Italians consume few foods rich in omega-3: health at risk

The health of a portion of Italians is at risk due to suboptimal intake of marine Omega-3s. Increasing the consumption of foods rich in EPA and DHA is a simple and effective strategy to reduce the risk associated with various chronic diseases, particularly cardiovascular ones.

We are certainly not the worst consumers of Omega-3 rich foods worldwide, but we could definitely do better. This emerges from a systematic analysis published in The British Medical Journal by a group of researchers led by Dariush Mozaffarian, an expert at the Harvard School of Public Health (Boston, USA). According to the study, Italians consume on average 994 mg per day of these valuable polyunsaturated fats; however, there is a significant problem: less than one third of this daily dose corresponds to marine-origin Omega-3s, meaning those actually needed by the human body.

Considering that in Italy, deaths from coronary dysfunction attributable to dietary deficiency of these Omega-3s (the EPA – eicosapentaenoic acid – and the DHA – docosahexaenoic acid) amount to about 31 per 100,000 people, the results of this analysis prompt reflection on whether we too belong to that group of Italians whose health is at risk due to staying below the average daily intake of marine-origin Omega-3s.

Proper nutrition is fundamental for good health

Mozaffarian and colleagues included in their analysis data on consumption of dietary fats and oils in 1990 and 2010, collected through 266 nationwide surveys. Their work is part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), a worldwide report on diseases and mortality which showed, more generally, how poor nutrition is one of the main risk factors for diseases and disabilities globally.

The GBD is the most authoritative study on causes determining poor health status. Data published in 2013 (Global Burden of Disease Study 2013, GBD 2013) update the previous version (the Global Burden of Disease Study 2010) – the largest systematic study ever conducted to describe the distribution and possible causes of a wide range of diseases, injuries, and their risk factors on a global scale.

Estimates indicate that by 2020 nearly 75% of all deaths and 60% of all health problems worldwide will be attributable to chronic diseases – including cardiovascular diseases, type 2 diabetes, obesity, and cancer – with a greater impact in low- and middle-income countries. Factors contributing to these diseases – such as high blood pressure, excess blood cholesterol, high blood sugar, and body mass index in overweight and obesity ranges – largely depend on diet. This alarming data has a positive note: diet is a modifiable factor. Its correlation with risk factors for chronic diseases makes it the main risk element for poor health conditions that can be actively addressed.

Several epidemiological and clinical studies have revealed that consumption of dietary fats and oils is associated on one hand with risks but also on the other with health benefits; both the quantity and type of fats consumed are fundamental. However, data on consumption patterns across different countries remain scarce and not very representative, as is the understanding of global dietary patterns accounting for heterogeneity by country, age, sex, and time.

Italy: deaths from omega-3 deficiency have decreased but marine source consumption remains low

Focusing on consumption of different fat sources worldwide in 2010, Boston researchers identified 16 adult groups, grouped by sex and age. The analysis specifically regarded intake of saturated fats, polyunsaturated fats, cholesterol, Omega-6, and Omega-3 from fish or plant sources. For Omega-3s, European citizen consumption data were collected and simplified by Adam Ismail, executive director of the GOED (Global Organization for EPA and DHA Omega-3), a non-profit promoting adequate Omega-3 consumption and of which U.G.A. Nutraceuticals is a member.

What emerged is some heterogeneity among countries. In countries such as France, Spain, Portugal, and especially Iceland, the average daily marine Omega-3 intake well exceeds 250 mg, the dose indicated by the European Food Safety Authority (EFSA) for maintaining normal heart function. In other nations, including the Netherlands, Ireland, Greece, and several Eastern European countries, consumption remains far below this amount. Italy is in a borderline situation: the average intake is 281 mg of marine-origin Omega-3s, more precisely between 213 and 358 mg per day. The intake of plant-based Omega-3s is higher, averaging 713 mg daily (ranging from 346 to 1257 mg per day).

Two critical points emerge from these data. With a daily intake ranging between 213 and 358 mg, in Italy some people do not reach the 250 mg of EPA + DHA recommended by EFSA for heart health and considered by the Italian Society of Human Nutrition (SINU) as the minimum intake necessary at any age. Also, there is a preference for plant sources of Omega-3; unfortunately, the human body cannot efficiently utilize plant Omega-3s, which do not correspond to the biologically active EPA and DHA forms but rather to their precursor, alpha-linolenic acid (ALA). It should be noted that marine-origin Omega-3s are considered essential fats (i.e., to be taken preformed) just like ALA, which human cells cannot synthesize at all.

Fortunately, in Italy, deaths from coronary dysfunctions attributable to EPA and DHA deficiency in the diet have been about 31 per 100,000 people, totaling 18,800 deaths, a relatively low figure compared to countries like Lithuania, Belarus, and Hungary. Another important parameter considered is the trend in these deaths from 1990 to 2010; in Italy mortality dropped from about 36,800 per 100,000 people in 1990 to 31,500 in 2010, a reduction of about 5 deaths per 100,000 over 20 years. Optimizing EPA and DHA intake could help further reduce victims of cardiovascular problems attributable to nutritional deficiencies.

Some data on global habits

Data published by Mozaffarian and colleagues also revealed other interesting information; globally, they found that 18.9% of the population consumes an optimal daily amount of Omega-3 from fish, and that the intake of EPA and DHA, together with that of polyunsaturated Omega-6 fatty acids, has increased over the past 20 years, while saturated fat and cholesterol intake remained stable.

There also appear to be few differences between men and women in EPA and DHA consumption, which was higher in adults than in younger people. Between countries, however, the preferred sources of Omega-3 vary.

Knowing dietary consumption is important to promote health

The data obtained show that in Italy the average daily intake of Omega-3 is mainly supported by plant sources and that over 20 years the number of deaths from coronary diseases attributable to EPA and DHA deficiency has decreased but not by much, especially compared to the achievements of Northern European countries.

Knowing dietary consumption in our country and others allows assessment of nutrient impact on health and to evaluate specific interventions and policies to reduce chronic disease risk. Specifically regarding fats, promoting the consumption of foods containing EPA and DHA (such as fatty fish – for example salmon, tuna, sardines, anchovies) by replacing at least some intake of foods rich in saturated fats (such as meats and cheeses) and preferring these as Omega-3 sources over plant sources (such as walnuts and flax seeds) can help protect cardiovascular health.

Sources:

Micha R et al. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ 2014;348:g2272 doi: 10.1136/bmj.g2272

Corrections. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ 2015;350:h1702. doi: doi: 10.1136/bmj.h1702

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