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Lipids and cardiovascular/metabolic health

U-shaped relationship between tissue docosahexaenoic acid and atrial fibrillation following cardiac surgery

European Journal of Clinical Nutrition volume 68, pages 114–118 (2014)Cite this article

Subjects

Abstract

Background/objectives:

Randomised controlled trials (RCTs) evaluating the effect of fish oil supplementation on postoperative atrial fibrillation (POAF) following cardiac surgery have produced mixed results. In this study, we examined relationships between levels of red blood cell (RBC) n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) and the incidence of POAF.

Subjects/methods:

We used combined data (n=355) from RCTs conducted in Australia and Iceland. The primary end point was defined as POAF lasting >10 min in the first 6 days following surgery. The odds ratios (ORs) for POAF were compared between quintiles of preoperative RBC n-3 LC-PUFA levels by multivariable logistic regression.

Results:

Subjects with RBC docosahexaenoic acid (DHA) in the fourth quintile, comprising a RBC DHA range of 7.0–7.9%, had the lowest incidence of POAF. Subjects in the lowest and highest quintiles had significantly higher risk of developing POAF compared with those in the fourth quintile (OR=2.36: 95% CI; 1.07–5.24 and OR=2.45: 95% CI; 1.16–5.17, respectively). There was no association between RBC eicosapentaenoic acid levels and POAF incidence.

Conclusions:

The results suggest a ‘U-shaped’ relationship between RBC DHA levels and POAF incidence. The possibility of increased risk of POAF at high levels of DHA suggests an upper limit for n-3 LC-PUFAs in certain conditions.

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Acknowledgements

This work was supported by grant 399333 from the National Health and Medical Research Council of Australia, Canberra, Australia, and by grants from the Icelandic Centre for Research (RANNIS, grant no. 080411021), the University of Iceland Research Fund and the Landspitali – The National University Hospital of Iceland Research Fund. Dr Sanders is supported by the National Heart Foundation of Australia, Melbourne, Australia. Dr Gibson is supported by the National Health and Medical Research Council of Australia, Canberra, Australia.

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Authors and Affiliations

  1. Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia

    R G Metcalf, L G Cleland & M J James

  2. Centre for Heart Rhythm Disorders, Discipline of Medicine, University of Adelaide, Adelaide, Australia

    R G Metcalf, P Sanders, A L Farquharson, G D Young & M J James

  3. Department of Physiology, School of Health Sciences, University of Iceland, Reykjavik, Iceland

    G V Skuladottir, L Bjorgvinsdottir & R Heidarsdottir

  4. Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland

    G V Skuladottir, L Bjorgvinsdottir, D O Arnar, R Heidarsdottir & R Palsson

  5. Division of Nephrology, Internal Medicine Services, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    O S Indridason & R Palsson

  6. Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia

    T R Sullivan

  7. Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia

    P Sanders & G D Young

  8. Division of Cardiology, Internal Medicine Services, Cardiovascular Research Center, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    D O Arnar

  9. FOODplus Research Centre, School of Agriculture Food and Wine, University of Adelaide, Adelaide, Australia

    R A Gibson

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  1. R G Metcalf
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Correspondence to R G Metcalf.

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Metcalf, R., Skuladottir, G., Indridason, O. et al. U-shaped relationship between tissue docosahexaenoic acid and atrial fibrillation following cardiac surgery. Eur J Clin Nutr 68, 114–118 (2014). https://doi.org/10.1038/ejcn.2013.215

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