title: Fish and omega-3 fatty acid intake in relation to circulating fibroblast growth factor 23 levels in renal transplant recipients.
abstract: OBJECTIVE
  A high circulating fibroblast growth factor 23 (FGF23) level is an independent risk factor for cardiovascular mortality in renal transplant recipients and the general population. N-3 fatty acids eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) may contribute to cardiovascular risk reduction. We investigated whether fish and EPA-DHA intake are related to FGF23 levels in renal transplant recipients.
  
  
  RESULTS
  We performed a cross-sectional analysis in 619 stable renal transplant recipients (mean age 53 years, 57% male, estimated glomerular filtration rate [eGFR] 53 ± 20 mL/min/1.73 m(2)). Dietary intake was assessed by a 177-item food frequency questionnaire. Serum intact FGF23 was measured by ELISA. We examined differences in FGF23 levels across categories of fish and EPA-DHA intake using analysis of variance models adjusted for age, sex, dietary and lifestyle factors and key determinants of FGF23. Patients consumed on average 15 g of fish and 139 mg EPA-DHA/day. Median FGF23 was 62 pg/mL (IQR 43-98 pg/mL). Higher dietary EPA-DHA and fish intake were associated with lower serum FGF23 levels. Subgroup analyses revealed that particularly in patients with reduced renal function (eGFR <60 mL/min/1.73 m(2)), adjusted FGF23 levels (114, 79, 75 pg/mL, P = 0.0001) were inversely associated with tertiles of EPA-DHA intake. Similarly, we observed an inverse association between fish consumption and serum FGF23 levels in adjusted analyses.
  
  
  CONCLUSIONS
  A higher intake of fish and dietary n-3 fatty acids (EPA-DHA) is related to lower circulating FGF23 levels in renal transplant recipients. Further research is needed to assess the causality of this association and the clinical implications.
authors: Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands; Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors: L C
authors: LC
authors: Baia
authors: Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands.
authors: E
authors: E
authors: Van den Berg
authors: Department of Nephrology, VU University Medical Center Amsterdam, The Netherlands.
authors: M G
authors: MG
authors: Vervloet
authors: Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors: I P
authors: IP
authors: Heilberg
authors: Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands.
authors: G
authors: G
authors: Navis
authors: Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands.
authors: S J L
authors: SJ
authors: Bakker
authors: Division of Human Nutrition, Wageningen University, The Netherlands.
authors: J M
authors: JM
authors: Geleijnse
authors: Division of Human Nutrition, Wageningen University, The Netherlands.
authors: D
authors: D
authors: Kromhout
authors: Division of Human Nutrition, Wageningen University, The Netherlands.
authors: S S
authors: SS
authors: Soedamah-Muthu
authors: Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands. Electronic address: m.h.de.borst@umcg.nl.
authors: M H
authors: MH
authors: De Borst
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005399:Fishes; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D066027:Transplant Recipients
chemical_list: C000717427:FGF23 protein, human; D015525:Fatty Acids, Omega-3; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Cardiovascular; Fibroblast growth factor; Kidney transplantation; Omega-3 fatty acids