Plasma omega-3 fatty acids are positively associated with appendicular muscle mass index only in adults with low protein intake: Results from NHANES 2011–2012

Omega-3 (ω-3) fatty acids may indirectly increase muscle protein synthesis making the muscle more sensitive to amino acids uptake; therefore, ω-3 could promote benefits on muscle mass mainly when protein intake is low. However, no study has evaluated the association between ω-3 fatty acids and muscle mass according to protein intake.To evaluate the association between plasma ω-3 fatty acids and appendicular muscle mass index (AMMI) in adults according to the protein intake.A cross-sectional study was performed evaluating 1037 individuals aged 20-59 years from a sub-sample of the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Gas chromatography-mass spectrometry method was used to assess plasma ω-3 fatty acids. The lean mass was evaluated by dual-energy x-ray absorptiometry (DXA) and AMMI (kg/m2) was calculated by appendicular lean mass (kg) divided by height squared. The evaluation of protein intake was performed using two 24-h dietary recalls. Linear regression analysis was performed to assess the association of total plasma ω-3, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), alpha-linolenic acid (ALA), and EPA plus DHA with AMMI according to protein intake (<0.8; ≥0.8; ≥0.8 - <1.2; ≥1.2 - <1.6; and ≥1.6 g/kg/d).Total plasma ω-3 (β = 0.0030; CI = 0.0013-0.0046; p = 0.002), ALA (β = 0.0063; CI = 0.0020-0.0107; p = 0.008), EPA (β = 0.0073; CI = 0.0005-0.0142, p = 0.037), DHA (β = 0.0057; CI = 0.0022-0.0093; p = 0.004) and EPA + DHA (β = 0.0040; CI = 0.0010-0.0071; p = 0.013) were positively associated with AMMI in individuals with low protein intake (<0.8 g/kg). However, no association was observed in individuals with protein intake higher than 0.8 g/kg.Plasma ω-3 fatty acids were positively associated with AMMI only in individuals with low protein intake.