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James J. DiNicolantonio, PharmD
James J. DiNicolantonio, PharmD, is v the Mid America heart Institute in ~ Saint Luke’s Hospital, Kansas City and also Wegmans Pharmacy, Ithaca, NY
Carl J. Lavie, MD, is at man Ochsner Heart and also Vascular institute at the university of Queensland school of Medicine, new Orleans and Pennington Biomedical research Center, Baton Rouge, LA
James H. O’Keefe, MD, MSMA member due to the fact that 2003, is v the Mid America love Institute at Saint Luke’s Hospital and University of Missouri-Kansas City, Kansas City
Corresponding author.

You are watching: Can fish oil cause prostate cancer


There has been recent controversy as to whether fish oil increases the hazard of prostate cancer. The worry stems indigenous a paper published freshly by Brasky and also colleagues break up that boosted blood levels of long-chain omega-3 in plasma phospholipids are connected prospectively v an boosted risk for total as well as high-grade prostate cancer.1 They got to this conclusion based upon their own retrospective analysis of serum samples and also data derived from the pick trial, as well as a meta-analysis of previous pertinent prospective epidemiological studies. The writer speculate that this finding might reflect a pathogenic function for fish oil omega-3s in the induction that prostate cancer. Widespread publicity given to this speculation v the popular media has actually triggered both consternation and also skepticism among the public.

It should be emphasized the this examine cannot prove that fish oil causes prostate cancer, together it is observational; the was no a controlled trial in i m sorry patients to be randomized to obtain fish oil additionally or placebos. Furthermore, dietary intake of fish or fish oil was not assessed in this study, so, even as epidemiology, it cannot establish an association in between fish oil intake per se and prostate cancer risk. Rather, that only establishes a correlation the prostate cancer danger with omega-3s in plasma phospholipids. Even if it is this correlation reflects a pathogenic role for omega-3s is hypothetical, and also there is significant reason to think that this theory is incorrect. Conceivably, if their observation proves to be confirmable in subsequent research, the usual elevations that plasma phospholipid omega-3s observed in subjects who go on to develop prostate cancer might reflect part metabolic aspect influencing omega-3 partitioning and/or oxidation that additionally influences prostate cancer induction.

It have to be provided that the test provided by Brasky and also colleagues to assess “omega-3 status” – plasma phospholipid omega-3s – is no the many accurate method to assess permanent omega-3 dietary intake. Rather, the percentage of EPA + DHA in erythrocyte membrane as defined by Harris together the “omega-3 index,”2 is more useful in this regard. The parameter measure by Brasky et al. Is extremely susceptible come day-to-day sports in omega-3 fatty acid intake, rendering it less than optimal as a surrogate for the characteristics omega-3 join or organization levels that the subjects studied.

More importantly, a substantial variety of epidemiological studies, both prospective and also case-control, have previously examined the association between fish or fish oil ingestion and also prostate cancer risk, and these findings clearly do no incriminate long-chain omega-3 gulp down as variable in prostate cancer induction.3–9 A current meta-analysis of these studies suggests that fish consumption has a null or slightly protective affect on prostate cancer incidence, but is strong protective v respect to prostate cancer mortality.4 Moreover, the minimal prospective public health that has evaluated the association of fish oil supplementation through prostate cancer hazard – including one examine by Brasky’s own team – does not provide any grounds for worry in this regard.3 through respect to patient who currently have prostate cancer, constant fish usage has been associated with improved survival.

Prior proof has displayed that patients through a greater mean baseline blood level that omega-3 fat acids are at a lower risk the cardiac sudden death.10 Indeed, one study discovered that fairly high omega-3 blood level (5.63% and 6.87%) were associated with a 72% and also 81% lower risk of suddenly death, respectively, contrasted to patients v a median omega-3 blood level that 3.58%.10 Brasky and colleagues report a 43% raised risk of complete prostate cancer v an omega-3 blood level > 5.31% vs. < 3.68% (hazard proportion


1.43, 95% conference interval : 1.09–1.88, p=0.007).1 Hence, also in the unlikely event that Brasky and colleagues are correct in your speculation that omega-3 rises prostate cancer risk, one would should balance a 43% boosted risk that prostate cancer associated with replete omega-3 status, against a 72% higher risk of suddenly cardiac death associated with low omega-3 status.

If fish omega-3 did indeed rise prostate cancer risk, then populaces with high omega-3 fatty acid intakes could be intended to have a relatively high risk for prostate cancer; this does no seem to be the case. The input of fish in Japan is one of the highest possible in the world,11–13 being about eight times more than the of American men,2 and also yet the age-adjusted mortality native prostate cancer in Japan was about seven times reduced than that in the U.S. In the 1950s.14 Additionally, omega-3 fatty acid levels in red blood cell are around 8 to 10% in Japanese patients,15 around twice the of those in the merged cancer team (4.66%) and controls (4.48%) in the paper by Brasky and also colleagues.1 Thus, the average omega-3 fatty acid blood levels in the Brasky examine are rather low from the standpoint of cardiovascular (CV) protection, and only differed by 0.18% in instances vs. Controls - a negligible difference from a clinical perspective.

The very high omega-3 intake of the traditionally-living Inuit, evoked as a most likely reason for your low threat for CV disease, first brought omega-3 nutrition to renowned attention several years ago. Less famous is the reality that the Inuit were also at an extremely low danger for prostate cancer incidence and also mortality.15, 16

Japanese men have a two-fold greater serum level the omega 3-fatty acids 보다 whites and Japanese americans in the United says (U.S.),11 and coronary heart an illness in Japan is about fifty percent as typical as in the U.S.17 Contributing come the proof that a greater omega-3 input is linked with a reduction in coronary heart disease is JELIS, a randomized managed trial which showed that adding 1.8 grams of eicosapentaenoic mountain (EPA) day-to-day as an adjunct to statin therapy in males with a reasonably high baseline input of omega-3s (Japanese patients) causes a significant reduction in the risk of significant coronary heart an illness events as well as stroke.18, 19 unlike the examine by Brasky and also colleagues, this trial can prove causation, demonstrating that fish oil reduces the risk of CV disease. It would be a dead if patients quit taking your fish oil supplements, owing to an unwarranted fear regarding prostate cancer, and subsequently experienced a CV occasion or sudden death.

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A possible indication the Brasky’s document is seriously flawed is the their data proved that the threat of prostate cancer diminished as the amount of pack-years of cigarette smoking increased.1 contrasted to non-smokers, there was a 3%, 13% (trend because that reduction) and far-reaching 19% lower risk for prostate cancer in those that smoked ≤ 12.5 pack-years, 12.5–25 pack-years and also ≥ 25 pack-years, dong (relative threat 0.97, 95% CI:0.84–1.11, p=0.63, RR 0.87, 95% CI:0.74–1.02, p=0.09, RR 0.81, 95% CI:0.69–0.95, p = 0.01). Moreover, those v diabetes had a 33% reduced risk of emerging prostate cancer contrasted to those who were no diabetic (RR 0.67, 95% CI:0.54–0.83, p=0.0003). However, a reduced risk because that prostate cancer in diabetics is, in fact, a well established phenomenon.20

In conclusion, the Brasky file only displayed an association in between plasma phospholipid omega-3s and also subsequent prostate cancer risk; it can not prove the omega-3 fatty acids (and an especially fish oil) reason prostate cancer. A an ext thorough summary of the pertinent literature says that boosted omega-3 fat acid consumption does not rise prostate cancer risk, and also notably reduce prostate cancer mortality – and also most absolutely decreases threat for sudden death and CV events.