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Meta-Analysis
. 2018 Sep 7;1(5):e182327.
doi: 10.1001/jamanetworkopen.2018.2327.

Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis

Kuan-Pin Su  1   2   3 , Ping-Tao Tseng  4 , Pao-Yen Lin  5   6   7 , Ryo Okubo  8 , Tien-Yu Chen  9   10   11 , Yen-Wen Chen  12 , Yutaka J Matsuoka  3   8
Affiliations
Meta-Analysis

Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis

Kuan-Pin Su et al. JAMA Netw Open. .

Abstract

Importance: No systematic review or meta-analysis has assessed the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) for anxiety.

Objective: To evaluate the association of anxiety symptoms with omega-3 PUFA treatment compared with controls in varied populations.

Data sources: PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases were searched up to March 4, 2018.

Study selection: A search was performed of clinical trials assessing the anxiolytic effect of omega-3 PUFAs in humans, in either placebo-controlled or non-placebo-controlled designs. Of 104 selected articles, 19 entered the final data extraction stage.

Data extraction and measures: Two authors independently extracted the data according to a predetermined list of interests. A random-effects model meta-analysis was performed and this study was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Main outcomes and measures: Changes in the severity of anxiety symptoms after omega-3 PUFA treatment.

Results: In total, 1203 participants with omega-3 PUFA treatment (mean age, 43.7 years; mean female proportion, 55.0%; mean omega-3 PUFA dosage, 1605.7 mg/d) and 1037 participants without omega-3 PUFA treatment (mean age, 40.6 years; mean female proportion, 55.0%) showed an association between clinical anxiety symptoms among participants with omega-3 PUFA treatment compared with control arms (Hedges g, 0.374; 95% CI, 0.081-0.666; P = .01). Subgroup analysis showed that the association of treatment with reduced anxiety symptoms was significantly greater in subgroups with specific clinical diagnoses than in subgroups without clinical conditions. The anxiolytic effect of omega-3 PUFAs was significantly better than that of controls only in subgroups with a higher dosage (at least 2000 mg/d) and not in subgroups with a lower dosage (<2000 mg/d).

Conclusions and relevance: This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. Further well-designed studies are needed in populations in whom anxiety is the main symptom.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Su reported grants from the Ministry of Science and Technology, the National Health Research Institutes, and the China Medical University during the conduct of the study. Dr Matsuoka reported receiving donations from Morinaga Milk Industry Co, Ltd outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Selection Strategy and Inclusion and Exclusion Criteria for This Meta-analysis
PUFAs indicates polyunsaturated fatty acids.
Figure 2.
Figure 2.. Meta-Analysis Forest Plot of the Association of Treatment With Reduced Anxiety Symptoms in Patients Receiving and Not Receiving omega-3 PUFAs
There was a significant improvement in anxiety symptoms in patients receiving omega-3 PUFAs than in those not receiving omega-3 PUFAs (k, 19; Hedges g, 0.374; 95% CI, 0.081-0.666; P = .01).
Figure 3.
Figure 3.. Forest Plot of Subgroup Meta-analysis
A, Subgroup meta-analysis of the anxiolytic effect of omega-3 polyunsaturated fatty acids (PUFAs) based on an underlying specific clinical diagnosis or not. The anxiolytic effect of omega-3 PUFAs was not significant in the subgroup of participants without specific clinical conditions (k, 5; Hedges g, –0.008; 95% CI, –0.266 to 0.250; P = .95) but was significant in the subgroup of participants with specific clinical diagnoses (k, 14; Hedges g, 0.512; 95% CI, 0.119-0.906; P = .01). Furthermore, the association of treatment with reduced anxiety symptoms of omega-3 PUFAs were significantly stronger in subgroups with specific clinical diagnoses than in subgroups without specific clinical conditions (P = .03). B, Subgroup meta-analysis of the anxiolytic effect of omega-3 PUFAs based on different mean omega-3 PUFA dosages. The anxiolytic effect of omega-3 PUFAs was not significant in subgroups of mean omega-3 PUFA dosages less than 2000 mg/d (k, 9; Hedges g, 0.457; 95% CI, –0.077 to 0.991; P = .09) but was significant in the subgroup of mean omega-3 PUFA dosage of at least 2000 mg/d (k, 11; Hedges g, 0.213; 95% CI, 0.031-0.395; P = .02).
Figure 4.
Figure 4.. Subgroup Meta-analysis With Different Eicosapentaenoic Acid (EPA) Percentages
Subgroup meta-analysis of the anxiolytic effects of omega-3 polyunsaturated fatty acids (PUFAs) based on different EPA percentages. The anxiolytic effects of omega-3 PUFAs were significant in the subgroup with an EPA percentage less than 60% (k, 11; Hedges g = 0.485; 95% CI, 0.017 to 0.954; P = .04) but not significant in the subgroups with an EPA percentage of at least 60% (k, 9; Hedges g, 0.092; 95% CI, –0.102 to 0.285; P = .35).
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References

    1. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):-. doi:10.1002/mpr.1359 - DOI - PMC - PubMed
    1. Strine TW, Mokdad AH, Balluz LS, et al. . Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv. 2008;59(12):1383-1390. doi:10.1176/ps.2008.59.12.1383 - DOI - PubMed
    1. Stein MB, Roy-Byrne PP, Craske MG, et al. . Functional impact and health utility of anxiety disorders in primary care outpatients. Med Care. 2005;43(12):1164-1170. doi:10.1097/01.mlr.0000185750.18119.fd - DOI - PubMed
    1. Tolmunen T, Lehto SM, Julkunen J, Hintikka J, Kauhanen J. Trait anxiety and somatic concerns associate with increased mortality risk: a 23-year follow-up in aging men. Ann Epidemiol. 2014;24(6):463-468. doi:10.1016/j.annepidem.2014.03.001 - DOI - PubMed
    1. Katzman MA, Bleau P, Blier P, et al. ; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University . Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(suppl 1):S1. doi:10.1186/1471-244X-14-S1-S1 - DOI - PMC - PubMed

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