The relationship between omega-3, omega-6 and total polyunsaturated fat and musculoskeletal health and functional status in adults: a systematic review and meta-analysis of RCTs

Asmaa Abdelhamid, Lee Hooper, Ruksana Sivakaran, Richard Hayhoe, Ailsa Welch

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45 Citations (Scopus)
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Purpose: We conducted a systematic review and meta-analysis to assess effects of increasing dietary omega-3, omega-6 and mixed polyunsaturated fatty acids (PUFA) on musculoskeletal health, functional status, sarcopenia and risk of fractures.

Methods: We searched Medline, Embase, The Cochrane library,, and the WHO International Clinical Trials Registry Platform (ICTRP) databases for Randomised Controlled Trials (RCTs) of adults evaluating effects of higher versus lower oral omega-3, omega-6 or mixed PUFA for ≥ 6 months on musculoskeletal and functional outcomes.

Results: We included 28 RCTs (7288 participants, 31 comparisons), 23 reported effects of omega-3, one of omega-6 and four of mixed total PUFA. Participants and doses were heterogeneous. Six omega-3 trials were judged at low summary risk of bias.  We found low-quality evidence that increasing omega-3 increased lumbar spine BMD by 2.6% (0.03 g/cm2, 95% CI -0.02 to 0.07, 463 participants). There was also the suggestion of an increase in femoral neck BMD (of 4.1%), but the evidence was of very low-quality. There may be little or no effect of omega-3 on functional outcomes and bone mass, effects on other outcomes were unclear. Only one study reported on effects of omega-6 with very limited data. Increasing total PUFA had little or no effect on BMD or indices of fat free (skeletal) muscle mass (low-quality evidence); no data were available on fractures, BMD or functional status and data on bone turnover markers were limited.

Conclusions: Trials assessing effects of increasing omega-3, omega-6 and total PUFA on functional status, bone and skeletal muscle strength are limited with data lacking or of low quality. While there is an indication that omega-3 may improve BMD, high quality RCTs are needed to confirm this and effects on other musculoskeletal outcomes.
Original languageEnglish
Pages (from-to)353–372
Number of pages20
JournalCalcified Tissue International
Issue number4
Early online date25 Jul 2019
Publication statusPublished - Oct 2019

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