Effect of omega-3 (n23) fatty acid supplementation in patients with sickle cell anemia: randomized, double-blind, placebo-controlled trial1–3
Ahmed A Daak, Kebreab Ghebremeskel, Zahir Hassan, Bakhita Attallah, Haj H Azan, Mustafa I Elbashir, and Michael Crawford
Background: Blood cell aggregation and adherence to vascular endothelium and inflammation play a central role in vaso-occlusive crisis in sickle cell disease. The antiaggregatory, ntiadhesive, antiinflammatory, and vasodilatory omega-3 (n23) fatty acids (DHA and EPA) are significantly reduced in patients with the disease.
Objective: The aim was to investigate the therapeutic potential of omega-3 fatty acids for patients with homozygous sickle cell disease in a randomized, placebo-controlled, double-blind trial.
Design: One hundred forty patients recruited from a single center in Sudan were randomly assigned and received, daily, 1 (age 2–4 y), 2 (age 5–10 y), 3 (age 11–16 y), or 4 (age $17 y) omega-3 capsules containing 277.8 mg DHA and 39.0 mg EPA or placebo for 1 y. Of these patients, 128 were followed up and the data were obtained. The primary and secondary endpoints—rates of clinical vaso-occlusive crisis and hemolytic events, blood transfusion rate, school attendance, and blood count—were analyzed by intention-to-treat analysis
Results: Omega-3 treatment reduced the median rate of clinical vaso-occlusive events (0 compared with 1.0 per year, P , 0.0001), severe anemia (3.2% compared with 16.4%; P , 0.05), blood transfusion (4.5% compared with 16.4%; P , 0.05), white blood cell count (14.4 6 3.3 compared with 15.6 6 4.0 3103/mL; P , 0.05), and the OR of the inability to attend school at least once during the study period because of illness related to the disease to 0.4 (95% CI: 0.2, 0.9; P , 0.05).
Discussion: Supplementation of patients with HbSS with the omega-3 fatty acids DHA and EPA was effective at reducing the frequency and severity of vaso-occlusive episodes, severe anemia, and blood transfusion rate. These beneficial effects were reflected in noticeable improvements in health and related quality of life as evaluated by significant reductions in the number of inpatient hospital days and improvements in school absence due to sickle cell–related illness.
Conclusion: The findings of this trial, which need to be verified in a large multicenter study, suggest that omega-3 fatty acids can be an effective, safe, and affordable therapy for sickle cell anemia. This trial was registered with Current Controlled Trials as ISRCTN80844630. Am J Clin Nutr 2013;97:37–44.