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The relationship of dietary omega-3 fatty acid and omega-6 to omega-3 ratio intake and likelihood of type 2 diabetes in a cross-sectional study

BMC Endocrine Disorders volume 24, Article number: 259 (2024) Cite this article

Abstract

Background

There is a belief that consuming a significant amount of omega-3 and omega-6 fatty acids can positively affect chronic diseases. However, the connection between these fatty acids and type 2 diabetes mellitus (T2DM) risk remains unclear. To explore this further, we conducted a study to investigate the relationship between dietary intake of omega-3 and omega-6 fatty acids (FA), as well as omega-6 to omega-3 ratio, and the odds of T2DM.

Methods

Our research involved a cross-sectional analysis of data from the Ravansar Non-Communicable Disease (RaNCD) cohort. We evaluated their dietary habits using a comprehensive 118-item food frequency questionnaire (FFQ). To determine the aforementioned association, we employed logistic regression analysis to calculate odds ratios (OR) and 95% confidence intervals (CIs).

Results

The prevalence of T2DM among 8744 qualified participants was 751 (8.6%). After considering all the possible factors that could affect the outcome, high dietary omega-3 intake was associated with a 58% lower likelihood of T2DM (OR: 0.42; 95% CI: 0.32, 0.56; P-trend: <0.001). In contrast, participants at the fourth quartile of the dietary omega 6 to omega 3 FA ratio had a higher odd of T2DM (OR: 1.42; 95%CI: 1.11, 1.84; P-trend: 0.01). Nevertheless, there was no significant connection between the highest and lowest quartile of dietary omega-6 intake (OR: 0.91; 95% CI: 0.71, 1.17; P-trend: 0.80).

Conclusion

According to the study, consuming omega-3 fatty acids through diet was linked with lower odds of type 2 diabetes. Conversely, an elevated omega-6 to omega-3 ratio was associated with a greater likelihood of T2DM.

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Introduction

Diabetes mellitus is the most prevalent health issue in recent decades. According to the International Diabetes Federation, the prevalence of diabetes in 2019 was 9.3%, and it is projected to increase to 10.9% by 2045 [1]. Type 2 diabetes mellitus (T2DM) accounts for almost 90% of all diabetes cases, and its prevalence has significantly increased in countries across all income levels [1]. Patients with T2DM usually suffer from major complications including retinopathy, nephropathy, and peripheral neuropathy [2, 3].

Various types of risk factors, including non-modifiable factors such as age, family history, ethnicity, and modifiable factors such as obesity, diet, smoking, alcohol consumption, and physical activity, can elevate the risk of developing T2DM [4, 5]. Previous research suggested that adhering to a healthy dietary pattern, characterized by lower intake of red and processed meats, salt, sugar, saturated and trans fats, and greater consumption of fruits, non-starchy vegetables, legumes, nuts, fish, and vegetable oils, may reduce the risk of T2DM [6].

Essential fatty acids such as omega-3 and omega-6 are polyunsaturated fatty acids (PUFA) that our bodies cannot produce them, so they must be obtained through our diet [7]. They are considered vital components of a healthy eating pattern [8]. Previous meta-analyses have highlighted a positive association between omega-3 fatty acids biomarkers and the risk of total cardiovascular disease (CVD), coronary heart disease, mortality [9] and T2DM [10]. Another meta-analysis suggested an inverse relationship between linoleic acid—the primary omega-6 fatty acids—and the risk of T2DM [11]. These findings may indicate a beneficial association between dietary intake of omega-3 and omega-6 fatty acids and the prevention of T2DM. However, conflicting evidence remains regarding the association between dietary omega-3 and omega-6 fatty acids, and the risk of T2DM. Wu et al., in a systematic review and meta-analysis of cohort studies could not find any significant association between dietary intake of omega-3 polyunsaturated fatty acids and T2DM risk [12]. Another meta-analysis conducted in 2020 found no significant linear association between dietary consumption of omega-6 intake and the risk of T2DM [13]. However, they found a significant inverse association between omega-3 intake and the risk of T2DM in Asian populations, while in US populations, omega-3 intake was associated with a significant increase in T2DM incidence [13].

In addition to the individual associations of omega-3 and omega-6 fatty acids with T2DM, the dietary omega-6 to omega-3 fatty acids ratio is also remarkably important. Research indicates that a higher omega-6 to omega-3 ratio is associated with increased inflammation and heightened risk of autoimmune diseases, cancer, CVD, and diabetes [14, 15]. However, in a 2019 meta-analysis of randomized clinical trials (RCTs), Brown et al. found that higher ratio of omega-3/omega-6 intake had no effect on the prevention and treatment of type 2 diabetes mellitus [16]. Above mentioned systematic-review and meta-analysis of two cohort studies conducted in 2020, could not also find any significant association between omega-6/omega-3 ratio and risk of T2DM [13]. Overall, further observational studies are needed for several reasons: first, there is conflicting evidence on the association between omega-3, omega-6, and particularly the omega-6/omega-3 ratio, with T2DM risk; second, no observational studies have yet examined this relationship within the Iranian population; and finally, few studies have investigated the association between dietary omega-6 to omega-3 ratio and T2DM [17,18,19]. Therefore, this cross-sectional study, based on cohort data, aims to assess the association between dietary intake of omega-3 and ometga-6 fatty acids, as well as the omega-6/omega-3 ratio, with the odds of T2DM.

Methods

RaNCD study

Ravansar Non-Communicable Disease (RaNCD) study is a population-based prospective cohort study that was performed with the aim of evaluating the non-communicable diseases in Iranian Kurdish ethnicity in Ravansar city, Kermanshah province. More details about the study have been published previously [20,21,22]. The RaNCD cohort is part of the Prospective Epidemiological Research Studies in Iran (PERSIAN) cohort study. Data collection was carried out on 10,025 adults aged 35–65 years, from October 2014 up to August 2022 [20]. We excluded 1281 participants including, 774 participants who had a calorie intake of more than 4200 kcal or less than 800 kcal per day, 131 pregnant women, 78 subjects with cancer, 76 patients diagnosed with renal failure, as well as 222 cases with missing information. Overall, we included 8744 eligible participants in the final analyses (Fig. 1).

Fig. 1
figure 1

Flowchart of the present study

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Data collection

Dietary intake measurement

We gathered dietary information of the study participants using a reliable and accurate 118-item food frequency questionnaire (FFQ) [20]. This questionnaire included the standard portion sizes of typical local foods consumed by the Iranian Kurdish population [20]. FFQ was completed by trained researchers, and then the food item frequency was converted to grams per day. Daily energy, macro, and micronutrients, as well as PUFA intakes of each subject were assessed by Nutritionist IV software which is a revised food composition dataset for Iranian foods in agreement with the US Department of Agriculture [23].

Identification of T2DM

In the present study, we defined type 2 diabetes mellitus as fasting blood sugar ≥ 126 mg/dL and/or a history of diabetes medication including Metformin, acarbose, glibenclamide, sitagliptin, gliclazide, repaglinide, reserpine, insulin regular, novorapid, lantus, novomix, and /or having diabetes confirmed by a health practitioner [24, 25].

Assessment of other factors

In the present study to collect information we used clinical examinations and face-to-face interviews. An application was used to fill out all the questionnaires and a team of specialists ensured their accuracy. Moreover, we utilized an electronic questionnaire system available online to register the sociodemographic data including age, gender, physical activity, living habitat, marital status, education, economic status, as well as personal behaviors such as smoking history, in addition to history of chronic diseases. We assessed body weight as well as body mass index (BMI) with a Bio-Impedance Analyzer BIA (Inbody 770, Inbody Co, Seoul, Korea) [20]. Participants were instructed to remove their shoes, heavy clothing, and accessories to obtain precise anthropometric measurements. Height was measured using BSM 370 with a precision of 0.1 cm (Biospace Co, Seoul, Korea). We used flexible and non-stretch tape to measure waist circumference (WC) and hip circumference (HC) using the standard method. Then, we calculated waist-to-hip ratio by dividing WC by HC in centimeters. The physical activity of subjects was evaluated using a 22-item PERSIAN Cohort standard physical activity questionnaire. According to physical activity intensity, we classified participants as light, moderate, and high physical activity.

Statistical analysis

We controlled dietary PUFA including omega-3 and omega-6 as well as omega-6 to omega-3 ratio for total energy intake using a method introduced by Willett [26]. We classified all subjects based on the quartiles of energy-adjusted dietary omega-3, omega-6, and omega-6/omega-3 ratio, then the first quartile was regarded as a reference. The study participants’ traits across the quartiles of energy-adjusted dietary omega-6, omega-3, and omega-6/omega-3 ratio were reported as mean ± standard deviation (SD) from ANOVA analysis for continuous variables, and number (%) using Chi-square analysis for qualitative variables. Logistic regression analyses were utilized to estimate the odds ratios (OR) and 95% confidence intervals (CIs) to assess the possible association between dietary intake of omega-6, omega-3, and the ratio of omega-6 to omega-3 with the probability of developing T2DM. We also considered some variables as potential confounders in the analyses. Then, we defined three logistic regression models as follows: Model 1 (crude model), model 2 (adjusted for gender and age), and model 3 (additionally controlled for age, gender, residence type, marital status, BMI, smoke, carbohydrate percentage, protein percentage, energy intake, fiber, history of CVD, physical activity, education, and socioeconomic status). P for trend was calculated by treating quartile categories as continuous in logistic regression analysis. The statistical analyses were performed using SPSS software (version 26). A p-value of < 0.05 was considered statistically significant.

A dose-response analysis was performed to examine the association between of dietary omega-6, omega-3, and the omega-6 to 3 ratios fatty acid intake and the odds of T2DM. Participants were categorized into quartiles based on their omega-3 intake. Adjusted (model 3) odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each quartile, with the lowest quartile serving as the reference group. To visualize the dose-response relationship, we plotted the ORs against the mean omega-3 intake for each quartile.

Results

Out of 8744 eligible participants, a total of 1480 (16.9) cases of CVD and 751 (8.6) cases of T2DM were identified. Table 1 presents data regarding the characteristics of the participants based on their intake of dietary omega-6, omega-3, and the omega-6 to 3 ratios. Individuals at top intake of omega 3 were typically younger, male, smokers, had a higher socioeconomic status, were married, living in urban areas, had a low level of education, and were less likely to have a history of CVD, and physical activity. Instead, those with a higher intake of omega 6 were generally younger, heavier, female, living in urban areas, had a higher socioeconomic status, history of CVD and diabetes, and were less likely to physically active, smoke, and educated. The individuals who were in the fourth quartile of the omega 6:3 ratio were more likely to be female, living in urban areas, and had a higher socioeconomic status. They were also younger and heavier compared to others. Their cardiovascular disease history was higher, although they were less likely to smoke or engage in physical activity.

Table 1 The study participants’ general characteristics based on their quartile (Q) of intake for omega-3, omega-6, and the ratio of omega-6 to omega-3 fatty acids
Full size table

Table 2 displays the dietary nutrient intake of the participants in the study, categorized by quartiles of dietary omega 3, omega 6, and the ratio of omega 6 to omega 3. Those in the highest quartile of dietary omega-3 intake had greater consumption of protein, fat, and magnesium, but lower consumption of energy, sodium, carbohydrates, and calcium. Participants in the top quartile of dietary omega-6 intake consumed more fiber, fat, potassium, and magnesium, but less carbohydrates, sodium, energy, and calcium. Individuals in the highest quartile for the dietary omega 6:3 ratio had a reduced consumption of protein and calcium but a greater intake of carbohydrates, fat, and fiber.

Table 2 The nutrient intake of the individuals under study based on the quartile (Q) classification of omega-3, omega-6, and the ratio of omega-6 to omega-3 fatty acids
Full size table

Table 3 provides the OR and 95% CI for T2DM based on quartile categories of dietary omega-3, omega-6, and omega-6:3 fatty acids. In the initial model (model 1), there was no significant association between the dietary omega-3 intake and omega 6:3 ratio and the odds of T2DM. However, a higher dietary omega 6 was significantly linked to developed odds of T2DM (OR: 1.24; 95% CI: 1.05, 1.45; P-trend: 0.012). After accounting for age and gender in model 2, a noteworthy association was observed between T2DM and dietary omega-3 (OR: 1.34; 95% CI: 1.08, 1.66; P-trend: 0.023) and omega-6 (OR: 1.50; 95% CI: 1.20, 1.87; P-trend < 0.001). However, in the third model, accounting for all confounders, the top quartile of dietary omega-3 intake exhibited an inverse association with T2DM versus the first quartile (OR: 0.42; 95% CI: 0.32, 0.56; P-trend: <0.001). Moreover, participant at the fourth quartile of the omega 6 to omega 3 ratio had higher odds of T2DM (OR: 1.42; 95%CI: 1.11, 1.84; P-trend: 0.01).

Table 3 The odds ratio and 95% confidence intervals for type 2 diabetes based on quartile categories of intake for omega-3, omega-6, and the ratio of omega-6 to omega-3 fatty acids
Full size table

Figure 2 shows the dose response analysis of omega-3, omega-6 and omega 6 to 3 intake in relation to T2DM. Regarding dietary omega-3 intake, the analysis indicated a clear trend where higher quartiles of omega-3 intake were associated with lower odds of type 2 diabetes, supporting the hypothesis of a protective effect (P for trend: <0.001). The dose response analysis for intake of omega-6 to omega-3 ratios showed a clear trend where higher ratio was associated with increased odds of type 2 diabetes (P for trend: <0.01). However, the results indicate no linear relationship between dietary omega-6 intake and T2DM (P for trend: 0.803).

Fig. 2
figure 2

Dose response analysis of omega-3, omega-6 and omega 6 to 3 intake in relation to type 2 diabetes mellitus

Full size image

Discussion

The current cross-sectional study revealed that a greater amount of omega-3 in one’s diet was associated with lower chances of T2DM and higher ratio of omega-6 to 3 was related with higher chance of T2DM. Nevertheless, no significant link was seen between dietary consumption of omega-6 and T2DM.

It is believed that chronic diseases can be improved by consuming a significant amount of polyunsaturated fatty acids, specifically omega-3 and omega-6 [16]. However, the link between omega-3 fatty acids as well as omega-6 and type 2 diabetes risk are not yet conclusive. Similar to our findings, the Singapore Chinese Cohort Study conducted in 2011 yielded similar findings, indicating that higher intake of omega-3 FAs was linked to a lower incidence of diabetes [18]. Also, the incidence of type 2 diabetes was not found to be associated with dietary omega-6 intake [18]. A pooled analysis on 20 prospective cohort studies in 2021 indicated that higher levels of omega-3 FA biomarkers in circulation were connected with lower risk of T2D [27]. On the contrary, a dose response meta-analysis of cohort studies conducted in 2022 found that the consumption of omega-3 FA nonlinearly increased the T2DM risk [28]. A systematic review and meta-analysis of randomized controlled trials in 2019 found no evidence to support the claim that increasing omega-3, omega-6, or PUFA had any effect on preventing or treating type 2 diabetes mellitus [16]. Interestingly, in 2017, a meta-analysis of various cohort studies indicated that there was no noteworthy correlation between the consumption of omega-3 and the possibility of developing type 2 diabetes [29]. However, after conducting a subgroup analysis, it was discovered that there exists a noteworthy inverse correlation between the consumption of omega-3 and the risk of type 2 diabetes in individuals of Asian ethnicity [29]. This implies that a range of factors, such as age, dosage, and ethnicity, could have an impact on the effect of omega-3 in the management of type 2 diabetes.

Studies have demonstrated that omega-3 PUFA can enhance multiple metabolic abnormalities that lead to the onset of DM. These advantages consist of heightened manufacturing and excretion of adiponectin, which can assist in improving insulin sensitivity [30]. The anti-inflammatory effects of omega-3 can help in preventing insulin resistance either by direct or indirect means such as conversion to specialized pro-resolution mediators like resolvins and protectins [31]. Moreover, oxidative stress plays a crucial role in the development of complications related to type 2 diabetes [32]. Omega-3 fatty acids possess antioxidant properties that can mitigate oxidative stress and safeguard against such complications [32]. Sterol regulatory element binding protein-1c can be modified by omega-3 fatty acids to enhance fatty acid oxidation and decrease de novo lipogenesis [32]. This can lead to a reduction in hepatic fat accumulation and help to maintain hepatic insulin sensitivity. Moreover, omega-3 fatty acids may positively influence gut microbiota composition, promoting a healthy microbiome that is associated with improved metabolic health [33]. A balanced gut microbiome can enhance gut barrier function and reduce systemic inflammation, further contributing to the prevention of T2DM [33]. In summary, omega-3 fatty acids may protect against T2DM by improving insulin sensitivity, reducing inflammation and oxidative stress, modulating lipid metabolism, and positively influencing gut microbiota.

The top quartile of the dietary ratio likely represents a higher intake of omega-6 fatty acids relative to omega-3 fatty acids, which could contribute to the T2DM. This aligns with previous research suggesting that maintaining a balanced ratio of these fatty acids is important for metabolic health [34]. Omega-6 fatty acids tend to be pro-inflammatory, while omega-3 fatty acids have anti-inflammatory properties [34]. A high omega-6 to omega-3 ratio can lead to chronic inflammation, which is a known risk factor for insulin resistance and T2DM [34]. These results underscore the importance of dietary balance between omega-6 and omega-3 fatty acids in the prevention of T2DM. Future research should focus on identifying optimal dietary patterns and interventions to achieve this balance and reduce the risk of T2DM.

The study’s robust sample size and examination of the connection between omega-3, omega-6, and T2DM in a Middle Eastern nation are noteworthy strengths. However, some limitations could not be avoided. Firstly, the study was cross-sectional, so it could not establish a cause-and-effect relationship between exposure and outcome. Although the diet was measured with some inaccuracies, this would likely result in underestimating risk. Furthermore, despite accounting for all covariates, residual confounding factors may still exist. Lastly, the study only focused on Iranian Kurds, so it is important to exercise caution when generalizing the findings to other populations with distinct demographic characteristics.

Based on our research, it seems that omega-3 fatty acids may have a protective effect against T2DM. However, more studies are necessary to confirm a cause-and-effect relationship. It’s crucial to conduct randomized controlled trials to assess the effectiveness and safety of omega-3 supplementation in lowering the risk of T2DM. Furthermore, it’s important to investigate the ideal dosage, duration of intake, and potential interactions with other dietary and lifestyle factors. In the meantime, adding omega-3-rich foods to a healthy diet can be part of an overall strategy to prevent T2DM. Fatty fish such as salmon, mackerel, and sardines, as well as flaxseeds, chia seeds, and walnuts are all excellent sources of omega-3 fatty acids.

Conclusion

According to evidence from a cross-sectional study, a higher intake of dietary omega-3 FA was associated with a lower likelihood of T2DM. In contrast, a higher ratio of omega-6 to omega-3 fatty acids was linked to an increased odd of T2DM. However, the intake of omega-6 fatty acids did not show significant associations with T2DM.

Data availability

The manuscript includes all the data that was created and analyzed during the study.

References

  1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843.

    Article  PubMed  Google Scholar 

  2. Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of Diabetes 2017. J Diabetes Res 2018, 2018:3086167.

  3. Zakir M, Ahuja N, Surksha MA, Sachdev R, Kalariya Y, Nasir M, Kashif M, Shahzeen F. Tayyab A, Moazzam Khan MS: Cardiovascular complications of diabetes: from microvascular to macrovascular pathways. Cureus 2023, 15(9).

  4. Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: an exposure-wide umbrella review of meta-analyses. PLoS ONE. 2018;13(3):e0194127.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Standl E, Khunti K, Hansen TB, Schnell O. The global epidemics of diabetes in the 21st century: current situation and perspectives. Eur J Prev Cardiol. 2019;26(2suppl):7–14.

    Article  PubMed  Google Scholar 

  6. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133(2):187–225.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ponnampalam EN, Sinclair AJ, Holman BW. The sources, synthesis and biological actions of omega-3 and omega-6 fatty acids in red meat: an overview. Foods. 2021;10(6):1358.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Saini RK, Keum Y-S. Omega-3 and omega-6 polyunsaturated fatty acids: Dietary sources, metabolism, and significance—A review. Life Sci. 2018;203:255–67.

    Article  CAS  PubMed  Google Scholar 

  9. Jiang H, Wang L, Wang D, Yan N, Li C, Wu M, Wang F, Mi B, Chen F, Jia W. Omega-3 polyunsaturated fatty acid biomarkers and risk of type 2 diabetes, cardiovascular disease, cancer, and mortality. Clin Nutr. 2022;41(8):1798–807.

    Article  CAS  PubMed  Google Scholar 

  10. Qian F, Ardisson Korat AV, Imamura F, Marklund M, Tintle N, Virtanen JK, Zhou X, Bassett JK, Lai H, Hirakawa Y. n-3 fatty acid biomarkers and incident type 2 diabetes: an individual participant-level pooling project of 20 prospective cohort studies. Diabetes Care. 2021;44(5):1133–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wu JH, Marklund M, Imamura F, Tintle N, Korat AVA, De Goede J, Zhou X, Yang W-S, de Oliveira Otto MC, Kröger J. Omega-6 fatty acid biomarkers and incident type 2 diabetes: pooled analysis of individual-level data for 39 740 adults from 20 prospective cohort studies. Lancet Diabetes Endocrinol. 2017;5(12):965–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wu JH, Micha R, Imamura F, Pan A, Biggs ML, Ajaz O, Djousse L, Hu FB, Mozaffarian D. Omega-3 fatty acids and incident type 2 diabetes: a systematic review and meta-analysis. Br J Nutr. 2012;107(S2):S214–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Neuenschwander M, Barbaresko J, Pischke CR, Iser N, Beckhaus J, Schwingshackl L, Schlesinger S. Intake of dietary fats and fatty acids and the incidence of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective observational studies. PLoS Med. 2020;17(12):e1003347.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Simopoulos AP. Evolutionary aspects of the dietary omega-6/omega-3 fatty acid ratio: medical implications. Evolutionary Think Medicine: Res Policy Pract 2016:119–34.

  15. Chaves H, Singh RB, Khan S, Wilczynska A, Takahashi T. High omega-6/omega-3 fatty acid ratio diets and risk of noncommunicable diseases: is the tissue, the main issue? The role of functional food security in global health. edn.: Elsevier; 2019. pp. 217–59.

  16. Brown TJ, Brainard J, Song F, Wang X, Abdelhamid A, Hooper L. Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. bmj 2019, 366.

  17. Ericson U, Hellstrand S, Brunkwall L, Schulz CA, Sonestedt E, Wallström P, Gullberg B, Wirfält E, Orho-Melander M. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am J Clin Nutr. 2015;101(5):1065–80.

    Article  CAS  PubMed  Google Scholar 

  18. Brostow DP, Odegaard AO, Koh WP, Duval S, Gross MD, Yuan JM, Pereira MA. Omega-3 fatty acids and incident type 2 diabetes: the Singapore Chinese Health Study. Am J Clin Nutr. 2011;94(2):520–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Alhazmi A, Stojanovski E, McEvoy M, Garg ML. Macronutrient intake and type 2 diabetes risk in middle-aged Australian women. Results from the Australian longitudinal study on women’s Health. Public Health Nutr. 2014;17(7):1587–94.

    Article  PubMed  Google Scholar 

  20. Pasdar Y, Najafi F, Moradinazar M, Shakiba E, Karim H, Hamzeh B, Nelson M, Dobson A. Cohort Profile: Ravansar Non-communicable Disease cohort study: the first cohort study in a kurdish population. Int J Epidemiol. 2019;48(3):682–f683.

    Article  PubMed  Google Scholar 

  21. Hamzeh B, Bagheri A, Pasdar Y, Darbandi M, Rezaeian S, Najafi F, Moradinazar M. Predicting metabolic syndrome by anthropometric measures among adults 35–65 years in the west of Iran; a cross sectional study from an Iranian RaNCD cohort data. Diabetes Metab Syndr. 2020;14(5):1293–8.

    Article  PubMed  Google Scholar 

  22. Shakiba E, Najafi F, Pasdar Y, Moradinazar M, Navabi J, Shakiba MH, Bagheri A. A prospective cohort study on the association between dietary fatty acids intake and risk of hypertension incident. Sci Rep. 2023;13(1):21112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Azar M, Sarkisian E. Food composition table of Iran: National Nutrition and Food Research Institute. Shaheed Beheshti University, Tehran; 1980.

  24. Safari-Faramani R, Rajati F, Tavakol K, Hamzeh B, Pasdar Y, Moradinazar M, Najafi F. Prevalence, awareness, treatment, control, and the associated factors of diabetes in an Iranian Kurdish population. Journal of diabetes research 2019.

  25. Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S151.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65(4):S1220–8.

    Article  Google Scholar 

  27. Qian F, Ardisson Korat AV, Imamura F, Marklund M, Tintle N, Virtanen JK, Zhou X, Bassett JK, Lai H, Hirakawa Y, et al. n-3 fatty acid biomarkers and incident type 2 diabetes: an individual participant-level Pooling Project of 20 prospective cohort studies. Diabetes Care. 2021;44(5):1133–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hu M, Fang Z, Zhang T, Chen Y. Polyunsaturated fatty acid intake and incidence of type 2 diabetes in adults: a dose response meta-analysis of cohort studies. Diabetol Metab Syndr. 2022;14(1):34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Chen C, Yang Y, Yu X, Hu S, Shao S. Association between omega-3 fatty acids consumption and the risk of type 2 diabetes: a meta‐analysis of cohort studies. J Diabetes Invest. 2017;8(4):480–8.

    Article  CAS  Google Scholar 

  30. Sepidarkish M, Rezamand G, Qorbani M, Heydari H, Estêvão MD, Omran D, Morvaridzadeh M, Roffey DM, Farsi F, Ebrahimi S. Effect of omega-3 fatty acids supplementation on adipokines: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2022;62(27):7561–75.

    Article  CAS  PubMed  Google Scholar 

  31. Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45(5):1105–15.

    Article  CAS  PubMed  Google Scholar 

  32. Bayram SŞ, Kızıltan G. The role of Omega-3 polyunsaturated fatty acids in diabetes Mellitus Management: a narrative review. Curr Nutr Rep 2024:1–25.

  33. Kumar M, Pal N, Sharma P, Kumawat M, Sarma DK, Nabi B, Verma V, Tiwari RR, Shubham S, Arjmandi B. Omega-3 fatty acids and their interaction with the gut microbiome in the prevention and amelioration of type-2 diabetes. Nutrients. 2022;14(9):1723.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Shetty SS, Suchetha Kumari N, Varadarajan R. The ratio of omega-6/omega-3 fatty acid: implications and application as a marker to diabetes. Biomarkers in diabetes. edn.: Springer; 2022. pp. 449–67.

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Acknowledgements

The collaborators of the PERSIAN Cohort Study and Kermanshah University of Medical Sciences are acknowledged by the authors. The funding used in the PERSIAN Cohort has been contributed by the Iranian Ministry of Health and Medical Education through Grant no 700/534.

Funding

The Kermanshah University of Medical Sciences provided support for this research (grant number: 4010177).

Author information

Authors and Affiliations

  1. Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Ebrahim Shakiba, Yahya Pasdar & Farid Najafi

  2. Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Ebrahim Shakiba

  3. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Farzaneh Asoudeh

  4. Department of Nutritional Sciences, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Amir Saber & Amir Bagheri

  5. School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Mohammad Hossein Shakiba

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  1. Ebrahim Shakiba
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Contributions

The study’s design was contributed to by ESH, FN, YP, AS, and MHSH. AB and FA were responsible for data analysis and manuscript writing. The manuscript was extensively reviewed and edited by AB.

Corresponding author

Correspondence to Amir Bagheri.

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Shakiba, E., Pasdar, Y., Asoudeh, F. et al. The relationship of dietary omega-3 fatty acid and omega-6 to omega-3 ratio intake and likelihood of type 2 diabetes in a cross-sectional study. BMC Endocr Disord 24, 259 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01787-y

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01787-y

Keywords

BMC Endocrine Disorders

ISSN: 1472-6823

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