Recipient Organization
SOUTH DAKOTA STATE UNIVERSITY
PO BOX 2275A
BROOKINGS,SD 57007
Performing Department
College of Education & Human Sciences
Non Technical Summary
In the 2015 South Dakota Health Survey 5.6% of participants had symptoms of depression and 7.5% had symptoms of anxiety. In the South Dakota Youth Risk Behavior Surveillance (2019), 35.7% of students reported feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the previous 12 months. Rates of depression also appear to be greater in with college/university students. Results from the spring 2019 National College Health Assessment indicated that: 57.5% of undergraduate students felt things were hopeless any time within the past 12 months; 88.0% felt overwhelmed by all you had to do; 67.4% felt very lonely, 72.0% felt very sad, and 46.2% felt so depressed that it was difficult to function. Sixteen percent of students reported having both anxiety and depression. The percentages in all tended to be higher for females than for males. These results suggest young adults attending a higher education setting may be undergoing a mental health crisis.Inflammation has been associated with a number of conditions such as cardiovascular disease, diabetes, obesity and various mental health conditions. Results from meta-analyses found greater concentrations of compounds which increase inflammation in patients with major depressive disorder (MDD) compared with controls. Increased concentrations of these compounds have been found to predict the development of depressive and depression has been shown to predict increased concentrations of these compounds. In a recent review, Kiecolt-Glaser and colleagues (2015) stated, "This bidirectional loop, in which depression facilitates inflammatory responses and inflammation promotes depression, has clear health consequences."Omega-3 fatty acids are key nutrients in the diet but are not ubiquitous in the food supply and are under-consumed in the United States. This suboptimal consumption is of public health concern due to the health benefits (cardiovascular and brain) associated with these fatty acids. Lower brain docosahexaenoic acid (DHA) concentrations have been observed in depressed adults who died by suicide suggesting dietary intake of omega-3 fatty acids may be important in this mental health disorder. It has been noted that omega-3 fatty acid supplementation (at least 2,000 mg/d) may have antianxiety effects. Without regular consumption of seafood (tuna and other nonfried fish), it may be difficult for individuals to consume the recommended amounts of eicosapentaenoic acid (EPA) and DHA.Consumers may have an elevated sense of the healthfulness of their own diets and may require guidance and education to achieve optimal diets. Research indicates 78% of the participants in a study agreed n-3 FAs were beneficial for health. Only 40% agreed their diet was adequate in n-3 FAs. The Omega-3 Index (O3I) is EPA + DHA as a % of red blood cell total fatty acids and a level between 8 - 12% has been associated with improved brain health. The O3I of adults in the U.S. was observed to be 4.3%, less than the desirable range. The low levels of the participants was in spite of participants exhibiting adequate knowledge about food sources of n-3 FAs and believing omega-3 fatty acids are beneficial for health. Similarly, in previous research by the PI's group, in undergraduate students (n=75), 77% knew about omega-3 fatty acids prior to the start of the study and 70.6% correctly identified salmon as the best choice for omega-3 fatty acids. However, only 16% of the participants marked omega-3 fatty acids as good for health and the estimated intake (60.11 ± 70.33 mg/day) of participants was less than the recommended amount of 250-500 mg/day of combined EPA and DHA. The O3I was 3.89 ± 0.61 (n=36), much less than the desired >8%. The results from these studies, and others, emphasize the need to further evaluate the relationships among self-perceived healthfulness of diets, intake of n-3 FAs, facilitators and barriers to consumption of n-3 FAs, and the O3I as a reflection of status.Reasons/Needs for the Proposed Research at this TimeMental health disorders tend to present between the ages of 18 and 24, a time in which many students are enrolling in and adapting to college life. One in four college students have been diagnosed with some form of mental illness and the number one reason students drop out of college has been attributed to depression. These statistics have led some to suggest college/university students are undergoing a mental health crisis. The transition to college can be stressful leading to such things as feelings of isolation, stress, loss of sleep and changes in eating habits. These students also now face a world changed by a global viral pandemic. All of these are contributing factors in the development of mental health issues.Our long-term goal is to contribute towards improving the omega-3 fatty acid status of young adults through a combination of supplementation and education. The primary positive impact of our anticipated findings would be evidence-based scientific verification of an effective intervention to improve the omega-3 fatty acid status of young adults. Such results would provide strong justification for the continued development of a complementary health approach for young adults suffering from mental health issues.Previous Work and Present OutlookFish and fish oil are rich sources of the omega-3 fatty acids EPA and DHA, which have been reported to have anti-inflammatory effects as evidenced by decreased levels of pro-inflammatory markers. Experts in numerous countries have recommended a minimum daily consumption of 250-500 mg EPA/DHA to achieve health benefits. However, evidence demonstrates that a large percentage of adults in the U.S. are not meeting these recommendations. Previous research by the PI's group (unpublished data) indicates that young adults in a university setting consumed less than the recommended intake for EPA and DHA and had an Omega-3 Index lower than considered to be optimal (3.98% versus 8%).Evidence suggests consumption of these longer chain omega-3 fatty acids can have benefits in college-age students. Medical students (21-29 years) consuming 2.5 g/d (2085 mg EPA and 348 mg DHA) had a 14% decrease in an inflammatory compound. In another study with healthy, young adults (20-25 years), supplemental EPA+DHA (300 - 1,800 mg EPA+DHA/d for 5 months) had no effect on IL-6 or CRP; however, there was a marginal treatment effect for TNF-α. A supplement of EPA and DHA (1.4 g/d for 21-days) taken by young adults (mean age 20 years) resulted in 67% of those taking the supplement no longer meeting the criteria for being depressed compared with 20% in the placebo group. Recent research also indicates omega-3 fatty acid supplementation may also improve sleep quality, which could have an impact on mental health.ObjectivesDetermine self-perceptions of dietary adequacy and beliefs about omega-3 fatty acids in young adults.Assess the self-perceived versus estimated intake of omega-3 fatty acids in young adults.Assess the self-perceived versus actual O3I in young adults.Predict the level of omega-3 supplementation needed to increase the omega-3 index to 8% using an individual's baseline omega-3 index value.Determine the effectiveness of omega-3 fatty acid supplementation in improving the omega-3 index, sleep quality, and inflammatory marker profile in young adults in a university setting. The A.S.E. Trial.
Animal Health Component
70%
Research Effort Categories
Basic
30%
Applied
70%
Developmental
(N/A)
Goals / Objectives
In the South Dakota Youth Risk Behavior Surveillance (2019), 35.7% of students reported feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the previous 12 months. Results from the spring 2019 National College Health Assessment (American College Health Association, 2019) indicated that: 57.5% of undergraduate students felt things were hopeless any time within the past 12 months; 88.0% felt overwhelmed by all you had to do; 67.4% felt very lonely, 72.0% felt very sad, and 46.2% felt so depressed that it was difficult to function. Sixteen percent of students reported having both anxiety and depression. These results suggest young adults attending a higher education setting may be undergoing a mental health crisis. The increasing rates of mental health issues are of even more concern now due to the onset and continuance of the global COVID-19 pandemic. Son and colleagues (2020) observed that 71% of surveyed students reported an increase in stress and anxiety due to the COVID-19 outbreak and the authors emphasized the urgent need to develop interventions and preventive strategies to address the mental health of young adults attending college.Increased concentrations of IL-6 and CRP have been found to predict the development of depressive symptoms (Valkanova et al., 2013) and depression has been shown to predict increased concentrations of IL-6 and C-reactive protein (CRP) (Matthews et al., 2010; Deverts et al., 2010). These findings demonstrate the linkage between inflammation and depression. In a recent review, Kiecolt-Glaser and colleagues (2015) stated, "This bidirectional loop, in which depression facilitates inflammatory responses and inflammation promotes depression, has clear health consequences."Omega-3 fatty acids are key nutrients in the diet but are not ubiquitous in the food supply and are under-consumed in the United States (Murphy et al., 2015). This suboptimal consumption of n-3 FAs is of public health concern due to the health benefits associated with these fatty acids. Lower brain docosahexaenoic acid (DHA) concentrations have been observed in depressed adults who died by suicide (McNamara et al., 2013) suggesting dietary intake of omega-3 fatty acids may be important in this mental health disorder. Su and colleagues (2018) noted that omega-3 fatty acid supplementation (at least 2,000 mg/d) may have an anxiolytic effect. Evidence does exist to suggest that EPA and DHA can attenuate depression and depressive symptoms in young adults (Ginty and Conklin, 2015). Without regular consumption of seafood (tuna and other nonfried fish), it may be difficult for individuals to consume the recommended amounts of the longer chain n-3 FAs eicosapentaenoic acid (EPA) and DHA.Additionally, consumers may have an elevated sense of the healthfulness of their own diets and may require guidance and education to achieve optimal diets (Bailey et. al., 2015). Seventy-eight percent of the participants in this study agreed omega-3 fatty acids were beneficial for health. Only 40% agreed their diet was adequate in omega-3 fatty acids. The Omega-3 Index (O3I) is EPA + DHA as a % of erythrocyte total fatty acids and a level between 8 - 12% has been associated with improved brain health (Jackson et al, 2019). The O3I of adults in the U.S. was observed to be 4.3%, less than the desirable range (Thuppal et al 2017). The low status of the participants in the Thuppal study was in spite of participants exhibiting adequate knowledge about food sources of n-3 FAs and believing n-3 FAs are beneficial for health. Similarly, in previous research by the PI's group, in undergraduate students (n=75), 77% knew about omega-3 fatty acids prior to the start of the study and 70.6% correctly identified salmon as the best choice for omega-3 fatty acids. However, only 16% of the participants marked omega-3 fatty acids as good for health and the estimated intake (60.11 ± 70.33 mg/day) of participants was less than the recommended amount of 250-500 mg/day of combined EPA and DHA. The O3I was 3.89 ± 0.61 (n=36), much less than the desired >8%. The results from these studies, and others, emphasize the need to further evaluate the relationships among self-perceived healthfulness of diets, intake of n-3 FAs, facilitators and barriers to consumption of n-3 FAs, and the O3I as a reflection of status.Our long-term goal is to contribute towards improving the omega-3 fatty acid status of young adults through a combination of supplementation and education. The rationale that underlies the proposed research is that improving the omega-3 fatty acid status of these young adults will be a part of complementary health approaches to preventing and treating depression and anxiety. The primary positive impact of our anticipated findings would be evidence-based scientific verification of an effective intervention to improve the omega-3 fatty acid status of young adults. Such results would provide strong justification for the continued development of a complementary health approach for young adults suffering from mental health issues.Fish and fish oil are rich sources of the omega-3 fatty acids EPA and DHA, which have been reported to have anti-inflammatory effects as evidenced by decreased levels of pro-inflammatory markers (Gil and Gil 2015). Experts in numerous countries have recommended a minimum daily consumption of 250-500 mg EPA/DHA to achieve health benefits (Mozaffarian and Wu 2012). However, evidence demonstrates that a large percentage of adults in the U.S. are not meeting these recommendations (Papanikolaou et al., 2014). Previous research by the PI's group (unpublished data) indicates that young adults in a university setting consumed less than the recommended intake for EPA and DHA and had an Omega-3 Index lower than considered to be optimal (3.98% versus 8%).Evidence suggests consumption of these longer chain omega-3 fatty acids can have benefits in college-age students. Medical students (21-29 years) consuming 2.5 g/d (2085 mg EPA and 348 mg DHA) had a 14% decrease in lipopolysaccharide stimulated IL-6 production (Kiecolt-Glaser et al., 2011). In another study with healthy, young adults (20-25 y), supplemental EPA+DHA (300 - 1,800 mg EPA+DHA/d for 5 months) had no effect on IL-6 or CRP; however, there was a marginal treatment effect for TNF-α (p < 0.08) (Flock et al., 2014). A supplement of EPA and DHA (1.4 g/d for 21-days) taken by young adults (mean age 20 years) resulted in 67% of those taking the supplement no longer meeting the criteria for being depressed compared with 20% in the placebo group (Ginty and Conklin, 2015). Recent research also indicates omega-3 fatty acid supplementation may also improve sleep quality (Dai and Liu 2020), which could have an impact on mental health.ObjectivesDetermine self-perceptions of dietary adequacy and beliefs about omega-3 fatty acids in young adults.Assess the self-perceived versus estimated intake of omega-3 fatty acids in young adults.Assess the self-perceived versus actual O3I in young adults.Predict the level of omega-3 supplementation needed to increase the omega-3 index to 8% using an individual's baseline omega-3 index value.Determine the effectiveness of omega-3 fatty acid supplementation in improving the omega-3 index, sleep quality, and inflammatory marker profile in young adults in a university setting. The A.S.E. Trial.
Project Methods
All projects will have approval by the South Dakota State University (SDSU) Institutional Review board. Participants (18-25 years of age) will be recruited from the SDSU campus-dwelling residential student population.Objective #1: Determine self-perceptions of dietary adequacy and beliefs about omega-3 fatty acids in young adults.Participants (target 200 students) will be asked: 1) Do you believe that you consume a diet that is adequate in the omega-3 fatty acids (e.g. fat found in fish)? and, 2) Do you believe that the fats found in foods like oily fish are good for your health, including mental health? The self-perceived level of dietary adequacy and beliefs about omega-3 fatty acids will be determined. Participants will be entered into a drawing for 20 - $10 gift cards.Objective 2: Assess the self-perceived versus estimated intake of omega-3 fatty acids in young adults.Participants recruited for objective #1 will also be asked the following: 1) How often do you eat tuna or nonfried fish? and, 2) Do you take an omega-3 supplement, if yes what kind? Participants will also complete a validated, triple-pass 24-hour dietary recall. The responses to questions #1 and 2 will be coded, and then descriptive statistics run to determine the levels of self-perceived intake of omega-3 fatty acids. The 24-hour dietary recalls will be used to determine to total caloric intake, percentage of macronutrient intakes, amount of vitamin D intake, and intake of omega-3 fatty acids. Participants will be entered into a drawing for 30 - $20 gift cards.Objective 3: Assess the self-perceived versus actual O3I in young adults. Hypothesis: The self-perceived O3I in young adults attending SDSU will be greater than the measured O3I.Participants (target 200 students) will be asked: Do you believe that you have an adequate amount of good fats (e.g. omega-3 fatty acids) within your body to help keep you healthy? The O3I will be determined by obtaining a dried blood spot from a finger prick and using the validated method of Omega Quant Inc (Sioux Falls SD) for determining the amounts of EPA and DHA as a percentage of total fatty acids within the red blood cell membranes. The desirable O3I range is 8-12%. Correlations will be determined between the self-perceived O3I and actual O3I. Participants will receive a $5 SDSU Dairy Bar gift card.Objective #4: Predict the level of omega-3 supplementation needed to increase the omega-3 index to 8% using the baseline omega-3 index value.The baseline omega-3 fatty acid status of young adults will be determined using the O3I results obtained from Objective #3. Previous work found that on average, students had an O3I less than the desired 8% (n=62, 3.98% ± 0.01). Once the baseline value of the O3I is determined (n=200) a predictor equation (Walker et. al., 2019) will be used to predict the amount of EPA/DHA supplementation needed to increase an individual's O3I to 8%. The regression model developed found that baseline O3I, dose and chemical formulation are significant predictors of the O3I response to supplementation. It is expected that the needed level of supplementation will be approximately 2 g/day if using a liquid triglyceride supplement or approximately 3 g/day if using an ethyl ester.Objective #5: Determine the effectiveness of omega-3 fatty acid supplementation in improving the omega-3 index and inflammatory marker profile in young adults in a university setting. The A.S.E. Trial: Improving the Omega-3 Index, Sleep Quality and Inflammatory Profile of Young Adults Living in a University Setting. Assess. Supplement. Evaluate. Hypothesis: Supplementation of at least 2,000 mg EPA+DHA/day will improve: the omega-3 index (to 8% or greater), sleep quality, and the inflammatory marker profile (decrease CRP, TNF-a, IL-6).Sample-Size Calculation/Participants. The calculation of sample size was based on detecting changes in cytokine levels with an a level of 0.05 (2 tailed), 90% power and 10% loss to follow-up. A three-fold difference was used for the sample-size calculation. A sample size of 30 participants per treatment group was determined for a total of 90 participants recruited from participants in Objective #4 with an O3I of 4% or lower. Participants will be randomized to treatment groups (30 per group) (control [no supplementation], ProOmega2000 (fish source), Algae Omega [Vegan]) by stratified random assignment on the basis of sex and age. The supplements will be purchased from Nordic Naturals. The randomization scheme will be generated using Randomization.com (http://www.randomization.com). Reasons for removal/exclusion of a participant will be for non-compliance with the study protocol or medical issues. Reasons for exclusion or dropout will be documented.Supplementation will be for 6 months with assessments at baseline, 3- and 6-months. Dose titrations will be performed if needed at 3-months to achieve the goal of an O3I of 8%. Participants will meet bi-weekly with a registered dietician (RD) to review food intake, along with compliance and physical activity, and receive their allotment of supplement. Participants will be asked to refrain from consuming flaxseed or other sources of ALA, EPA, DHA (e.g., chia seeds, walnuts, fish, fish or algae oil supplements) for the duration of the study.Blood samples will be collected via venipuncture at baseline, 3- and 6-months. The Omega-3 Index (Harris 2014) will be determined. This index is a validated biomarker of tissue omega-3 fatty acid status and has been linked with inflammatory status; a low index is associated with increased inflammation. Serum levels of CRP, TNF-a and IL-6 will be determined using a multiplex system.Descriptive and comparison statistics of baseline characteristics will be determined for all participants randomized to treatment groups. Characteristics of dropouts will be compared with those completing the study to determine if any differences exist between completers and non-completers. Variables will be analyzed by a two-way analysis of variance (ANOVA) to compare baseline values for the groups before treatment began. Statistical analysis will be performed using repeated measures for changes evaluated over time within participants and for the treatment by time interaction across groups. The associations between RBC membrane omega-3 fatty acids, sleep quality, and inflammatory markers will be determined. All results will be considered significant at p £ 0.05. Statistical analysis will be performed using the Statistical Analysis Software (SAS).Participants will receive a summary of their individual results. Compensation will be in the form of gift cards. Upon completion of all assessments at baseline, participants will receive a $20 gift card. Upon completion of all assessments at 3 months, participants will receive a $60 gift card. Upon completion of all assessments at 6 months, participants will receive a $60 gift card.Interpretation of Results. Comparison of the mean values between the control and supplement groups at the given time points will provide an indication of the effectiveness of supplementation. Changes over time will also be evaluated for each participant. Sex differences can exist with metabolism of the omega-3 fatty acids, thus a subgroup analysis by sex is planned (Desci and Kennedy 2011). An Omega-3 Index greater than 8% is considered optimal thus, the percentage of participants with indices meeting this will be determined.