title: Long chain omega-3 dietary supplements: a review of the National Library of Medicine Herbal Supplement Database.
abstract: BACKGROUND
  Dietary fish oil supplements are increasingly used as an alternative to prescription-grade omega-3 fatty acids (P-OM3) for the treatment of hypertriglyceridemia. The content of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in these supplement products varies widely and may result in a suboptimal response. The aim of this study was to review marketed fish oil supplements and to develop a reference for clinicians to compare products.
  
  
  METHODS
  The National Library of Medicine Herbal Supplement Database was systematically searched using fish oil, EPA, DHA, and omega-3 fatty acid as search terms. Daily doses needed to achieve the Food and Drug Administration (FDA)-approved dose (RxDose) (3,360 mg of combined EPA and DHA) were calculated from the milligrams of EPA and DHA per serving, and suggested retail prices were used to calculate monthly cost of each product. A "usage criteria" was set to highlight products at the RxDose with a monthly cost of <$50, daily servings <8, daily amount of vitamins A and D less than or equal to the U.S. Dietary Reference Intake upper limit defined as 10,000 and 4,000 IU, respectively, and if the product was U.S. Pharmacopeia verified.
  
  
  RESULTS
  A total of 163 products were identified, and 102 nonliquid and liquid products met our entry criteria. The median amount of EPA and DHA per serving in the nonliquid products was 216 mg and 200 mg, respectively, and the median number of servings at the RxDose was 11.2 at a median monthly cost of $63.49. The median amount of EPA (460 mg) and DHA (400 mg) per serving in the liquid products was higher than the nonliquid products. Thus, the median number of servings at the RxDose was only 3.6 teaspoons and the median monthly cost of $13.60. Only 22% of products met our "usage criteria."
  
  
  CONCLUSIONS
  The amount of EPA and DHA per recommended serving in these products was highly variable. Clinicians should heighten their scrutiny in terms of selection of the appropriate product.
authors.affiliation: Oregon State University and Oregon Health & Science University College of Pharmacy, USA.
authors.forename: Atanaz
authors.initials: A
authors.lastname: Zargar
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Ito
mesh_terms: D016208:Databases, Factual; D019587:Dietary Supplements / Q000032:analysis / Q000592:standards; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000032:analysis; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage / Q000032:analysis; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000032:analysis; D005395:Fish Oils / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D009317:National Library of Medicine (U.S.); D018673:Nutrition Policy; D014481:United States
chemical_list: D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid