Omega-3 fatty acids, especially EPA and DHA, may have a protective effect against COVID-19 infection andor adverse outcomes, according to a new study published in the American Journal of Clinical Nutrition (AJCN) that explores the role of omega-3 fatty acids, specifically EPA and DHA, and whether they may have a protective effect against COVID-19 infection andor adverse outcomes.

The study compared the risk of three COVID-19 outcomes - testing positive, hospitalization, and death - as a function of baseline plasma DHA levels. DHA levels (as a percentage of total fatty acids) were measured by nuclear magnetic resonance (NMR) spectroscopy but were converted to an omega-3 index (red blood cell EPA+DHA%) in this analysis. Prospective cohort studies from the UK Biobank were used to obtain the three outcomes and relevant covariates for 110,584 participants (hospitalization and death) and 26,595 participants who had been tested (COVID-19 PCR positive) during the period of January 2020 to March 2021.

In fully adjusted models, individuals in the highest fifth (with the highest omega-3 index levels) had a 21% lower likelihood of testing positive than those in the lowest fifth, and for each 1-SD (standard deviation) increase in plasma DHA%, the risk of testing positive was 8% lower. The likelihood of hospitalization was also 26% lower for individuals in the highest fifth than for those in the lowest fifth, and for each 1-SD increase in DHA%, the risk of hospitalization was 11% lower. For COVID-19 death, the risk decreased monotonically before the fourth fifth, but the decrease was partially attenuated beyond the fifth fifth and became nonsignificant. Omega-3 index estimates for the five DHA fifths ranged from 3.5% (lowest fifth) to 8% (highest fifth).

The researchers noted in their paper that these values are consistent with an omega-3 index risk cutoff [initially proposed for cardiovascular disease mortality in 2004] of 8% (low risk) and suggest that these target levels may also be applicable to COVID-19 outcomes.

The researchers also noted that South Korea and Japan reported very low severity of COVID-19 disease, and although underreporting of cases, social distancing policies, and other population-wide interventions undoubtedly contributed to this, it is interesting to note that healthy Koreans and Japanese have omega-3 index values of approximately 8-12% and 7-11%, respectively, which is much higher than the 4-5% omega-3 index in Western populations like the US.

Vivar-Sierra et al. documented a worldwide pattern of higher omega-3 fatty acid intakes being associated with lower COVID-19 death rates. Although only suggestive, this observation further supports a potential role for omega-3s EPA and DHA in preventing fatal COVID-19 disease, the researchers said.

This study confirms earlier findings that low omega-3 status is associated with an increased risk of COVID-19 hospitalization, said William S. Harris, PhD, FASN, President of the Fatty Acid Research Institute (FARI). We extend these findings by showing evidence for a lower risk of testing positive for the infection and also provide evidence that the risk of death may also be lower. Additionally, we identify specific omega-3 fatty acids that may be most strongly protective.

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