| EARLY Trial | UCSF School of Nursing |
| Endothelial Assessment of Risk from Lipids in Youth | University of California, San Francisco |
In our first study, children with high cholesterol levels changed their diet to lower the amount of fat and cholesterol eaten every day. That meant fewer visits to fast food restaurants or making heart healthy food choices at these restaurants! Food labels on packaged foods also had to be checked for low fat content before buying them. It also meant that these children had to increase the number of fruits and vegetables eaten to at least 5 or more a day. We found that when the diet had less fat and cholesterol, the levels of LDL (low density lipoprotein) or the "bad cholesterol" were much lower in children than when they started the study. This is the type of cholesterol that can accumulate in blood vessels and cause heart disease.
We also looked at the effects of vitamins C (500 mg/day) and E (400 IU/day) for 6 weeks and found that these vitamins increased the ability of the blood vessel to relax, which means that it improves the function of the blood vessel. This may be very helpful in preventing heart disease.
In our second study, we evaluated whether an omega-3 fatty acid supplement called docosahexaenoic acid, found in fish and plant oils can improve blood vessel function in children with high cholesterol levels. When we gave the supplement (1.2 grams/day) for 6 weeks, we found that the blood vessel relaxed more than before the supplement and blood flow increased.
This is very exciting news because it explains one reason why many studies over that past 20 years have shown heart healthy benefits of omega-3 fatty acids. It also suggests that these fatty acids may improve heart health in children with high cholesterol levels. We have examined the role of docosahexaenoic acid in the laboratory for several years and some of these studies are listed below in the references.
Another important effect that we have found when children with high cholesterol eat a low fat diet and take the omega-3 supplement is that the quality of their cholesterol improves! In other words, the cholesterol particles become larger and float more easily in the bloodstream. This makes it much harder for the cholesterol to stick to the blood vessel wall. This may prevent the cholesterol from accumulating in the blood vessels in the heart which causes heart disease later in life.
Although more studies are needed before specific recommendations can be made for vitamins C & E and docosahexaenoic acid, the results are very promising and may provide a nutritional approach to preventing heart disease in children with high cholesterol levels.
The results of our omega-3 supplement study were included in a special news report on ABC·7 television in San Francisco on Feb. 15th, 2004. The report may be found (in both written and video formats) at their web site: http://abclocal.go.com/kgo/news/assignment7/021504_assign7_fish_oil.html; or visit http://www.abc7news.com and search for "Fish Oil."
The results of our clinical studies have been presented at the American Heart Association Scientific Sessions in 2001-03.
Engler, M.M., Engler, M.B. ., Malloy, M.J., Chiu, E.Y., Schloetter, M.S., Paul, S., Stuehlinger, M., Lin, K.Y., Cooke, J.P., Morrow, J.D., Ridker, P.M., Rifai, N., Miller, E., Witztum, J.L., Mietus-Snyder, M. (2003). Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Trial.
Circulation, 108: 1059-1063.
Web: http://www.circ.ahajournals.org/cgi/content/abstract/108/9/1059
Engler, M.M., Engler, M.B., Malloy, M.J., Chiu, E.Y., Schloetter, M.C., Morrow, J.D., Rifai, N., Ridker, P.M., Mietus-Snyder, M. (2002). Docosahexaenoic acid, an omega-3 fatty acid, improves endothelial function in hyperlipidemic children: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Study.
Circulation 2002; 106: II-368 (abstract).
Engler, M.M., Engler, M.B., Malloy, M.J., Chiu, E.Y., Kulkarni, K.R., Mietus-Snyder, M.L. (2003) The effect of docosahexaenoic acid on lipoprotein subclasses in hyperlipidemic children: The EARLY Study.
Circulation, 108(17), IV-651(abstract).
Engler, M.B., Engler, M.M., Malloy, M.J., Browne, A., Chiu, E., Chen, C.Y., Milbury, P., Blumberg, J., Mietus-Snyder, M. (2003). Effects of flavonoid-rich chocolate consumption on endothelial function and oxidative stress.
FASEB Journal, 17 (5, Part II), A110 (abstract).
Engler, M.B., Engler, M.M. (2004). The vasculoprotective effects of flavonoid-rich cocoa and chocolate.
Nutrition Research, 24(9): 695-706.
Engler, M.M., Engler, M.B., Malloy, M.J., Chiu, E.L., Besio, D., Stuehlinger, M., Morrow, J.D., Ridker, P.M., Rifai, N., Mietus-Snyder, M. (2004). Docosahexanenoic acid restores endothelial function in children with hyperlipidemia: Results from the EARLY Study.
International Journal of Clinical Pharmacology and Therapeutics, 42(12), 672-679.
Web: http://www.dustri.com/ze/cp/33cp0412.htm#cp42_672
Engler, M.B., Engler, M.M., Chen, C.Y., Malloy, M.J., Browne, A., Chiu, E., Kwak, HK, Milbury, P., Paul SM, Blumberg, J. Mietus-Snyder, M. (2004). Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults.
Journal of the American College of Nutrition 23(3), 197-204.
Engler, M.M., Engler, M.B., Arterburn, L.M., Bailey, E., Chiu, E.Y., Malloy, M.J. (2004). Docosahexanenoic acid supplementation alters plasma phospholipid fatty acid composition in hyperlipidemic children: Results from the EARLY Study.
Nutrition Research, 24: 721-729.
Bautista, M.C., Engler, M.M. (2005). The Mediterranean Diet: Is it cardioprotective? Progress in Cardiovascular Nursing, 20: 70-76.
Engler, M.M., Engler, M.B., Malloy, M.J., Paul, S.M., Kulkarni, K.R. Mietus-Snyder, M. (2005). Effect of docosahexaenoic acid on lipoprotein subclasses in hyperlipidemic children (The Early Study). The American Journal of Cardiology, 95: 869-871.
Engler, M.M., Engler, M.B. (2006). Omega-3 fatty acids: Role in cardiovascular health and disease.
Journal of Cardiovascular Nursing 2006 Jan/Feb 21(1) 17-24.
Laboratory Studies
Engler, M.M., Engler, M.B., Goodfriend, T.L., Ball, D.L., Yu, Z., Su, P., Kroetz, D.L. (1999). Docosahexaenoic acid is an antihypertensive nutrient which affects aldosterone production in SHR. Proc Soc Exp Biol Med, 221:1, 32-38.
Engler, M.B., Engler, M.M., Mayes, M., Ursell, P.C. (1999). Effects of the omega-3 fatty acids on vascular tone in hypercholesterolemia and balloon arterial injury. Asia Pacific Heart J, 8:1, 27-35.
Engler, M.M., Engler, M.B., Kroetz, D.L., Boswell, K.D., Neeley, E., Krassner, S. (1999). The effects of a diet rich in docosahexaenoic acid on organ and vascular fatty acid composition in spontaneously hypertensive rats. Prostaglandins, Leukot Essent Fatty Acids, 61: 5, 289-295.
Engler, M.M., Bellenger-Germain, S.H., Engler, M.B., Narce, M.M., Poisson, J.-P. (2000). Dietary docosahexaenoic acid affects unsaturated fatty acid biosynthesis in spontaneously hypertensive rats. Lipids, 35:1011-1015.
Engler, M.B., Engler, M.M. (2000). Docosahexaenoic acid-induced vasorelaxation in the hypertensive rat: mechanisms of action. Biological Research for Nursing, 2:(2), 85-95.
Engler, M.M., Engler, M.B., Pierson D.M., Molteni, L.B., Molteni A. (2003). Effects of docosahexaenoic acid on vascular pathology and reactivity in hypertension. Experimental Biology and Medicine, 228: 299-307.
[Revised: Jan. 2006]
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For more information, contact:
marguerite.engler@nursing.ucsf.edu
Version 1.7 · 17 Jan. 2006