Failing heart—medical aspects
Fish Oils Produce Anti-inflammatory Effects and Improve Body Weight in Severe Heart Failure

Presented in part at the 25th program of the International Society for Heart and Lung Transplantation, April, 2005, Philadelphia, Pennsylvania.
https://doi.org/10.1016/j.healun.2006.03.005Get rights and content

Background

Fish oils have been shown to reduce production of tumor necrosis factor-alpha (TNF-α) in healthy subjects. We sought to evaluate the effects of fish oils on pro-inflammatory cytokines and body weight in patients with advanced heart failure.

Methods

Fourteen patients (New York Heart Association [NYHA] Class III to IV heart failure) were randomized in a double-blinded trial to active therapy with 8 g of n-3 fatty acids (Group A, n = 7) or placebo (Group B, n = 7) for 18 weeks. TNF-α and interleukin-1 (IL-1) production were measured by radioimmunoassay after endotoxin stimulation of peripheral blood mononuclear cells.

Results

Placebo-treated patients had a 44% increase in TNF-α (from 1.28 to 1.84 pg/ml; p = 0.07) but no significant change in IL-1 (from 0.68 to 0.78 pg/ml) production. n-3 fatty acids resulted in a 59% reduction in TNF-α (from 1.64 to 0.68 pg/ml; p = 0.02) and 39% decrease in IL-1 (from 1.98 to 1.21 pg/ml; p = 0.09) production. There was an inverse correlation between change in TNF-α production and change in percent body fat (r = −0.6; p = 0.02).

Conclusions

Fish oils decrease TNF-α production in heart failure and improve body weight. Fish oil therapy may represent a novel therapeutic approach in late-stage heart failure characterized by cardiac cachexia.

Section snippets

Study Population

The study population consisted of 14 patients (10 men and 4 women, aged 48 to 74 years, mean 57 ± 12 years) with stable New York Heart Association (NYHA) Class III to IV congestive heart failure (CHF), randomized in a double-blinded manner to active therapy with n-3 fatty acids (fish oils, n = 7) or placebo (n = 7). Patients were excluded if they had evidence of infectious, inflammatory or neoplastic disease. The etiology of heart failure was ischemic cardiomyopathy in 6 patients and idiopathic

Baseline Comparison

At baseline, there were no differences between placebo and fish oil–treated groups with respect to demographic, hemodynamic and biochemical characteristics (Table 1). At baseline, TNF-α production was similar between the fish oil and placebo groups (1.6 ± 1.1 vs 1.3 ± 0.9 pg/ml, respectively). In the sub-set of 8 patients in whom IL-1 production was assessed, there were also no baseline difference between the fish oil (n = 4) and placebo (n = 4) patients (1.9 ± 1.5 vs 0.7 ± 0.6 pg/ml,

Principle Findings

This study has demonstrated that dietary supplementation with n-3 fatty acid fish oils significantly inhibits synthesis of TNF-α and IL-1 in severe heart failure. Importantly, these anti-inflammatory effects are associated with an increase in body fat in this predominantly malnourished study population.

Cytokines and Cardiac Cachexia

Experimental evidence suggests that administration of TNF-α can cause cachexia in laboratory animals and during long-term administration in humans. This has led to the suggestion of this cytokine

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    Supported by a grant from the NIH/NOAA Biomedical Test Material Program.

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