Fish oils produce anti-inflammatory effects and improve body weight in severe heart failure

Background: Fish oils have been shown to reduce production of tumor necrosis factor-alpha (TNF-alpha) in healthy subjects. We sought to evaluate the effects of fish oils on pro-inflammatory cytokines and body weight in patients with advanced heart failure. Methods: Fourteen patients (New York Heart Association [NYHA] Class III to IV heart failure) were randomized in a double-blinded trial to active therapy with 8 g of n-3. fatty acids (Group A, n = 7) or placebo (Group B, n = 7) for 18 weeks. TNF-alpha and interleukin-1 (IL-1) production were measured by radioimmunoassay after endotoxin stimulation of peripheral blood mononuclear cells. Results: Placebo-treated patients had a 44% increase in TNF-alpha (from 1.28 to 1.84 pg/ml; p = 0.07) but no significant change in IL-1 (from 0.68 to 0.78 pg/ml) production. n-3 fatty acids resulted in a 59% reduction in TNF-a (from 1.64 to 0.68 pg/ml;p = 0.02) and 39% decrease in IL-1 (from 1.98 to 1.21 pg/ml; p = 0.09) production. There was an inverse correlation between change in TNF-alpha production and change in percent body fat (r = -0.6; p = 0.02). Conclusions: Fish oils decrease TNF-alpha production in heart failure and improve body weight. Fish oil therapy may represent a novel therapeutic approach in late-stage heart failure characterized by cardiac cachexia.