• C von Schacky.
• Präventive Kardiologie, Medizinische Klinik I, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland. clemens.vonschacky@med.uni-muenchen.de.
• Internist (Berl). 2019 Dec 1; 60 (12): 1319-1327.

BackgroundConfusion reigns about omega‑3 fatty acids and their effects. Scientific investigations did not appear to clarify the issue. Guidelines and regulatory authorities contradict each other.ObjectiveThis article provides clarity by considering not intake but levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes as a percentage of all fatty acids measured (omega‑3 index).Current DataThe largest database of all methods of fatty acid analyses has been generated with the standardized HS-Omega‑3 Index® (Omegametrix, Martinsried, Deutschland). The omega‑3 index assesses the in EPA+DHA status of a person, has a minimum of 2%, a maximum of 20%, and is optimal between 8% and 11%. In many western countries but not in Japan or South Korea, mean levels are suboptimal. Suboptimal levels correlate with increased total mortality, sudden cardiac death, fatal and non-fatal myocardial infarction, other cardiovascular diseases, cognitive impairment, major depression, premature birth and other health issues. Interventional studies on surrogate and intermediary parameters demonstrated many positive effects, correlating with the omega‑3 index when measured. Due to issues in methodology that became apparent from the perspective of the omega‑3 index many, even large interventional trials with clinical endpoints were not positive, which is reflected in pertinent meta-analyses. In contrast, interventional trials without issues in methodology the clinical endpoints mentioned were reduced.ConclusionAll humans have levels of EPA+DHA that if methodologically correctly assessed in erythrocytes, are optimal between 8% and 11%. Deficits can cause serious health issues that can be prevented by optimal levels.

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