SOURCE: Chew EY. JAMA 2017;317:2226-2227.

In the spirit of full disclosure, with rare exception (folate for reproductive age women), I am not an advocate for supplements. I want to make sure readers can clearly identify the difference between omega-3 fatty acid supplements and omega-3 fatty acids as provided by fish in the diet. The use of supplements by Americans has been fairly stable over the past decade at about 50%, despite little in the way of substantive scientific evidence support their use. However, let’s not confuse the difference between the potential benefits of enhancement of diet with enhancement of intake through supplements. For instance, data from the Women’s Health Initiative suggest that the cardiovascular effects of calcium intake through dietary enhancement differ from those of calcium supplements. The PREDIMED clinical trial was a prospective investigation that compared a Mediterranean diet augmented with extra virgin olive oil and nuts with a control (n = 7,447). Approximately half of the PREDIMED participants were diabetic. After a follow-up of six years, the hazard ratio for new retinopathy requiring intervention was approximately half that for the Mediterranean diet group compared to the control group. Although it may be tempting to extrapolate these observations to simply take an omega-3 fatty acid supplement of comparable quantity, it remains to be determined whether this isolated ingredient from fish, when taken as a single-entity intervention, will provide similar benefits.