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24 March 2012

Approximately 310,000 Australians suffer from chronic heart disease and is the second largest disease burden to Australian economy.  The total direct healthcare cost attributed to cardiovascular disease is AUD$5.9 billion each year in Australia.  A latest health economic analysis by Deloitte Access Economics showed that fish oil supplementation is a cost-effective intervention to prevent future cardiovascular mortality and morbidity in Australia.

Fish oil supplements offer a number of advantages through lowering potential risk profiles. The World Health Organization (WHO), American Heart Association, National Health and Medical Research Council (NHMRC), and the National Heart Foundation of Australia recommend fish oil as a complementary treatment in addition to standard treatments following a Myocardial Infarction (MI), commonly known as heart attack. MI typically occurs when the blood supply to parts of the heart is cut off by a blocked artery, causing damage to the heart tissue, and the cells in the affected area to start to die. In the days and weeks following a cardiac incident, this area may grow, eventually leaving a large part of the heart unable to function properly and increasing the risk of further heart problems.

Epidemiological studies have shown that the consumption of fatty fish is associated with lower incidence rates of coronary heart disease (CHD), stroke and MI.  The Complementary Healthcare Council of Australia (CHC) recently commissioned Deloitte Access Economics to undertake cost benefit analysis (CBA) of fish oils and estimate the net benefit of fish oils as adjunctive treatment for prevention of heart disease among those who have experienced MI, versus no fish oils, taking into account the cost per person of the treatment and the DALYs (Disability-Adjusted Life Years) avoided. DALY is a measure of overall disease burden adopted by WHO.

The analysis by Deloitte Access Economics is based on fish oil supplementation with dosage of 510-540mg EPA/day and 345-360mg DHA/day.  The result showed an ICER (incremental cost-effectiveness ratio) of $2,041 per DALY averted, indicating that fish oils are cost effective in the secondary prevention of CHD relative to the WHO benchmark.  The maximum value of the DALY benefits from the fish oil intervention was estimated at up to $3.4 billion.

This latest report offers further evidence that fish oil supplementation not only is effective in the reduction of incidence rates for cardiovascular disease, but also offers a genuine opportunity to reduce disease burden in a cost effective manner.

CHC Report on Fish oils for the secondary prevention of Coronary Heart Disease, 17 Feb 2012


17 March 2012

Fats are a necessary part of dietary energy supply.  However the quality of dietary fats, particularly long-chain Polyunsaturated fatty acids (PUFAs), plays critical roles in physiological functions such as central nervous system (CNS) development and visual function in infants and children.  In addition, the effect of dietary fats on lipids metabolism at an earlier age may be associated with cardiovascular mobidity and mortality in later life.

In recent years, there has been growing researches in the quality of dietary fat intake in early life as a major determinant of growth and development in children as well as long-term health.  The selection of dietary fatty acid sources during the first years of life is now considered to be of critical importance.

Lipids are structural components of all tissues and are indispensable for the assembly of membranes and cell organelles. The brain, retina and other neural tissues are particularly rich in long-chain polyunsaturated fatty acids (PUFAs).  For example, docosahexaenoic acid (DHA), a type of long-chain omega-3 PUFA, is a critical component of cell membranes, especially in the brain and the retina, and plays an important role in brain and visual function, due to its high content in cerebral cortex and retinal phospholipids.  DHA is considered conditionally essential during early development in childhood.

During the first 6 months of life, dietary total fat should contribute 40–60% of total energy to cover the energy needed for growth and the fat required for tissue deposition. From age 6 months to 3 years, fat intake requirements are reduced gradually to approximately 30–35% of energy depending on the physical activity of the child.  Many health organizations recommend that daily DHA intake should be between 0.2-0.5% of total fat intake for infants.  The daily Omega-3 intake for prevention of nutrition-related chronic disease should ideally fall within 1-2% of total energy intake for children over 2-yrs of age.

Vegetarian source of fats has virtually no long-chain PUFA unless algae are included in the diet.  Fish is the major source of the two important PUFAs – DHA and EPA.  Recent scientific evidence have shown that direct supply of DHA and EPA in the diet provides many health benefits including retinal and brain development and function during early childhood, cardiovascular health, inflammatory response, and allergy.  Balanced dietary intake of beneficial fats in childhood can influence risk of Cardio Vascular Diseases (CVD) later in life.

In summary, lifelong intakes of EPA and DHA are associated with reduced risk of cardiovascular disease and metabolic syndrome, as well as optimal mental development, behaviour, and immune response. Since the dietary intakes of EPA and DHA among infants and children in many western and non-western countries are lower than desirable on a unit of body weight basis and as percent of total energy, it is prudent that parents take measures to ensure that their children obtain optimal levels of EPA and DHA through diet and supplementation where required.

R Uauy and AD. Dangour; Ann Nutr Metab 2009;55:76–96

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