Critical considerations about the generalized use of n-3 polyunsaturated fatty acids in patients with Polycystic Ovary Syndrome.

Ann Palliat Med 2022;11(1):407-409 | https://dx.doi. org/10.21037/apm-21-3430 I ’ve read with great interest the review recently published by Yuan et al. (1) about the efficacy of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on hormonal, oxidative and inflammatory parameters in women with polycystic ovary syndrome (PCOS). The authors conducted a systematic review and a meta-analysis, finding that n-3 PUFA administration significantly improved (I) inflammatory and oxidative state, as indicated by the levels of C-Reactive Protein (CRP), Malondialdehyde (MDA) and Total Antioxidant Capacity (TAC), (II) and the hormonal profile, as reported by the levels of Luteinizing Hormone (LH), Total Testosterone (TT) and Sex Hormone Binding Protein (SHBG). However, the n-3 PUFA supplementation failed to improve other inflammatory, hormonal and oxidative factors in PCOS women, including Glutathione (GSH), Dehydroepiandrosterone Sulphate (DHEAS), Free Androgen Index (FAI) and Follicle-stimulating hormone (FSH). Indeed, the overall effects of n-3 PUFAs on the hormonal profile, oxidative stress, and inflammation in PCOS patients are still conflicting in the scientific literature. Furthermore, the authors report in their discussion that some limitations to their work exist. First, the analysis included few eligible studies: in particular, among the 314 studies initially identified, only 10 met the eligible criteria and were included. Second, there is a wide heterogeneity among the identified studies, with increased risk of bias. The authors conclude the analysis proposing the supplementation with n-3 PUFAs as a low-risk and addon therapy for patients with PCOS, without discussing crucial critical points. Based on current evidence, I strongly believe that the use of n-3 PUFAs in PCOS management needs deeper assessments regarding the effectiveness and the limitations concerning their application throughout women’s life and their high cost. EPA and DHA are two essential n-3 PUFAs, commonly used as dietary supplements for improving pathological cardiovascular parameters and inflammatory processes. Specifically, their use at different ratios and dosages correlates with different therapeutic benefits. The recommended minimum dosage for supplementation is 500 mg/day, reaching 2,000–4,000 mg/day in patients who have experienced myocardial infarction or altered blood triglycerides levels in the recent past. Therefore, considering such dosages and the high current cost associated to n-3 PUFAs (2), their use should be carefully assessed and reserved only to specific patients who may derive actual benefits from the treatment. PCOS women exhibit heterogenous pathological features, besides the common diagnostic criteria of Rotterdam (oligo or amenorrhea, polycystic ovary, hyperandrogenism). Such syndrome indeed spans women’s life, and menstrual and fertility problems evolve into metabolic complications as age advances (3). In particular, women after 40 years of age may commonly experience cardiovascular problems related to metabolic alterations Letter to the Editor