Sustainable and available sources of omega-3 fatty acids for health: Are the current dietary recommendations, food sources and legislation fit for purpose?

The health benefits of the long-chain omega-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been known for over 50 years and underpin the UK population recommendation to consume > 450 mg EPA+DHA per day. These recommendations, last revised in 2004, are based mainly on epidemiological evidence. Much research has been conducted in the interim. Most RCTs use doses of EPA+DHA of 840 mg per day or more. For anti-inflammatory, triglyceride lowering and anti-hypertensive effects, > 1.5 g EPA+DHA per day is needed. Cognitive benefits are also likely to require these higher intakes. Farmed salmon now contains considerably less EPA+DHA relative to wild-fish, and relative to farmed fish of 20 years ago, meaning one portion per week will no longer provide the equivalent of 450 mg EPA+DHA per day. Oily fish alone can only provide a fraction of the EPA+DHA required to meet global needs. Furthermore, there is low global oily fish consumption, with typical intakes of < 200 mg EPA+DHA per day, and limited intakes in vegans and vegetarians. Therefore, there is an urgent need for affordable, acceptable, alternative EPA+DHA sources, including vegan/vegetarian friendly options, such as bio-enriched poultry, red meat and milk products; fortified foods; enriched oilseeds e.g. genetically modified Camelina sativa; algae and algal oils; and approaches which enhance endogenous EPA/DHA synthesis. In this narrative review we suggest that current EPA+DHA intake recommendations are too low, consider EPA/DHA from a holistic health-sustainability perspective, and identify research, policy and knowledge mobilisation areas which need attention.