09
Jul

D*action Type 1 Diabetes Prevention Project – Call to Action

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An increasing body of evidence has shown that chronic inflammation can cause or advance many common chronic diseases (1), with higher levels of cellular inflammation indicating a greater risk of the development of and/or accelerated progression towards chronic disease.  Type 1 Diabetes (T1D) is one of the diseases that are highly affected by inflammation (2,3).

It is known that progression to many forms of diabetes, including T1D, can be predicted by measuring levels of inflammation.  Research has also shown that vitamin D and omega-3 fatty acids are both anti-inflammatory (4,5), therefore, progression of T1D could be predicted by measuring levels of inflammation using such blood spot tests as 25(OH)D (6,7,8) and the ratio of AA:EPA (9).  48 international vitamin D researchers have recommended a vitamin D serum level of 40-60 ng/ml (100-150 nmol/L) for the prevention of many chronic diseases, while a AA:EPA ratio of <3 is a target for the most reduced rates of chronic inflammation.

Numerous studies show that intake of vitamin D and omega-3 fatty acids reduces inflammation (10,11).  A number of health conditions related to low vitamin D have also been correlated to low levels of omega-3 fatty acids (12-21).  Anecdotal evidence suggests a role of vitamin D and omega-3 fatty acids in possibly reversing or stopping this progression. (5,22)   Epidemiologic studies show that children given Cod Liver Oil, which contains both vitamin D and omega-3 fatty acids have significantly reduced rates of diagnosis of T1D. (23,24,25).

Incidence of Type 1 Diabetes Rises 3-5% Each Year (26)

Omega-3s are often found in foods that are also naturally high in vitamin D (such as fatty fish).  There is very little research available on the combined effect of vitamin D and omega-3 fatty acid intake and resulting blood levels on specific health outcomes.  Incorporating omega-3 education and testing (using omega-3 status testing such as the ratio of AA:EPA (27,28) along with vitamin D education and testing will help shed light on such a combined effect.  It will also allow us to study levels of both nutrients independent of consumption since the effect of intake on blood status will vary from person to person, and it may take different doses to reduce inflammation if a person has a diet high in AA.  The ratio of omega-6 (pro-inflammatory) to omega-3 (anti-inflammatory) fatty acids in humans has changed from 1:1 to 20-30:1 over time (4,29,30).

This study sub-set will help identify potential changes in the progression towards a T1D diagnosis that may result from nutrient status testing and education of both vitamin D and omega-3 fatty acids, as well as provide additional education about islet autoantibodies, inflammation and anti- and pro-inflammatory foods, and other T1D related information.

 

References:

  1. Hunter P. The inflammation theory of disease.  2012 Nov; 13(11): 968–970.
  2. Limbert C. Type 1 diabetes – an auto-inflammatory disease: a new concept, new therapeutical strategies.  2012; 10(Suppl 3): I12.
  3. Bending D, Zaccone P,   Cooke A.  Inflammation and type one diabetes.  2012 Jun;24(6):339-46.
  4. Simopoulis AP. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother 2006;60:502-7.
  5. Razavi M, Jamilian M, Samimi M, Afshar Ebrahimi F, Taghizadeh M, Bekhradi R, Seyed Hosseini E, Haddad Kashani H, Karamali M, Asemi Z. The effects of vitamin D and omega-3 fatty acids co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes. Nutr Metab 2017;14:80.
  6. Riachy R, Vandewalle B, Moerman E, Belaich S, Lukowiak B, Gmyr V, Muharram G, Kerr Conte J, Pattou F. 1,25-Dihydroxyvitamin D3 protects human pancreatic islets against cytokine-induced apoptosis via down-regulation of the Fas receptor.  2006 Feb;11(2):151-9.
  7. Rizzo AM, Montorfano G, Negroni M, Adorni L, Berselli P, Corsetto P, Wahle K, and Berra B. “A rapid method for determining arachidonic:eicosapentaenoic acid ratios in whole blood lipids: correlation with erythrocyte membrane ratios and validation in a large Italian population of various ages and pathologies.” Lipids in Health and Disease 9:7 (2010)
  8. Chase HP1, Boulware D, Rodriguez H, Donaldson D, Chritton S, Rafkin-Mervis L, Krischer J, Skyler JS, Clare-Salzler M; Type 1 Diabetes TrialNet Nutritional Intervention to Prevent (NIP) Type 1 Diabetes Study Group. Effect of docosahexaenoic acid supplementation on inflammatory cytokine levels in infants at high genetic risk for type 1 diabetes. Pedatr Diabetes 2015;16(4):271-9.
  9. Ergas D1, Eilat E, Mendlovic S, Sthoeger ZM; n-3 fatty acids and the immune system in autoimmunity. Isr Med Assoc J.2002;4(1)34-38.
  10. Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-Analysis of the Effects of Eicosapentaenoic Acid (EPA) in Clinical Trials in Depression. J Clin Psychiatry 2011, doi:10.4088/JCP.10m06634.
  11. van der Wurff ISM, von Schacky C, Berge K, Zeegers MP, Kirschner PA, de Groot RHM. Association between Blood Omega-3 Index and Cognition in Typically Developing Dutch Adolescents. Nutrients 2016, 8, 13; doi:10.3390/nu8010013.
  12. Stonehouse W, Conlon CA, Podd J, Hill SR, Minihane AM, Haskell C, Kennedy D. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial. Am J Clin Nutr. 2013 May;97(5):1134-43.
  13. Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ. Low Blood Long Chain Omega-3 Fatty Acids in UK Children Are Associated with Poor Cognitive Performance and Behavior: A Cross-Sectional Analysis from the DOLAB Study. PLoS One. 2013 Jun 24;8(6):e66697.
  14. Schaefer EJ, Bongard V, Beiser AS, Lamon-Fava S, Robins SJ, Au R, Tucker KL, Kyle DJ, Wilson PW, Wolf PA. Plasma Phosphatidylcholine Docosahexaenoic Acid Content and Risk of Dementia and Alzheimer Disease. Arch Neurol. 2006 Nov;63(11):1545-50.
  15. Souied EH, Delcourt C, Querques G, Bassols A, Merle B, Zourdani A, Smith T, Benlian P. Oral Docosahexaenoic Acid in the Prevention of Exudative Age-Related Macular Degeneration. Ophthalmology. 2013 Aug;120(8):1619-31.
  16. Luxwolda MF, Kuipers RS, Boersma ER, van Goor SA, Dijck-Brouwer DA, Bos AF, Muskiet FA. DHA status is positively related to motor development in breastfed African and Dutch infants. Nutr Neurosci. 2014 Apr;17(3):97-103.
  17. Bisgaard H, Stokholm J, Chawes BL, Vissing NH, Bjarnadóttir E, Schoos AM, Wolsk HM, Pedersen TM, Vinding RK, Thorsteinsdóttir S, Følsgaard NV, Fink NR, Thorsen J, Pedersen AG, Waage J, Rasmussen MA, Stark KD, Olsen SF, Bønnelykke K. Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring. N Engl J Med. 2016 Dec 29;375(26):2530-9.
  18. Lembke P, Capodice J, Hebert K, Swenson T. Influence of Omega-3 (N3) Index on Performance and Wellbeing in Young Adults after Heavy Eccentric Exercise. J Sports Sci Med. 2014 Jan; 13(1): 151–156.
  19. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children’s IQ at 4 Years of Age. Pediatrics. 2003 Jan;111(1):e39-44.
  20. Chase HP1, Boulware D, Rodriguez H, Donaldson D, Chritton S, Rafkin-Mervis L, Krischer J, Skyler JS, Clare-Salzler M; Type 1 Diabetes TrialNet Nutritional Intervention to Prevent (NIP) Type 1 Diabetes Study Group. Effect of docosahexaenoic acid supplementation on inflammatory cytokine levels in infants at high genetic risk for type 1 diabetes. Pedatr Diabetes 2015;16(4):271-9.
  21. Stene LC1, Joner G, Norwegian Childhood Diabetes Study Group; Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population based, case-controlled study. Am J Clin Nutr 2003;78(6):1128-1134.
  22. Sørensen IM, Joner G, Jenum PA, Eskild A, Brunborg C, Torjesen PA, Stene LC. Vitamin D-binding protein and 25-hydroxyvitamin D during pregnancy in mothers whose children later developed type 1 diabetes. Diabetes Metab Res Rev 2016;32(8):883-890.
  23. Stene LC1, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of type 1 diabetes in the offspring. Diabetologia 2000; 43(9)1093-8.
  24. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014 Jan 4; 383(9911): 69–82.
  25. Superko HR, Superko AR, Lundberg GP, Margolis B, Garrett BC, Nasir K, Agatston AS. Omega-3 Fatty Acid Blood Levels Clinical Significance Update.  2014;8(11):407.
  26. Rupp H, Wagner D, Rupp T, Schulte LM, Maisch B. Risk stratification by the “EPA+DHA level” and the “EPA/AA ratio” focus on anti-inflammatory and antiarrhythmogenic effects of long-chain omega-3 fatty acids.  2004 Nov;29(7):673-85.
  27. Gómez Candela C, Bermejo López LM and Loria Kohen V. Importance of a balanced omega 6/omega 3 ratio for the maintenance of health. 2011;26(2):323-329.
  28. Simopoulos AP. Omega–6/Omega–3 Essential Fatty Acids: Biological Effects. 2009, vol 99, pp 1–16.

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