Page 46 - JSOM Summer 2024

Factors Influencing Omega-3 Index Status
in Active-Duty Military Personnel

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Jonathan Brown, MSc, RDN ; Mario A. Soto, MD ;
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Keston G. Lindsay, PhD ; Margaret Harris, PhD, MS ; Stephen A. Karagosian, PA-C ;
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Kelsey Bailey, MSc, RDN ; Andrea M. Hutchins, PhD, RDN *

ABSTRACT
Background: This study assessed omega-3 fatty acid (O3FA) from 15% to 23%, with mTBI accounting for the vast major-
status, previous brain injury risk exposures, and associations ity (75%–83%) of TBIs. A TBI causes functional changes in
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between O3FA status and risk exposures among active-duty the body leading to injury and inflammation. Since omega-3
military personnel. Methods: O3FA status was measured by a fatty acids (O3FAs) have been shown to reduce inflammation,
Holman omega-3 blood test. A survey was conducted to assess dietary O3FA sources may play a role in minimizing secondary
brain injury risk history and dietary O3FA factors. Results: conditions resulting from head trauma. However, most of the
More than 50% of the participants had high-risk status, based available evidence is from animal studies. 7–9
on an omega-3 index (O3I) <4%, while less than 2% of the
participants recorded low-risk O3I (>8%). O3FA supplemen- A growing body of research suggests that O3FAs are protec-
tation (p<.001, Cramer’s V=0.342) and fish consumption tive against brain injuries in addition to being effective as an
(p<.001, Cramer’s V=0.210) were positively correlated with acute phase treatment following TBI. 10,11 Studies indicate that
O3FA status. Only 5 O3FA supplement users (n=97 [5.2%]) supplemental O3FAs can lessen the damage by decreasing the
had a low-risk O3I status, while all nonusers (n=223) had magnitude of inflammation and programmed cell death after
moderate- to high-risk O3I status. Conclusions: Supplement- injury. 5,12–18 O3FAs are also associated with improvement in
ing with O3FA was associated with better O3I status in this other indicators of brain damage, including balance, memory,
population. However, only a few participants achieved opti- reaction time, cognitive and neurological performance, and
mal O3I status even when taking an O3FA supplement. Par- brain lesion size. 5,16,19–23 This suggests that a soldier with ade-
ticipants who ate fish and did not supplement were in the quate blood levels of O3FAs may be protected from significant
moderate- or high-risk O3I groups. damage after a head injury.

Keywords: omega-3 fatty acids; brain health; brain injury; Docosahexaenoic acid (DHA) and eicosapentaenoic acid
brain injury risk; traumatic brain injury; TBI; active-duty mil- (EPA) are metabolites of O3FAs and their potential for reduc-
itary; Special Operations; Special Operations Forces; SOF ing brain injury–induced inflammation has been studied. DHA
influence on the brain appears to be stronger than that of EPA,
but both appear to be protective. In the U.S., it is difficult
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to get adequate DHA from diet. Only a few foods contain
Introduction
meaningful levels of EPA and DHA, and they almost exclu-
Traumatic brain injuries (TBIs), also known as concussions, sively come from fatty fish, such as salmon and sardines. Plant
are a major health concern for military personnel. TBIs are foods are common sources of alpha-linolenic acid (ALA), a
increasing in frequency and result in significant physical, be- precursor to EPA and DHA. However, EPA and DHA precur-
havioral, and cognitive deficits, placing a burden on healthcare sors from plant foods have low conversion rates to EPA and
systems. The majority of military-related TBIs are uniquely DHA and are therefore far less effective at increasing inter-
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associated with various blast exposures and tend to be classified nal stores of EPA and DHA compared with the direct forms
as mild TBI (mTBI). Repeated TBIs, including mTBI, increase of EPA and DHA. Further, studies show that being male and
the risk of long-term adverse effects, such as Alzheimer’s dis- living in a Western culture increases chances of having a high
ease, Parkinson’s disease, and chronic traumatic encephalopa- omega-6:omega-3 ratio (O6:O3) which allows the omega-6
thy. Studies also show that brain injuries lead to dementia. 3,4 FAs to compete with the O3FAs for use by the body. 24–30 A
A single TBI can increase the risk of neurodegenerative dis- high O6:O3 ratio in the body results from the consumption
ease by 60%. In recent conflicts, the incidence of TBIs ranged of a diet that is high in fast, convenient, and highly processed
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*Correspondence to Andrea M. Hutchins, Department of Human Physiology and Nutrition, Helen and Arthur E. Johnson Beth-El College
of Nursing and Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918 or
andrea.hutchins@uccs.edu
1 Jonathan Brown is affiliated with Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colo-
rado Springs, CO. Lt Col Mario A. Soto is a flight surgeon with the Medical Corps and a dive medical officer with the 10th Special Forces Group
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(Airborne). Dr. Keston G. Lindsay is an associate professor at Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences,
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University of Colorado Colorado Springs, CO. Dr. Margaret Harris is an associate professor at Helen and Arthur E. Johnson Beth-El College of
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Nursing and Health Sciences, University of Colorado Colorado Springs, CO. CPT Stephen A. Karagosian is an aeromedical physician assistant
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with the 10th Special Forces Group (Airborne). Kelsey Bailey is a performance dietitian at B. Well LLC, Denver, CO. Dr. Andrea M. Hutchins
is an associate professor at Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado, Colorado
Springs, CO.
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