From the Guidelines
Omega-3 fatty acid supplements, particularly eicosapentaenoic acid (EPA), may have a limited role in managing fatty liver disease and metabolic syndrome, as recent high-quality evidence suggests they may not provide significant histological efficacy. The most recent and highest quality study, published in 2024, found that supplementation with eicosapentaenoic acid did not show any histological efficacy vs. placebo in RCTs 1. However, previous studies have reported that omega-3 fatty acids may help reduce liver fat accumulation, decrease inflammation, improve insulin sensitivity, and enhance lipid profiles by lowering triglycerides 1.
Key Considerations
- A typical recommended dosage of omega-3 fatty acids ranges from 1-4 grams daily of combined EPA and DHA, with higher doses generally requiring medical supervision.
- For optimal results, supplements should be taken consistently for at least 6-12 months alongside lifestyle modifications including weight loss, regular exercise, and a Mediterranean-style diet low in processed foods and added sugars.
- Patients should choose high-quality, purified supplements to minimize contaminants and consult healthcare providers before starting supplementation, especially those with bleeding disorders or on anticoagulant medications.
- The effects of omega-3 supplementation on improving severe liver injury markers are still unclear, and more research is needed to fully understand their role in managing fatty liver disease and metabolic syndrome.
Mechanism of Action
- Omega-3 fatty acids, particularly EPA and DHA, have hepatic anti-inflammatory and insulin-sensitising effects, which may help reduce liver fat accumulation and improve insulin sensitivity 1.
- They may also help reduce oxidative stress in the liver and enhance lipid profiles by lowering triglycerides 1.
Side Effects and Interactions
- Side effects of omega-3 supplements are generally mild but can include fishy aftertaste, gastrointestinal discomfort, and potential interaction with blood-thinning medications.
- Patients with bleeding disorders or on anticoagulant medications should consult their healthcare provider before starting supplementation.
From the Research
Role of Omega 3 Fatty Acids in Fatty Liver Disease and Metabolic Syndrome
- Omega 3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been studied for their potential benefits in managing fatty liver disease and metabolic syndrome 2, 3.
- Non-alcoholic fatty liver disease (NAFLD) is a liver manifestation of metabolic syndrome, and omega 3 fatty acids may help reduce the risk of cardiovascular disease and improve liver function 2.
- Studies have shown that omega 3 fatty acid supplementation can improve liver fat, triglyceride levels, and body mass index in patients with NAFLD 4.
Mechanisms of Action
- Omega 3 fatty acids may exert their beneficial effects by regulating hepatic lipid metabolism, adipose tissue function, and inflammation 3.
- The anti-inflammatory action of omega 3 fatty acids may help reduce liver inflammation and improve insulin sensitivity 3, 4.
- However, one study found that high-dose omega 3 supplementation had no beneficial effects on adipose tissue lipolysis or inflammation in insulin-resistant adults 5.
Dosage and Duration of Therapy
- The optimal dose and duration of omega 3 fatty acid supplementation for NAFLD are still unclear, and further research is needed to establish these parameters 3, 4.
- One study used a dose of 450-1300 mg of omega 3 fatty acids (DHA + EPA) per day for 24 weeks 2.
- Another study found that omega 3 fatty acid supplementation significantly reduced liver fat and improved metabolic parameters after 6 months of treatment 4.
Combination Therapy
- Omega 3 fatty acid supplementation may be used in combination with other therapies, such as weight loss, diet, and exercise, to manage NAFLD and metabolic syndrome 6, 4.
- Bariatric surgery has also been shown to be effective in reducing hepatic steatosis, inflammation, and fibrosis in patients with NAFLD 6.