-3 index is associated with cardiometabolic risk factors but is not improved by walnut intake in free-living elderly: a single-blind, randomised controlled trial.

-3 index, the erythrocyte proportion of the EPA + DHA fatty acids is a clinical marker of age-related disease risk. It is unclear whether regular intake of -linolenic acid (ALA), a plant-derived -3 polyunsaturated fatty acid, raises -3 index in older adults. Of the 356 participants at the Loma Linda, CA centre from the original study, a randomly selected subset ( 192) was included for this secondary analysis (mostly Caucasian women, mean age 69 years). Participants were assigned to either the walnut (15 % of daily energy from walnuts) or the control group (usual diet, no walnuts) for 2 years. Erythrocyte fatty acids were determined at baseline and 1-year following intervention. No differences were observed for erythrocyte EPA, but erythrocyte DHA decreased albeit modestly in the walnut group (-0·125 %) and slightly improved in the control group (0·17 %). The change in -3 index between the walnut and control groups was significantly different only among fish consumers (those who ate fish ≥ once/month). Longitudinal analyses combining both groups showed significant inverse association between the 1-year changes of the -3 index and fasting plasma TAG ( = -10), total cholesterol ( = -5·59) and plasma glucose ( = -0·27). Consuming ALA-rich walnuts failed to improve -3 index in elders. A direct source of EPA/DHA may be needed to achieve desirable -3 index, as it is inversely associated with cardiometabolic risk. Nevertheless, incorporating walnuts as part of heart healthy diets is still encouraged.