Impact of Administering Omega-3 Fatty Acids on the Risk of Metabolic Syndrome in Patients with Schizophrenia

Introduction

Patients with schizophrenia have significantly higher mortality than the general population, with a shortened life expectancy of 10–20 years. The reason is not only suicides but primarily higher cardiovascular mortality. MetS, which includes visceral obesity, hypertension, insulin resistance, and dyslipidemia, significantly contributes to this. The prevalence of MetS in people with schizophrenia reaches 33%. The incidence of MetS increases with the duration of this psychiatric disorder. In addition to increased mortality, MetS also leads to poorer functional outcomes, reduced quality of life, non-adherence to antipsychotic treatment, and worse cognitive outcomes.

Polyunsaturated omega-3 fatty acids (FAs) exhibit anti-inflammatory effects partly through the down-regulation of cytokines involved in the pathophysiology of MetS. It has been demonstrated that EPA and DHA can correct metabolic abnormalities in patients with MetS.

Study Methodology and Course

Polish experts attempted to assess whether administering omega-3 FAs along with antipsychotics would influence the risk of developing MetS in patients with first-episode schizophrenia. The randomized placebo-controlled OFFER study included 71 untreated or early-treated patients, of whom 36 received a mixture of EPA and DHA (1.32 g EPA/day and 0.88 g DHA/day) and 35 received a placebo (olive oil containing primarily monounsaturated fatty acids) in the form of identical capsules. Both groups had comparable demographic and entry characteristics, including administered antipsychotics and other medications.

Cardiometabolic risk was assessed at the study's entry and after 8 and 26 weeks. Monitored parameters included body weight and height, waist circumference, blood pressure, fasting blood glucose, triglycerides, HDL, LDL, and total cholesterol levels.

Results

Over the 26-week duration of the study, the risk of developing MetS was significantly higher in the placebo group compared to the EPA + DHA supplementation group (p = 0.0408). While the incidence of MetS increased over the course of the study in the placebo group, it decreased with omega-3 acid supplementation.

A significant difference between the therapeutic groups was also observed regarding fasting blood glucose, which was significantly higher at the end of treatment in the placebo group (p < 0.05).

Regarding the other components of MetS, the differences between the groups were not statistically significant, although a trend of reduced triglyceride and total cholesterol levels was noted in the supplementation group.

The beneficial effect of omega-3 FA supplementation was more pronounced in patients treated with olanzapine, in whom EPA + DHA supplementation was also associated with a significant drop in total cholesterol (p = 0.037) and fasting blood glucose (p = 0.034) compared to the placebo.

Conclusion

Administering omega-3 fatty acids to patients with first-episode schizophrenia along with antipsychotics may, according to these preliminary results, represent a safe and feasible intervention that can reduce the risk of developing metabolic syndrome and its adverse consequences.

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Source: Pawełczyk T., Grancow-Grabka M., Żurner N., Pawełczyk A. Omega-3 fatty acids reduce cardiometabolic risk in first-episode schizophrenia patients treated with antipsychotics: findings from the OFFER randomized controlled study. Schizophr Res 2021 Apr; 230: 61−68, doi: 10.1016/j.schres.2021.02.012.