Methods of assessment of n-3 long-chain polyunsaturated fatty acid status in humans: a systematic review

Background: The availability of reliable biomarkers of n-3 (omega-3) long-chain polyunsaturated fatty acid (LCPUFA) status is a prerequisite for linking dietary n-3 LCPUFA status to clinical outcomes. Objective: The objective of this meta-analysis was to assess the usefulness of different biomarkers of n-3 LCPUFA status in healthy humans. Design: We searched Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases from inception to September 2007 for human intervention studies in which n-3 LCPUFA status changed after >= 2 wk of n-3 LCPUFA supplementation. We used formal inclusion/exclusion criteria and applied standard procedures for data extraction, validity assessment, and meta-analysis. Results: We included 41 studies (34 randomized controlled trials and 7 before-after studies) reporting on 18 different biomarkers. The data allowed specific evaluation of biomarkers of docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA, 20:5n-3) status in response to supplementation. There were sufficient data to determine that plasma DHA, plasma phospholipid DHA, plasma triacylglycerol DHA, plasma cholesteryl ester DHA, plasma nonesterified DHA, erythrocyte DHA, erythrocyte phospholipid DHA, and platelet DHA were all effective biomarkers of DHA status and that plasma phospholipid EPA was an effective marker of EPA status. Plasma phospholipid DHA appears to be a good marker of DHA status in adult men and women irrespective of DHA baseline status or supplementation dose, but its usefulness in other population subgroups is unclear. Conclusion: There appears to be a range of useful biomarkers of DHA status in humans, but further research is needed to characterize which work best in particular population subgroups. Am J Clin Nutr 2009; 89(suppl): 2070S-84S.