title: A combination of omega-3 fatty acids, folic acid and B-group vitamins is superior at lowering homocysteine than omega-3 alone: A meta-analysis.
abstract: The aim of the study was to assess whether omega-3 polyunsaturated fatty acid supplementation alone or in combination with folic acid and B-group vitamins is effective in lowering homocysteine. The Medline Ovid, Embase and Cochrane databases were searched for randomized-controlled trial studies that intervened with omega-3 supplementation (with or without folic acid) and measured changes in homocysteine concentration. Studies were pooled using a random effects model for meta-analysis. Three different models were analyzed: all trials combined, omega-3 polyunsaturated fatty acid trials, and omega-3 polyunsaturated fatty acids with folic acid and B-group vitamin trials. Nineteen studies were included, consisting of 3267 participants completing 21 trials. Studies were heterogeneous; varying by dose, duration and participant health conditions. Across all trials, omega-3 supplementation was effective in lowering homocysteine by an average of 1.18μmol/L (95%CI: (-1.89, -0.48), P=.001). The average homocysteine-lowering effect was greater when omega-3 supplementation was combined with folic acid and B-group vitamins (-1.37μmol/L, 95%CI: (-2.38, -0.36), P<.01) compared to omega-3 supplementation alone (-1.09μmol/L 95%CI: (-2.04, -0.13), P=.03). Omega-3 polyunsaturated fatty acid supplementation was associated with a modest reduction in homocysteine. For the purposes of reducing homocysteine, a combination of omega-3s (0.2-6g/day), folic acid (150 - 2500μg/day) and vitamins B6 and B12 may be more effective than omega-3 supplementation alone.
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Pigdons Rd, Geelong, 3220, Australia. Electronic address: samantha.dawson@deakin.edu.au.
authors.forename: Samantha Loren
authors.initials: SL
authors.lastname: Dawson
authors.affiliation: Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood Hwy, Burwood, 3125, Australia. Electronic address: s.bowe@deakin.edu.au.
authors.forename: Steven John
authors.initials: SJ
authors.lastname: Bowe
authors.affiliation: School of Exercise and Nutrition Sciences, Deakin University, Burwood Hwy, Burwood, 3125, Australia. Electronic address: tim.crowe@deakin.edu.au.
authors.forename: Timothy Charles
authors.initials: TC
authors.lastname: Crowe
mesh_terms: D000818:Animals; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology*; D005492:Folic Acid / Q000494:pharmacology*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D023421:Models, Animal; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D014803:Vitamin B Complex / Q000494:pharmacology*
chemical_list: D015525:Fatty Acids, Omega-3; D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid
keywords: B-group Vitamins; Folic acid; Homocysteine; Meta-analysis; Omega-3 PUFAs