Newly established clinical biomarkers including the AA to EPA ratio highlight the extent to which inflammation underlies chronic illnesses. Dr Bailey presents compelling evidence for an EPA-based fatty acid approach to resolving inflammation that, when applied together with Igennus’ new Opti-O-3 blood spot fatty acid biomarker test, provides an effective nutrition management strategy for health practitioners treating a variety of conditions. Learn how this straightforward blood spot method can add value to your clinical approach by identifying your clients’ individual omega-3 requirements needed to manage biomarkers that correlate with long-term health and reduced disease risk.

1. Nina Bailey
BSc (hons) MSc PhD ANutr

2. Health consequences associated with low intake of the long-chain,
marine omega-3 fatty acids have become a central issue in nutritional
lipid research
Low-grade systemic inflammation is highly prevalent within the UK
population and is and a known risk factor for numerous health
conditions
Current recommendations for omega-3 intake are set at 450mg/day
The evidence that omega-3 can reduce disease risk (i.e. CVD) is
sufficiently strong that both the American Heart Association and
European Cardiology Society recommend intake of ≥1g

3. Additional intake of long-chain omega-3 fatty acid beyond
current recommendation appears to be needed to raise omega-
3 levels to predetermined levels defined as ‘health protective’
The importance of biomarkers:
 The omega-3 index could serve as a diagnostic and/or
predictive biomarker of poor health/disease risk
 AA to EPA ratio (correlates with symptom severity in
numerous health conditions)

4. Omega-3 fatty acids have broad health-promoting effects, with
diverse actions on genes, metabolism and multiple regulatory
systems
Although omega-3 fatty acids have direct actions, they are also
precursors to bioactive metabolites
Prostaglandins
Thromboxanes
Leukotrienes
Resolvins
As omega-3 intake increases, there is a corresponding increase
in metabolites

6. The increase in the anti-inflammatory metabolites derived
from EPA lowers the more pro-inflammatory metabolites
derived from omega-6 AA
This is believed to, at least partially, explain the health
benefits of omega-3 (fish/fish oil) consumption
Anti-inflammatory actions of omega-3 - well defined in vitro
and animal experiments - demonstrate benefits of marine
omega-3 fatty acids

7. Trials of marine omega-3 fish oil in patients are generally
inconsistent
These conflicting results are likely due to differences in study
design, sample size, sample studied, background diet, omega-3
supplement choice, dose, study length, baseline levels of omega-
3, etc.
Often the most prominent outcomes are observed in those
individuals with the lowest omega-3 levels and predominantly
with the lowest levels of EPA

8. In spite of the importance of the omega-3 fatty acids, relatively
few studies have monitored the correlation of supplement
intake and subsequent enrichment of these fatty acids in RBC
membranes and plasma
Measurement of EPA and DHA can be used to assess for
suboptimal intake of omega-3 fatty acids
Biomarkers for personalising omega-3 fatty acid dosing
 The omega-3 index
 Omega-6 to omega-3 ratio
 AA to EPA ratio

9. The omega-3 index
The omega-3 index was originally developed as an informative risk factor
for developing cardiovascular disease and is defined as the content of EPA
and DHA in the cell membrane of RBCs, expressed as a weight percentage
of total fatty acids and reflects tissue fatty acid composition (Harris & Von
Schackey 2004)
Data from epidemiological and dietary intervention studies suggest a
desirable target value for the omega-3 index of more than 8%, with less
than 4% recognised as an undesirable level
A low omega-3 index is also associated with numerous health conditions
including neurodevelopmental and mental health disorders, with
increasing interest in its use as a biomarker of mental health (Milte et al.,
2009)

10. Risk of sudden cardiac death and omega-3 blood levels
Source: Albert et al., 2002

11. Harris & Von Schacky, 2004

12. Flock et al., 2013

13. The incorporation of omega-3 into RBC membranes increases in
a dose-dependent manner
Individuals with the lowest omega-3 index have been shown to
respond more favourably than individuals with higher omega-3
levels
Individuals with a higher baseline omega-3 index have shown a
lower omega-3 index response to treatment incorporating
additional omega-3 at a slower rate than those with lower
baseline levels
(Cao et al., 2006; Keenan et al., 2012; Flock et al., 2013 )

14. Additional intake of long-chain omega-3 fatty acid beyond
current recommendation appears to be needed to achieve an
omega-3 index considered to be health protective (8-10%)
Higher (initial) doses may be required to effect rapid change in
individuals with lower initial omega-3 index values
An ‘average healthy adult’ with a low omega-3 index (i.e. 4.3%)
would require at least 1 g/day of long-chain omega-3 for 5
months to achieve an omega-3 index of 8% (Flock et al., 2013)

15. Accounting for individual differences in body weight could
potentially improve precision for omega-3 recommendations
Body weight explains a high level of variability in omega-3 index
response to omega-3 supplementation
Individuals with lower (versus higher) body weight tended to have a
greater response to set dose of omega-3
This suggests that omega-3 recommendations to achieve a target
omega-3 index may be most appropriately made on the basis of
body weight, similar to current dietary protein requirements

16. Western dietary and lifestyle factors, particularly those that
create an inflammatory environment, contribute significantly to
inflammatory-related disorders
Diets that are high in omega-6 increase ‘risk’, whilst diets that are
rich in long-chain omega-3 may reduce ‘risk’
Specifically, a high AA to EPA ratio and low EPA [rather than DHA]
appears to be associated with many inflammatory conditions
Modifying the diet can reduce systemic inflammation by
manipulating the AA to EPA ratio

17. Shifting the balance
The omega-6 to omega-3 ratio is well documented as a marker of health
status; however, the ratio of AA to EPA is a more accurate indicator of
inflammatory status
AA and EPA contents of cell membranes can be altered through
consumption of omega-3 EPA (marine products/marine oils)
Changing the fatty acid composition of cell membranes affects
• changes in membrane structure
• products involved in immune function and the inflammatory cascade
• cell signalling
• gene expression and cell cycle control

18. R² = 0.649
14
12
10
8
6
4
2
0
1 2 3 4 5 6 7 8
Omega-3 index
Omega-6 to Omega-3 ratio
R² = 0.6493
14
12
10
8
6
4
2
0
0 5 10 15 20
Omega-3 index
AA to EPA ratio
In house data n=25
A higher omega-3 index correlates with a lower AA to EPA ratio

20. The omega-6 to omega-3 ratio of the RBC membrane is
significantly higher in patients compared to healthy
comparisons
The fatty acid content of RBC membranes could serve as a
diagnostic and/or predictive biomarker
Increasing research is focusing on lipid changes with relation
to the duration and progression of conditions
(Rizzo et al., 2010)

21. Using the model developed by Flock and colleagues (2013), it is possible to
estimate the dose (mg/kg/day) required to raise the omega-3 index to a
desirable level (8-10%) knowing an individual’s baseline omega-3 level
The Opti-0-3 is the only omega-3 biomarker test that offers a bespoke dosing
guide to optimise omega-3 fatty acid biomarkers for optimal health
Recommendations are to retest after 6-months

22. Omega-3 index
an early cardiovascular risk indicator
Omega-6 to omega-3 ratio
an established marker of long-term health and chronic illness
AA to EPA ratio
a measure of ’silent’ or chronic inflammation
A personalised plan aims to achieve:
An omega-3 index of more than 8% (10%)
An omega-6 to omega-3 ratio of between 3 and 4
An AA to EPA ratio of between 1.5 and 3

26. R² = 0.649
14
12
10
8
6
4
2
0
1 2 3 4 5 6 7 8
Omega-3 index
Omega-6 to Omega-3 ratio
R² = 0.6493
14
12
10
8
6
4
2
0
0 5 10 15 20
Omega-3 index
AA to EPA ratio
In house data n=25
A higher omega-3 index correlates with a lower AA to EPA ratio

28. Omega-3 index
an early cardiovascular risk indicator
Omega-6 to omega-3 ratio
an established marker of long-term health and chronic illness
AA to EPA ratio
a measure of ’silent’ or chronic inflammation
A personalised plan aims to achieve:
An omega-3 index of more than 8% (target 10%)
An omega-6 to omega-3 ratio of between 3 and 4
An AA to EPA ratio of between 1.5 and 3

29. Price?
 Kit RRP £120
 Practitioner trade rate £65 + VAT
 Clients can purchase direct using affiliated
practitioner code
 (25% discount client/25% commission practitioner)
Turnaround time?
7-10 working days

30. Dosing with omega-3 – how much do I need?
Establishing omega-3 levels identifies those individuals with
higher omega-3 requirements
Knowing baseline levels of omega-3 enables a bespoke dosing
that aims to achieve biomarker status associated with positive
health outcomes
A long-term minimum maintenance dose of 500mg/day is
advisable
Recommendations should be set to retest after 6 months to
monitor outcomes

31. ninab@igennus.com
www.igennus.com
drninabailey.co.uk
0044 1223 421434