (PUFAs) may increase lipid peroxidation, thus contributing to the pathogenesis of atherosclerosis. As the susceptibility of individual fatty acids to oxidation directly depends on their degree of unsaturation, and the oxidative modification of lipoproteins may be an important determinant of atherogenesis, the aim of this study was to evaluate the susceptibility to auto-oxidation and copper-mediated oxidation of chylomicron remnants (CMRs) enriched in n-3 or n-6 PUFA. METHODS AND RESULTS: The remnants were prepared in vitro from chylomicrons obtained from rats given an oral dose of fish or corn oil, using rat plasma containing lipoprotein lipase. Their propensity to oxidate and the extent of the oxidation were estimated by measuring the formation of conjugated dienes and the detrimental products of lipid peroxidation. The results showed that: 1) the corn oil CMRs contained a relatively high proportion of n-6 PUFA (mainly linoleic acid), whereas the fish oil CMRs contained more n-3 PUFA, mainly eicosapentanoic and docosahexaenoic acids; 2) n-3-rich CMRs have a significantly lower propensity to oxidate than n-6-rich CMRs despite their 50% lower alpha-tocopherol content and 40% higher unsaturation index. CONCLUSION: Our data indicate that the precise allocation of n-3 PUFA within the lipid core of CMRs may play a pivotal role in lowering the susceptibility to oxidation of fish CMRs by overcoming the effects of unfavourable alpha-tocopherol concentration. Eating n-3 rather than n-6 PUFAs seems to make CMRs more resistant against free radical attack, which may contribute to attenuating their potential atherogenic properties.     

Effect of fish diet versus meat diet on blood lipids, coagulation and fibrinolysis in healthy young men

Twelve healthy young men followed a 10-d controlled diet that included 210 g of fatty fish d-1. The diet was repeated after 18 d, but with lean meat substituted for fish. Blood samples were collected for assessment of serum lipids and haemostatic variables in the plasma. Both experimental diets caused serum triglycerides and plasma factor VIIc to decline to the same extent. The meat diet was also associated with significant changes in plasma levels of tissue plasminogen activator (t-PA) antigen. PA inhibitor type I (PAI-1) antigen, PAI activity, and t-PA activity of the euglobulin fraction of plasma. The fish diet left these variables unchanged from initial values. Thus, in a paired comparison of the two diets, the fish diet was associated with higher levels of t-PA antigen (5.4 vs. 4.7 g ml-1), which is considered to be beneficial with regard to prevention of cardiovascular disease. However, the fish diet was concurrently associated with the putative unfavourable higher levels of PAI-1 antigen (3.0 vs. 1.2 ng ml-1) and PAI activity (6.1 vs. 3.2 IU ml-1), and lower t-PA activity (80 vs. 140 mIU ml-1). Thus it is unclear which of the two diets has the greatest potential in the prevention of cardiovascular disease.     

Insulin sensitivity is related to the fatty acid composition of serum lipids and skeletal muscle phospholipids in 70-year-old men

Summary Recent data indicate that peripheral insulin sensitivity may be influenced by dietary fat quality and skeletal muscle phospholipid fatty acid composition. During a health survey of 70-year-old men insulin sensitivity was measured by the euglycaemic hyperinsulinaemic clamp technique and the fatty acid composition of the serum cholesterol esters was determined (n=215) by gas liquid chromatography. In a subsample the fatty acids of the skeletal muscle phospholipids and triglycerides were determined after fine needle biopsy from m. vastus lateralis (n=39). The peripheral insulin sensitivity was significantly and negatively correlated to the proportion of palmitic (r=–0.31, p<0.001), palmitoleic (r=–0.25, p<0.001) and di-homo--linolenic (r=–0.33, p<0.001) acids and positively to the content of linoleic (r=0.28, p<0.001) acid in the serum cholesterol esters. There was an even stronger negative relationship to the proportion of palmitic acid in the skeletal muscle phospholipds (r=–0.45, p<0.004). The fatty acid composition was also significantly related to insulin sensitivity in a stepwise multiple regression analysis in the presence of other clinical variables, which were associated with insulin action in univariate analysis. Thus, more than 51% of the variation of the insulin sensitivity was explained by an equation containing body mass index, serum triglyceride concentration and the content of palmitic acid in the skeletal muscle phospholipids. It is concluded that the fatty acid composition in serum and of the phospholipids of skeletal muscle may influence insulin action in elderly men.     

Serum fatty acid composition predicts development of impaired fasting glycaemia and diabetes in middle-aged men.

AIMS: Dietary fatty acid intake is reflected in serum fatty acid composition. Studies prospectively investigating serum fatty acids and development of impaired fasting glycaemia (IFG) or diabetes mellitus (DM) are largely lacking. We assessed the association of serum fatty acid composition with development of IFG or DM. METHODS: Middle-aged normoglycaemic men (n = 895) participating in a prospective cohort study were followed up after 4 years. RESULTS: At baseline proportions of serum esterified and non-esterified saturated fatty acids were increased and polyunsaturated fatty acids decreased in men who after 4 years had developed IFG (n = 56) or DM (n = 34). No differences in dietary fatty acid composition as recorded in 4-day dietary records were noted. In logistic regression analyses adjusting for age; obesity; and fasting lipid, glucose and insulin concentrations, men with proportions of non-esterified and esterified linoleate in the upper third had nearly half the risk for IFG or DM compared with the lower third. In covariate analyses, baseline non-esterified linoleate proportions were associated with changes in fasting insulin and glucose concentrations over the 4-year follow-up. Baseline esterified fatty acid composition was also associated with changes in insulin. CONCLUSIONS: High serum linoleate proportions decreased the risk of developing IFG or DM in middle-aged men over a 4-year follow-up, possibly mediated in part by insulin resistance. These findings support recommendations to substitute vegetable fat for animal and dairy fat in the prevention of disturbances of glucose and lipid metabolism.     

Analysis of omega-3 fatty acid content of South African fish oil supplements

Introduction

Substantial evidence describes the protective effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFA) on cardiovascular diseases as well as many other conditions. Numerous fatty acid preparations are marketed for supplementing the Western diet, which is low in n-3 fats. Since these preparations may vary in their n-3 PUFA content, we tested 45 commercially available products on the South African market for their fatty acid composition.

Method

Forty-five commercially available n-3 fatty acid supplements were analysed using gas–liquid chromatography to determine their fatty acid content.

Results

More than half of the n-3 supplements available on the South African market contained ≤ 89% of the claimed content of EPA and/or DHA as stated on the product labels. To meet ISSFAL’s recommendation of 500 mg EPA + DHA/day can cost consumers between R2 and R5 per person per day (R60 to R150 p/p/month). Regarding rancidity, the majority of capsules contained conjugated diene (CD) levels higher than that of vegetable oil obtained from opened containers (three months) used for domestic cooking purposes, despite the addition of vitamin E as antioxidant.

Conclusion

Since no formal regulatory structure for dietary supplements currently exists in South Africa, consumers depend on self-regulation within the nutraceutical industry for assurance of product quality, consistency, potency and purity. Our results indicate that more than half of the n-3 fatty acid supplements on the South African market do not contain the claimed EPA and/or DHA contents as stated on product labels, and they contained CD levels higher than that in unused vegetable oils obtained from opened containers used for domestic cooking purposes.     

Effect of Helicobacter pylori eradication on gastric mucosal phospholipid content and its fatty acid composition

BACKGROUND AND AIMS: Whether Helicobacter pylori eradication alters gastric mucosal phospholipid contents and their fatty acid composition remains unclear. The aim of the present study was to clarify the effect of H. pylori eradication on gastric mucosal phosphatidylcholine (PC) content and its fatty acid composition. METHODS: Endoscopic biopsy specimens were taken from the antrum and body of each of 19 asymtomatic male volunteers for detection of H. pylori, histopathological assessment of gastritis, phospholipid determination and fatty acid analysis. All the subjects with H. pylori infection were treated with eradication therapy. Endoscopy and tissue sampling were repeated again 1 and 6 months after all treatment. RESULTS: In eight subjects, H. pylori infection was evident and was successfully eradicated. Pretreatment degrees of lymphocytes and plasma cells (inflammation) and polymorphonuclear neutrophils (activity) were greater in H. pylori-positive subjects compared with H. pylori-negative subjects (P<0.001), whereas the degree of inflammation decreased (P<0.001), and neutrophils had completely disappeared at 6 months after eradication. Moreover, the gastric mucosal PC contents at the antrum and body were unchanged within 1 month after cessation of treatment, but increased at 6 months after eradication (P<0.05). At 6 months after cessation of treatment, H. pylori-eradicated subjects had an increase (+30% at antrum, +18% at body) in linoleic acid composition and a decrease (-37%, -43%) in arachidonic acid composition of PC at the antrum and body, respectively. CONCLUSIONS: These findings suggest that H. pylori eradication reduces the production of various eicosanoids, resulting in the normalization of gastric mucosal PC content and its fatty acid composition, which may consequently cause the gastric mucosal hydrophobicity to be normalized.     

Correlations between the intensity of fMLP-dependent respiratory burst and cellular fatty acid composition in human neutrophils

Summary. The peripheral blood neutrophils were isolated from a group of normal subjects and their fatty acid composition determined by capillary gas-chromatography. The superoxide (O₂) release by the same cell preparations in response to formyl-methionyl-leucyl-phenylalanine was also determined following cytochrome c reduction in a microplate assay. A strong negative correlation was found between C18:2 (linoleic acid) (r = -0.703, P -0.01) and C:16:0 (palmitic acid) ( r = -0.569, P = 0.009) and fMLP-stimulated O₂ release, whereas C20:4 (arachidonic acid) correlated Positively ( r = 0.448, P = 0.048). Other fatty acids, namely C12:0, C14:0, C16:1, C18:1, C18:3, C18:4, C20:0, C20:1, C20:2, C20:5, C22:0, C22:1, C22:6, C24:0 and C26:0, were not correlated with O₂. No correlations were found between fatty acid composition and O₂ release from resting cells and from cells stimulated by phorbol-myristate acetate. These results suggest that the fatty acid composition of blood neutrophils may be a critical factor determining the capability of releasing free radicals in response to formylpeptides. Moreover, since a concomitant increase of arachidonic acid and decrease of its precursor linoleic acid has been found in high-responsive neutrophils, the rate of the enzymes of the arachidonic acid biosynthetic pathway (elongases and desaturases) appear to play an important role.     

Effect of palmitic acid and fatty acid binding protein on ventricular fibrillation threshold in the perfused rat heart

The effects of increased free fatty acid (FFA) levels on ventricular arrhythmias remain controversial. Using ventricular fibrillation threshold (VFT), we examined the relationship between FFA levels and ventricular arrhythmias. Isolated rat hearts were perfused with palmitate bound to either albumin or fatty acid binding protein (FABP) by Langendorf's method. The VFT was determined by electrical stimulation. Perfusion with 0.12 mM albumin alone, 0.12 mM palmitate bound to 0.12 mM albumin, and 0.36 mM palmitate bound to 0.12 mM albumin did not lower the VFT significantly. However, 0.60 mM palmitate bound to 0.12 mM albumin lowered VFT from 2.19 +/- 0.20 mA to 1.56 +/- 0.13 mA. The perfusion of 0.36 mM palmitate bound to 0.12 mM FABP lowered the VFT from 2.05 +/- to 0.19 mA to 1.47 +/- 0.23 mA, but 0.12 mM FABP alone did not affect the VFT. Perfusion with 0.36 mM palmitate bound to 0.12 mM FABP caused the VFT to fall more than perfusion with 0.36 mM palmitate bound to 0.12 mM albumin. Then the effects of verapamil perfusion or a low concentration of perfusate Ca2+ on VFT were examined. VFT was determined by electrical stimulation. Palmitate (0.6 mM) bound to 0.12 mM albumin lowered VFT. Verapamil 10(-7) M perfusion and a low concentration of Ca2+ (Ca2+ 1.67 mM) suppressed the FFA-induced fall of VFT. These results suggested that the arrhythmogenic action of FFA was related to Ca2+ overload in myocardial cells.     

Efficacy of flaxseed oil compared with fish oil supplementation in the treatment of coronary heart disease: a retrospective study

BackgroundMany studies have demonstrated the beneficial effects of omega‐3 fatty acids in animal models and human diseases. Compared with commonly used fish oil, flaxseed oil has better palatability. However, the relative efficacy of the two types of oil on the cardiovascular health of type 2 diabetes mellitus (T2DM) patients with coronary heart disease (CHD) is unclear.MethodsThis was a retrospective study based on the prospectively maintained database of Hubei Provincial Hospital of Traditional Chinese Medicine. Patients meeting the inclusion criteria were enrolled and then divided into two groups: the flaxseed oil group received 1,000 mg flaxseed oil, which contains 400 mg of α-Linolenic acid, as their omega‐3 fatty acid source; the fish oil group received 1,000 mg of fish oil, which contains 250 mg of eicosapentaenoic acid and 150 mg of docosahexaenoic acid. The primary outcome was cardiovascular risk biomarker changes between the two groups. P values less than 0.05 were considered statistically significant.ResultsA total of 120 patients were enrolled in the present study: 60 in the flaxseed oil group and 60 in the fish oil group. After a median follow-up of 10.0 weeks (95% CI: 8.4–11.6 weeks), flaxseed oil was found to be significantly better at reducing serum insulin levels and high‐sensitivity C‐reactive protein (hs‐CRP) levels than fish oil (P=0.03 and P=0.02, respectively). The effects of flaxseed oil and fish oil on homeostatic model assessment for insulin resistance (HOMA-IR), fasting plasma glucose (FPG); body weight, and body mass index (BMI) were found to be similar. Moreover, patients who received flaxseed oil tended to have a better overall survival than those who received fish oil, although the difference was not statistically significant (P=0.067).ConclusionsCompared with fish oil, flaxseed oil was more effective in reducing serum insulin levels and hs‐CRP levels for T2DM patients with CHD. For these patients, flaxseed oil might become a novel choice.     

Circulating n-3 fatty acids and linoleic acid as indicators of dietary fatty acid intake in post-myocardial infarction patients

Background and aims

Population-based studies often use plasma fatty acids (FAs) as objective indicators of FA intake, especially for n-3 FA and linoleic acid (LA). The relation between dietary and circulating FA in cardiometabolic patients is largely unknown. We examined whether dietary n-3 FA and LA were reflected in plasma lipid pools in post-myocardial infarction (MI) patients.

Incorporation, distribution, and metabolism of polyunsaturated fatty acids in the pineal gland of rainbow trout (Oncorhynchus mykiss) in vitro

The in vitro incorporation of 3H-radio-labeled arachidonic (20:4n-6) and docosahexaenoic (22:6n-3) acids by the photosensitive trout pineal gland was visualized using photon and electron microscopy. After 6 hr of incubation, 3H-20:4n-6 appeared distributed in photoreceptors, as well as in glial cells, whereas 3H-22:6n-3 was preferentially taken up by photoreceptors, mainly in the apical part (including the photoreceptive outer segment). Radioactivity was mainly seen over membranes of glia when the incorporation of 3H-20:4n-6 was followed by 12-18 hr of chase. We also report differences in the incorporation of 14C-radio-labeled linoleic (18:2n-6), linolenic (18:3n-3), eicosapentenoic (20:5n-3), 20:4n-6, and 22:6n-3 acids into the lipids in glands cultured under different lighting regimes. Phosphatidylcholine and triacylglycerols contained most of the radio-labeled polyunsaturated fatty acids (PUFA) incorporated. The proportion of incorporated 20:4n-6 recovered in phosphatidylinositol was always significantly higher than that found with the other PUFA. At least 10% of radioactivity from each incorporated substrate, except 22:6n-3, was recovered in elongation products. It is concluded that the pineal gland of the trout can assimilate exogenous PUFA into cellular lipids in vitro, in a manner consistent with our previous in vivo findings. In terms of lipid composition, the trout pineal gland resembles more the vertebrate retina than the rat pineal gland. This might be related to the loss of direct photosensitivity of the mammalian pineal. Together, the differences reported herein between 22:6n-3 and 20:4n-6 suggest the former plays an important role in the phototransduction process, whereas the latter might be more specifically involved in the production of phosphoinositide-derived second messengers.     

A protein-enriched low glycemic index diet with omega-3 polyunsaturated fatty acid supplementation exerts beneficial effects on metabolic control in type 2 diabetes

AimsThe current study aims to investigate practicability and effects of a combined dietary intervention with increased relative protein content supplemented with omega-3 polyunsaturated fatty acids (PUFA) on metabolic control and inflammatory parameters in a real life situation in type 2 diabetes patients.MethodsIn this observational study we advised thirty mostly obese patients with type 2 diabetes to follow a protein-enriched diet with carbohydrates of low glycemic index (low GI) and moderate fat reduction supplemented with omega-3 PUFA for 24 weeks. Primary efficacy parameter was the change in HbA1c; secondary parameters included changes in systemic inflammation (measured by ultrasensitive C-reactive protein, usCRP), body weight, waist circumference, fat mass. The study is registered at clinicaltrials.gov (NCT01474603).ResultsThe dietary intervention significantly reduced the primary efficacy variable HbA1c from a baseline value of 63 ± 11 mmol/mol to 59 ± 14 mmol/mol (P = 0.033) and 56 ± 12 mmol/mol (P = 0.001) after 12 and 24 weeks, respectively. In addition, usCRP decreased significantly at 24 weeks (P = 0.039). Waist circumference, an important indicator for cardiometabolic-risk and silent inflammation, decreased from baseline 116.0 ± 14.1 cm to 114.9 ± 13.5 cm (P = 0.019), 114.0 ± 14.4 cm (P = 0.001), and 112.7 ± 13.4 cm (P = 0.049), after 3, 12 and 24 weeks, respectively.ConclusionCounseling a protein enriched and low glycemic index diet supplemented with long-chain omega-3 PUFA in a real-life clinical setting improves glycemic control and also reduces waist circumference and silent inflammation in overweight or obese patients with type 2 diabetes.     

The Mediterranean dietary pattern as the diet of choice for non‐alcoholic fatty liver disease: Evidence and plausible mechanisms

Non‐alcoholic fatty liver disease (NAFLD) has become a major global health burden, leading to increased risk for cirrhosis, hepatocellular carcinoma, type‐2 diabetes and cardiovascular disease. Lifestyle intervention aiming at weight reduction is the most established treatment. However, changing the dietary composition even without weight loss can also reduce steatosis and improve metabolic alterations as insulin resistance and lipid profile. The Mediterranean diet (MD) pattern has been proposed as appropriate for this goal, and was recommended as the diet of choice for the treatment of NAFLD by the EASL‐EASD‐EASO Clinical Practice Guidelines. The MD has an established superiority in long term weight reduction over low fat diet, but it improves metabolic status and steatosis even without it. However, the effect on liver inflammation and fibrosis was tested only in few observational studies with positive results. Furthermore, considering the strong association between NAFLD and diabetes and CVD, the MD has a highly established advantage in prevention of these diseases, demonstrated in randomized clinical trials. The individual components of the MD such as olive oil, fish, nuts, whole grains, fruits, and vegetables, have been shown to beneficially effect or negatively correlate with NAFLD, while consumption of components that characterize a Western dietary pattern as soft drinks, fructose, meat and saturated fatty acids have been shown to have detrimental association with NAFLD. In this review we will cover the epidemiological evidence and the plausible molecular mechanisms by which the MD as a whole and each of its components can be of benefit in NAFLD.     

Cardiac fatty acid metabolism is preserved in the compensated hypertrophic rat heart

Cardiac hypertrophy and failure are associated with alterations in cardiac substrate metabolism. It remains to be established, however, whether genomically driven changes in cardiac glucose and fatty acid (FA) metabolism represent a key event of the hypertrophic remodeling process. Accordingly, we investigated metabolic gene expression and substrate metabolism during compensatory hypertrophy, in relation to other cardiac remodeling processes. Thereto, cardiac hypertrophy was induced in rats by supra–renal aortic constriction to various degrees, resulting in increased heart/body weight ratios of 22% (Aob–1), 24% (Aob–2) and 32% (Aob–3) (p < 0.005) after 4 weeks. The unaltered ejection fraction in all groups indicated that the hypertrophy was still compensatory in nature. β–Myosin Heavy Chain protein and ANF mRNA levels were increased in all groups. Only in Aob–3 rats were SERCA2a mRNA levels markedly reduced. In this group, glycolytic capacity was modestly elevated (+ 25%; p < 0.01). Notwithstanding these phenotypical changes, the expression of genes involved in FA metabolism and FA oxidation rate in cardiac homogenates was completely preserved, irrespective of the degree of hypertrophy. These findings indicate that cardiac FA oxidative capacity is preserved during compensatory hypertrophy, and that a decline in metabolic gene expression does not represent a hallmark of the development of hypertrophy.     

Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women.

OBJECTIVE: To study the effects of a carbohydrate-enriched (HiCarbo) or olive-oil-enriched (HiMUFA) hypocaloric diet on plasma lipoprotein levels and physical properties. DESIGN: A six-month follow-up dietary intervention study with a HiCarbo diet providing 60% of total calories as complex carbohydrates, 15% as proteins and 25% as fats [10% saturated (SFA); 7% monounsaturated (MUFA); 8% polyunsaturated fatty acids (PUFA)]; or a HiMUFA diet with 40% complex carbohydrates, 15% proteins and 45% fats (10% SFA; 27% MUFA; 8% PUFA). SUBJECTS: Twenty consecutive, mildly obese, normolipidemic premenopausal women (11 on HiCarbo and nine on HiMUFA diets) and 14 age- and sex-matched, lean controls. MEASUREMENTS: Body mass index (BMI), waist/hip ratio, plasma lipoproteins, apolipoprotein (apo) AI and B, LDL and HDL density distribution, and phospholipid fatty acid composition at baseline, and after 3 and 6 months on dietary treatment. RESULTS: Body weight progressively decreased during the first 3 months and then it stabilized during the following 3 months (-11% vs. baseline in both groups; P < 0.01). LDL-Cholesterol decreased significantly in both groups. HDL-Cholesterol increased significantly in the HiMUFA group, whereas a decreased level was observed in the HiCarbo group. At baseline the obese women had higher very low density lipoprotein (VLDL) and dense LDL-Cholesterol, and lower HDL2 cholesterol levels than the controls; these abnormalities persisted in the HiCarbo diet, whilst a significant decrease in the dense LDL associated with an increase in the HDL2 cholesterol was seen in the HiMUFA diet. HDL3 was not affected by either diet. The LDL/HDL-Cholesterol ratio was not affected by the HiCarbo diet, whilst it was significantly reduced after 6 months of HiMUFA diet as compared with baseline. Apo AI increased in the HiMUFA group, and decreased in the HiCarbo group. CONCLUSIONS: Both diets were effective in decreasing body weight. At steady weight conditions, only the HiMUFA diet improved LDL and HDL subclass distribution abnormalities present in mildly obese normolipidemic women.     

Influence of dietary cod liver oil on fatty acid composition of plasma lipids in human male subjects after myocardial infarction

A randomized crossover study was carried out to investigate the fatty acid profile and concentrations of plasma lipids in male patients with myocardial infarction (MI) who supplemented their diet with 20 ml cod liver oil daily for 6 weeks. Subjects were divided into two groups, A and B. Group A received cod liver oil daily for 6 weeks after hospital discharge, but none for the subsequent 6 weeks. Group B did not start taking cod liver oil until 6 weeks after hospital discharge, and they then took cod liver oil for 6 weeks. Diet, medication or smoking habits were kept as constant as possible during the study. During the period of cod liver oil intake, eicosapentaenoic acid (20:5 (n-3), EPA) and docosahexaenoic acid (22:6 (n-3), DHA) increased significantly in phospholipids (PL), triglycerides (TG) and cholesterol esters (CE), whereas linoleic acid (18:2 (n-6), LA), dihomo-gamma-linolenic acid (20:3 (n-6), DHGLA) and arachidonic acid (20:4 (n-6), AA) were significantly decreased in phospholipids. The plasma level of TG was significantly decreased during the cod liver oil intake. Total cholesterol, high density lipoprotein (HDL) cholesterol, and levels of apolipoproteins A1 and B were not affected by cod liver oil in these MI patients.     

Omega-3 polyunsaturated fatty acids in the treatment of atherogenic dyslipidemia

Epidemiological studies have established an association between high triglycerides (TG) plasma levels and increased cardiovascular risk. Increased TG levels, commonly coupled with low HDL-C levels, are common in high cardiovascular risk subjects including those with dyslipidemia, metabolic syndrome and type 2 diabetes. Management of hypertriglyceridemia (HTG) includes lifestyle modification for mild-to-moderate HTG and pharmacological therapies for the treatment of high and very high TG levels. Among drugs, fibrates, nicotinic acid and omega-3 polyunsaturated fatty acids may be considered. Omega-3 fatty acids reduce plasma TG levels by several mechanisms; beside the effects on TG, omega-3 can also influence the levels of other lipids and lipoproteins including HDL-C and LDL-C. Clinical trials have also shown that omega-3 fatty acid supplementation is effective also when added in combination with other lipid-lowering drugs. These findings suggest that omega-3 fatty acids may be usefully considered for the management of high TG levels.