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Effect of Essential Fatty Acids on Depression
A total of 60% of the human brain is made out of fat. Omega-3 fatty acids in the brain regulate serotonin synthesis, release and re-uptake. Since the body cannot make this essential fatty acid...
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Effect of Essential Fatty Acids on Psoriasis
Inflammation plays a role in psoriasis, and fish oil has also shown promise as an anti-inflammatory treatment.
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Effect of Essential Fatty Acids on Congestive Heart Failure (CHF)
Fish oil may have a number of beneficial effects on congestive heart failure. Fish oil has been shown to reduce triglyceride levels, raise HDL ("good") cholesterol levels, "thin" the blood, lower...
Read more about Congestive Heart Failure (CHF) and Fish Oil.
Effect of Essential Fatty Acids on Heart Attack
Fish oil has been shown to reduce triglyceride levels, raise HDL ("good") cholesterol levels, "thin" the blood, lower levels of homocysteine, prevent dangerous heart arrhythmias, slow heart rate,...
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Effect of Essential Fatty Acids on Polycystic Ovarian Syndrome
Fish oil, rich in omega-3s, is sometimes used as a treatment for PCOS Flax seeds are also rich in omega-3s.
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Effect of Essential Fatty Acids on Hypertension
Fish oil has a number of effects on the cardiovascular system. It may help lower blood pressure by acting as a blood thinner and slightly reducing the heart rate, among other actions.
Read more about Hypertension and Fish Oil.
Effect of Essential Fatty Acids on Bipolar Disorder
Though the exact mechanism is unknown, it is thought that supplementing omega 3s through fish and/or flaxseed oil may help in the treatment of depression - a symptom of bipolar disorder.
Read more about Bipolar Disorder and Omega-3 Oil(s).
Effect of Essential Fatty Acids on Lipid Disorders
Fish oil has a number of effects on cardiovascular processes and conditions, including reducing triglycerides and increasing HDL ("good") cholesterol.
Read more about Lipid Disorders and Fish Oil.
Effect of Essential Fatty Acids on Menopause
Read more about Menopause and Essential Fatty Acids.
Consumption of fish oil alters the body’s production of certain substances in the class of chemicals called prostaglandins. Some prostaglandins increase inflammation while others decrease it. The prostaglandins whose production is enhanced by fish oil fall into the anti-inflammatory category. Based on this, fish oil has been tried as a treatment for early stages of rheumatoid arthritis , with positive results. It is thought to significantly reduce symptoms without causing side effects and may magnify the benefits of standard arthritis drugs. 1 However, while some standard medications can slow the progression of the disease, there is no evidence that fish oil can do this. Much weaker evidence hints that fish oil might be helpful for the related disease ankylosing spondylitis. 2 Fish oil’s apparent anti-inflammatory properties are the likely explanation for its apparent benefit in dysmenorrhea (menstrual pain), as seen in two studies. 3 Similarly, fish oil may be helpful for the autoimmune disease lupus . 4 (However, two studies failed to find fish oil helpful for kidney disease caused by lupus. 5 ) Evidence has been mixed regarding whether fish oil is beneficial for Crohn's disease or ulcerative colitis , conditions in which parts of the digestive tract are highly inflamed. 6 More recently, however, two well-designed trials enrolling a total of 738 patients convincingly failed to find any benefit for omega-3 fatty acid supplementations in the prevention of Crohn’s disease relapse. 7 Incomplete evidence hints but does not prove that fish or fish oil might help prevent death caused by heart disease . 8 This effect seems to result from several separate actions. The best documented involves reducing high triglyceride levels ; studies enrolling more than 2,000 people have substantiated this use. 9 In addition, fish oil might raise HDL ("good") cholesterol levels, "thin" the blood, lower levels of homocysteine , prevent dangerous heart arrhythmias, slow heart rate, improve blood vessel tone, and decrease blood pressure . 10 These effects also support findings that fish oil may help prevent strokes . 11 However, results are conflicting on whether people with angina should take fish oil or increase intake of fatty fish; one large study actually found that fish oil increasedrisk of sudden death. 12 For a number of theoretical reasons, it has been suggested that fish oil and its constituents (especially a slightly modified form of EPA called ethyl-EPA) might have positive effects on various psychiatric disorders, most notably depression . However, there is no convincing evidence that low levels of omega-3 fatty acids in the bloodstream leads to even mild depression. 13 Moreover, larger trials have generally failed to demonstrate a beneficial effect of fish oil-related products in depressed patients. 14 Preliminary, and not altogether consistent, evidence hints that high doses of fish oil may produce benefits in bipolar disorder (more commonly known as manic-depressive illness), reducing risk of relapse and improving emotional state. 15 Other preliminary, and again not altogether consistent, evidence hints that fish oil might enhance the effectiveness of standard drugs (such as phenothiazines ) for schizophrenia. 16 One trial of 81 adolescents and young adults (considered at very high risk) found that daily omega-3 fatty acid supplements for 12 weeks delayed transition to a first full-blown psychotic episode (e.g., shcizophrenia) within one year. 17 Fish oil has also shown a bit of promise for borderline personality disorder. 18 In one study, DHA failed to augment the effectiveness of standard therapy for attention deficit disorder (ADD). 19 However, two studies that evaluated the potential benefits of fish oil combined with omega-6 fatty acids found some evidence of benefit for this condition. 20 Finally, one small trial found evidence that use of fish oil might decrease anger and aggressiveness in people with a history of aggressive behaviors, substance abuse, and problems with the law. 21 Small studies also suggest that fish oil may be helpful in Raynaud's phenomenon (a condition in which a person's hands and feet show abnormal sensitivity to cold temperatures), 22 sickle-cell anemia , 23 and a form of kidney disease called IgA nephropathy. 24 According to some, but not all studies, fish oil may help treat the undesired weight loss often experienced by people with cancer. 25 In addition, highly preliminary evidence hints that DHA might enhance the effects of the cancer chemotherapy drug doxorubicin 26 and decrease side effects of the chemotherapy drug irinotecan. 27 Use of fish oil by pregnant women might help prevent premature birth, 28 although evidence is somewhat inconsistent. In addition, use of fish oil by pregnant women may support healthy brain function 29 and help prevent eczema and allergies in offspring. 30 Intriguing, but not yet at all reliable, evidence hints that fish oil, or its constituents, might be helpful for treating kidney stones or alleviating the symptoms of chronic fatigue syndrome , and reducing the risk of prostate cancer . 31 Results are inconsistent regarding whether the use of fish oil can decrease seizure frequency in people with epilepsy . 32 One study found that insulin metabolism in 278 young, overweight subjects improved on a calorie-restricted diet rich in fish oil from seafood or supplements compared to those on a diet low in fish oil, suggesting that fish oil may help delay the onset of diabetes in susceptible individuals. 33 Fish oil has also been proposed as a treatment for many other conditions, including diabetic neuropathy , 34 allergies , and gout , but there has been little real scientific investigation of these uses.
Some, but not all, studies suggest that fish oil combined with omega-6 essential fatty acids may augment the effectiveness of calcium in the treatment of osteoporosis . 35 One promising, but highly preliminary, double-blind, placebo-controlled study suggests that the same combination therapy may improve symptoms of the severe neurological illness called Huntington’s disease. 36 Use of a fish oil product as part of a total parenteral nutrition regimen (intravenous feeding) may help speed recovery after major abdominal surgery . 37 For several other conditions, the current balance of the evidence suggests that fish oil is noteffective.
For example, despite widely publicized claims that fish oil helps asthma , most preliminary studies have failed to provide evidence that it is effective, and one study found that fish oil can actually worsen aspirin-related asthma. 38 However, there is some evidence that use of fish oil could help prevent exercise-induced asthma in athletes. 39 And, in an interesting randomized, controlled trial with long-term follow-up, mothers who take fish-oil during late pregnancy reduced the risk of asthma in their children up to 16 years later. 40 One study found that fish oil did not benefit the lung function of patients with cystic fibrosis. 41 Similarly, a 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent migraine headaches found that fish oil did not significantly reduce headache frequency or severity. 42 Conflicting results have been seen in other, much smaller trials of fish oil for migraines. 43 One study found weak evidence that use of fish oil might decrease aggressive behavior in young girls (but, in this study, not in young boys). 44 Another study found benefit in developmental coordination disorder (a condition in which children suffer from lack of physical coordination as well as problems with learning and behavior). 45 Fish oil is also sometimes recommended for enhancing immunity in HIV infection. However, one 6-month, double-blind study found that a combination of the omega-3 fatty acids in fish oil plus the amino acid arginine was no more effective than placebo in improving immune function in people with HIV. 46 Fish oil, however, might help individuals with HIV gain weight. 47 In one large, randomized, controlled trial, diets rich in fish and omega-3 fatty acids from fish were associated with a significant reduction in the risk of developing colorectal cancer among men over a 22-year period. 48 Another study provides preliminary evidence for the benefits of fish oil in reducing the risk of prostate cancer. 49 On balance, however, there is still relatively little evidence that the consumption of fish oil reduces cancer risk . 50 Preliminary studies have suggested that fish oil could help symptoms of multiple sclerosis ; however, the largest double-blind study on the subject found no difference between people taking fish oil and those taking olive oil (used as a placebo). 51 Although one study found fish oil somewhat helpful in psoriasis , 52 a much larger study found no benefit. 53 DHA has been evaluated as a possible treatment for male infertility , but a double-blind trial of 28 men with impaired sperm activity found no benefit. 54 Combination therapy with GLA and fish oil has failed to prove effective for cyclic breast pain . 55 One study failed to find fish oil more effective than placebo for treating stress . 56 DHA has also been tried for slowing the progression of retinitis pigmentosa (a condition in which the retina gradually degenerates), but without much success. 57 In observational studies, people who happen to consume a diet rich in omega-3 fatty acids seem to lower their risk of age-related macular degeneration (the most common cause of blindness in the elderly). However, in the absence of randomized controlled trials, it is not possible to say whether or not it is omega-3 that produces this benefit. 58 Studies of fish oil have failed to find it helpful for Alzheimer's disease , whether for slowing its progression or improving symptoms. 59 And, one well-designed study failed to find any benefit of fish oil for enhancing memory and mental function in older adults without dementia over a 26 week period. 60 Use of essential fatty acids in the omega-3 family has also shown some promise for the treatment of non-alcoholic fatty liver. 61
- James MJ, Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum. 1997;27:85-97.
- Sundström B, Stålnacke K, Hagfors L, Johansson G. Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis. Scand J Rheumatol. 35(5):359-62.
- Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 174(4):1335-8.
- Walton AJE, Snaith ML, Locniskar M, et al. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis. 1991;50:463-466.
- Clark WF, Parbtani A, Naylor CD, Levinton CM, Muirhead N, Spanner E, Huff MW, Philbrick DJ, Holub BJ. Fish oil in lupus nephritis: clinical findings and methodological implications. Kidney Int. 44(1):75-86.
- Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med. 334(24):1557-60.
- Feagan BG, Sandborn WJ, Mittmann U, Bar-Meir S, D'Haens G, Bradette M, Cohen A, Dallaire C, Ponich TP, McDonald JW, Hébuterne X, Paré P, Klvana P, Niv Y, Ardizzone S, Alexeeva O, Rostom A, Kiudelis G, Spleiss J, Gilgen D, Vandervoort MK, Wong CJ, Zou GY, Donner A, Rutgeerts P. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. JAMA. 299(14):1690-7.
- Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 112(4):298-304.
- Harris WS. n-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 65(5 Suppl):1645S-1654S.
- Montori VM, Farmer A, Wollan PC, Dinneen SF. Fish oil supplementation in type 2 diabetes: a quantitative systematic review. Diabetes Care. 23(9):1407-15.
- Iso H, Rexrode KM, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, Hennekens CH, Willett WC. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA. 285(3):304-12.
- Burr ML, Dunstan FD, George CH. Is fish oil good or bad for heart disease? Two trials with apparently conflicting results. J Membr Biol. 206(2):155-63.
- Appleton KM, Gunnell D, Peters TJ, Ness AR, Kessler D, Rogers PJ. No clear evidence of an association between plasma concentrations of n-3 long-chain polyunsaturated fatty acids and depressed mood in a non-clinical population. Prostaglandins Leukot Essent Fatty Acids. 78(6):337-42.
- Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry. 159(3):477-9.
- Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 56(5):407-12.
- Peet M, Brind J, Ramchand CN, Shah S, Vankar GK. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophr Res. 49(3):243-51.
- Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, Berger GE. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 67(2):146-54.
- Zanarini MC, Frankenburg FR. omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 160(1):167-9.
- Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird WC. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. J Pediatr. 139(2):189-96.
- Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry. 26(2):233-9.
- Buydens-Branchey L, Branchey M. Long-chain n-3 polyunsaturated fatty acids decrease feelings of anger in substance abusers. Psychiatry Res. 157(1-3):95-104.
- DiGiacomo RA, Kremer JM, Shah DM. Fish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study. Am J Med. 86(2):158-64.
- Tomer A, Kasey S, Connor WE, Clark S, Harker LA, Eckman JR. Reduction of pain episodes and prothrombotic activity in sickle cell disease by dietary n-3 fatty acids. Thromb Haemost. 85(6):966-74.
- Donadio JV Jr, Grande JP, Bergstralh EJ, Dart RA, Larson TS, Spencer DC. The long-term outcome of patients with IgA nephropathy treated with fish oil in a controlled trial. Mayo Nephrology Collaborative Group. J Am Soc Nephrol. 10(8):1772-7.
- Barber MD. Cancer cachexia and its treatment with fish-oil-enriched nutritional supplementation. Nutrition. 17(9):751-5.
- Rudra PK, Krokan HE. Cell-specific enhancement of doxorubicin toxicity in human tumour cells by docosahexaenoic acid. Anticancer Res. 21(1A):29-38.
- Hardman WE, Moyer MP, Cameron IL. Consumption of an omega-3 fatty acids product, INCELL AAFA, reduced side-effects of CPT-11 (irinotecan) in mice. Br J Cancer. 86(6):983-8.
- Smuts CM, Huang M, Mundy D, Plasse T, Major S, Carlson SE. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol. 101(3):469-79.
- Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics. 111(1):e39-44.
- Dunstan JA, Mori TA, Barden A, Beilin LJ, Taylor AL, Holt PG, Prescott SL. Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial. J Allergy Clin Immunol. 112(6):1178-84.
- Hibbeln JR, Salem N Jr. Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nutr. 1995;62:1-9.
- Yuen AW, Sander JW, Fluegel D, Patsalos PN, Bell GS, Johnson T, Koepp MJ. Omega-3 fatty acid supplementation in patients with chronic epilepsy: a randomized trial. Epilepsy Behav. 7(2):253-8.
- Ramel A, Martinéz A, Kiely M, Morais G, Bandarra NM, Thorsdottir I. Beneficial effects of long-chain n-3 fatty acids included in an energy-restricted diet on insulin resistance in overweight and obese European young adults. Diabetologia. 51(7):1261-8.
- Gerbi A, Maixent JM, Ansaldi JL, Pierlovisi M, Coste T, Pelissier JF, Vague P, Raccah D. Fish oil supplementation prevents diabetes-induced nerve conduction velocity and neuroanatomical changes in rats. J Nutr. 129(1):207-13.
- Kruger MC, Coetzer H, de Winter R, Gericke G, van Papendorp DH. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging (Milano). 10(5):385-94.
- Vaddadi KS, Soosai E, Chiu E, Dingjan P. A randomised, placebo-controlled, double blind study of treatment of Huntington's disease with unsaturated fatty acids. Neuroreport. 13(1):29-33.
- Wichmann MW, Thul P, Czarnetzki HD, Morlion BJ, Kemen M, Jauch KW. Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): data from a prospective, randomized, multicenter trial. Crit Care Med. 35(3):700-6.
- Thien FC, Woods RK, Walters EH. Oily fish and asthma--a fishy story? Further studies are required before claims can be made of a beneficial effect of oily fish consumption on asthma. Med J Aust. 164(3):135-6.
- Mickleborough TD, Murray RL, Ionescu AA, Lindley MR. Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med. 168(10):1181-9.
- Olsen SF, Osterdal ML, Salvig JD, et al. Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial. Am J Clin Nutr. 2008;88:167-175.
- Van Biervliet S, Devos M, Delhaye T, Van Biervliet JP, Robberecht E, Christophe A. Oral DHA supplementation in DeltaF508 homozygous cystic fibrosis patients. Prostaglandins Leukot Essent Fatty Acids. 78(2):109-15.
- Pradalier A, Bakouche P, Baudesson G, Delage A, Cornaille-Lafage G, Launay JM, Biason P. Failure of omega-3 polyunsaturated fatty acids in prevention of migraine: a double-blind study versus placebo. Cephalalgia. 21(8):818-22.
- Harel Z, Gascon G, Riggs S, Vaz R, Brown W, Exil G. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adolesc Health. 31(2):154-61.
- Itomura M, Hamazaki K, Sawazaki S, Kobayashi M, Terasawa K, Watanabe S, Hamazaki T. The effect of fish oil on physical aggression in schoolchildren--a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 16(3):163-71.
- Richardson AJ, Montgomery P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 115(5):1360-6.
- Pichard C, Sudre P, Karsegard V, Yerly S, Slosman DO, Delley V, Perrin L, Hirschel B. A randomized double-blind controlled study of 6 months of oral nutritional supplementation with arginine and omega-3 fatty acids in HIV-infected patients. Swiss HIV Cohort Study. AIDS. 12(1):53-63.
- Scevola D, Oberto L, Faggi A, et al. Fish oil in the treatment of wasting syndrome. Int Conf AIDS. 1996;11:122.
- Hall MN, Chavarro JE, Lee IM, Willett WC, Ma J. A 22-year prospective study of fish, n-3 fatty acid intake, and colorectal cancer risk in men. Cancer Epidemiol Biomarkers Prev. 17(5):1136-43.
- Norrish AE, Skeaff CM, Arribas GLB, et al. Prostate cancer risk and consumption of fish oils: a dietary biomarker-based case-control study. Br J Cancer. 1999;81:1238-1242.
- Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, Worthington HV, Durrington PN, Higgins JP, Capps NE, Riemersma RA, Ebrahim SB, Davey Smith G. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 332(7544):752-60.
- Nightingale S, Woo E, Smith AD, French JM, Gale MM, Sinclair HM, Bates D, Shaw DA. Red blood cell and adipose tissue fatty acids in mild inactive multiple sclerosis. Acta Neurol Scand. 82(1):43-50.
- Bittiner SB, Cartwright I, Tucker WFG, et al. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet. 1988;1:378-380.
- Søyland E, Funk J, Rajka G, Sandberg M, Thune P, Rustad L, Helland S, Middelfart K, Odu S, Falk ES. Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. N Engl J Med. 328(25):1812-6.
- Conquer JA, Martin JB, Tummon I, Watson L, Tekpetey F. Effect of DHA supplementation on DHA status and sperm motility in asthenozoospermic males. Lipids. 35(2):149-54.
- Blommers J, de Lange-De Klerk ES, Kuik DJ, Bezemer PD, Meijer S. Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol. 187(5):1389-94.
- Bradbury J, Myers SP, Oliver C. An adaptogenic role for omega-3 fatty acids in stress; a randomised placebo controlled double blind intervention study (pilot) [ISRCTN22569553]. Nutr J. 3():20.
- Berson EL, Rosner B, Sandberg MA, et al. Further evaluation of docosahexaenoic acid in patients with retinitis pigmentosa receiving vitamin A treatment. Arch Ophthalmol. 2004;122:1306-1314.
- Chong EW, Kreis AJ, Wong TY, Simpson JA, Guymer RH. Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol. 126(6):826-33.
- Freund-Levi YF, Eriksdotter-Jonhagen M, Cederholm T, et al. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD Study. Arch Neurol. 2006;63:1402-1408.
- van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Dullemeijer C, Olderikkert MG, Beekman AT, de Groot CP. Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology. 71(6):430-8.
- Spadaro L, Magliocco O, Spampinato D, Piro S, Oliveri C, Alagona C, Papa G, Rabuazzo AM, Purrello F. Effects of n-3 polyunsaturated fatty acids in subjects with nonalcoholic fatty liver disease. Dig Liver Dis. 40(3):194-9.