Supplementation with omega-3 plus vitamin E and zinc plus vitamin C on metabolic syndrome components in postmenopausal women with type 2 diabetes

Document Type: Original Article


1 Physiology Research Center, Institute of Basic and Clinical Physiology & Nutrition Department, School of Health, Kerman University of Medical Sciences. Kerman, Iran

2 Department of Health and Social Medicine, School of Medicine, Shaheed Beheshti University of Medical Sciences. Tehran, Iran

3 Human Nutrition & Diet Therapy Department, School of Nutrition and Food Technology, Shaheed Beheshti University of Medical Sciences. Tehran, Iran

4 Iranian Diabetes Society, Malakotti St., Tehran, Iran


Background: The aim of this study was to find the influence of supplementation with omega-3 plus vitamin E and vitamin C plus zinc on metabolic syndrome components.
Methods: In a double-blind controlled clinical trial, 75 diabetic postmenopausal women were randomly assigned to one of the three therapeutic groups of daily supplementation of 1.8g omega-3 plus 400mg vitamin E (group A), 5mg zinc plus 300mg vitamin C (group B), or placebo (group C) for 12 weeks and the results were evaluated.
Results: One-way repeated measures ANOVA showed that systolic and diastolic blood pressure and waist circumference showed significant difference before and after the intervention (P= 0.0001, 0.001, and 0.045, respectively). Results of Univariate ANOVA showed that the level of plasma fasting blood sugar (FBS) and HDL-cholesterol significantly increased (P=0.01 and P=0.03, respectively) in patients who had been diagnosed as diabetic ≤7 years in group B. The plasma TG concentration significantly decreased (P=0.007) in patients who had been diagnosed as diabetic ≤7 years in group A. Systolic and diastolic BP significantly decreased (P=0.005 and P=0.04, respectively) in patients who had been diagnosed as diabetic ≤7 years in group A. The most effectiveness of nutraceutical supplementation was on patients that had been diagnosed as diabetic ≤7 years. Plasma TG and systolic BP decreased with omega-3 plus vitamin E; however, plasma FBS and HDL- cholesterol increased with zinc plus vitamin C supplementation.
Conclusion: Several factors, such as duration of diabetes, age, gender, pathophysiology status, genetic, and other anthropometric characteristics may influence the effectiveness of supplementation.


  1. Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care 2008; 31(9):1898-904.
  2. Shin JA, Lee JH, Lim SY, Ha HSKwon HSPark YM, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. J Diabetes Investig 2013; 4(4):334-43.
  3. Sempertegui F, Estrella B, Tucker KL, Hamer DH, Narvaez X, Sempertegui M, et al. Metabolic syndrome in the elderly living in marginal peri-urban communities in Quito, Equador. Public Health Nutr 2011; 14(5):758-67.
  4. Penckofer S, Schwertz D, Florczak K. Oxidative stress and cardiovascular disease in type 2 diabetes: the role of antioxidants and pro-oxidants. J Cardiovasc Nurs 2002; 16(2):68-85.
  5. Ceriello A. Controlling oxidative stress as a novel molecular approach to protecting the vascular wall in diabetes. Curr Opin Lipidol 2006; 17(5):510-8.
  6. McAuley K, Mann J. Nutritional determinants of insulin resistance. J Lipid Res 2006; 47(8):1668-76.
  7. Garg ML, Wood LG, Singh H, Moughan PJ. Means of delivering recommended levels of long chain n-3 polyunsaturated fatty acids in human diets. J Food Sci 2006; 71(5):R66-71.
  8. Lombardo YB, Chicco AG. Effects of dietary polyunsaturated n-3 fatty acids on dyslipidemia and insulin resistance in rodents and humans. A review. J Nutr Biochem 2006; 17(1):1-13.
  9. McCarty MF. Complementary measures for promoting insulin sensitivity in skeletal muscle. Med Hypotheses 1998; 51(6):451-64.
  10. Schroder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem 2007; 18(3):149-60.
  11. Partida-Hernandez G, Arreola F, Fenton B, Cabeza M, Roman-Ramos R, Revilla-Monsalve MC. Effect of zinc replacement on lipids and lipoproteins in type 2-diabetic patients. Biomed Pharmacother 2006; 60(4):161-8.
  12. Al-Maroof RA, Al-Sharbatti SS. Serum zinc levels in diabetic patients and effect of zinc supplementation on glycemic control of type 2 diabetics. Saudi Med J 2006; 27(3):344-50.
  13. Rodriguez-Villar C, Perez-Heras A, Mercade I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med 2004; 21(2):142-9.
  14. Mahmoodi MR, Abadi AR, Kimiagar SM. Sex differences in myocardial infarction events between patients with and without conventional risk factors: the Modares Heart Study. Am Heart Hosp J 2007; 5(4):228-35.
  15. Mahmoodi MR, Baneshi MR, Rastegari A. Comparison of conventional risk factors in middle-aged versus elderly diabetic and nondiabetic patients with myocardial infarction: prediction with decision-analytic model. Ther Adv Endocrinol Metab 2015; 6(6):258-66.
  16. Mahmoodi MR, Kimiagar M, Mehrabi Y. The effect of omega-3 plus vitamin E and zinc plus vitamin C supplementation on cardiovascular risk markers in postmenopausal women with type 2 diabetes. Ther Adv Endocrinol Metab 2014; 5(4):67-76.
  17. Hammond KA, Mahan LK. Intake: Analysis of the Diet. In: Mahan LK, Raymond JL. Krause’s Food & The Nutrition Care Process. 13th ed. Philadelphia: WB Saunders; 2016. P. 52-63.
  18. Hartweg J, Perera R, Montori V, Dinneen S, Neil HA, Farmer A. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2008; 1:CD003205.
  19. Kesavulu MM, Kameswararao B, Apparao CH, Kumar EG, Harinarayan CV. Effect of omega-3 fatty acids on lipid peroxidation and antioxidant enzyme status in type 2 diabetic patients. Diabetes Metab 2002; 28(1):20-6.
  20. Shidfar F, Keshavarz A, Hosseyni S, Ameri A, Yarahmadi S. Effects of omega-3 fatty acid supplements on serum lipids, apolipoproteins and malondialdehyde in type 2 diabetes patients. East Med Health J 2008; 14(2):305-13.
  21. Lovegrove JA, Lovegrove SS, Lesauvage SV, Brady LM, Saini N, Minihane AM, et al. Moderate fish-oil supplementation reverses low-platelet, long-chain n-3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians. Am J Clin Nutr 2004; 79(6):974-82.
  22. Brady LM, Lovegrove SS, Lesauvage SV, Gower BA, Minihane AM, Williams CM, et al. Increased n-6 polyunsaturated fatty acids do not attenuate the effects of long-chain n-3 polyunsaturated fatty acids on insulin sensitivity or triacylglycerol reduction in Indian Asians. Am J Clin Nutr 2004; 79(6):983-91.
  23. Axelrod L, Camuso J, Williams E, Kleinman K, Briones E, Schoenfeld D. Effects of a small quantity of omega-3 fatty acids on cardiovascular risk factors in NIDDM. A randomized, prospective, double-blind, controlled study. Diabetes Care 1994; 17(1):37-44.
  24. Woodman RJ, Mori TA, Burke V, Puddey IB, Watts GF, Beilin LJ. Effects of purified eicosapentaenoic and docosahexaenoic acids on glycemic control, blood pressure, and serum lipids in type 2 diabetic patients with treated hypertension. Am J Clin Nutr 2002; 76(5):1007-15.
  25. Mori TA, Burke V, Puddey IB, Watts GF, O'Neal DN, Best JD, et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr 2000; 71(5):1085-94.
  26. Puhakainen I, Ahola I, Yki-Jarvinen H. Dietary supplementation with n-3 fatty acids increases gluconeogenesis from glycerol but not hepatic glucose production in patients with non- insulin-dependent diabetes mellitus. Am J Clin Nutr 1995; 61(1):121-6.
  27. Ebbesson SO, Risica PM, Ebbesson LO, Kennish JM, Tejero ME. Omega-3 fatty acids improve glucose tolerance and components of the metabolic syndrome in Alaskan Eskimos: the Alaska Siberia project. Int J of Circumpolar Healt 2005; 64(4):396-408.
  28. Ble-Castillo JL, Carmona-Diaz E, Mendez JD, Larios-Medina FJ, Medina-Santillan R, Cleva-Villanueva G, et al. Effect of alpha-tocopherol on the metabolic control and oxidative stress in female type 2 diabetics. Biomed Pharmacother 2005; 59(6):290-5.
  29. Farvid MS, Siassi F, Jalali M, Hosseini M, Saadat N. The impact of vitamin and/or mineral supplementation on lipid profiles in type 2 diabetes. Diabetes Res Clin Pract 2004; 65(1):21-8.
  30. Asleh R, Blum S, Kalet-Litman S, Alshiek J, Miller-Lotan, R, Asaf R, et al. Correction of HDL dysfunction in individuals with diabetes and the haptoglobin 2-2 genotype. Diabetes 2008; 57(10):2794-800.