{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T18:15:24Z","timestamp":1770488124781,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,11,11]],"date-time":"2017-11-11T00:00:00Z","timestamp":1510358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Fibroblast growth factor 23 (FGF23) is an independent risk factor for cardiovascular mortality in chronic kidney disease. Omega-3 (n-3) fatty acid consumption has been inversely associated with FGF23 levels and with cardiovascular risk. We examined the effect of marine n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and plant-derived alpha-linolenic acid (ALA) on plasma FGF23 levels in post-myocardial infarction patients with chronic kidney disease. In the randomized double-blind Alpha Omega Trial, 4837 patients with a history of myocardial infarction aged 60\u201380 years (81% men) were randomized to one of four trial margarines supplemented with a targeted additional intake of 400 mg\/day EPA and DHA, 2 g\/day ALA, EPA-DHA plus ALA, or placebo for 41 months. In a subcohort of 336 patients with an eGFR &lt; 60 mL\/min\/1.73 m2 (creatinine-cystatin C-based CKD-EPI formula), plasma C-terminal FGF23 was measured by ELISA at baseline and end of follow-up. We used analysis of covariance to examine treatment effects on FGF23 levels adjusted for baseline FGF23. Patients consumed 19.8 g margarine\/day on average, providing an additional amount of 236 mg\/day EPA with 158 mg\/day DHA, 1.99 g\/day ALA or both, in the active intervention groups. Over 79% of patients were treated with antihypertensive and antithrombotic medication and statins. At baseline, plasma FGF23 was 150 (128 to 172) RU\/mL (mean (95% CI)). After 41 months, overall FGF23 levels had increased significantly (p &lt; 0.0001) to 212 (183 to 241) RU\/mL. Relative to the placebo, the treatment effect of EPA-DHA was indifferent, with a mean change in FGF23 (95% CI) of \u221217 (\u221297, 62) RU\/mL (p = 0.7). Results were similar for ALA (36 (\u221242, 115) RU\/mL) and combined EPA-DHA and ALA (34 (\u221244, 113) RU\/mL). Multivariable adjustment, pooled analyses, and subgroup analyses yielded similar non-significant results. Long-term supplementation with modest quantities of EPA-DHA or ALA does not reduce plasma FGF23 levels when added to cardiovascular medication in post-myocardial patients with chronic kidney disease.<\/jats:p>","DOI":"10.3390\/nu9111233","type":"journal-article","created":{"date-parts":[[2017,11,13]],"date-time":"2017-11-13T11:12:36Z","timestamp":1510571556000},"page":"1233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of Omega-3 Fatty Acid Supplementation on Plasma Fibroblast Growth Factor 23 Levels in Post-Myocardial Infarction Patients with Chronic Kidney Disease: The Alpha Omega Trial"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4127-8733","authenticated-orcid":false,"given":"Martin","family":"De Borst","sequence":"first","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leandro","family":"Baia","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Nephrology, UNIFESP, Rua Botucatu, 740, Vila Clementino, S\u00e3o Paulo 04023900, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Hoogeveen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Nephrology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ Den Bosch, The Netherlands"},{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8874-2292","authenticated-orcid":false,"given":"Erik","family":"Giltay","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerjan","family":"Navis","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-6791","authenticated-orcid":false,"given":"Stephan","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7638-0589","authenticated-orcid":false,"given":"Johanna","family":"Geleijnse","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition, Wageningen University &amp; Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daan","family":"Kromhout","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition, Wageningen University &amp; Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabita","family":"Soedamah-Muthu","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition, Wageningen University &amp; Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S0140-6736(13)60687-X","article-title":"Chronic Kidney Disease: Global Dimension and Perspectives","volume":"382","author":"Jha","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S0735-1097(02)02956-X","article-title":"Influence of Concurrent Renal Dysfunction on Outcomes of Patients with Acute Coronary Syndromes and Implications of the use of Glycoprotein IIb\/IIIa Inhibitors","volume":"41","author":"Freeman","year":"2003","journal-title":"J. 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