Evidence Report/Technology Assessment Number 89

Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis

File Inventory


Prepared by:

Southern California/RAND Evidence-based Practice Center
Los Angeles, CA

Program Directors
   Paul G. Shekelle, M.D., Ph.D.
   Sally C. Morton, Ph.D.
Project Director
   Catherine H. MacLean, M.D., Ph.D.
Project Manager
   Rena Hasenfeld Garland, B.A.
Statistician
   Wenli Tu, M.S.
Programmer/Analyst
   Lara K. Jungvig, B.A.
Scientific Reviewers
   Walter A. Mojica, M.D., M.P.H.
   James Pencharz, B.Sc. (Kin)
    Jennifer Grossman, M.D.
   Puja Khanna, M.D., M.P.H.
Editor
   Sydne J. Newberry, Ph.D.
Technical Advisors
   Ian Gralnek, M.D., M.S.H.S.
   Alan Nissenson, M.D.
Librarians
   Jessie McGowan, M.L.I.S.
   Nancy Santesso, R.D., M.L.I.S.
Staff Assistants
   Donna Mead, B.A.
   Shannon Rhodes, M.F.A.
   Shana Traina, M.A.


File Name	Description			Software	Version	File	Size
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01front.doc	Microsoft Word® Document	MS Word®	2002	191KB	11 pages
Contents: Title Page, Preface, Acknowledgments, Structured Abstract, Table of Contents
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02chap1.doc	Microsoft Word® Document	MS Word®	2002	391KB	11 pages
Contents: Chapter 1. Introduction: The Recognition of Essential Fatty Acids; Fatty Acid 
Nomenclature; Table 1.1. Nomenclature of omega-3 fatty acids; Fatty Acid Metabolism; 
Physiological Functions of EPA and AA; Dietary Sources and Requirements; Figure 1.1. Classical 
omega-3 and omega-6 fatty acid synthesis pathways and the role of omega-3 fatty acid in regulating 
health/disease markers; Table 1.2. Sources and proportions of omega-3 fatty acids in common foods 
and supplements; Table 1.3. Good food sources* of omega 3 fatty acids; Table 1.4. Estimates of the 
mean intake of LA, ALA, EPA, and DHA in the U.S. Population from analysis of NHANES III data; 
Table 1.5. Mean, range, and median usual daily Intakes (ranges) of n-6 and n-3 PUFAs, in the 
U.S. population, from analysis of CSFII data (1994 to 1998); Rationale for and Organization 
of this Report; Table 1.6. The omega-3 fatty acid content, in grams per 100 g food serving, of a 
representative sample of commonly consumed fish, shellfish, and fish oils, and nuts and seeds, 
and plant oils that contain at least 5 g omega-3 fatty acids per 100 g
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03chap2.doc	Microsoft Word® Document	MS Word®	2002	193KB	10 pages
Contents: Chapter 2. Methodology: Objectives; Scope of Work; Original Proposed Key Questions; 
Technical Expert Panel; Key Questions Addressed in this Report; Assessment of Adverse Events; 
Identification of Literature Sources; Evaluation of Evidence; Extraction of Data; Grading Evidence; 
Data Synthesis; Meta-Analysis; Sensitivity Analyses; Publication Bias; Interpretation of the 
Results; Peer Review
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04chap3.doc	Microsoft Word® Document	MS Word®	2002	1.6MB	39 pages
Contents: Chapter 3. Results: Results of Literature Search; Figure 3.1. Literature flow; 
DIABETES: Table 3.1. Diabetes: mean difference for total cholesterol; Table 3.2. Relationship 
 between methodologic quality and applicability for estimates of effect of omega-3 fatty acid 
 consumption on total cholesterol among people with type II diabetes; Table 3.3. Diabetes: mean 
 difference for high-density lipoprotein (HDL); Table 3.4. Relationship between methodologic 
 quality and applicability for estimates of effect of omega-3 fatty acid consumption on HDL 
 among people with type II diabetes; Figure 3.3. Diabetes: High Density Lipoprotein (HDL); 
 Table 3.5. Diabetes: mean difference for low-density lipoprotein (LDL); Table 3.6. Relationship 
 between methodologic quality and applicability for estimates of effect of omega-3 fatty acid 
 consumption on LDL among people with type II diabetes; Figure 3.4. Diabetes: Low Density 
 Lipoprotein (LDL); Table 3.7. Diabetes: mean difference for triglycerides; Table 3.8. Relationship 
 between methodologic quality and applicability for estimates of effect of omega-3 fatty acid 
 consumption on triglycerides among people with type II diabetes; Figure 3.5. Diabetes: 
 Triglycerides; Table 3.9. Diabetes: mean difference of fasting blood glucose; Table 3.10. 
 Relationship between methodologic quality and applicability for estimates of effect of omega-3 
 fatty acid consumption on fasting blood sugar among people with type II diabetes; Figure 3.6. 
 Diabetes: Fasting Blood Glucose; Table 3.11.  Diabetes: effect size of hemoglobin A1c (HbA1c); 
 Table 3.12. Relationship between methodologic quality and applicability for estimates of effect 
 of omega-3 fatty acid consumption on glycosylated hemoglobin among people with type II diabetes; 
 Figure 3.7. Diabetes: Hemoglobin A1c (HgA1c); 
INFLAMMATORY BOWEL DISEASE: Table 3.13. Ulcerative colitis disease: relative risk of relapse; 
 Table 3.14. Relationship between methodological quality and applicability for estimates of effect 
 of omega-3 fatty acid consumption with ulcerative colitis disease for relapse/remission; 
 Figure 3.8. Ulcerative Colitis Disease: Relative Risk of Relapse; 
RHEUMATOID ARTHRITIS: Table 3.15. RA: effect size for patient assessment of pain; Table 3.16. 
 Relationship between methodologic quality and applicability for estimates of effect of omega-3 
 fatty acid consumption on pain among people with rheumatoid arthritis; Figure 3.9. RA: Patient 
 Assessment of Pain; Table 3.17. RA: effect size for swollen joint count; Table 3.18. Relationship 
 between methodologic quality and applicability for estimates of effect of omega-3 fatty acid 
 consumption on swollen joints among people with rheumatoid arthritis; Figure 3.10. RA: Swollen 
 Joint Count; Table 3.19. RA: effect size for ESR; Table 3.20. Relationship between methodologic 
 quality and applicability for estimates of effect of omega-3 fatty acid consumption on ESR among 
 people with rheumatoid arthritis; Figure 3.11. RA: ESR; Table 3.21. RA: effect size for patient 
 global assessment; Table 3.22. Relationship between methodologic quality and applicability for 
 estimates of effect of omega-3 fatty acid consumption on global assessment among people with 
 rheumatoid arthritis; Figure 3.12. RA: Patient Global Assessment; 
RENAL DISEASE; SYSTEMIC LUPUS ERYTHEMATOSUS; BONE DENSITY/OSTEOPOROSIS; Publication Bias; 
Adverse Events; Table 3.23. Summary of reported adverse events; 
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05chap4.doc	Microsoft Word® Document	MS Word®	2002	45KB	4 pages
Contents: Chapter 4. Discussion: Overview, Main Findings, Conclusions, Future Research
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06refs.doc	Microsoft Word® Document	MS Word®	2002	186KB	8 pages
Contents: References and Included Studies
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07exstud.doc	Microsoft Word® Document	MS Word®	2002	535KB	73 pages
Contents: Listing of Excluded Studies
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08acro.doc	Microsoft Word® Document	MS Word®	2002	64KB	2 pages
Contents: Acronyms
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09appa.doc	Microsoft Word® Document	MS Word®	2002	325KB	16 pages
Contents: Appendix A. Methodologic Approach: A.1. Preliminary Research Questions; 
A.2. Technical Expert Panel; A.3. Search Strategies; A.4. Inclusion/Exclusion Criteria; 
A.5. Evidence Grading System; A.6. External Peer Reviewer
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10appb.doc	Microsoft Word® Document	MS Word®	2002	286KB	10 pages
Contents: Appendix B. Coding/Data Abstraction Forms: B.2. Literature Screener Form; 
B.3. Quality review form
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11appc.doc	Microsoft Word® Document	MS Word®	2002	1.1MB	163 pages
Contents: Appendix C. Evidence Tables: Table C.1. Evidence table of clinical effect of omega-3 
fatty acids in type II diabetes or metabolic syndrome; Table C.2. Evidence table of clinical effect 
of omega-3 fatty acids in inflammatory bowel disease; Table C.3. Evidence table of clinical effect 
of omega-3 fatty acids in rheumatoid arthritis; Table C.4. Evidence table of clinical effect of 
omega-3 fatty acids in renal disease; Table C.5. Evidence table of clinical effects of omega-3 
fatty acids in systemic lupus erythematosus; Table C.6. Evidence table of clinical effect of 
omega-3 fatty acids in bone mineral density/osteoporosis
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AHRQ Publication No. 04-E012-2
Current as of March 2004


Internet Citation:

Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis. File Inventory, Evidence Report/Technology Assessment Number 89. AHRQ Publication No. 04-E012-2, March 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/o3lpdinv.htm


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