Fish Oil Supplementation Does Not Affect Cognitive Outcomes in Cardiac Surgery Patients in the Omega 3 Fatty Acids for Prevention of Post Operative Atrial Fibrillation (OPERA) Trial.
Background Cognitive decline has been reported following cardiac surgery, leading to great interest in interventions to minimize its occurrence. Long chain n 3 (o 3) polyunsaturated fatty acids (PUFAs) have been associated with less cognitive decline in observational studies, yet no trials have tested the effects of n 3 PUFAs on cognitive decline after surgery. Objective We sought to determine whether perioperative n 3 PUFA supplementation reduces postoperative cognitive decline in patients postcardiac surgery. Methods The study comprised a randomized, double blind, placebo controlled, multicenter, clinical trial conducted on cardiac surgery recipients at 9 tertiary care medical centers across the United States. Patients were randomly assigned to receive fish oil (1 g capsules containing =840 mg n 3 PUFAs as ethyl esters) or placebo, with preoperative loading of 8 10 g over 2 5 d followed postoperatively by 2 g/d until hospital discharge or postoperative day 10, whichever came first. Global cognition was assessed using in person testing over 30 d with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (primary outcome) Mini Mental State Exam (secondary outcome) and Trails A and B (secondary outcome) tests. All end points were prespecified. Statistical methods were employed, including descriptive statistics, logistic regression, and various sensitivity analyses. Results A total of 320 US patients were enrolled in the Omega 3 Fatty Acids for Prevention of Post Operative Atrial Fibrillation (OPERA) Cognitive Trial (OCT) a substudy of OPERA. The median age was 62 y (IQR 53, 70 y) No differences in global cognition were observed between placebo and fish oil groups at day 30 (P 0.32) for the primary outcome, a composite neuropsychological RBANS score. The population demonstrated resolution of initial 4 d cognitive decline back to baseline function by 30 d on the RBANS. Conclusion Perioperative supplementation with n 3 PUFAs in cardiac surgical patients did not influence cognition =30 d after discharge. Modern anesthetic, surgical, and postoperative care may be mitigating previously observed long term declines in cognitive function following cardiac surgery. This trial was registered at clinicaltrials.gov as NCT00970489.
The Journal of nutrition