The Effects of Omega-3 Fatty Acid Supplementation on the Lipid Profile and Cardiovascular Markers Following Downhill Running in Long-Distance Runners
More details
Hide details
Department of Physiological and Medical Sciences, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland.
Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland.
Submission date: 2022-12-28
Acceptance date: 2023-10-10
Online publication date: 2023-10-27
Corresponding author
Aleksandra Żebrowska   

Institute of Sport Sciences, Academy of Physical Education, Poland
Journal of Human Kinetics 2023;89:123–138
Exercise-induced injury may intensify inflammatory response and reduce the cardiovascular protection mechanisms of omega 3 polyunsaturated fatty acids (ω 3 PUFA). Therefore, this study aimed to determine the erythrocyte content of fatty acids (ω 3 and ω 6), the levels of cardiac damage markers (CKMB, hsTnT, H - FABP), the concentration of inflammation mediators (IL-6, TNF α) in long distance runners supplemented with ω 3 PUFA. Twenty-four male long distance runners, who were randomly assigned to a placebo group (GrP) or a group supplemented (GrSuppl) with a daily dose of 3,000 mg of ω 3 PUFA for three weeks, participated in the study. Participants performed a downhill running exercise test. Blood samples were collected at rest and after the exercise protocol to analyse the levels of cardiac markers and inflammatory cytokines. The erythrocyte membrane content of EPA and DHA in the GrSuppl at the 3rd week of supplementation was significantly higher than at the baseline (p < 0.001). The erythrocyte membrane content of ω 3 PUFA in the GrSuppl was significantly higher at the completion of supplementation (p < 0.001). Supplementation with ω 3 PUFA improved blood lipid profiles and reduced the concentration of inflammation mediators measured after the eccentric exercise tests. The increased ω 3 PUFA content in the erythrocyte membrane and lower blood concentrations of cardiac damage markers and inflammation mediators in distance runners supplemented for three weeks with ω 3 PUFA suggest that the cardiovascular function has been improved.
Adbelhamid, A. S., Brown, T. J., Brainard, J. S., Biswas, P., Thorpe, G. C., Moore, H. J., Deane, K. HO., Summerbell, C. D., Worthington, H., Song, F., & Hooper, L. (2020). Omega-3 fatty acids for primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, 3, CD003177. doi: 10.1002/14651858.CD003177.pub5.
Bernasconi, A. A., Wiest, M. M., Lavie, C. J., Milani, R. V., & Laukkanen, J. A. (2021). Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated Meta-Analysis and Meta-Regression of Interventional Trials. Mayo Clinic Proceedings, 96(2), 304–313. doi:10.1016/j.mayocp.2020.08.034.
Becic, T. & Studenik, C. (2018). Effects of omega-3 supplementation on adipocytokines in prediabetes and type 2 diabetes mellitus: Systematic review and meta-analysis of randomized controlled trials. Diabetes and Metabolism Journal, 42(2), 101–116. doi: 10.4093/dmj.2018.42.2.101.
Bilinski K., Chang D., Fahley P., & Bensoussan A. (2020). Effect of omega-3 supplementation on the omega-3 blood index and fatty acid biomarkers in healthy individuals. Advances in Integrative Medicine, 7, 23–28. doi:10.1016/j.aimed.2019.04.003.
Buonocore, D., Verri, M., Giolitto, A., Doria, E., Ghitti, M., & Dossena, M. (2020). Effect of 8-week n-3 fatty-acid supplementation on oxidative stress and inflammation in middle- and long-distance running athletes: a pilot study. Journal of the International Society of Sports Nutrition, 17(1), 1–19. doi:10.1186/s12970-020-00391-4.
Burkule, N. (2016). Marathon running for amateurs: Benefits and risks. Journal of Clinical and Preventive Cardiology, 5(4), 113–124 doi: 10.4103/2250-3528.192681.
Burillo, E., Martin-Fuentes, P., Mateo-Gallego, R., Baila-Rueda, L., Cenarro, A., Ros, E., & Civeira, F. (2012). Omega-3 Fatty Acids and HDL. How Do They Work in the Prevention of Cardiovascular Disease?. Current Vascular Pharmacology, 10, 432–441. doi:10.2174/157016112800812845.
Camont, L., Chapman, M. J., & Kontush, A. (2011). Biological activities of HDL subpopulations and their relevance to cardiovascular disease. Trends in Molecular Medicine, 17, 594–603. doi:10.1016/j.molmed.2011.05.013 .
Choi, H. M., Doss, H. M., & Kim, K. S. (2020). Multifaceted Physiological Roles of Adiponectin in Inflammation and Diseases. International Journal of Molecular Sciences, 21(4), 1219. doi: 10.3390/ijms21041219.
Costa, R. J. S., Knechtle, B., Tarnopolsky, M., & Hoffman, M. D. (2019). Nutrition for ultramarathon running: Trail, track, and road. International Journal of Sport Nutrition and Exercise Metabolism, 29(2), 130–140. doi:10.1123/ijsnem.2018-0255.
Cunningham, T.C., Maghrabi, K., & Sanatani, S. (2017). Morbidities in the Ultra-Athlete and Marathoner. Cardiology in the Young, 27, 94–100. doi:10.1017/S1047951116002304.
Davinelli, S., Corbi, G., Righetti, S., Casiraghi, E., Chiappero, F., Martegani S., Pina, R., De Vivo, I., Simopoulos, A. P., & Scapagnini G. (2019). Relationship between distance run per week, omega-3 index, and arachidonic acid (AA)/ Eicosapentaenoic acid (EPA) ratio: An observational retrospective study in non-elite runners. Frontiers in Physiology, 10, 487. doi: 10.3389/fphys.2019.00487.
Devereux, R. B., & Reichek, N. (1977). Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation, 55(4), 613–618. doi:10.1161/01.CIR.55.4.613.
Drobnic, F., Rueda, F., Pons, V., Banquells, M., Cordobilla, B., & Domingo, J. C. (2017). Erythrocyte Omega-3 Fatty Acid Content in Elite Athletes in Response to Omega-3 Supplementation: A Dose-Response Pilot Study. Journal of Lipids, 2017, 1472719 doi:10.1155/2017/1472719.
Eston, R. G., Mickleborough, J., & Baltzopoulos, V. (1995). Eccentric activation and muscle damage: biomechanical and physiological considerations during downhill running. British Journal of Sports Medicine, 29(2), 89–94. doi:10.1136/bjsm.29.2.89.
Gammone, M. A., Riccioni, G., Parrinello, G., & D’Orazio, N. (2019). Omega-3 polyunsaturated fatty acids: benefits and endpoints in sport. Nutrients, 11(1), 46. doi:10.3390/nu11010046.
Gutiérrez, S., Svahn, S. L., & Johansson, M. E. (2019). Effects of omega-3 fatty acids on immune cells. International Journal of Molecularsciences, 20(20), 5028. doi:10.3390/ijms20205028.
Higashihara, A., Nakagawa, K., Inami, T., Fukano, M., Iizuka, S., Maemichi, T., Hashizume, S., Narita, T., & Hirose, N. (2020). Regional differences in hamstring muscle damage after a marathon. PLoS One, 15(6), e0234401. doi: 10.1371/journal.pone.0234401.
Harris, W. S., Del Gobbo, L., & Tintle, N. L. (2017). The Omega-3 Index and relative risk for coronary heart disease mortality: Estimation from 10 cohort studies. Atherosclerosis, 262, 51–54. doi:10.1016/j.atherosclerosis.2017.05.007.
Hayakawa, S., Yoshikawa, D., Ishii, H., Tanaka, M., Kumagai, S., Matsumoto, M., Hayashi, M., Sugiura, T., Hayashi, K., Ando, H., Amano, T., & Murohara, T. (2012). Association of plasma omega-3 to omega-6 polyunsaturated fatty acid ratio with complexity of coronary artery lesion. Internal Medicine, 51, 9, 1009–1014.
Innes, J. K., & Calder, P. C. (2020). Marine omega-3 (N-3) fatty acids for cardiovascular health: an update for 2020. International Journal of Molecularsciences, 21(4), 1362. doi:10.3390/ijms21041362.
Jastrzębski, Z., Żychowska, M., Radzimiński, Ł., Konieczna, A., & Kortas, J. (2009). Damage to Liver and Skeletal Muscles in Marathon Runners During a 100 km Run With Regard to Age and Running Speed. Journal of Human Kinetics, 45, 93–102. doi:10.1515/hukin-2015-0010.
Jouris, K. B., McDaniel, J. L., & Weiss, E. P. (2011). The effect of omega-3 fatty acid supplementation on the inflammatory response to eccentric strength exercise. Journal of Sports Science and Medicine, 10(3), 432–438. doi:10.1249/01.mss.0000354215.91342.08.
Kaleta-Duss, A. M., Lewicka-Potocka, Z., Dabrowska-Kugacka, A., Raczak, G., & Lewicka, E. (2020). Myocardial injury and overload among amateur marathoners as indicated by changes in concentrations of cardiovascular biomarkers. International Journal of Environmental Research and Public Health, 17(17), 1–11. doi:10.3390/ijerph17176191.
Khodaee, M., Spittler, J., VanBaak, K., Changstrom, B. G., & Hill, J. C. (2015). Effects of Running an Ultramarathon on Cardiac, Hematologic, and Metabolic Biomarkers. International Journal of Sports Medicine, 94(11), 867–871. doi:10.1055/S-0035-1550045.
Kim, Y. J., Shin, Y. O., Lee, J. B., Lee, Y. H., Shin, K. A., Kim, A. C., & Yang, H. M. (2014). The effects of running a 308 km ultra-marathon on cardiac markers. European Journal of Sport Science, 14(sup1), 92–97. doi:10.1080/17461391.2011.654267.
Knebel, F., Schimke, I., Schroeckh, S., Peters, H., Eddicks, S., Schattke, S., & Borges, A. C. (2009). Myocardial function in older male amateur marathon runners:.
Assessment by Tissue Doppler Echocardiography, Speckle Tracking, and Cardiac Biomarkers. Journal of the American Society of Echocardiography, 22(7), 803–809. doi:10.1016/j.echo.2009.04.009.
Knechtle, B., & Nikolaidis, P. T. (2018). Physiology and pathophysiology in ultra-marathon running. Frontiers in Physiology, 9, 634. doi:10.3389/fphys.2018.00634.
Kolar, L., Stupin, M., Stupin, A., Šušnjara, P., Mihaljević, Z., Matić, A., Jukić, I., Kolobaric, N., & Drenjančević, I. (2021). Does the endothelium of competitive athletes benefit from consumption of n-3 polyunasaturated fatty acid-enriched hen eggs? Preventive Nutrition and Food Science, 26(4), 388–399. doi: 10.3746/pnf.2021.26.4.388.
Leckie, T., Richardson, A., Watkins, E., Fitzpatrick, D., Galloway, R., Grimaldi, R., Roberts, A., & Baker, P. (2019). High-sensitivity troponin T in marathon runners, marathon runners with heart disease and collapsed marathon runners. Scandinavian Journal of Medicine and Science in Sports, 29(5), 663–668.
Mahanty, A., & Xi, L. (2020). Utility of cardiac biomarkers in sports medicine: Focusing on troponin, natriuretic peptides, and hypoxanthine. Sports Medicine and Health Science, 2(2), 65–71. doi:10.1016/j.smhs.2020.05.003.
Martínez-Navarro, I., Montoya-Vieco, A., Collado, E., Hernando, B., & Hernando, C. (2021). Pacing and Body Weight Changes During a Mountain Ultramarathon: Sex Differences and Performance. Journal of Human Kinetics, 80, 71–82.
Mickleborough, T. D. (2013). Omega-3 Polyunsaturated Fatty Acids in Physical Performance Optimization. International Journal of Sport Nutrition and Exercise Metabolism, 23, 83–96. doi:10.1123/ijsnem.23.1.83.
Mickleborough, T. D., Sinex, J. A., Platt, D., Chapman, R. F., & Hirt, M. (2015). The effects PCSO-524®, a patented marine oil lipid and omega-3 PUFA blend derived from the New Zealand green lipped mussel (Perna canaliculus), on indirect markers of muscle damage and inflammation after muscle damaging exercise in untrained men: a randomized, placebo controlled trial. Journal of the International Society of Sports Nutrition, 12(1), 10. doi:10.1186/S12970-015-0073-Z.
Mielgo-Ayuso, J., Calleja-González, J., Refoyo, I., León-Guereño, P., Cordova, A., & Del Coso, J. (2020). Exercise-induced muscle damage and cardiac stress during a marathon could be associated with dietary intake during the week before the race. Nutrients, 12(2), 316. doi:10.3390/nu12020316.
Neilan, T. G., Yoerger, D. M., Douglas, P. S., Marshall, J. E., Halpern, E. F., Lawlor, D., Picard, M., H., & Wood, M. J. (2006). Persistent and reversible cardiac dysfunction among amateur marathon runners. European Heart Journal, 27(9), 1079–1084. doi:10.1093/eurheartj/ehi813.
Nelson, J. R., & Raskin, S. (2019). The eicosapentaenoic acid:arachidonic acid ratio and its clinical utility in cardiovascular disease. Postgraduate Medicine, 131(4), 268–277. doi:10.1080/00325481.2019.1607414.
Oppedisano, F., Macrì, R., Gliozzi, M., Musolino, V., Carresi, C., Maiuolo, J., Bosco, F., Nucera, S., Zuto, M., Guarnieri, L., Scarano, F., Nicita, S., Capoletta, A., Ruga, S., Scicchitano, M., Mollace, R., Palma, E., & Mollace, V. (2020). The anti-inflammatory and antioxidant properties of n-3 PUFAs: Their role in cardiovascular protection. Biomedicines, 8(9), 306. doi:10.3390/biomedicines8090306.
Predel, H. G. (2014). Marathon run: cardiovascular adaptation and cardiovascular risk. European Heart Journal, 35(44), 3091–3098. doi:10.1093/eurheartj/eht502.
Prior, B. M., Yang, H. T., & Terjung, R. L. (2004). What makes vessels grow with exercise training ?. Journal of Applied Physiology, 97, 1119–1128. doi:10.1152/japplphysiol.00035.2004.
Raj Kulshrestha, M., Raj, A., Tiwari, V., Chandra, S., Tiwari, B. C., & Jha, A. (2022). Evaluation of Dual Marker Approach Using Heart-Type Fatty Acid Binding Protein and High Sensitivity Troponin-I as an Alternative to Serial Sampling for Diagnosis of Acute Myocardial Infarction. Electronic Journal of the International Federation of Clinical Chemistry, 33(1), 43–55.
Richardson, A. J., Leckie, T., Watkins, E. R., Fitzpatrick, D., Galloway, R., Grimaldi, R., & Baker, P. (2018). Post marathon cardiac troponin T is associated with relative exercise intensity. Journal of Science and Medicine in Sport, 21(9), 880–884. doi: 10.1016/j.jsams.2018.02.005.
Rubio-Arias, J., Andreu, L., Martínez-Aranda, L. M., Martínez-Rodríguez, A., Manonelles, P., & Ramos-Campo, D. J. (2021). Effects of medium- and long-distance running on heart-damage markers in amateur runners: A systematic review, meta-analysis, and metaregression. Journal of Sport and Health Science, 10(2), 192–200. doi:10.1016/j.jshs.2019.10.003.
Reusser, M., Sousa, C. V., Villiger, E., Alvero Cruz, J. R., Hill, L., Rosemann, T., Nikolaidis, P. T., & Knechtle, B. (2021). Increased Participation and Decreased Performance in Recreational Master Athletes in "Berlin Marathon" 1974–2019. Frontiers in Physiology, 12, 631237.
Schacky, C. (2020). Omega-3 index in 2018/19. Proceedings of the Nutrition Society, 79(4), 381–387. doi:10.1017/S0029665120006989.
Schacky, C., Kemper, M., Haslbauer, R., & Halle, M. (2014). Low omega-3 index in 106 german elite winter endurance athletes: A pilot study. International Journal of Sport Nutrition and Exercise Metabolism, 24(5), 559–564. doi:10.1123/ijsnem.2014-0041.
Schoenfeld, J., Schindler, M. J., Haller, B., Holdenrieder, S., Nieman, D. C., Halle, M., La Gerche, A., & Scherr, J. (2020). Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: Study design of the Pro-MagIC study. BMJ Open Sport and Exercise Medicine, 6(1), 1–7. doi:10.1136/bmjsem-2020-000786.
Sorichter, S., Mair, J., Koller, A., Gebert, W., Rama, D., Calzolari, C., Artner-Dworzak, E & Puschendorf, B. (1997). Skeletal troponin I as a marker of exercise-induced damage. Journal of Applied Physiology, 83(4), 1076–82. doi:10.1152/jappl.1997.83.4.1076.
Stavroulakis, G. A., & George, K. P. (2020). Exercise-induced release of troponin. Clinical Cardiology, 43(8), 872–881. doi:10.1002/clc.23337.
Tartibian, B., Maleki, B. H., & Abbasi, A. (2011). Omega-3 Fatty Acids Supplementation Attenuates Inflammatory Markers After Eccentric Exercise in Untrained Men. Clinical Journal of Sport Medicine, 21(2), 131–137. doi:10.1097/jsm.0b013e31820f8c2f.
Thielecke, F., & Blannin, A. (2020). Omega-3 fatty acids for sport performance—are they equally beneficial for athletes and amateurs? A narrative review. Nutrients, 12(12), 1–28. doi:10.3390/nu12123712.0.
Tiller, N. B., Roberts, J. D., Beasley, L., Chapman, S., Pinto, J. M., Smith, L., Wiffin, M., Russell, M., Sparks, S. A., Duckworth, L., O'Hara, J., Sutton, L., Antonio, J., Willoughby, D. S., Tarpey, M. D., Smith-Ryan, A. E., Ormsbee, M. J., Astorino, T. A., Kreider, R. B., McGinnis, G. R., … & Bannock, L. (2019). International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing. Journal of the International Society of Sports Nutrition, 16(1), 50.
Yanai, H., & Yoshida, H. (2019). Beneficial effects of adiponectin on glucose and lipid metabolism and atherosclerotic progression: Mechanisms and perspectives. International Journal of Molecular Sciences, 20(5), 1–25. doi:10.3390/ijms20051190.
Zhuang, W., Wang, G., Li, L. Lin, G., & Deng, Z. (2013). Omega-3 Polyunsaturated Fatty Acids Reduce Vascular Endothelial Growth Factor Production and Suppress Endothelial Wound Repair. Journal of Cardiovascular Translational Research, 6, 287–293. doi:10.1007/s12265-012-9409-0.
Żebrowska, A., Mizia-Stec, K., Mizia, M., Gąsior, Z., & Poprzęcki, S. (2014). Omega-3 fatty acids supplementation improves endothelial function and maximal oxygen uptake in endurance-trained athletes. European Journal of Sport Science, 15(4), 305–314.
Żebrowska, A., Waśkiewicz, Z., Nikolaidis, P., Mikołajczyk, R., Kawecki, D., Rosemann, T., & Knechtle, B. (2019). Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon. Journal of Clinical Medicine, 8(1), 57. doi:10.3390/jcm8010057.
Żebrowska, A., Hall, B., Stolecka-Warzecha, A., Stanula, A., & Sadowska-Krępa, E. (2021). The Effect of Omega-3 Fatty Acid Supplementation on Serum Adipocytokines, Lipid Profile and Biochemical Markers of Inflammation in Recreational Runners. Nutrients, 13, 456. doi:10.3390/nu13020456.