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ORIGINAL RESEARCH COMMUNICATION |
1 From the School of Biomedical & Molecular Sciences, University of Surrey, Guildford, Surrey, United Kingdom (MDG, IGD, LMM, DJM, and BAG); the Nutritional Sciences Research Division, King's College London, London, United Kingdom (TABS, FL, and SS); the Centre for the Genetics of Cardiovascular Disease, Royal Free and University College London Medical School, London, United Kingdom (JAC); the Medical Research Council Cardiovascular Research Group, Wolfson Institute, Barts and The London Queen Mary's School Medicine and Dentistry, London, United Kingdom (GLM)
Background: Insulin resistance is associated with elevated plasma triacylglycerol, low HDL concentrations, elevated postprandial lipemia, and a predominance of small, dense LDLs (sdLDLs). It has been hypothesized that the dietary ratio of n–6 to n–3 (n–6:n–3) polyunsaturated fatty acids (PUFAs) may have favorable effects on these risk factors by increasing insulin sensitivity.
Objective: The objective was to measure changes in insulin sensitivity, lipoprotein size, and postprandial lipemia after a 6-mo alteration in n–6:n–3.
Design: In a randomized, parallel design in 258 subjects aged 45–70 y, we compared 4 diets providing 6% of energy as PUFAs with an n–6:n–3 between 5:1 and 3:1 with a control diet that had an n–6:n–3 of 10:1. The diets were enriched in 
-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or both. Insulin sensitivity was assessed with the homeostatic model assessment of insulin resistance and the revised quantitative insulin sensitivity test.
Results: Dietary intervention did not influence insulin sensitivity or postprandial lipase activities. Fasting and postprandial triacylglycerol concentrations were lower, and the proportion of sdLDLs decreased (by 12.7%; 95% CI: –22.9%, 2.4%), with an n–6:n–3 of 
3:1, which was achieved by the addition of long-chain n–3 PUFAs (EPA and DHA).
Conclusions: Decreasing the n–6:n–3 does not influence insulin sensitivity or lipase activities in older subjects. The reduction in plasma triacylglycerol after an increased intake of n–3 long-chain PUFAs results in favorable changes in LDL size.
Key Words: Blood lipids • n–3 fatty acids • n–6 fatty acids • insulin sensitivity • lipoprotein lipase • LDL • HDL • long-chain polyunsaturated fatty acids
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