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http://ncp.sagepub.com/content/27/4/553The online version of this article can be found at:

DOI: 10.1177/0884533612444535

2012 27: 553 originally published online 1 June 2012Nutr Clin PractIzabella Candido Carvalho Crochemore, Aline F. P. Souza, Andressa C. F. de Souza and Eliane Lopes Rosad

Resistance, and Lipemia in Women With Type 2 Diabetes and Obesity

-3 Polyunsaturated Fatty Acid Supplementation Does Not Influence Body Composition, Insuli

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Nutrition in Clinical Practice

Volume 27 Number 4

August 2012 553-560

2012 American Society

for Parenteral and Enteral Nutrition

DOI: 10.1177/0884533612444535

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hosted at

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Clinical Research

Diabetes mellitus is a nontransmittable chronic disease (NTCD)

that affects individuals worldwide.1 The worldwide mortality

estimate was 987,000 in 2002, which corresponds to 1.7% of

the total deaths in the world.2 In Brazil, a multicenter popula-

tion base study carried out in 1988 in 9 capitals of Brazilian

states demonstrated that the predominance of diabetes mellitus

and glucose intolerance in the urban population (30 and 69

years) was 7.6% and 7.8%, respectively, and almost half of this

total was not aware that they had glucose intolerance (46%). 3

Type 2 diabetes mellitus (T2DM) is a multiple-etiology dis-

ease characterized by chronic hyperglycemia, resulting from

the deficiency of insulin and/or the inability to mediate insulin

receptor signals, with subsequent insulin resistance (IR).4 Its

risk reduction and control can be carried out by changes in

lifestyle. Obesity and sedentarianism are important risk factors

for T2DM development.5,6

In addition, obesity is considered a risk factor for insulin

resistance, mainly the deposition of visceral fat, which can

result in pathophysiological alterations such as reduced insulin

extraction by the liver, increased hepatic production of glu-

cose, and reduced glucose uptake by muscular tissue.7

T2DM can result in micro- and macrovascular alterations

over time and is also associated with dyslipidemia, systemic

hypertension, and endothelial dysfunction.4 Because T2DM is

one of the main NTCDs that raise the morbidity and mortality

in the population and is related to IR, dyslipidemia, and obesity,

it becomes important to propose alternative treatments that

improve the prognosis of individuals with T2DM. Thus, the

quantity and quality of the fats in the diet, mainly series 3 poly-

unsaturated fatty acids (-3 PUFAs), have been considered by

researchers. -3 PUFAs can be associated with a reduction in

serum triglyceride (TG) levels, platelet aggregation, and car-

diac arrhythmias8 and improvement in body composition.9

Epidemiologic and clinical evidence demonstrates the cardio-

protective effects of -3 PUFA, despite modest or no changes

in the concentrations of lipids and lipoproteins in the blood. 10

. /

From the Instituto de Nutrio Josu de CastroUniversidade Federal do

Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.

Financial disclosure: This work was supported by the Fundao de

Amparo Pesquisa do Estado do Rio de Janeiro (FAPERJ).

Dr Crochemore was responsible for creating the concept and design of

the study; generation, collection, assembly, analysis and interpretation of

the data; and revision and approval of the final version of the manuscript;

Dr Rosado was responsible for creating the concept of the study; analysis

and interpretation of the data; and revision and approval of the final

version of the manuscript; Drs Aline F. P. Souza and Andressa C. F. de

Souza were responsible for collaboration in data collection and approval

of the final version of the manuscript.

Corresponding Author: Eliane Lopes Rosado, Universidade Federal do

Rio de Janeiro, Centro de Cincias da SadeInstituto de Nutrio Josu

de Castro., Avenida Brigadeiro Trompovisky, s/n, Bloco J, 2 andar,

sala 24CEP: 21949-900, Brazil; e-mail: [email protected],

[email protected].

-3 Polyunsaturated Fatty Acid Supplementation Does Not

Influence Body Composition, Insulin Resistance, and Lipemia

in Women With Type 2 Diabetes and Obesity

Izabella Candido Carvalho Crochemore, MSc; Aline F. P. Souza; Andressa C. F. de Souza;

and Eliane Lopes Rosado, PhD

Abstract

To evaluate the influence of -3 polyunsaturated fatty acid (-3 PUFA) supplementation on body composition, insulin resistance, and

lipemia of women with type 2 diabetes, the authors evaluated 41 women (60.64 7.82 years) with high blood pressure and diabetes

mellitus in a randomized and single-blind longitudinal intervention study. The women were divided into 3 groups: GA (2.5 g/d fish

oil), GB (1.5 g/d fish oil), and GC (control). The capsules with the supplement contained 21.9% of eicosapentaenoic acid and 14.1%

of docosapentaenoic acid. Biochemical (glucose, glycated hemoglobin, total and fractional cholesterol, triglycerides, and insulin) and

anthropometric (body mass, stature, waist circumference [WC], and body composition) evaluations were performed before and after the

30 days of intervention. Homeostasis model assessmentinsulin resistance and the Quantitative Insulin Sensitivity Check Index were usedto evaluate the insulin resistance and insulin sensitivity (IS), respectively. GB presented a greater loss of body mass and WC (P< .05),

greater frequency of glycemic and total cholesterol reduction, and an increase of high-density lipoprotein cholesterol compared with GA.

Thus, a high dose of -3 PUFA can reduce IS. A lower dose of -3 PUFA positively influenced body composition and lipid metabolism.

(Nutr Clin Pract. 2012;27:553-560)

Keywords

diabetes mellitus; diabetes mellitus, type 2; fatty acids, -3; hyperlipidemias; body composition; insulin resistance

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554 Nutrition in Clinical Practice27(4)

The promising effects of fish oil consumption, a source of

-3 PUFA, in the health industry are controversial due to

research that emphasizes the harmful effects in the glycemic

control of patients with diabetes mellitus.11 However, other

studies demonstrate that a low intake of PUFAs, mainly -3, is

associated with an increased risk of T2DM in women.12-14

The present study suggests that -3 PUFA supplementationcould improve lipemia and glycemia and reduce body weight.

Therefore, the aim of this study was to evaluate the influence

of the supplemented diet with different doses of -3 PUFA on

body composition, insulin resistance, and lipemia in women

with T2DM.

Materials and Methods

Population

We evaluated women with T2DM who participated in the

High Blood Pressure and Diabetes Program of the Municipal

Hospital Carlos Tortely, in Niteri, Rio de Janeiro, Brazil.

The study was approved by the Research Ethics Committee

of the Hospital Clementino Fraga Filho (protocol 067/07).

The eligibility criteria included menopausal women diag-

nosed with T2DM and grade 1 and 2 hypertension who were

nonsmokers with noncongenital heart disease and no recent

infectious diseases.

Experimental Design

A randomized, single-blind clinical intervention study was

conducted.

After a 12-hour overnight fast, blood samples were col-lected in the antecubital vein for analyses of serum levels of

glucose, glycated hemoglobin (A1c), total cholesterol, TG, and

insulin. Afterward, anthropometric evaluation (total body

mass, stature, waist circumference [WC], and body composi-

tion) was carried out.

The women were randomly placed into 3 groups, composed

of 2 test groups (-3 PUFA supplementation in different doses)

and 1 control, which received the respective capsules to be

taken daily for 30 days. The women were instructed to main-

tain their usual diet and physical activity.

Follow-up visits occurred every 15 days for intervention

control and distribution of capsules for the next 15 days. After

30 days, biochemical and anthropometric evaluations were

carried out while patients were in a fasting state.

Dietetic Intervention

Group A (GA) received capsules containing 2.5 g fish oil

(547.5 mg eicosapentaenoic acid [EPA] and 352.5 mg docosa-

pentaenoic acid [DHA]) (n = 14), Group B (GB) received 1.5

g fish oil (328.5 mg EPA and 211.5 mg DHA) (n = 14), and the

Group C (GC) received the placebo (n = 13). The capsules

with the supplement contained 21.9% of EPA and 14.1% of

DHA per gram and were gelatinous, colorless, and oblong.

The placebo capsules were composed of gelatin. All the cap-

sules were the same volume (500 mg) and contained vitamin

E in the same amount. The use of the capsules was controlled

by counting the remaining capsules during subsequent visits.

Anthropometric Evaluation and Body

Composition

Total body mass and stature were measured according to

Gibson,15 using a mechanical anthropometric balance (Welmy,

Santa Brbara dOeste, SP, Brazil), with a maximum capacity of

150 kg, divided by 100g, and the stadiometer from the anthropo-

metric balance with a scale of 0.1 cm. The volunteers were

weighed with minimum clothes possible and while barefoot.

Based on these variables, body mass index (BMI) was calcu-

lated.16 To measure the WC, an unextendable and inelastic tape

was used. The WC was measured at the midpoint between the

last rib and the iliac crest, with the arms and abdomen relaxed.

WC values above 80 and 88 cm were associated with an

increased and very increased risk of metabolic complications

associated with obesity, respectively.17

Body composition was evaluated by electric bioimpedance

(Biodynamics Corp, Seattle WA), which is based on the prin-

ciple of the bodys resistance to the passage of an electric cur-

rent in hydrated tissue, making it possible to obtain total body

water (TBW) and lean mass (LM). The difference of the total

body mass to LM results in the total body fat (TBF) estimate,

considering the 2-compartment body model.18

Biochemical Evaluation

The serum TG levels were determined by the enzymatic-

colorimetric method (Triglicrides GPO-ANA Liquiform;

Diagnostic Labtest S.A., Lagoa Santa, MG, Brazil), as indi-

cated by McGowan et al.19 The serum concentrations of total

cholesterol, high-density lipoprotein (HDL)cholesterol and

glucose were analyzed by the enzymatic-colorimetric method

(Cholesterol Liquiform, HDL-c LE, and Glucose Pad

Liquiform, respectively; Diagnostic Labtest S.A., Lagoa

Santa, MG, Brazil).20-22 The concentrations of low-density

lipoprotein (LDL)cholesterol were calculated based on the

Friedwald equation.23 To determine the hemoglobin A1c

level, the turbidimetric inhibition immunoassay technique

was carried out (TINIA) on the total hemolysate blood (com-

mercial kit HBA1C II; Roche Diagnostics, Mannheim,

Germany). The serum insulin was determined by radioimmu-

noassay (RIA) (insulin Coat-a-Count; Diagnostic Products

Corporation, Los Angeles, CA). Homeostasis model assess-

mentinsulin resistance (HOMA-IR) and Quantitative Insulin

Sensitivity Check Index (QUICKI) were used to do the insu-

lin resistance (IR) and insulin sensitivity (IS) calculations,

respectively.24,25

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-3 Polyunsaturated Fatty Acid Supplementation in Type 2 Diabetes and Obesity / Crochemore et al 555

Statistical Analysis

Data are presented as mean and standard deviation. To assess the

distribution of continuous variables, the Kolmogorov-Smirnov

test was used, which showed a nonparametric distribution.

For comparisons between groups, the nonparametric

Kruskal-Wallis (3 groups) and Mann-Whitney (2 groups) tests

were carried out. To verify the effect of the intervention in eachtest group, we carried out the Wilcoxon test.

Statistical analysis of data was performed using the Statistical

Package for Social Sciences software Version 16.0 (SPSS, Inc,

an IBM Company, Chicago, IL), consideringP< .05.

Results

Characteristics of the Groups at Baseline

Of 45 women selected, 41 were evaluated (age 60.78 7.82

years), being GA, GB, and GC (age 60.64 7.37, 60.00

7.49, and 61.83 9.07 years, respectively; P> .05). Eightypercent of the women used the oral antidiabetic medications

metformina (metformin) and 61% glibenclamida (glyburide).

The baseline anthropometric and biochemistry parameters

of the groups are presented in Table 1. GC presented with

higher TBF and lower LM levels compared with GB (P< .05);

however, this did not differ from GA. The serum insulin level

was greater in GC compared with GA and GB (P< .05). The

remaining variables did not differ between groups (P> .05).

All women presented with excess body mass, central hyperadi-

posity, fasting hyperglycemia, and IR.

Characteristics of the Groups After the

Intervention

The anthropometric and biochemical parameters between

groups, after the intervention, are presented in Table 2. GC

presented with higher TBF and lower LM compared with GA

and GB (P< .05). It is important to note that before the inter-

vention, GC differed only from GB. The remaining variablesdid not differ between groups (P > .05), except the serum

insulin level that was greater in GC at baseline.

After the evaluation of the effect of the intervention in each

individual group, it could be noted that GB had a reduction in

BMI and WC. GC experienced an increase in TBW, a reduc-

tion of TBF, and consequently an increase in LM (P< .05).

Also, a tendency could be seen in the reduction of BMI (P=

.08) and an increase of A1C (p=0.09) in GC (Table 3 and

Figure 1).

Evaluating the frequency of alterations in the anthropomet-

ric and biochemistry parameters, it was found that 35.7%,

71.4%, and 30.77% of the women in GA, GB, and GC, respec-tively, experienced a BMI reduction. The WC decreased in

64.3%, 64.3%, and 53.8% of the women in GA, GB, and GC,

respectively. As for TBF, there was a reduction in 64.3%,

57.14%, and 69.23% of the women in GA, GB, and GC,

respectively. Hyperglycemia was reduced in 35.7%, 42.9%,

and 30.8% of the women in GA, GB, and GC, respectively.

The serum A1C level also decreased in 14.3%, 35.7%, and

7.69% in the same groups. There was a reduction of serum

levels of total cholesterol, LDL-cholesterol, and TG in 42.8%,

54.1%, and 46.1%; 50%, 50%, and 38.5%; and 57.1%, 64.3%,

Table 1. Anthropometric and Biochemical Variables (Mean SD) of Groups at Baseline

Group A (n = 14) Group B (n = 14) Group C (n = 13)

Variables Mean SD Mean SD Mean SD PValue

BMI, kg/m2

29.86 5.97 30.88 6.76 33.82 5.17 .17

WC, cm 98.29 14.02 96.36 12.95 105.08 9.03 .19

TBW, L 35.34 6.38 34.86 4.31 35.49 6.08 .88

TBF, % 34.90 6.16 34.57 6.85 40.33a

3.21 .02

LM, % 65.02 6.16 65.43 6.85 59.67a

3.21 .03

Glucose, mg/dL 197.64 82.30 142.93 50.75 144.46 49.33 .07

Glycated hemoglobin, % 7.94 2.52 6.54 1.45 6.50 1.39 .28

Insulin, U/mL 7.91 6.15 8.56 4.24 13.77ab

6.67 .02

HOMA-IR 3.95 4.59 2.89 1.41 5.30 4.22 .11

QUICKI 0.33 0.03 0.34 0.03 0.31 0.03 .14

Cholesterol, mg/dL 214.07 36.52 199.0 24.48 203.83 50.48 .56

LDL-cholesterol, mg/dL 137.0 33.91 123.79 25.79 120.92 36.62 .57

HDL-cholesterol, mg/dL 51.43 10.46 48.0 14.71 47.85 11.13 .33

Triglycerides, mg/dL 132.93 69.35 149.21 102.50 161.75 116.23 .81

Differences between groups were tested with the Kruskal-Wallis test at 5% probability, and the Mann-Whitney test was used for analysis posttest. BMI,body mass index; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessmentinsulin resistance (HOMA-IR); LDL, low-density lipopro-

tein; LM, lean mass; QUICKI, Quantitative Insulin Sensitivity Check Index; TBF, total body fat; TBW, total body water; WC, waist circumference.aP< .05 vs GB.

bP< .05 vs GA.



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Table 2. Anthropometric and Biochemical Variables (Mean SD) of Groups After the Intervention


Variables Mean SD Mean SD Mean SD PValue

BMI, kg/m2

29.74 6.02 30.59 6.55 33.93 5.32 .14

WC, cm 97.86 14.42 94.71 12.66 104.92 9.00 .13

TBW, L 35.81 6.16 34.54 4.22 36.30 5.80 .85

TBF, % 34.32 6.67 34.20 6.17 39.23a,b

3.60 .05

LM, % 65.68 6.68 65.81 6.17 60.77a,b

3.60 .05

Glucose, mg/dL 208.71 85.54 153.07 62.06 161.15 50.08 .10

Glycated hemoglobin, % 8.15 2.26 6.76 1.88 7.24 1.44 .15

Insulin, U/mL 10.42 7.33 10.24 6.29 13.69 5.78 .20

HOMA-IR 5.23 4.39 3.99 2.92 5.55 3.52 .34

QUICKI 0.31 0.03 0.33 0.04 0.31 0.02 .39

Cholesterol, mg/dL 218.29 36.81 196.00 27.77 204.62 45.70 .24

LDL-cholesterol, mg/dL 142.43 29.93 122.86 22.97 125.15 31.93 .16

HDL-cholesterol, mg/dL 52.29 12.52 50.21 15.90 47.77 10.01 .53

Triglycerides, mg/dL 123.14 64.48 120.07 74.96 168.15 105.37 .27

Differences between groups were tested with the Kruskal-Wallis test at 5% probability, and the Mann-Whitney test was used for analysis posttest. BMI,body mass index; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessmentinsulin resistance (HOMA-IR); LDL, low-density lipopro-

tein; LM, lean mass; QUICKI, Quantitative Insulin Sensitivity Check Index; TBF, total body fat; TBW, total body water; WC, waist circumference.aP< .05 vs GB.

bP< .05 vs GA.

Table 3. Evolution of Anthropometric and Biochemical Variables (Mean SD) of the Groups After the Intervention


Variables Basal After Basal After Basal After

BMI, kg/m2

29.86 5.97 29.74 6.02 30.88 6.76 30.59 6.55a

33.82 5.17 33.93 5.32

WC, cm 98.29 14.02 97.86 14.42 96.36 12.95 94.71 12.66a

105.08 9.03 104.92 9.00

TBW, L 35.34 6.38 35.81 6.16 34.86 4.31 34.54 4.22 35.49 6.08 36.30 5.80

a

TBF, % 34.90 6.16 34.32 6.67 34.57 6.85 34.20 6.17 40.33 3.21 39.23 3.60a

LM, % 65.02 6.16 65.68 6.68 65.43 6.85 65.81 6.17 59.67 3.21 60.77 3.60a

Glucose, mg/dL 197.6 82.3 208.7 85.54 142.9 50.75 153.1 62.06 144.5 49.33 161.2 50.08

Glycated hemoglobin, % 7.94 2.52 8.15 2.26 6.54 1.45 6.76 1.88 6.50 1.39 7.24 1.44

Insulin, mU/mL 7.91 6.15 10.42 7.33 8.56 4.24 10.24 6.29 13.77 6.67 13.69 5.78

HOMA-IR 3.95 4.59 5.23 4.39 2.89 1.41 3.99 2.92 5.30 4.22 5.55 3.52

QUICKI 0.33 0.03 0.31 0.03 0.34 0.03 0.33 0.04 0.31 0.03 0.31 0.02

Cholesterol, mg/dL 214.1 36.52 218.3 36.81 199.0 24.48 196.0 27.77 203.8 50.48 204.6 45.70

LDL-cholesterol, mg/dL 137.0 33.91 142.4 29.93 123.8 25.79 122.9 22.97 120.9 36.62 125.2 31.93

HDL-cholesterol, mg/dL 51.43 10.46 52.29 12.52 48.00 14.71 50.21 15.90 47.85 11.13 47.77 10.01

Triglycerides, mg/dL 132.9 69.35 123.1 64.48 149.2 102.5 120.1 74.96 161.8 116.2 168.2 105.4

Differences between groups were tested with the Wilcoxon test at 5% probability. BMI, body mass index; HDL, high-density lipoprotein; HOMA-IR,

homeostasis model assessmentinsulin resistance (HOMA-IR); LDL, low-density lipoprotein; LM, lean mass; QUICKI, Quantitative Insulin SensitivityCheck Index; TBF, total body fat; TBW, total body water; WC, waist circumference.aSignificant at 5% probability, by ttest.

and 53.8% in GA, GB, and GC, respectively. There was an

increase of serum HDL-cholesterol concentration in 42.9%,

50%, and 38.9% of the women in GA, GB, and GC,

respectively.

The HOMA-IR decreased in 21.4%, 35.7%, and 38.5% of

the women in GA, GB, and GC, respectively. Regarding the

QUICKI, which represents the IS, there was a reduction of

85.7%, 57.1%, and 61.5% in these groups.



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Discussion

The incidence of T2DM has increased markedly worldwide,

particularly in association with cardiovascular disease (CVD),

especially among women. Studies indicate that IR is an impor-

tant factor for the pathogenesis of T2DM.25, 26 Genetic factors

and high body weight, particularly visceral adiposity, are

directly associated with the pathogenesis of IR and T2DM

development.27

In the present study, the groups were homogeneous in terms

of gender, age, and the remaining anthropometric and dietetic

parameters, except TBF, LM, and serum insulin levels, which

were higher in GC. However, the parameters of interest (IR andIS) did not differ between groups at baseline. Despite the main-

tenance of the diet habitually ingested by the volunteers, an

influence from supplementation with -3 PUFA was observed

in body weight, with a greater loss of total body mass in GB. The

largest dose of -3 PUFA did not influence weight and body

composition. GB experienced a reduction of WC, an important

marker of visceral adiposity, which can represent a reduction of

metabolic complication risks associated with obesity.17

The measurement of WC accurately predicts the quantity of

adipose visceral tissue, although Desprs28 reported that the

way in which body fat is distributed is more important than the

quantity to determine individual risk of NTCDs. The excess of

total body mass and/or obesity is present in a majority of

patients with T2DM, which can result in an increased risk of

CVD.29 Qiao and Nyamdori30 conducted a systematic review

using 17 prospective and 35 cross-sectional studies in adults

aged 1874 years, with the aim of comparing the BMI, WC,

and waist-to-hip ratio (WHR) and their relation to the inci-

dence and prevalence of T2DM. The study concluded that

either BMI or WC predicted T2DM, regardless of the contro-

versial results about what is a best obesity indicator.

Other researchers have evaluated the effect of -3 fatty

acids on body fat. Kabir et al31 analyzed the effect of -3 PUFA

supplementation for 2 months on the reduction of adiposity

and of some atherogenic effects in 26 women with T2DM in a

randomized and double-blind controlled study. They did not

observe changes in total body mass; however, the fat mass

(mainly in the region between the shoulders and hip) wasreduced in the group supplemented with -3 PUFA (1.8 g)

compared with placebo. Derosa et al12 also did not find varia-

tion of body weight or BMI between groups that consumed 1 g

-3 PUFA vs placebo. Peyron-Caso et al32 observed the same

result in their study. In the present study, GC had reductions of

TBF, which was not observed in the supplemented groups.

However, the reduction of TBF could be the result of the larger

TBF presented by these women at baseline.32

Favorable results in GB were observed in terms of glucose

metabolism, found by the greater frequency of hyperglycemia

and A1C reduction, compared with the other groups. However,

the fasting insulin difference that existed at baseline (higher

insulin levels in GC compared with the other groups) was not

maintained after the intervention, suggesting that women who

did not receive the supplementation reached insulinemia val-

ues similar to those of the supplemented groups. Furthermore,

despite the absence of statistical differences, there was an

absolute increase in the serum insulin concentrations in the

supplemented groups, which did not occur with placebo.

In the 1980s, it was observed that supplementation with -3

PUFA resulted in an increase of insulin requirements, serum

A1C concentrations, and fasting and postprandial hyperglyce-

mia in patients with type 1 and type 2 diabetes mellitus.11,33

However, some of these earlier studies did not have a control

group, and the dosage of -3 PUFA was, in some cases, ele-vated for diabetic and nondiabetic patients (1016 g/d instead

of 3 g/d). In another study, -3 PUFA supplements did not

cause adverse effects in glycemic control.34

Sirtori et al35 carried out a randomized multicenter study

evaluating 89 patients with T2DM supplemented with EPA +

DHA for 6 months, initially with 2.6 g/d (2 months) and fol-

lowed by 1.7 g/d (4 months) using olive oil as a placebo.

Differences were not observed between the groups in terms of

fasting glucose and insulin. Supplementation was offered with

1.7 g/d to all patients for 6 additional months, and worsening

in glycemic control was not found after 1 year of treatment.

Despite some reports of worsening metabolic during treatment

with -3 PUFA, the authors suggest that it could be a result of

the natural course of the disease.

The results in the present study suggest a tendency for there

to be a negative influence from supplementation and its dosage

on glycemic control, considering that the group that received

the largest dose of the -3 PUFA showed a tendency toward

reduction of IS and a high frequency of reduced serum glucose

levels. IR increased in all the groups, similar to the study by

Geloneze et al36 carried out with Brazilian individuals with

Figure 1. Evolution of anthropometric variables (mean

standard deviation) that differed after intervention by group.

BMI 1, body mass index baseline; BMI 2, body mass index final;

WC 1, waist circumference baseline; WC 2, waist circumference

final; TBW 1, total body water baseline; TBW 2, total body water

final; TBF 1, total body fat baseline; TBF 2, total body fat final;

LM 1, lean mass baseline; LM 2, lean mass final. * represents

statistically different variables.



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metabolic syndrome. It is worth pointing out that the women in

the current study had a high WC and were hypertensive and

obese, thus having metabolic syndrome characteristics.

On the other hand, studies have also demonstrated that

high-PUFA diets, particularly -3, present antiobesity effects

and improve insulin action through several metabolic

effects.37,38

The IS can improve as a result of the effects of theconsumption of fatty acids in the fluid membrane.39,40 The

increase in glucose uptake occurs after the membrane is

enriched with PUFA, apparently related to GLUT4 (glucose

transporter 4) in the plasmatic membrane, which drives the

intracellular expansion of glucose-6-phosphate and the

increase in glycogen synthesis in the skeletal muscle.40 These

effects on IS and glycemic metabolism are a result of the con-

sumption of -3 PUFA, which can be explained as a conse-

quence of the alteration in the composition of the serum fatty

acid.41

In GB, favorable results were observed in serum lipid lev-

els, as suggested by the greater frequency of reduced serum

levels of total cholesterol and TG and increased HDL-

cholesterol, compared with the other groups. Despite Kris-

Etherton et al42 affirming that supplementation with -3 PUFA

at the maximum dose of 4 g/d is recommended for individuals

with hypertriglyceridemia, the present study demonstrated that

the lower dose (GB) was more efficient in reducing total cho-

lesterol and TG compared with the high dose.

West et al43 found similar results with the supplementation

of -3 PUFA (replacing 7.8% of EPA and DHA of 50 g fat

from high oleic safflower and canola oils) in adults with

T2DM, in which a reduction in serum TG concentrations in

individuals who presented with hypertriglyceridemia was

observed. Although a small increase in serum LDL-cholesterollevels occurred, the increase in serum HDL-cholesterol con-

centration might compensate for this result, due to its benefi-

cial effect on CVD.

McEwen et al44 observed in their review that diets rich in

fish and -3 PUFA may reduce cardiovascular risk in individu-

als with DM by inhibiting platelet aggregation, improving

lipid profiles, and reducing mortality from CVD.

It should be emphasized that the results presented in the

studies are contradictory because of variations in the number

of evaluated patients, as well as the dose of -3 PUFA used

and the intervention period. In a review published by De

Caterina et al,45 85.4% of the total evaluated studies included

studies with fewer than 40 subjects, 14.6% of interventions

were carried out for a month, 19.5% of studies supplemented

individuals with -3 PUFA for less than a month, and 73.2% of

studies had less than a month of intervention.

Despite our suggestion that the increase in monitoring time

could account for results distinct from those found in the pres-

ent study, the results still remain inconclusive. A study carried

out by Popp-Snijders et al46 with 6 T2DM patients who

received a dose of 3 g/d of -3 PUFA for 8 weeks showed a

reduction in serum TG levels. Annuzzi et al47 evaluated 8

patients with T2DM who received 3 g/d -3 PUFA for 2 weeks

and also showed a reduction in TG. However, they also had an

increase in LDL-cholesterol. On the other hand, Pelikanova et

al48 evaluated 20 patients with T2DM for 3 weeks with a dose

of 3.1 g/d -3 PUFA and did not find alterations in the param-

eters referring to lipemia and glycemia. This result matches thepresent study, although Pelikanova et al studied fewer numbers

of patients for less time, despite the higher dose.

Kris-Etherton et al42 recommend as the ingestion of up to

4 g EPA + DHA for patients with hypertriglyceridemia, but they

do not determine the time of intervention, which might lead to

poor glycemic control, as was observed in the present study,

because GA presented a tendency of IS reduction. However, the

lipemia might be favored by the supplementation, because

Axelrod et al49 evaluated 20 individuals with T2DM for 6

weeks receiving 2.5 g/d -3 PUFA, showing a reduction of

serum concentrations of total cholesterol and LDL-cholesterol,

although an increase in HDL-cholesterol and TG was seen.

Our results demonstrated that a lower dose of -3 PUFA

was more effective than control or higher dose of -3 PUFA in

reducing total body mass and WC, and there was also less fre-

quency in IS reductions. The high dose did not alter body com-

position and resulted in a tendency to reduce the IS. As such, it

does not justify the increase of the -3 PUFA dose in the form

of supplements because the results with a smaller dose, likely

reached with a weekly consumption of 2 portions of fish with

high fat, presented themselves to be more effective on body

composition and lipemia in T2DM and obesity, without

hypertriglyceridemia.

It was concluded that a sample of women with T2DM using

oral hypoglycemics would not need -3 PUFA supplementa-tion with the intention of controlling body weight, promoting

favorable alterations in body composition, and improving lipe-

mia. Still, new studies that aim to confirm the -3 PUFA influ-

ence on the evaluated parameters in this study are necessary,

such as the establishment of the best dose indicated for patients

with an increased risk of NTCDs, besides the supplementation

time, which reflects satisfactory results and the reduction of

harmful effects. Also, other studies of interventions similar to

ours, in other population groups with diabetes mellitus, such as

children and adolescents, should be encouraged.

Acknowledgments

We thank Fundao Oswaldo Cruz (FIOCRUZ) and Associao

dos Pais e Amigos dos Excepcionais (APAE) for their collabora-

tion in laboratory tests.

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