Recent research has focused on looking at the type of fat in the diet instead of the total amount to indicate risk of certain diseases, such as heart disease. (1, 2) Studies have found that the composition of cellular membranes tends to reflect the fatty acid composition of one’s dietary intake. (3-8) One type of fat that has been studied is the essential fatty acid, omega-3. Both omega-3 fatty acids and omega-6 fatty acids produce different eicosanoids that lead to different effects on blood pressure, endothelial activation, and platelet aggregation, which are all factors that relate to coronary heart disease (CHD). (1)

Omega-3 fatty acids play many important roles in the body and recent studies have shown many beneficial effects. In infants, omega-3 fatty acids are essential for brain development and function, as well as vision. In adults, omega-3 fatty acids are known for their ability to decrease serum triglycerides in hyperlipidemia (1, 9-14), improve immune function, possibly decrease risk for stroke and cancer (15), and help with elevated blood pressure (9, 16) and inflammatory diseases (such as rheumatoid arthritis and Crohn’s disease). (17-18) In addition, omega-3 fatty acids have been found to regulate and enhance mood, improve memory, and aid in concentration and learning. (19)

Lipodystrophy has increased in prevalence in recent years in patients with HIV. The condition is characterized by body shape changes including fat deposition, fat atrophy, or both, as well as metabolic complications, including hyperlipidemia and insulin resistance. (20-28) It is important to study nutrition intake to find ways to help treat these issues and to minimize dietary contributions to this syndrome. Since many of the symptoms of lipodystrophy mimic issues in non-HIV populations, such as metabolic syndrome and type 2 diabetes, it is important to look at those treatment methods as models to help with this syndrome because there are limited studies in HIV.

OMEGA-3 FATTY ACIDS

The most common dietary forms of omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is primarily from plant sources and must be converted to EPA and DHA (primarily found in marine sources) to perform most of the biological functions noted. The effectiveness of the conversion from ALA to EPA and DHA is controversial. Emken et al found a 15% conversion of ALA to DHA and EPA (29), while Pawlosky et al found a 0.2% conversion. (30) Also, they found the conversion to DHA to be much less than EPA. (29, 30) However, the Indian Experiment of Infarct Survival suggests adequate conversion of ALA to EPA and DHA. In this study, myocardial infarction (MI) survivors were randomized to take fish oil supplements (1.08 grams {gm} per day of EPA and DHA), mustard oil supplements (contained 2.9 gm ALA), or a placebo; both the fish and mustard oil groups decreased incidence of nonfatal MIs. (31)

The differences between DHA and EPA still need to be studied to know which is targeted for specific outcomes. For example, DHA seems to be more effective than EPA in lowering blood pressure. (16) Another study found that 4 gm per day of DHA, without EPA, decreased blood pressure, heart rate, and endothelial function in overweight hypercholesterolemic patients. (32) In another study, EPA, not DHA was found to increase fasting glucose concentrations. (33)