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The NCAA amended Nutritional Supplements Bylaw 16.5.2.7 in January 2019. The language now reads:

…Permissible nutritional supplements do not contain any NCAA banned substances and are identified according to the following classes: carbohydrate/electrolyte drinks, energy bars, carbohydrate boosters, protein supplements, omega-3 fatty acids, and vitamins and minerals.

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● Provide a general description of omega-3 and implications for athletic populations.

● Describe current landscape of the omega-3 status of collegiate athletes and factors associated with this status.

● Discuss implications of our research and applications to sports nutrition practice, particularly in light of recent developments in NCAA legislation.

●○ Short-chain, plant-based○ Energy source, building block for LC

●○ Long-chain, marine-based○ Inflammation, muscle protein synthesis

●○ Long-chain FA, marine-based○ Brain/ Eye health & development

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• Currently NO consensus, but 2019 IOC recommendation is ~2 grams total Omega-3• Academy of Nutrition & Dietetics: 500 mg EPA + DHA daily*• American Heart Association

• General Public- at least 6-8 oz of seafood consumption weekly*• Individuals w/ Coronary Heart Disease (CHD)- at least 5g /day EPA + DHA• Individuals w/o CHD- at least 1 g /day EPA + DHA• Individuals in need of improving blood lipids- 2.4 g/day EPA+DHA

• Institute of Medicine• 1.1 g/d ALA for adult women• 1.6 g/d of ALA for adult men

• Canada: 1.2-1.6 g/d total omega-3’s

• Currently NO consensus, but 2019 IOC recommendation is ~2 grams total Omega-3• Academy of Nutrition & Dietetics: 500 mg EPA + DHA daily*• American Heart Association

• General Public- at least 6-8 oz of seafood consumption weekly*• Individuals w/ Coronary Heart Disease (CHD)- at least 5g /day EPA + DHA• Individuals w/o CHD- at least 1 g /day EPA + DHA• Individuals in need of improving blood lipids- 2.4 g/day EPA+DHA

• Institute of Medicine• 1.1 g/d ALA for adult women• 1.6 g/d of ALA for adult men

• Canada: 1.2-1.6 g/d total omega-3’s

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● Sum of EPA + DHA as a % of total erythrocyte fatty acids (4/32 = 12.5%)

● NOTE: Benchmarks primarily based on studies assessing CV markers & all-cause mortality

● Why use O3I?○ Lowest biological variability, results not altered in the fed state○ Correlates w/ EPA + DHA content of variety of tissues, not just RBC’s○ Relationship observed between O3I and CVD risk, but not with daily dose!

Associated w/ highest risk of CVD event

Moderate risk Optimal

0% 4% 8%8

●○ O6:O3 ratio○ Exercise-induced oxidative stress, impacts ability for recovery between training sessions

●○ Blood lipids in high mass positions

●○ Immobilized limbs and muscle disuse atrophy

●○ High impact sports and neuroprotection○ Neurotransmission efficiency- memory, reaction time

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Linoleic Acid

alpha-Linolenic Acid

Arachidonic Acid

Eicosapentaenoic Acid

Docosahexaenoic Acid

Desaturases & Elongases

Cyclooxygenases & Lipoxygenases

EicosanoidsProstaglandins & Leukotrienes

EicosanoidsResolvins & Protectins

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Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century, Blasbalg et al 2011 11

• O6 consumption in the last century

• O6 Food Sources- poultry, eggs, nuts, seeds, cereals, vegetable oils (olive, soybean, corn)

Population Nutrition Intervention FindingsWu et al, 2014

*Rodent study Neuronal DHA significantly reduced following experimental TBI

Desai et al,2014

*Rodent study Dietary restriction of DHA Heightened response to TBI

Amen et al, 2011

30 retired NFL players (signs of brain damage & cognitive impairment)

-5.6 g fish oil dose

~6 month intervention

↑ Cerebral blood flow↑ Cognitive function

Oliver et al, 2016

81 NCAA DI Football Players (TCU)

-2, 4, or 6 g/d DHA~6 month intervention

↓serum Nf-L(measure of axonal injury/ mTBI)

Guzman et al, 2011

24 elite female soccer players

3.5 g/d DHA ↑ Neuromotor function(Reaction time & efficiency)

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Population Nutrition Intervention

Findings

Yates et al, 2009

36 active players from the Pittsburgh Steelers

2.56 g dose of Fish Oil60 days

↓ triglycerides,VLDL, IDL

↑HDL (+26%)Gravinaet al, 2017

13 competitivesoccer players

.1 g/kg/d of Fish Oil 4 weeks

↑Anaerobic endurance capacity

Hingleyet al,2017

26 trained males 2 g/d of Fish Oil 8 weeks

↑Oxygen efficiency

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Demographic Dietary Intake Blood Status

Wilson & Madrigal 2016

n=58 (Nebraska, 84% female)

Avg ALA = 30 mg/dAvg EPA = 20 mg/dAvg DHA = 50 mg/d

Avg O3I = 4.79%

Anzalone et al 2019

n=404(4 NCAA DI football programs)

Avg O3I = 4.4%

No college athletes measured in research above 8%

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● Cross-sectional assessment of Omega-3 status of NCAA DI collegiate athletes

● Are athletes consuming sufficient levels of Omega-3’s?

● Secondary Questions● How many athletes are taking supplements on their own accord?● How does intake/ O3 status relate to demographics? (Age, sport, geography)● How do reported dietary intake and blood status relate?● Post-legislation change: who should we be supplementing?

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● 8 geographically distinct NCAA Division I institutions (Power 5)

● Male & female from a variety of sports

● Dietary intake & supplement use via previously validated FFQ

● Blood status via fingerstick measuring omega-3 index & full fatty acid analysis

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● 21-item food frequency questionnaire

● Administered virtually via Qualtrics link and using physical paper copies

● Revised to include flax and chia, information on supplement use

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*Adapted from Sublette et al, 2011

● After completion of FFQ, subjects offered opportunity to participate in blood testing (up to 45 fingersticks per school)○ Minimum blood requirement○ Stability during storage (spot cards pre-treated w/ antioxidant cocktail)

● RD or designated Sports Medicine employee

completed all blood work

● Shipped to OmegaQuant to be processed

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Freshmen n=438 (28%)

Sophomores n=362 (25%)

Juniors n=355 (24%)

Seniors n=251 (17%)

5th year/ Graduate Students n=61 (4%)

Not specified n=4 (.5%)

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0

50

100

150

200

250

300

Distribution by Sport

**p<0.01 in all except ALA

Daily Average SD Male Female

ALA 578.5 mg 87.4

EPA 46.9 mg 165.3

DHA 87.4 mg 1164.0

EPA + DHA 142.0 mg 251.4

Total O3 720.6 mg 1227.1 No difference

24IOC: 2 grams total (36%)

720.6 mg

● 45% reported eating no fish in the last 6 months● 13% reported eating no fish or seafood in the last 6 months (0 mg/d DHA + EPA)

● 15% reported using some sort of omega-3 supplement● 67% purchased on their own● 33% received through athletic department via prescription

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Average Male Female

Avg Omega-3

Index

4.3%(2.5-7.2%)

4.3% 4.4%

Serum O6:O3Ratio

9.2(4.4-17.1)

10.5 7.6

26OmegaQuant Fatty Acid Profile

High risk Moderate risk Optimal27

0

20

40

60

80

100

120

140

<2% 2 to 3% 3 to 4% 4 to 5% 5 to 6% 6 to 7% 7 to 8% >8%

# O

F ST

UDE

NT-

ATHL

ETES

Omega-3 Index

Dietary component

O3i Blood ALA

Blood EPA Blood DHA Blood o6:3 ratio

Total O3 + + + +

EPA+DHA + + + +

EPA + + + +

DHA + + + +

ALA

•

•

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Football Non-FootballOmega-3 Index 4.4% 4.3%

O6:O3 Ratio 11.7 8.7*

Males FemalesOmega-3 Index 4.3% 4.4%

O6:O3 Ratio 10.5* 7.6*

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

Less than 2 times per week 2 times or more per week

OM

EGA-

3 IN

DEX

Fish Meal Frequency vs O3I

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*4.2%

5.1%But, still not enough to

achieve “desirable”

levels..

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Non-Supplementers Supplementers

OM

EGA-

3 IN

DEX

Supplement Use vs O3I

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*

3.7%

4.7%

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●

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●

●

●

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●● Athletes only meeting 35% of 2 g/ day Omega-3 recommendation ● 45% of those surveyed reported they hadn’t eaten fish in the last 6 months

●● Avg Omega-3 Index observed = 4.3%

● Levels this low have been associated with cardiovascular disease● Regular fish intake & supplement use resulted in higher O3I values

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Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2002). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. circulation, 106(21), 2747-2757.

Meyer, B. J., Mann, N. J., Lewis, J. L., Milligan, G. C., Sinclair, A. J., & Howe, P. R. (2003). Dietary intakes and food sources of omega-6 and omega-3 polyunsaturated fatty acids. Lipids, 38(4), 391-398.

Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., ... & Meeusen, R. (2018). IOC consensus statement: dietary supplements and the high-performance athlete. International journal of sport nutrition and exercise metabolism, 28(2), 104-125.

Papanikolaou, Y., Brooks, J., Reider, C., & Fulgoni, V. L. (2014). US adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003–2008. Nutrition journal, 13(1), 31.

Shulkin, M. L., Pimpin, L., Bellinger, D., Kranz, S., Duggan, C., Fawzi, W., & Mozaffarian, D. (2016). Effects of omega-3 supplementation during pregnancy and youth on neurodevelopment and cognition in childhood: a systematic review and meta-analysisThe FASEB Journal, 30(1 Supplement), 295-5.

Mori, T. A. (2014). Omega-3 fatty acids and cardiovascular disease: epidemiology and effects on cardiometabolic risk factors. Food & function, 5(9), 2004-2019.

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Simopoulos, A. P. (2001). Evolutionary aspects of diet and essential fatty acids. In Fatty Acids and Lipids-New Findings (Vol. 88, pp. 18-27). Karger Publishers.

Raper, N. R., Cronin, F. J., & Exler, J. (1992). Omega-3 fatty acid content of the US food supply. Journal of the American College of Nutrition, 11(3), 304-308.

Siscovick, D. S., Barringer, T. A., Fretts, A. M., Wu, J. H., Lichtenstein, A. H., Costello, R. B., ... & Appel, L. J. (2017). Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American Heart Association. Circulation, CIR-0000000000000482.

Blasbalg, T. L., Hibbeln, J. R., Ramsden, C. E., Majchrzak, S. F., & Rawlings, R. R. (2011). Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. The American journal of clinical nutrition, 93(5), 950-962.

Mickleborough, T. D. (2013). Omega-3 polyunsaturated fatty acids in physical performance optimization. International journal of sport nutrition and exercise metabolism, 23(1), 83-96.

Wu, A., Ying, Z., & Gomez-Pinilla, F. (2014). Dietary strategy to repair plasma membrane after brain trauma: implications for plasticity and cognition. Neurorehabilitation and neural repair, 28(1), 75-84.

Desai, A., Kevala, K., & Kim, H. Y. (2014). Depletion of brain docosahexaenoic acid impairs recovery from traumatic brain injury. PloS one, 9(1), e86472. 38

Amen, D. G., Wu, J. C., Taylor, D., & Willeumier, K. (2011). Reversing brain damage in former NFL players: implications for traumatic brain injury and substance abuse rehabilitation. Journal of psychoactive drugs, 43(1), 1-5.

Oliver, J. M., Jones, M. T., Kirk, K. M., Gable, D. A., Repshas, J. T., Johnson, T. A., ... & Zetterberg, H. (2016). Effect of docosahexaenoic acid on a biomarker of head trauma in American football. Medicine & Science in Sports & Exercise, 48(6), 974-982.

Guzmán, J. F., Esteve, H., Pablos, C., Pablos, A., Blasco, C., & Villegas, J. A. (2011). DHA-rich fish oil improves complex reaction time in female elite soccer players. Journal of sports science & medicine, 10(2), 301.

Yates, A., Norwig, J., Maroon, J. C., Bost, J., Bradley, J. P., Duca, M., ... & Ross, N. (2009). Evaluation of lipid profiles and the use of omega-3 essential fatty acid in professional football players. Sports health, 1(1), 21-30.

Gravina, L., Brown, F. F., Alexander, L., Dick, J., Bell, G., Witard, O. C., & Galloway, S. D. (2017). n-3 fatty acid supplementation during 4 weeks of training leads to improved anaerobic endurance capacity, but not maximal strength, speed, or power in soccer players. International journal of sport nutrition and exercise metabolism, 27(4), 305-313.

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Hingley, L., Macartney, M. J., Brown, M. A., McLennan, P. L., & Peoples, G. E. (2017). DHA-rich fish oil increases the omega-3 index and lowers the oxygen cost of physiologically stressful cycling in trained individuals. International journal of sport nutrition and exercise metabolism, 27(4), 335-343.

Sublette, M. E., Segal-Isaacson, C. J., Cooper, T. B., Fekri, S., Vanegas, N., Galfalvy, H. C., ... & Mann, J. J. (2011). Validation of a food frequency questionnaire to assess intake of n-3 polyunsaturated fatty acids in subjects with and without major depressive disorder. Journal of the American Dietetic Association, 111(1), 117-123.

Wilson, P. B., & Madrigal, L. A. (2016). Associations between whole blood and dietary omega-3 polyunsaturated fatty acid levels in collegiate athletes. International journal of sport nutrition and exercise metabolism, 26(6), 497-505.

Anzalone, A., Carbuhn, A., Jones, L., Gallop, A., Smith, A., Johnson, P., ... & Harris, W. (2019). The Omega-3 Index in National Collegiate Athletic Association Division I Collegiate Football Athletes. Journal of athletic training, 54(1), 7-11.

Heller, A., Koch, T., Schmeck, J., & van Ackern, K. (1998). Lipid mediators in inflammatory disorders. Drugs, 55(4), 487-496.Paschos, G. K., Magkos, F., Panagiotakos, D. B., Votteas, V., & Zampelas, A. (2007). Dietary supplementation with flaxseed oil lowers blood pressure in dyslipidaemic patients. European journal of clinical nutrition, 61(10), 1201.

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