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Table 2 The effect of eicosapentaenoic acid and docosahexaenoic acid (EPA & DHA) on plasma concentration of small dense low density lipoprotein (LDL), LDL particle number, and LDL particle size

From: The beneficial effects of nutraceuticals and natural products on small dense LDL levels, LDL particle number and LDL particle size: a clinical review

Author, Year

Intervention

Dose per day

Treatment duration

Subjects

Method of assessment

Main outcomes

Final effects of specific diet ingredients or nutraceuticals on LDL (number, size and concentration)

Ouellette et al. 2014 [61]

Fish oil supplementation

5 g/day

6 weeks

210 healthy adults

2–16% PAGE

The n-3 PUFA supplementation had no effect on plasma LDL-C concentrations and LDL particle size

LDL particle size —

Oelrich et al. 2013 [62]

Fish oil supplementation, Soy oil supplement (placebo)

4 g/day (800 mg EPA and DHA)

12 weeks

60 hypertriglyceridemic adults

Gradient gel electrophoresis

In comparison to the baseline, four particle sizes in terms of LDL1 (+ 20 ± 5%), LDL2 (+ 64 ± 13%), and LDL3 (+ 26 ± 6%) significantly increased in all fish oil groups.

LDL particle size

Petersen et al. 2002 [63]

Fish oil supplementation, Corn oil supplement (placebo)

4 g/day (2.6 g EPA and DHA + 13.4 mg vitamin E)

8 weeks

42 diabetic patients with moderate hypertriglyceridemia

Ultracentrifugation

Small dense LDL particles did not significantly change compared with control group.

Small dense LDL

Suzukawa et al. 1995 [64]

Fish oil, Corn oil (placebo)

4 g/day (3.4 g of n-3)

6 weeks

20 hypertensive adults

ND

Fish oil increased LDL size (+ 0.16 nm) compared to the baseline.

LDL particle size

Asztalos et al. 2016 [65]

EPA, DHA, Olive oil (placebo)

EPA 600 mg/day

EPA 1800 mg/day

DHA 600 mg/day

Olive oil placebo 6 g/day

6 weeks

121 healthy individuals with normal lipid profiles

Denka-Seiken Corporation (for LDL-C and sdLDL-C, Tokyo, Japan)

In all 4 groups no significant change in sdLDL-C (p = 0.82)

Small dense LDL —

Satoh et al. 2007 [66]

EPA

1.8 g/d

3 months

44 obese patients with metabolic syndrome

The Quantimetrix Lipoprotein LDL system (LDL3–7:sdLDL)

sdLDL (− 5 mmol/l) and sdLDL proportion (− 1.27%) significantly decreased in EPA group compared with baseline but no significant differences between the two groups.

Small dense LDL

Mori et al. 1999 [67]

EPA,

DHA,

Olive oil (placebo)

4 g/d

6 weeks

59 overweight adults with mildly hypercholesterolemic

Using commercially available 3–13% nondenaturing native gels

There was no statistically significant difference in LDL particle size between and within groups.

LDL particle size —

Kelley et al. 2007 [68]

DHA,

Olive oil (placebo)

7.5 g/d DHA oil (~ 3 g/d DHA), or 7.5 g/d olive oil

90 days

34 healthy or mildly hyperlipidemic men

NMR

Participants who consumed DHA had lower the number of small dense LDL particles (21%) whereas the change was not statistically significant compared to the placebo. Mean LDL particle size significantly increased (0.6 nm or 3%) compared with baseline.

LDL particle size

LDL particle number

Maki et al. 2005 [69]

DHA,

Olive oil (placebo)

1.52 g/day DHA

6 weeks

57 subjects with below average levels of HDL

Vertical Auto Profile II (VAP-II)

DHA had no effect on small dense LDL. In addition, the percentage of cholesterol concentration in small dense LDL was significantly reduced in the DHA group than the control (− 9.7 vs. -3.0%).

Small dense LDL —

Cholesterol concentration in small dense LDL

Kawakami et al. 2015 [70]

FO,

Corn oil (placebo)

10 g FO (5.49 g of ALA),

10 g corn oil (0.09 g of ALA)

12 weeks

15 healthy males

sd-LDL-EX “SEIKEN”

In the intervention group, concentration of sd-LDL significantly reduced after 4 (− 25.8%) and 12 weeks (− 21.2%) in compared with the baseline.

In addition, sd-LDL concentrations significant decreased than placebo after 4 weeks.

Small dense LDL

Harper et al. 2006 [71]

FO supplementation, Olive oil capsules (placebo)

5.2 g/d FO (3 g/d of ALA),

Or 5.2 g of olive oil

26 weeks

56 patients without known coronary heart disease

Ultracentrifugal separation by enzymatic determination of cholesterol with 400 sequential spectrophotometric measurements

FO had no effect on atherogenic LDL subfractions (LDL3 and LDL4). However, FO significantly increased on less atherogenic LDL subfractions (LDL1 and LDL2) as compared to the olive oil (+ 0.08 and + 0.01 mmol/l) and the baseline (+ 0.06 and + 0.1 mmol/l).

Small dense LDL —

LDL subfractions (LDL1 and LDL2)

  1. sdLDL small dense Low-Density Lipoprotein, LDL-C Low-density lipoprotein cholesterol, High Density Lipoprotein Cholesterol, PUFA polyunsaturated fatty acid, ALA α-Linolenic acid, EPA Eicosapentaenoic acid, DHA Docosahexaenoic acid, NMR Nuclear magnetic resonance, FO Flaxseed oil, mg milligrams, mmol/l millimoles per litre, nm nanometer