The Effect of Total Omega 3 Fatty Acid Intake on Blood Homocysteine and C-Reactive Protein - Research Proposal Example

?The Effect of Total Omega 3 Fatty Acid Intake on Blood Homocysteine and C-Reactive Protein in Cuban Americans With and Without Type 2 Diabetes Student’s Name Grade Course Instructor’s Name (November 28th, 2013) The results suggest positive associations between omega 3 fatty acids and homocysteine quartiles but not CRP levels, controlling for a number of additional measures. Diabetic status was not associated with either homocysteine quartiles or CRP levels. The implications of the results are discussed below. Why were the results non-significant? What roles do these additional factors play, substantively, that would make no association possible? Adipocytes are fatty acid cells that secrete leptin and adiponectin which are substances or hormones that regulate insulin resistance and energy metabolism. There is a positive relationship between circulating levels of adiponectin and omega-3 fatty acid (Shidfar, Keshavarz, & Hosseyni, 2008). In obese people, this positive relationship may translate into a reduced risk of developing diabetes. In the same note, a higher concentration of omega-3 in serum is associated with lower concentrations of CRP. Obesity may easily increase inflammation as fat cells or adipocytes secrete proteins which stimulate the production of CRP. Individuals with C - reactive protein levels greater than 3 mg/L have an elevated risk of getting diabetes in comparison to individuals with lower levels of C-Reactive Protein (Singhal et al., 2013). Homocysteine is an amino acid that occurs naturally and is associated with elevated risk of cardiovascular disease (CVD). Factors that lead to increased levels of Homocysteine in obese subjects are low levels of folic acid and vitamin B12 (Smith & Barnett, 2005). Therefore, what would make the association not possible is the fact that there is an inverse relationship between omega-3 fatty acids and hs-CRP in healthy subjects. Omega 3 - > homocysteine hypothesized in literature The researchers have established that homocysteine and fatty acids levels were comparable amongst the normal weight and obese subjects. However, the levels of folate and vitamin B12 were much lower in the obese subjects in relation to the normal weight subjects. Elevated levels of homocysteine correlate with increased decreased levels of omega-3 fatty acid. The results of this study suggest positive associations between omega 3 fatty acids and homocysteine quartiles. Therefore, omega 3 - > homocysteine is not hypothesized in literature but established to be factual, though research in some areas is still going on. Omega 3 -> CRP hypothesized in literature There is a negative relationship between hs-CRP and levels of omega-3. When the levels of hs-CRP are in excess of 3 mg/L, then the levels of omega-3 are significantly reduced. Levels of C-Reactive Protein less than 1 mg/L are actually desirable and result in an overall cardiovascular risk that is low. Levels of C-Reactive Protein between 1 and 3 mg/L mean or indicative of moderate risk. These findings are in line with the findings of this study; there is a negative relationship between omega 3 fatty acids and CRP levels. In short, there is an inverse relationship between omega-3 fatty acids and hs-CRP in healthy subjects. Diabetes associations with CRP and homocysteine in the literature The diabetes association with CRP and homocysteine is evident both in a range of current and past literature. Idzior-Walus et al (2003) researched about the concentrations of C-reactive protein and Homocysteine in serum of diabetic men and women and the results show the potential function of CRP and homocysteine level modification by affecting fat mass and lipid levels in subjects with type 2 diabetes. Ridker (2003) notes that CRP is a complex set of proteins made by the bodies when faced with a high risk trauma or infection thus a vital factor of the immune system. Everybody makes CRP, although in different levels depending on a range of factors, such as genetics and lifestyle habits (Brown, 2000; Shidfar, Froghifar, & Vafa, 2011). Generally, individuals have high blood pressure, smoke, and obese have elevated levels of CRP. An observational study amongst angiographically proven coronary artery disease individuals with and without type 2 diabetes found that circulating plasma homocysteine levels were significantly higher in individuals with diabetes than in those without (12.4 mmol/L versus 11.7 mmol/L, P = 0.011) (Ndrepepa et al. 2008). In a different study, Huffman et al (2003) establsihed that African Americans have higher C-reactive protein, waist circumferences and consume more calories in relation to Haitian Americans. However, intake of omega-3 fatty acid per calorie did not show any significance difference between these ethnicities, but still, African Americans with low levels omega-3 intake were more likely to have elevated levels of C-reactive protein in relation to other ethnicities [OR=3. 32 (1. 11, 9. 26) p=0.031]. Even though homocysteine also did not differ by ethnicity, Black Americans with low levels of omega 3 intake (12 mg/L) than their counterparts [OR=4.63 (1.59, 12.0) p=0.004]. By diabetes status, the intake or consumption of omega-3 fatty acids was not in any way associated with the levels or homocysteine and C-reactive protein. These findings are inline with the results of this study which established that diabetic status was not associated with either homocysteine quartiles or CRP levels. For certain ethnicities, consumption of omega-3 fatty acids may be protective of CVD risk factors like homocysteine and C-reactive protein. Therefore, the diabetes association with CRP and homocysteine is evident in the literature but is negative association as opposed to the positive association with omega-3 fatty acids. Elevated CRP levels have been associated with CVD for a number of ethnic groups. A two by two-randomized factorial controlled trial was performed in 10,251, in whites (67%), Latinos (7%), Blacks (17%), and Asians (2%) middle-aged and older individuals with type 2 diabetes, and it was observed that intensive glycemic control was related to decreased hs-CRP in this population (Samaropoulos et, al., 2012). Limitations of the study in terms of consistency or inconsistency with the literature No doubt, study is consistent with the available literature in the sense that, nearly all consulted studies have used similar methods of study, qualitative and quantitative methods. They have all used descriptive statistics for each study variable was examined by diabetes status. The continuous variables were characterized by means and standard deviations. Normally distributed measures (e.g. age, waist circumference, and total cholesterol) were compared across diabetic status using independent two sample t tests to assess whether diabetes status and age were associated. Non-normally distributed variables, including BMI, diastolic blood pressure, systolic blood pressure, HbA1c levels and omega 3 fatty acid levels, were compared across diabetic status using Mann-Whitney U tests to determine whether diabetes status was associated with any of these measures. Furthermore, just like other studies, this study strongly supports the utilization of omega-3 fatty acid supplementation for the treatment of diabetic patients and to enhance rates of patency. However, these positive results are derived from a study with some notable limitations such as modest follow-up and a small sample size that is only obtained from a single group of people with similar characteristics (Cuban Americans) as such it is not generalizeable. In short, although preliminary data recommend that using approximately 3 g/d of omega-3 supplementation may be safe for diabetic patients, official recommendations mandating the process are premature as no study has been able to establish the long-term, adverse impacts of the omega-3 supplementation (Kang et al., 2012). Strength of the study The major strength of the study is that its findings do not differ with other findings on a similar subject of study. This therefore means that the findings are consistent with the findings of other studies carried out in the past. The sample size of 293 Cubans (145 had diabetes and 148 did not have diabetes) is good for the study. This is because a research that needs to establish some facts about an issue usually utilizes a good sizeable sample to help reduce the probability of errors. The questions are also good in the sense that they are comprehensive. That is they touch on nearly all parameters of the study such as the age of subjects, waist circumference, BMI, diastolic blood pressure, systolic blood pressure, total cholesterol, C-reactive protein (CRP) levels, homocysteine levels, HbA1c levels and omega 3 fatty acid levels. Note the limitations associated with the sample and prevalence of conditions The study is limited by the fact that it was based on the effects of supplementation characterized by a small sample sizes suboptimal study design, and supraphysiologic doses of omega-3 fatty acid that may be easy to take for long periods of time, a lack of compliance confirmation and little long-term follow-up. The sample is not sufficient for generalizability purposes. In fact, it is hard to establish whether 293 people are a representative of millions of Cubans. The other thing is that the sample does not have a control sample and even the conditions under which the subjects were studied are not mentioned. It is not known whether the condition was controlled or non-controlled environment. Also, the management level of factors such as stress or trauma which increases the level of CRP is not mentioned. Although the results are consistent with other studies, the lack of these important factors makes it hard to establish the validity of these findings. Of note, compliance was also not routinely confirmed by omega-3 fatty acids measurements. Future implications Future work should be based on a model experiment where the sample size should be distributive and a representative of the tagged population. For instance, if the targeted population is 100,000, a third or a quarter of this population could do. In the future experiments, a control sample should be included and conditions under which the study is carried should be established. In other words, it should embrace a definitive, randomized clinical trial to also show the risks of omega-3. Furthermore, because there is a tendency of people skipping to take omega-3 fatty acids supplements, the researcher would do better by giving it to subjects on take to take basis rather than give the dose which would be thrown away. Talk about the clinical implications and conclusions As of now, the data on adverse impacts of omega-3 fatty acids supplementation are primarily restricted to those associated with fish oil. Although findings are not clear, the risk for elevated times of bleeding has been seen associated with >3 g/d of fish oil (Nguyen et al., 2008; Samaropoulos et al., 2012). Increases in levels of LDL and levels of serum glucose have as well been associated with large doses of fish oil >4.5 g/d (Moselhy & Demerdash, 2003). However, to date there is clear clinical implications of omega-3 fatty acids supplementation human beings. Therefore, more studies in this area are needed to establish clinical implications. In short, Omega-3 fatty acids play a significant modulatory function in the inflammatory and immune responses, the progression of vascular reactivity, arteriosclerosis and control of BP. On the basis of clinical viability, there are sufficient reasons to hint that omega-3 fatty acid supplementation may actually offer great benefits to diabetic patients References Brown, C. D., Higgins, M., Donato, K. A., Rohde, F. C., Garrison, R., Obarzanek, E., . . . Horan, M. (2000). Body mass index and the prevalence of hypertension and dyslipidemia. Obesity Research, 8(9), 605–619. DOI:10.1038/oby.2000.79. Huffman, F. G., De La Cera, M., Vaccaro, J. A., Zarini, G. G., & Exebio, J. (2013). 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