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Systematic Review J. Biol. Regul. Homeost. Agents. 2024; 38(6): 4607–4623
https://doi.org/10.23812/j.biol.regul.homeost.agents.20243806.367
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Polyunsaturated Fatty Acid Supplementation in
Athletes: A Systematic Review
Matheus Santos de Sousa Fernandes1, Jonathan Manoel da Costa2, Georgian Badicu3,*,
Gabriela Carvalho Jurema Santos4, Deyvison Guilherme Martins Silva5,
Claudia Jacques Lagranha5, Fatma Hilal Yagin6,*, Rui Miguel Silva7,
Francisco Tomás González-Fernández8, Jaya Shanker Tedla9, Raphael Fabricio de Souza10
1Keizo Asami Institute, Federal University of Pernambuco, 50670-901 Recife, Pernambuco, Brazil
2Graduate Program in Physiological Sciences, Academic Center of Vitória, Federal University of Pernambuco, 55608-680 Vitória de Santo Antão,
Pernambuco, Brazil
3Department of Physical Education and Special Motricity, Transilvania University of Brasov, 500068 Brasov, Romania
4Graduate Program in Nutrition, Federal University of Pernambuco, 50670-901 Recife, Pernambuco, Brazil
5Exercise Biochemistry Laboratory, Academic Center of Vitória, Federal University of Pernambuco, 55608-680 Vitória de Santo Antão, Pernambuco,
Brazil
6Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey
7Escola Superior Desporto e Lazer, Instituto Politécnico de Viana doCastelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-318 Viana
doCastelo, Portugal
8Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
9Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, 62521 Abha, Kingdom of Saudi Arabia
10Department of Physical Education, Federal University of Sergipe, 49100-000 São Cristovão, Sergipe, Brazil
*Correspondence: georgian.badicu@unitbv.ro (Georgian Badicu); hilal.yagin@inonu.edu.tr (Fatma Hilal Yagin)
Submitted: 14 March 2024 Revised: 29 March 2024 Accepted: 7 April 2024 Published: 1 June 2024
Background: This study aims to summarize the evidence regarding the effects of polyunsaturated fatty acids (PUFAs) supple-
mentation on both amateur and professional athletes.
Objective: The aim is to elucidate the impacts of PUFAs supplementation on physical performance, inflammatory response,
biochemical profile, anthropometric/body composition, and performance outcomes in athletes.
Methods: Articles published up to December 2023 were retrieved from databases including Cochrane Library, PubMed/Medline,
Scopus, and Embase. Selected articles met eligibility criteria and quality methodology. Data on inflammatory response, biochem-
ical markers, anthropometric/body composition, and neuromuscular indicators were extracted.
Results: Twenty-one studies were included in this systematic review. PUFAs supplementation resulted in decreased levels of
certain inflammatory markers (interferon-gamma, interleukin 1, prostaglandin E2, and tumor necrosis factor alpha). However,
no significant differences were observed in interleukin 4, 6, 8, 10, and matrix metalloproteinase 9. Additionally, there were
no differences in glycemic (glucose and insulin) and lipid metabolism (high density lipoprotein (HDL)) cholesterol, low density
lipoprotein (LDL), triglycerides). A reduction in reactive oxygen species levels was noted. No significant differences were found
in muscle fatigue markers and anthropometry. Some performance parameters (neuromuscular and aerobic) improved following
supplementation, including performance on the Yo-Yo distance test, resting energy expenditure, exercise time to exhaustion, and
maximum oxygen consumption/maximum heart rate.
Conclusion: Supplementation with PUFAs (600–3150 mg) in athletes led to reductions in inflammation and oxidative stress
markers, as well as improvements in specific aerobic performance parameters. However, no significant effects were observed on
glycemic and lipid profiles, anthropometric profiles, or body composition.
Keywords: polyunsaturated fatty acids; performance; athletes; physical activity; sports nutrition
4608
Introduction
Lipids are molecules responsible for energy reserves
and structural components, primarily for the formation of
plasma membranes. They also play a crucial role in signal-
ing and regulation through changes in the concentration of
specific lipids, resulting in repercussions on cellular func-
tions [1,2].
Malonyl coenzyme A (malonyl-CoA) synthesis is a
crucial step in the formation of fatty acids and serves as a
carbon donor for the elongation of these molecules. How-
ever, in humans, the production of certain fatty acids, such
as alpha-linolenic acid (ALA) and linoleic acid (LA), either
does not occur or is insufficient because of the absence of
the enzymes responsible for their synthesis. Therefore, an
exogenous intake is required [3]. These fatty acids give rise
to others and are classified as polyunsaturated fatty acids
(PUFAs), including essential unsaturated fatty acids. Thus,
the main PUFAs, such as omega-3 (ω-3) and omega-6 (ω-
6), are primarily obtained through diet [4,5].
Three fatty acids belong to the ω-3 group: ALA,
docosahexaenoic acid (DHA), and eicosapentaenoic acid
(EPA). In contrast, the ω-6 group comprises LA, conjugated
linoleic acid (CLA, which belongs to a group of positional
isomers of LA) [6], and arachidonic acid (AA). Eicosapen-
taenoic acid (EPA) and DHA are produced through ALA
metabolism during elongation, whereas LA metabolism
produces AA [7]. PUFAs have been associated with health
benefits such as increasing anti-inflammatory factors, re-
ducing blood pressure, arterial plaque accumulation, risks
of cardiovascular diseases, symptoms of neurodegenerative
diseases, positively impacting cognitive function, and help-
ing defend against autoimmune pathologies and infections
[8,9].
The anti-inflammatory action of PUFAs occurs by de-
creasing the release of pro-inflammatory cytokines, leuko-
cyte chemotaxis, and the expression of adhesion molecules
[10]. Furthermore, the cardioprotective effects result from
a reduction in plasma triglyceride levels, low-intensity
chronic inflammation, and functional remodeling of the car-
diac tissue, which is reflected in contractility.
In the field of sports, both professional and amateur
athletes generally exhibit fatty acid levels that are below the
ideal value (approximately 8%) [11–14]. This deficiency is
primarily caused by inadequate intake, and supplementa-
tion may be a viable option. The benefits of PUFA supple-
mentation include those already mentioned in addition to
indirectly improving performance through injury recovery,
reducing oxidative stress, increasing antioxidant action, op-
timizing energy metabolism, and enhancing mood and re-
action time.
Engaging in intense physical activity promotes an
increase in the formation of pro-inflammatory cytokines
and matrix metalloproteinases (MMPs), especially MMPs
present in muscles (such as MMP2 and MMP9), which fa-
cilitate the adaptation of skeletal muscles to injuries and in-
creased contractile effort [15]. Physical exercise also in-
duces significant metabolic changes, primarily in the cel-
lular components involved in bioenergetics, and attenuates
the levels of hormones such as cortisol, testosterone, and
estradiol [16].
Therefore, PUFA supplementation can play a funda-
mental role in health, particularly in terms of the cardio-
vascular aspects and inflammatory responses. Moreover,
they can directly and indirectly influence sports perfor-
mance, reduce the risk of chronic inflammatory processes,
and stimulate metabolic adaptations, thereby optimizing en-
ergy metabolism and enhancing the efficiency of substrate
utilization during sports practice.
This study aimed to elucidate the effect of PUFA sup-
plementation on physical performance and its effects on in-
flammatory and biochemical profiles, anthropometric/body
composition, and performance outcomes in professional
and amateur athletes.
Materials and Methods
The present study followed the Preferred Report Items
for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. Additionally, complete the PRISMA Checklist,
aiming to describe the location of each component during
the preparation of this review and this is available as part of
the submitted material for the present study (Supplemen-
tary Material).
Study Selection and Eligibility Criteria
The establishment of eligibility criteria were previ-
ously selected to minimize the occurrence of systematic bi-
ases. The inclusion and exclusion criteria followed the Pop-
ulation/Intervention/Control/Outcomes/Study Design (PI-
COS, Table 1). Thus, the following inclusion criteria were
applied: (a) Only studies published in English, (b) without
restriction on publication date, (c) involving athletes at dif-
ferent levels (amateur and professional/elite), (d) receiving
polyunsaturated fatty acid supplementation, (e) both sexes,
(f) withing age range 18–40 years old, (g) studies with a
Placebo group as a comparator, (h) assessing inflammatory
response, biochemical, and anthropometric/body composi-
tion outcomes, and (i) evaluating neuromuscular, aerobic
performance, and physical effort load outcomes. Exclu-
sion criteria: (a) articles not involving PUFAs supplemen-
tation or without a placebo group, (b) athletes subjected to
pharmacological and other nutritional strategies, as well as
those who presented associated physical or psychological
pathologies, (c) studies not assessing athletes, neuromus-
cular and aerobic performance components, (d) studies car-
ried out with below 18 years old and above 40 years old, and
(e) studies involving animals of any species, comments, re-
view publications, letters, duplicates, and missing data used
in different studies.
4609
Table 1. Population/Intervention/Control/Outcomes/Study Design (PICOS) strategy.
Inclusion criteria Exclusion criteria
Population Amateur and professional/elite athletes Any other population
Intervention PUFAs supplementation No PUFAs supplementation
Comparator Placebo Any other comparison group
Outcomes Inflammatory response, biochemistry, anthropometric/body com-
position, neuromuscular and aerobic performance outcomes
Any other outcome
Study design Intervention Studies Animal’s Studies; Commentary: review, letters,duplicates,
and missing data used in different studies were excluded.
PUFAs, polyunsaturated fatty acids.
Information Sources and Search Strategy
The search strategy was developed from Novem-
ber to December 2023. The following databases were
used to select and include articles: Cochrane Library,
PubMed/Medline, Scopus and Embase, using the follow-
ing search equation: ((((Acids, Unsaturated Fatty) OR (Un-
saturated Fatty Acids)) OR (Unsaturated Fatty Acid)) OR
(Polyunsaturated Fatty Acids)) AND ((((((Athlete Profes-
sional) OR (Professional Athletes)) OR (Elite Athletes))
OR (Elite Athletes)) OR (Athlete College)) OR (Athletes)).
Selection and Data Collection Process
The screening of studies involved reviewing the title,
abstract, and full text. The selection of studies was carried
out independently by the researchers (MSSF and GCJS).
Discrepancies were resolved by a third evaluator. Data
collection process were conducted by two independent re-
searchers. All the selection process is described in Fig. 1.
Data Items
In the present systematic review, information related
to the description of the sample was extracted including au-
thor and year, sample size, sex (male and female), sport
modality, and level of experience in sport (amateur or pro-
fessional/elite). Data on PUFAs supplementation included
dose, type of PUFA used in supplementation, frequency,
route of administration, and duration (days or weeks), as
well as description of the substance used by the placebo
group. In addition, data on inflammatory response mark-
ers were extracted, such as: interferon-gamma (IFN-γ);
IFN-γ/IL-4 ratio; interleukin-1 beta (IL-1β); interleukin1-
ra (IL1-ra); interleukin-2 (IL-2); interleukin-4 (IL-4);
interleukin-6 (IL-6); interleukin-8 (IL-8); interleukin-
10 (IL-10); matrix metalloproteinase-2 (MMP2); matrix
metalloproteinase-9 (MMP9), prostaglandin E2 (PGE2);
tumor necrosis factor alpha (TNF-α). biochemistry param-
eters included: catalase; carbonyls index; creatine kinase
(CK); creatine phosphokinase (CPK); Cu/Zn-superoxide
dismutase (SOD), glucose; glutathione peroxidase (GPx);
high density lipoprotein (HDL); insulin; lactate dehydro-
genase (LDH); low density lipoprotein (LDL); malonalde-
hyde (MDA); myeloperoxidase (MPO); MnSOD; nitric
oxide (NO); reduced glutathione (GSH); reactive oxygen
species (ROS); superoxide dismutase (SOD); triglycerides
(TG); total cholesterol (TC). Anthropometric/Body compo-
sition parameters included: body fat (%); body mass index
(BMI); body weight (BW); fat mass (kg); free fat mass (kg);
lean body mass (kg); muscle mass (kg).
In addition, neuromuscular outcomes including Back
Squat; Counter Movement Jump (cm); Dominant Leg Ex-
tension one-repetition maximum (1RM) (Kgs); Dominant
Leg Extension (repetitions); Dominant Leg Press Muscu-
lar Endurance (repetitions); Dominant Leg maximal volun-
tary isometric contractions (MVC) (N.m); Maximal Vol-
untary Isometric Contraction (MCV); Mean Power (W);
Non-Dominant Leg press (Kgs); Non-Dominant Leg MCV
(N.m); Non-Dominant Leg Extension and Muscular En-
durance (repetitions); Non-Dominant Leg Extension 1RM
(Kgs); Peak Torque Extension (N.m2); Peak Torque Flex-
ion (N.m2); Peak Power (W); Power (%Wmax ); Push up
(repetitions); Vertical Jump Height (cm); Squat Jump (cm);
Wingate Average Power (W); Wingate Power Drop (%);
Wingate PP; 1RM Left and Right (kg) were extracted. Data
related to aerobic performance included Anaerobic Thresh-
old (km/h); Change in Yo-Yo distance (m); Yo-Yo distance
(m); Exercise Time to Exhaustion (sec); Heart Rate (HR) in
beats per minute; HR max (bpm); Mean HR (bpm); Mean
VO2max; Peak HR (bpm); Race Duration (min); Resting
HR (bpm); Resting Energy Expenditure (%), Speed Race
(km/h); Sprint Time (Sec); Training Volume; 10 Km-Time
Trial (min); 250 kj Trial (sec) VO2max (mL/kg/min); VO2max
(%); VO2max; VO2max /HRmax. Finally, physical effort out-
come such Ratings of Perceived Exertion (RPE) was in-
cluded.
Methodological Quality Assessment
The Joanna Briggs Institute Critical Appraisal Check-
list for analytical randomized controlled trial and non-
randomized experimental studies was used to verify the
methodological quality of the included articles. This tool
comprises eight questions that assess the methodological
quality. Responses to these questions were recorded as
“Yes”, “No”, or “Unclear”. A scored was assigned for
“Yes” responses, while no score was given for “No” or “Un-
4610
Fig. 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. PRISMA,
Preferred Report Items for Systematic Reviews and Meta-Analyses.
clear” responses. The total score for each article was cal-
culated as a percentage and categorized as high (80–100%),
fair (50–79%), or low (50%). Two reviewers independently
evaluated all studies, and any discrepancies between them
were resolved through consensus (Table 2, Ref. [10,13–
15,17–33]).
Results
Search Results
A total of 1123 studies were identified through
searches in the databases [Cochrane Library (n = 28);
PubMed/Medline (n = 929); Scopus (n = 138); and Embase
(n = 228)]. After removing duplicates (n = 311), 812 articles
were screened for the inclusion process. Subsequently, 784
publications were excluded based on the title/abstract, leav-
ing 28 studies for full-text review. Finally, 21 studies were
included in the present systematic review. The process of
search, selection, and inclusion of studies was summarized
in the flow diagram of the PRISMA statement (Fig. 1).
Methodological Quality Assessment
All included studies demonstrated fair quality (75%).
Identification and control of confounders were not evalu-
ated in all studies. However, inclusion criteria, descrip-
tion of participant context, reliable and valid measurements,
and an adequate statistical analysis process were considered
(Table 2).
4611
Table 2. Methodological quality assessment for Non-Randomized and Randomized Studies - Joanna Briggs Institute.
Author, Year Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 %
Andrade, 2007 [13] YYYYNNYY 75
Baghi, 2016 [15] Y Y Y Y N N Y Y 75
Campo, 2020 [29] Y Y Y Y N N Y Y 75
Capó, 2015 [17] Y Y Y Y N N Y Y 75
Delfan, 2015 [28] Y Y Y Y N N Y Y 75
Drobnic, 2021 [27] YYYYNNYY 75
Filaire, 2010 [26] Y Y Y Y N N Y Y 75
Gravina, 2017 [18] YYYYNNYY 75
Jost, 2022 [21] Y Y Y Y N N Y Y 75
Lewis, 2015 [30] Y Y Y Y N N Y Y 75
Martorell, 2015 [14] Y Y Y Y N N Y Y 75
Martorell, 2014 [19] Y Y Y Y N N Y Y 75
Moradi, 2021 [31] Y Y Y Y N N Y Y 75
Nieman, 2009 [10] Y Y Y Y N N Y Y 75
Philpott, 2019 [33] Y Y Y Y N N Y Y 75
Raastad, 1997 [20] Y Y Y Y N N Y Y 75
Santos, 2013 [22] Y Y Y Y N N Y Y 75
Terasawa, 2017 [32] YYYYNNYY 75
Tomczyk, 2023 [23] Y Y Y Y N N Y Y 75
Zebrowska, 2015 [25]YYYYNNYY 75
Zebrowska, 2021 [24]YYYYNNYY 75
Notes: Y, YES; N, No; U, Not clear. Q1: Were the inclusion criteria well defined?
Q2: Have participants and context been described in detail? Q3: Were the measure-
ments collected in a valid and reliable way? Q4: Were standardized and objective
inclusion criteria used? Q5: Were any confounding variables found? Q6: Were
strategies used to deal with confounding variables? Q7: Were the results measured
validly and reliably? Q8: Was the statistical analysis used adequate?
Characteristics of Included Studies
The studies included were published between 1997
and 2022 (Table 3, Ref. [10,13–15,17–33]). The num-
ber of participants ranged from 10 to 36 athletes. Out of
the 21 included studies, 18 were conducted with male ath-
letes, and 3 studies included both genders. The partici-
pants’ mean age varied from 18 to 39.7 years old. Var-
ious sports modalities were observed in included studies.
Five studies solely assessed soccer players [14,17–20], four
studies were exclusively conducted with runners [21–24],
two studies evaluated cyclists [10,25]. Each of the follow-
ing modalities was represented by one study: Swimmers
[13], judo athletes [26], CrossFit athletes [27], paddlers
[28], endurance athletes [29], athletes in rowing, sailing,
triathlon, and running [30], soccer, volleyball, and swim-
ming athletes [31], basketball, volleyball, and swimming
athletes [32], and athletes in strength and endurance modal-
ities [33]. Eleven studies were conducted with elite athletes
[13,14,17,19,20,22,25,26,28,30,31], and ten included stud-
ies were conducted with amateur athletes [10,15,18,21,23,
24,27,29,32,33]. Various countries were identified in the
included studies: Spain (n = 5) [14,17,19,27,29], Poland (n
= 4) [21,23–25], Iran (n = 3) [15,28,31], Canada (n = 2)
[30,33], Brazil (n = 2) [13,22], Japan (n = 1) [32], France (n
= 1) [26], Scotland (n = 1) [18], and Norway (n = 1) [20].
Polyunsaturated Fatty Acid Supplementation
Protocol
Different PUFAs supplementation protocols were ob-
served in the included studies (Table 4, Ref. [10,13–
15,17–33]). Various substances were used in the placebo
group. Seven included studies used only olive oil in the
placebo group [14,17,19,20,27,29,30], 2 studies used paraf-
fin [15,31], 2 studies used only mineral oil [13,28], 2 studies
used medium chain triglycerides [21,23], 1 study used only
vegetable oil and 1 study included a composition of sub-
stances such as gelatin, glycerin, and water [26]. Another
study used caprylic, capric, lauric, and palmitic acids [18],
while 1 study used soybean oil, natural flavors, tocopherols,
canola oil, and citric acid [10]. One study used carbohy-
drates and proteins [33], 1 study used magical ace pow-
der [32], one study used lactose monohydrate [25], and 1
study used microcrystalline cellulose, magnesium stearate,
and lactose monohydrate as a placebo [24].
Regarding the types of PUFAs used in the included
studies, it was observed that 19 studies used ω-3 in the
4612
Table 3. Sample description.
Author, Year nSex Age (y) Sport modality Level Country
Andrade, 2007 [13] 20 M 20–35 Swimmers Elite Brazil
Baghi, 2016 [15] 23 M 18–24 Non-informed Amateur Iran
Campo, 2020 [29] 15 M 18–45 Endurance Amateur Spain
Capó, 2015 [17] 15 M 19.3 ±0.3 Soccer Elite Spain
Delfan, 2015 [28] 22 M 23.3 ±1.4 Paddlers Elite Iran
Drobnic, 2021 [27] 35 F/M 33.1 ±8.8 Crossfit Amateur Spain
Filaire, 2010 [26] 20 M 22.5 ±1.4 Judo Elite France
Gravina, 2017 [18] 26 F/M 24.0 ±5.0 Soccer Amateur Scotland
Jost, 2022 [21] 26 M 37.0 ±3.0 Endurance Runners Amateur Poland
Lewis, 2015 [30] 30 M 25.0 ±4.6 Rowing, sailing, triatlon, running Elite Canada
Martorell, 2015 [14] 15 M 39.7 ±0.4 Soccer Elite Spain
Martorell, 2014 [19] 15 M 19.7 ±0.4 Soccer Elite Spain
Moradi, 2021 [31] 36 M 21.8 ±3.1 Soccer, volleyball, swimming Elite Iran
Nieman, 2009 [10] 23 F/M 25.5 ±2.6 Cyclism Amateur United States
Philpott, 2019 [33] 20 M 23.0 ±1.0 Strenght, and Resistance Amateur Canada
Raastad, 1997 [20] 28 M 23.5 ±3.0 Soccer Elite Norway
Santos, 2013 [22] 21 M 36.5 ±3.5 Marathon runners Elite Brazil
Terasawa, 2017 [32] 10 M 19.3 ±1.4 Baseball, volleyball, swimming Amateur Japan
Tomczyk, 2023 [23] 26 M 37.0 ±3.5 Long Distance Runners Amateur Poland
Zebrowska, 2015 [25] 13 M 23.1 ±5.4 Cyclism Elite Poland
Zebrowska, 2021 [24] 24 M 34.1 ±6.3 Recreacional runners Amateur Poland
Notes: F, Female; M, Male; n, Number of participants; y, Years old.
forms of EPA, DHA, and DPA [8,10,13–15,17–20,22–30,
33]. However, only 2 studies utilized conjuged linoleic acid
(CLA) as a supplementation strategy [31,32]. Supplemen-
tation was administered in capsule in 16 included studies
[10,13,15,18,20–28,30–32], 4 studies observed administra-
tion through beverages [14,17,19,33], and 1 included study
used soft gels [29]. The quantities in milligrams (mg) and
grams (g) of the substances used were heterogeneous. The
amounts of EPA varied from 200 mg to 2.4 g, DHA levels
ranged from 240 mg to 2.4 g, DPA varied from 20 mg to
230 mg, and finally, CLA quantities ranged from 900 mg
to 5.4 g. All PUFAs supplementation protocols were ad-
ministered orally, with the administration duration ranging
from 2 weeks to 12 weeks.
Impacts of PUFA Supplementation on Biological
Outcomes
To understand the impacts of PUFAs supplementation
on athletes across various sports, we extracted data related
to inflammatory response, biochemical and anthropomet-
ric/body composition parameters (Table 5, Ref. [10,13–
15,17–33]).
Inflammatory Response
Within the included articles, 9 studies evaluated
various factors related to the inflammatory response
in blood samples from athletes [8,10,13,15,19,22,24,28,
29]. These parameters were essentially divided into
pro- and anti-inflammatory categories. Among the pro-
inflammatory factors, serum levels of interferon-gamma
(IFN-γ), interleukin-1 beta (IL-1β), interleukin-1 receptor
antagonist (IL-1ra), interleukin-6 (IL-6), interleukin-8 (IL-
8), matrix metalloproteinase-9 (MMP9), prostaglandin E2
(PGE2), and tumor necrosis factor alpha (TNF-α) were as-
sessed. For anti-inflammatory factors, IL-4 and IL-10 were
observed. Additionally, three indicators of the pro- and
anti-inflammatory balance were analyzed, including IFN-
γ/IL-4, IL-2, and MMP2 (Fig. 2).
Pro-Inflammatory Markers
Two included studies evaluated IFN-γlevels [13,28],
and it was observed that PUFAs supplementation in ath-
letes significantly reduce levels compared to the placebo.
Only 1 study assessed the effects of PUFAs supplemen-
tation on IL-1βlevels [29], which significantly decreased
compared to the placebo group. Only 1 included study eval-
uated IL-1ra levels [10], and 5 studies assessed IL-6 levels
after PUFAs supplementation [10,15,24,28,29]; however,
no statistically significant differences were observed com-
pared to the placebo. Similarly, 2 included studies also
did not demonstrate significant effects on IL-8 after the
PUFA supplementation protocol [10,29], and 1 study that
analyzed MMP9 levels after PUFAs supplementation did
not observe any significant difference [15]. However, 2 in-
cluded studies that assessed PGE2 identified a significant
decrease in the group of athletes who used PUFAs supple-
mentation compared to the placebo [13,19]. Finally, 6 stud-
ies evaluated TNF-αlevels after PUFAs supplementation
4613
Fig. 2. Impacts of Polyunsaturated Fatty Acid Supplementation on (A) Biological and (B) Performance outcomes in athletes.
Notes: IFN-γ, interferon-gamma; TNF-α, tumor necrosis factor alpha; PGE2, prostaglandin E2; ROS, reactive oxygen species; NO,
nitric oxide; REE, resting energy expenditure; RPE (A.U), ratings of perceived exertion; VO2max, maximum oxygen consumption;
HRmax, maximum heart rate; Resting HR, resting heart rate; CLA, conjugated linoleic acid; RM, maximum repetition.
[13,15,22,24,28,29]. Three studies did not observe signifi-
cant differences between the groups, but 3 studies observed
a significant decrease after the supplementation protocol
compared to the placebo, demonstrating the capacity of dif-
ferent PUFAs supplementation protocols to reduce markers
linked to inflammation.
Anti-Inflammatory Factors
Only two anti-inflammatory factors were assessed in
the included studies, IL-4, and IL-10. Three included
studies evaluated IL-4 levels after PUFAs supplementation
and did not observe significant differences compared to
the placebo group [13,22,28]. Two included studies as-
sessed IL-10 levels following PUFAs use in these athletes
[22,28]. One study noted a significant increase in IL-10 lev-
els. However, another study observed a significant decrease
compared to the placebo. These results indicate that the use
of PUFAs supplementation was not effective in enhancing
the production of indicators related to the anti-inflammatory
response in athletes at different levels of competition.
Indicators of the Pro- and Anti-Inflammatory Balance
Three indicators related to the regulation of inflam-
matory balance were assessed in the included studies,
namely IFN-γ/IL-4, IL-2, and MMP2. One included study
evaluated IFN-γ/IL-4 levels and demonstrated a signifi-
cant reduction after the PUFAs supplementation protocol
[28]. Two included studies analyzed IL-2 levels; one study
showed a significant decrease in IL-2 levels compared to the
placebo, while the other study did not find significance be-
tween the groups [22]. Finally, one included study assessed
MMP2 levels and did not observe significant differences
between the groups after PUFAs supplementation [15].
Biochemistry Parameters
Within the studies included in this systematic re-
view, 12 studies assessed indicators related to glycemic
metabolism (Glucose and Insulin), lipid profile (HDL,
LDL, TG, and TC), markers of oxidative stress (Carbonyl
index, NO, MDA, ROS levels) , antioxidant defenses (Cata-
lase, SOD and their associations with cofactors Cu/Zn-SOD
and MnSOD, GPx, GSH, MPO, and nitric oxide), and bio-
chemical compounds related to muscle fatigue (CPK, CK,
and LDH) [10,13–15,17,19,20,24–26,29,32].
Glycemic Metabolism
Five included studies analyzed glucose levels in both
amateur and elite athletes exposed to PUFAs supplemen-
tation [13,24–26,32]. Four studies did not observe signifi-
cant differences in glucose levels compared to the placebo
[13,24,25,32]. Nevertheless, only 1 study noted a signifi-
cant increase in glucose after PUFAs supplementation. Ad-
ditionally, two studies assessed insulin levels [13,26]. One
study showed an increase in insulin levels in athletes com-
pared to the placebo. However, one study did not show sig-
nificant differences. According to these findings, it can be
concluded that PUFAs supplementation was not effective in
regulating glucose and insulin in athletes.
4614
Table 4. Description of the PUFA supplementation protocol in athletes.
Author, Year Placebo Type of
PUFA
PUFA supplementation protocol Route and time of
administration
Andrade, 2007 [13] Mineral oil w-3 Capsules containing 950 mg of eicosapentaenoic acid (EPA) and 500 mg of docohexaenoic acid
(DHA) per day
OA, 6 wks
Baghi, 2016 [15] Paraffin CLA Capsules containing 5.6 g of CLA supplement per day OA, 2 wks
Campo, 2020 [29] Olive oil w-3 Soft Gel with 2.1 g of DHA and 240 mg of EPA, totaling 2.34 g per day OA, 10 wks
Capó, 2015 [17] Olive oil w-3 Drink containing 0.6% refined olive oil and 0.2% DHA-S market per day OA, 8 wks
Delfan, 2015 [28] Mineral oil w-3 Capsules containing 1.2 g of DHA and 2.4 g of EPA totaling a daily dose of 6 g OA, 4 wks
Drobnic, 2021 [27] Olive oil w-3 Capsules containing 2.5 g/day of Neptune krill oil (550 mg EPA/DHA and 150 mg choline) OA, 12 wks
Filaire, 2010 [26] Gelatin, glycerin and water w-3 Capsules containing 600 mg EPA and 400 mg DHA per day OA, 6 wks
Gravina, 2017 [18] Caprylic, capric, lauric and palmitic acids w-3 Capsules of 1000 mg contained (EPA, 70%), (DHA, 20%), docosapentaenoic acid (DPA) (2%) and
vitamin E (0.02 mg)
OA, 4 wks
Jost, 2022 [21] Medium-chain triglycerides w-3 Capsules contained a total of 2234 mg of EPA + 916 mg of DHA per day OA, 12 wks
Lewis, 2015 [30] Olive oil w-3 Capsules contained 5 mL seal oil, 375 mg of EPA, 230 mg of DPA, 510 mg of DHA, per day OA, 4 wks
Martorell, 2015 [14] Olive oil w-3 1 liter of the experimental drink for 5 days a week provided 1.14 g DHA/day OA, 8 wks
Martorell, 2014 [19] Olive oil w-3 Experimental drink contained 1.14 g of DHA/day OA, 8 wks
Moradi, 2021 [31] Paraffin w-3 Capsules per day containing 240 mg of DHA, 360 mg of EPA OA, 3 wks
Nieman, 2009 [10] Soybean oil, natural flavors, tocopherols,
canola oil, and citric acid
w-3 Capsules contained 2000 mg of EPA, and 400 mg of DHA OA, 6 wks
Philpott, 2019 [33] Carbohydrates and proteins w-3 Drink containing ∼1 g of EPA and ∼1 g of DHA OA, 6 wks
Raastad, 1997 [20] Corn oil w-3 Capsules contained 1.60 g/day EPA and 1.04 g/day DHA OA, 10 wks
Santos, 2013 [22] Vegetable oil w-3 Capsules containing 1.5 g DHA, 0.3 g EPA, and 18 mg α-tocopherol per day OA, 60 days
Terasawa, 2017 [32] Magical ace powder CLA Capsules with 1.8 g/day of CLA (0.9 g/day) OA, 2 wks
Tomczyk, 2023 [23] Medium-chain triglycerides w-3 Capsules containing 2234 mg of EPA and 916 mg of DHA per day OA, 12 wks
Zebrowska, 2015 [25] Lactose monohydrate w-3 Capsules with 660 mg of EPA, 440 mg of DHA, 200 mg other acids and 13.4 mg vitamin E per day OA, 3 wks
Zebrowska, 2021 [24] Microcrystalline cellulose, magnesium
stearate and lactose monohydrate
w-3 Capsules contained 852 mg EPA, 1602 mg of DHA, and 72 mg and 30 µg of vitamin E and D per day OA, 3 wks
Notes: EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; DPA, docosapentaenoic acid; OA, oral administration; wks, weeks; CLA, conjuged linoleic acid; mg, miligrams; g,
grams; mL, milliliter.
4615
Table 5. Supplementation of polyunsaturated fatty acids on the inflammatory response, biochemical and anthropometric parameters, and body composition in athletes.
Author, Year Inflammatory Response Biochemistry Parameters Anthropometric/Body composition
Andrade, 2007 [13] ↓ IFN-γ, PGE2; ↔ IL-2, IL-4, TNF-α↔ Glucose, Insulin -
Baghi, 2016 [15] ↔ MMP2, MMP9, IL-6; ↓ TNF-α↔ HDL, LDL, TC, TG ↔ BW (kg), BMI
Campo, 2020 [29] ↓ IL-1β; ↔ IL-6, IL-8, TNF-α↓ CPK, LDH -
Capó, 2015 [17] - ↔ Catalase, Cu/Zn-SOD, GPx, MnSOD; ↓ ROS ↔ BW (kg), BMI, FFM (%)
Delfan, 2015 [28] ↓ IFN-γ, IFN-γ/IL-4 ratio; ↑ IL-10; ↔ IL-1β,
IL-4, IL-6, TNF-α
- ↔ BW (kg), BMI, BF (%), LBM (kg)
Drobnic, 2021 [27] - - ↔ BMI, BF (%)
Filaire, 2010 [26] - ↓ TG; ↑ Insulin, MDA, NO; ↔ GPx ↔ BW (kg), BMI, BF (%)
Gravina, 2017 [18] - - ↔ BW (kg)
Jost, 2022 [21] - - ↔ BW (kg)
Lewis, 2015 [30] - - ↔ BW (kg), BF (kg)
Martorell, 2015 [14] - ↔ MDA, Carbonyls index, Catalase, Cu/Zn-SOD, GPx, MnSOD ↔ BW (kg), BMI, BF (%), FFM (%)
Martorell, 2014 [19] ↓ PGE2 ↔ MDA, Carbonyls index, Catalase, SOD, HDL, LDL, TC, LDH, CPK, Glucose -
Moradi, 2021 [31] - - ↔ BW (kg), BF (%), FM (kg), FFM (kg)
Nieman, 2009 [10] ↔ IL-1ra, IL-6, IL-8 ↔ CK, MPO ↔ BW (kg), BF (%)
Philpott, 2019 [33] - - ↔ BW (kg), BF (%), LBM (kg)
Raastad, 1997 [20] - ↔ TG ↔ BW (kg)
Santos, 2013 [22] ↓ IL-2, TNF-α, IL-10; ↔ IL-4 - ↔ BW (kg), BMI, BF (%)
Terasawa, 2017 [32] - ↔ CK, Glucose, LDH, TG ↔ BM (kg), BF (%)
Tomczyk, 2023 [23] - - ↓ BW (kg)
Zebrowska, 2015 [25] - ↔ HDL, LDL, TC, TG; ↑ Glucose -
Zebrowska, 2021 [24] ↔ IL-6; ↓ TNF-α↑ SOD; ↔ HDL, LDL, TG, Glucose, Catalase, GPx, GSH, MDA ↔ BW (kg), BMI, BF (%), MM (kg)
Notes: IFN-γ, interferon-gamma; TNF-α, tumor necrosis factor alpha; MMP2, matrix metalloproteinase-2; MMP9, matrix metalloproteinase-9; IL-6, interleukin-6; HDL, high density lipoprotein; LDL,
low density lipoprotein; TC, total cholesterol; TG, triglyceride; BW, body weight; BMI, body mass index; BF (%), body fat percentage; MM (kg), skeletal muscle mass; MDA, malondialdehyde; SOD,
superoxide dismutase; GPx, glutathione peroxidase; GSH, glutathione; CK, creatine phosphokinase; MPO, myeloperoxidase; CPK, creatine phosphokinase; NO, nitric oxide; LBM, lean body mass; FFM,
fat-free mass; IL-2, interleukin-2; IL-4, interleukin-4; IL-10, interleukin-10; IL-1β, interleukin-1 beta; IL-8, interleukin-8; Cu/Zn-SOD, copper/zinc superoxide dismutase; MnSOD, manganese superoxide
dismutase; ROS, reactive oxygen species; IL-1ra, interleukin-1 receptor antagonist. ↓, significant decrease; ↑, significant increase; ↔, no significant differences.
4616
Table 6. Impacts of polyunsaturated fatty acid supplementation on neuromuscular, aerobic, and physical effort performance outcomes in athletes.
Author, Year Neuromuscular Outcomes Aerobic Performance Physical Effort
Andrade, 2007 [13] - - -
Baghi, 2016 [15] - - -
Campo, 2020 [29] ↔ Peak Torque Flexion (N/m2), Peak Torque Extension (N/m2) - ↔ RPE (A.U)
Capó, 2015 [17] - ↔VO2max (mL/kg/min) -
Delfan, 2015 [28] - ↔VO2max (mL/kg/min) -
Drobnic, 2021 [27] - ↔ HRmax (bpm), Resting HR (bpm); VO2max (mL/kg/min) ↔ RPE (A.U)
Filaire, 2010 [26] - ↔Mean HR (bpm); VO2max (mL/kg/min) -
Gravina, 2017 [18] ↔ Vertical Jump Height (cm); 1RM Left Leg (kg), 1RM Right Leg (kg) ↔ Change in Yo-Yo distance (m), Sprint Time (Sec); ↑ Yo-Yo distance (m) -
Jost, 2022 [21] - - -
Lewis, 2015 [30] ↔ Back Squat (Rpts), Push up (Rpts), Counter Movement Jump (cm), MVC
(%), Squat Jump (cm), Wingate PP, Wingate Average Power (W); ↓ Wingate
Power Drop (%)
↔VO2max (mL/kg/min), 250 Kj Trial (sec) -
Martorell, 2015 [14] - ↔VO2max (mL/kg/min) -
Martorell, 2014 [19] - - -
Moradi, 2021 [31] - ↔VO2max (mL/kg/min); ↑ REE (%) -
Nieman, 2009 [10] ↔ Mean Power (W), Power (%Wmax) ↔ Mean HR (bpm), HR (%HRmax), Mean VO2max (mL/kg/min), VO2max (%),
10 Km-Time Trial (min)
-
Philpott, 2019 [33] ↔ D-Leg Extension and Leg Press 1RM (Kgs), N.D Leg Press (Kgs), D-Leg
MVC (N/m), D-Leg Extension and Leg Press Muscular Endurance (Rpts), N.D
Leg Extension and Leg Press Muscular Endurance (Rpts); ↑ Non-D-Leg
Extension 1RM (Kgs), ↓ N.D Leg MVC (N/m)
- -
Raastad, 1997 [20] - ↔Peak HR (bpm), VO2max (%), VO2max (mL/kg/min), Running Time to
Exhaustion (min), Anaerobic Threshold (km/h)
-
Santos, 2013 [22] - ↔ Race Duration (min), Speed Race (km/h) -
Terasawa, 2017 [32] - ↔ HR (bpm); ↑ Exercise Time to Exhaustion (sec) ↔ RPE (A.U)
Tomczyk, 2023 [23] - ↔ VO2max (mL/kg/min) at 12 Km/h, VO2peak(mL/kg/min) -
Zebrowska, 2015 [25] ↔ Peak Power (W) ↔ HR (bpm), ↑ VO2max (mL/kg/min), VO2max/HRmax ; ↓ HRmax (bpm) -
Zebrowska, 2021 [24] - ↔ HR (bpm), Training Volume, VO2max (mL/kg/min) -
Notes: 1RM, one-repetition maximum; MVC, maximal voluntary isometric contractions; Wingate PP, Wingate test-peak power; D-Leg, dominant leg; N.D Leg, non-dominant leg; VO2max , maximum
oxygen consumption; HRmax, maximum heart rate; Resting HR, resting heart rate; Mean HR, mean heart rate; REE, resting energy expenditure; RPE (A.U), ratings of perceived exertion (arbitrary units).
↓, significant decrease; ↑, significant increase; ↔, no significant differences.
4617
Lipid Profile
Seven studies assessed the responses of PUFAs sup-
plementation on components of the lipid profile [15,19,20,
24–26,32]. 4 studies evaluated the responses of this sup-
plementation on HDL, and no significant differences were
identified compared to the placebo [15,19,24,25]. 4 stud-
ies analyzed LDL levels, and none of them observed sta-
tistically significant differences after the supplementation
protocol [15,19,24,25]. 6 studies examined the responses
of PUFA supplementation on serum TG levels, and no
significant differences were identified between the groups
[15,20,24–26,32]. Finally, 3 studies assessed TC where no
significant differences were identified [15,19,25]. These
data suggest that the use of PUFA as a supplement does not
impact the lipid profile of athletes at diverse competition
levels.
Oxidative Balance
Six studies analyzed indicators related to oxidative
balance (markers of oxidative stress and/or related to an-
tioxidant defenses) [10,14,17,19,24,26]. 4 included studies
assessed MDA levels after PUFA supplementation [14,19,
24,26], and 3 studies did not observe significant differences
between the groups. However, 1 study noted a significant
increase in MDA after the PUFAsupplementation interven-
tion in athletes. 2 studies examined the indicator of protein
oxidation carbonyls [14,19], and after PUFA supplementa-
tion, no significant differences were observed. 1 included
study evaluated the levels of ROS produced after the PUFA
supplementation protocol, and the results showed a reduc-
tion in ROS levels. Therefore, we identified that PUFA sup-
plementation can reduce ROS levels in athletes [17].
Several markers related to antioxidant defenses were
evaluated in 5 included studies [14,17,19,24,26]. Two
studies assessed SOD activity, with one study observing
a significant increase after the use of PUFA supplemen-
tation, while another study did not find significance be-
tween the groups [19,24]. 2 studies analyzed the activity
of Cu/ZnSOD and Mn/SOD and did not observe differ-
ences between the groups [14,17]. Additionally, 4 studies
assessed catalase activity, where no statistical differences
were observed between the groups after PUFA supplemen-
tation [14,17,19,24]. 1 study evaluated GPx levels [26], 1
study assessed GSH [24], 1 study MPO [10], and 1 study an-
alyzed NO levels [26]; however, none of these studies found
significant differences between the groups after PUFA sup-
plementation.
Muscle Fatigue Markers
Parameters related to muscle fatigue were evaluated in
the studies included after PUFA supplementation. 2 stud-
ies included evaluated CPK levels, 1 study observed a de-
crease in CPK after supplementation, another study did not
observe significant differences [14,29]. 2 studies analyzed
CK levels, and similarly did not find statistical significance
[10,32]. Finally, 3 studies evaluated the levels of the LDH
enzyme [19,29,32], 1 study observed a decrease in its levels
after PUFA supplementation in athletes, the other 2 did not
demonstrate differences between the groups.
Anthropometric, and Body Composition Components
Aiming to analyze the impacts of PUFAs supplemen-
tation on anthropometric and body composition parameters,
data from BW, BMI, BF, FFM; muscle mass and lean body
mass were extracted. 16 included studies evaluated BW in
kilograms [10,14,15,17,18,20–24,26,28–31,33], 16 studies
did not observe significant differences after PUFAs sup-
plementation, however only 1 study demonstrated a sig-
nificant decrease in BW in relation to placebo. 8 stud-
ies evaluated the BMI, no significant differences were ob-
served between the groups [14,15,17,22,24,26–28]. 11 in-
cluded studies analyzed PUFAs supplementation responses
on BF levels, none of the studies found differences be-
tween groups [10,14,22,24,26–28,30–33]. 3 studies evalu-
ated FFM, in which no statistical differences were identified
between the groups [14,17,31]. 1 study only evaluated mus-
cle mass levels. No significant differences were seen after
PUFAs supplementation when compared to placebo [24].
Finally, 2 included studies evaluated lean body mass. Sim-
ilarly, no differences were identified between the groups
[17,33]. The findings indicate that the use of PUFAs did
not have significant impacts on anthropometric parameters
and body composition of amateur and elite athletes.
PUFA Supplementation on Performance Parameters
To observe the different responses of PUFAs supple-
mentation in neuromuscular, aerobic, and physical exer-
tion performance parameters, the included studies were ex-
tracted (Table 6, Ref. [10,13–15,17–33]).
Neuromuscular Outcomes
Six included studies evaluated different neuromuscu-
lar parameters linked to the performance of amateur and
elite athletes after PUFAs supplementation [10,18,25,29,30,
33]. 1 study evaluated the number of repetitions performed
in the back squat exercise, where there were no significant
differences after PUFA supplementation [30]. 1 study an-
alyzed performance in the counter movement jump test in
centimeters and did not observe statistical significance be-
tween the groups [30]. 1 study evaluated extension in 1 RM,
leg extension in repetitions, leg press muscle endurance and
MVC in the dominant leg, demonstrating no statistical sig-
nificance between the groups [33]. In the same included
study, no significant differences were observed in the non-
dominant leg in the variables in 1 RM, leg extension in rep-
etitions, and leg press muscle endurance [33]. However, in
the non-dominant leg extension 1 RM test there was a sig-
nificant increase in athletes who used PUFAs supplemen-
tation compared to placebo. Finally, when MVC was eval-
4618
uated in the non-dominant leg, a significant decrease was
observed in the group of athletes supplemented with PUFA
[33].
1 study included evaluated the mean power in watts,
with no significance observed between the groups [10]. 1
study analyzed peak torque extension and flexion in both
variables, with no statistically significant differences ob-
served [22]. 1 study evaluated peak power, also not ob-
serving significant differences between the groups [25]. 1
study analyzed power in % wattsMax and similarly no sig-
nificant differences were observed [10]. 1 study evaluated
performance in repetitions of the push-up exercise after PU-
FAs supplementation, without identifying statistical signifi-
cance [30]. 1 study evaluated performance in vertical jump
height and found no significance [18]. 1 study evaluated
the squat jump and similarly found no significance [30]. 1
study evaluated Wingate average power and Wingate PP,
identifying no significant differences between the groups
[30]. However, there was a significant decrease in Wingate
power drop in percentage in athletes who used PUFAs sup-
plementation. These results demonstrate that PUFAs sup-
plementation was responsible for the improvement in 1RM
performance in the non-dominant leg extension, and the de-
crease in non-dominant leg MVC, and Wingate power drop
in percentage in athletes.
Aerobic Performance
Aiming to elucidate the effects of PUFAs supplemen-
tation on aerobic performance, different parameters were
evaluated. 10 included studies evaluated VO2max levels
(mL·kg·min) after PUFA supplementation [14,17,20,23–
28,30]. 1 study included observed a significant increase
in VO2max when compared to placebo, however 9 studies
did not observe significant differences between the groups
[14,17,20,23,24,26–28,30]. 2 studies evaluated VO2max
as a percentage, observing no differences between groups
[10,20]. 1 study evaluated the levels of VO2max produced at
a speed of 12 km/h, similarly, no statistical significance was
observed [23]. 1 study observed the average VO2max , after
the PUFAs supplementation protocol, no significant differ-
ences were observed. 1 study included analyzed the ratio
between VO2max/HRmax and did not observe significant dif-
ferences in athletes when compared to placebo [25]. 1 study
included evaluated VO2peak levels, similarly, no statistical
significance was observed between the groups [23].
2 included studies evaluated HRmax in beats per
minute in response to PUFA supplementation [25,27]. 1
study did not observe significant differences. However, 1
study included observed a significant decrease after using
the supplement. 3 studies evaluated HR levels in athletes
compared to placebo, no significant differences were ob-
served [24,25,32]. 1 study analyzed HR (%HRmax) [25],
no statistical significance was also observed. Finally, 1
study included observed Peak HR in beats per minute, with-
out showing statistical differences [20]. 1 study evaluated
performance in seconds in the 250 Kj test, without observ-
ing differences between the groups [30]. 1 study analyzed
the REE in percentage, after the PUFA supplementation
protocol, demonstrating a significant increase in athletes
when compared to the placebo group [20]. 1 study included
evaluated performance in the 10 km-time tests in minutes
after PUFA supplementation, without observing statistical
differences between the groups [10]. 1 study evaluated
running time to exhaustion, also showing no significance
between the groups [20]. 1 study evaluated the anaero-
bic threshold (km/h) in athletes supplemented with PUFA,
compared to placebo, and did not observe statistically sig-
nificant differences. 1 study included evaluated the race
duration in minutes and speed race (km/h) after supplemen-
tation with PUFA and did not observe significance in ath-
letes in relation to placebo [20]. 1 included study evaluated
the change in Yo-Yo distance in meters and sprint time in
seconds, in both variables no statistically significant differ-
ences were observed when compared to placebo [18]. 1
study included after PUFA supplementation, analyzed Yo-
Yo distance in meters and demonstrated a significant in-
crease when compared to placebo [18]. 1 study evaluated
Exercise time to exhaustion in seconds, the authors iden-
tified a significant increase in the group of athletes sup-
plemented with PUFA compared to placebo [32]. Finally,
training volume was evaluated, and no statistically signif-
icant differences were observed between the groups after
supplementation.
Physical Effort
Finally, we evaluated the responses produced by
PUFA supplementation on RPE in arbitrary units. 3 studies
analyzed RPE (A.U) after PUFA use [27,29,32]. Similarly,
no significant differences were observed compared to the
placebo group. Demonstrating that PUFA supplementation
was not effective in modulating RPE in athletes.
Discussion
The present review sought to elucidate the impacts of
PUFAs supplementation in professional and amateur ath-
letes on physical performance, inflammatory and biochem-
ical profile, anthropometric/body composition, and perfor-
mance results. The present results demonstrated that oral
supplementation could promote improvements in the in-
flammatory profile, reactive oxygen species levels, and aer-
obic performance outcomes mainly.
PUFAs are characterized by the presence of a dou-
ble bond in their chemical structure, which provides greater
stability due to low interactions between molecules. ALA
is responsible for forming ω-3 PUFAs, which can be de-
rived into EPA and DHA [34]. These fatty acids are clas-
sified as essential, as there is a need to ingest them exoge-
nously, as the organism is not capable of synthesizing them.
Among adult individuals, international recommendations
4619
recommend a daily intake of 0.6–1.2% of the energy per-
centage coming from ω-3 [35]. In this review, most studies
used ω-3 as a PUFA supplement.
Several pieces of evidence have highlighted the role of
ω-3 PUFA on the inflammatory profile [36–38]. Its effects
have been related to the production of anti-inflammatory
mediators, reduction of leukocyte chemotaxis, expression
of adhesion molecules, and production of eicosanoids. It
is known that the inflammatory process is fundamental
for protection against invading pathogens and for the re-
pair and regeneration of damaged tissues [39–41]. Dur-
ing physical exercise, exercise-induced muscle damage can
result in acute inflammation, and consequently reduced
performance [42]. Given this perspective, the present re-
view demonstrated that supplementation with ω-3 PUFA
was able to promote the reduction of inflammatory mark-
ers; however, there were no changes in anti-inflammatory
mechanisms.
In healthy individuals, the beneficial effects of ω-3 on
reducing the inflammatory response have occurred through
effects on lipid mediators and cytokine secretion by T lym-
phocytes [43]. In a study that carried out ω-3 PUFAs sup-
plementation through the consumption of enriched eggs in
40 individuals aged between 19–28 years, it predicted an
increase in pro-resolvins, a reduction in serum levels of
prostaglandins, peripheral lymphocytes, and IL-6 [44].
In addition to the benefits on the inflammatory pro-
file, PUFAs has been related to a lower risk of develop-
ing metabolic diseases through improvements on the lipid
and glycemic profile [45]. In individuals with type 2 dia-
betes mellitus and non-alcoholic fatty liver disease, PUFAs
supplementation has demonstrated benefits through greater
insulin sensitivity and changes in the intestinal microbiota
[46,47]. These effects have been more evident in patholog-
ical cases. However, in healthy individuals, PUFAs supple-
mentation does not promote changes in lipid and glycemic
markers [48].
PUFAs supplementation has also demonstrated pos-
itive effects on oxidative stress through the reduction of
ROS [49]. Low concentrations of ROS have important
cellular functions. However, its excess can cause adverse
effects, causing oxidative stress, which can even activate
inflammation pathways [50]. Moderate physical exercise
has demonstrated beneficial effects on oxidative balance
[51]. However, vigorous exercise contributes to imbalance.
Therefore, PUFAs supplementation has been shown to be
effective in reducing ROS through its antioxidant and anti-
inflammatory potential [47].
PUFAs supplementation has also been correlated with
improvements in cardiovascular function via NO produc-
tion [52]. NO is the molecule responsible for promoting va-
sodilation and antiatherosclerosis action [53]. The increase
in oxidative stress can promote a reduction in NO bioavail-
ability through endothelial dysfunction. Thus, the greater
production of NO after supplementation with PUFA can be
explained both by the reduction in oxidative stress and by
the greater expression of endothelial nitric oxide synthase
(eNOS) [54].
In the present review, no differences were observed
regarding body composition parameters. The lack of dif-
ferences may have occurred due to comparisons between
the intervention group vs. placebo, which mostly used veg-
etable oils, such as olive oil. Vegetable oils such as olive
oil, soybean oil and corn oil contain PUFA in their compo-
sition [55]. In this way, comparisons between groups can
bring insignificant results, although the concentrations are
different.
Supplementation with olive oil has demonstrated ben-
efits on cardiometabolic parameters [56–58]. The same was
observed in a randomized trial carried out by healthy men
and women who ingested 50 g of olive oil daily in the diet or
as a supplement. No significant differences were observed
between weight, BMI, central adiposity, fasting blood glu-
cose, systolic or diastolic blood pressure when compared to
the control [59]. Therefore, the comparison with a placebo
group using other vegetable oils creates a confusing factor.
Next, we analyzed outcomes related to aerobic, neu-
romuscular performance, and physical effort. The data
demonstrated that PUFAs supplementation promoted im-
provements in parameters related to aerobic performance.
However, the different supplementation protocols were
not effective in enhancing neuromuscular performance and
modulating RPE. It is known that aerobic physical effort
is dependent on the effective performance of oxidative
metabolism, which mainly relies on the bioavailability of
lipids in the form of fatty acids as sources of ATP pro-
duction [60]. This production occurs mainly due to mito-
chondrial beta-oxidation, which consists of the transport of
fatty acids to be oxidized inside the mitochondria, promot-
ing large amounts of ATP molecules [61,62]. This energy
balance is fundamental for the execution of aerobic exer-
cises since they have long duration and low intensity. Defi-
ciencies in oxidative metabolism and energy supply during
physical effort are capable of drastically reducing perfor-
mance, as well as promoting mitochondrial dysfunction and
stress in the endoplasmic reticulum, culminating in delete-
rious effects such as the emergence of metabolic and infec-
tious diseases, mainly in athletes [62].
On the other hand, the lack of neuromuscular results
can be explained by the absence of changes in body compo-
sition after PUFAs supplementation in athletes, especially
in muscle mass levels. According to scientific literature,
the amount of skeletal muscle is directly related to greater
effectiveness in neuromuscular variables such as muscu-
lar strength and power [33,63–65]. The standardization
of supplementation protocols with this type of macronu-
trient (amount in milligrams, duration, type of substance
used) may also be behind the absence of these neuromus-
cular results [33]. However, Huang and collaborators in
a meta-analysis demonstrated that in non-athletes, more
4620
precisely in the elderly, ω-3 supplementation in amounts
greater than 2 grams/day was responsible for significantly
increasing muscle mass levels, as well as walking speed.
This demonstrates that in conditions of progressive physio-
logical degradation such as aging, PUFAs supplementation
was effective.
Finally, there were no differences in RPE after PUFA
supplementation. It is a subjective method of evaluating
perceived exertion, which does not effectively clarify the
real explanations behind the absence of these effects in ath-
letes. Furthermore, original studies must be carried out
with the aim of relating direct physiological measures re-
lated to physical effort in athletes to confirm the real causes
and mechanisms behind perceptual regulation, since ath-
letes exposed to exhaustive working hours of effort can al-
ter their subjective perception, thus adding a possible bias
to the results [66].
The present study is the first systematic review of the
scientific literature to address the impacts of different sup-
plementation protocols with PUFAs (w-3 e CLA) on bio-
logical outcomes (inflammatory response, biochemical and
anthropometry/body composition parameters), as well as
neuromuscular, aerobic, and physical effort performance
outcomes in amateur and elite athletes. One of the main
objectives of sports supplementation is to meet nutritional
demands that cannot be met by food in a logistically vi-
able way, since athletes at different levels are always ex-
posed to demands in training, and competitions. Secondly,
findings from the present study demonstrated that PUFAs
supplementation did not significantly alter anthropometric
and body composition outcomes. It is known that dras-
tic changes in body weight, BMI, fat percentage, as well
as muscle mass levels can harm the establishment of de-
termining physical capabilities including strength, speed,
agility, power, and others. Third, the articles included
in this review point to effective improvements in reduc-
ing the expression of indicators responsible for signaling
inflammation and oxidative stress. Containing these pro-
cesses is essential to avoid a decline in sports performance,
mainly because it is associated with chronic pain, volun-
tary muscle fatigue and bioenergetic dysregulations. Fi-
nally, we observed that PUFAs supplementation was effec-
tive mainly for outcomes linked to aerobic performance,
which can be explained by the interaction between lipid
metabolism and the production of chemical energy in the
form of ATP, through mitochondrial pathways that occur
in the presence of oxygen, culminating in high bioavail-
ability of energy during physical effort. Some limitations
were observed in the included studies that make up this sys-
tematic review. Initially, we observed a heterogeneity in
the amount of PUFA offered in each study, making it dif-
ficult to standardize protocols, which would be useful for
sports nutrition professionals to understand the dose nec-
essary to promote physiological and performance-related
benefits. Another limitation needs to be highlighted is the
scarcity of studies that specifically observe the impacts of
PUFA supplementation only in female athletes. Including
such studies would enable us to deepen discussions about
the biological individuality and unique physiological mech-
anisms of each gender in response to the practiced sport, as
well as their association with the PUFA supplementation
protocol. It is imperative to conduct studies that meet these
criteria. Other limitation is the lack of standardization of
the substance used in the placebo group. The diversity of
these substances used can confound the study due to their
potential interactions within the organism and may interfere
with the emergence of expected results. Finally, the pres-
ence of quantitative data, as well as greater homogeneity of
markers and measurement units, for example, could assist
in preparing confirmatory statistics analyzes with a lower
degree of heterogeneity.
Exposure to constant and exhausting physical exer-
tion can induce detrimental changes throughout the body,
including inflammatory processes and those associate with
oxidative stress. These interconnected processes may result
in performance and illness, mainly due to infectious pro-
cesses, depending on the frequency of exposure to such dis-
eases and the high volume and intensity demands. Further-
more, we highlight the effects of PUFA supplementation
on aerobic performance tests and parameters, indicating a
promising path for observing responses and mechanisms
that occur because of these interactions. It is strongly rec-
ommended that studies with original data standardize their
placebo group, including the substance used and its dosage,
to ensure consistency and comparability across studies.
Conclusion
We observed that PUFA supplementation, with doses
ranging from 600 to 3150 mg, led to a reduction in levels of
markers associated with inflammation and oxidative stress
in athletes. Furthermore, improvements were observed in
test performance and indicators related to aerobic perfor-
mance, such as the Yo-Yo distance test, REE, exercise time
to exhaustion, and the ratio of VO2max/HRmax . However,
PUFA supplementation did not show significant effective-
ness in modulating glycemic and lipid profiles, anthropo-
metric profiles, body composition, or neuromuscular per-
formance.
Availability of Data and Materials
The data and materials are available in the databases
used in this systematic review.
Author Contributions
Conceptualization: MSSF, JMC, GB, GCJS, DGMS,
CJL, FHY, RFS; Methodology: MSSF, JMC, FHY, JST
and RFS; Investigation and Data curation: MSSF, JMC,
GB, RMS, FTGF, RFS, JST and CJL. Writing - original
4621
draft: MSSF, JMC, GB, GCJS, RMS, FTGF, DGMS, CJL,
JST, FHY, RFS; Writing – editing & review draft: MSSF,
JMC, GB, FHY, and CJL; Resources and Project adminis-
tration: MSSF, JMC, FHY, CJL and RFS; Writing - review
& editing final version: MSSF, JMC, GB, CJL, FHY, RFS.
All authors read and approved the final manuscript. All au-
thors had full access to all the data in the study and take
responsibility for the integrity and the accuracy of the all
data analysis.
Ethics Approval and Consent to Participate
Not applicable.
Acknowledgment
The authors extend their appreciation to the Deanship
of Research and Graduate Studies at King Khalid Univer-
sity for funding this work through Large Research Project
under grant number RGP2/216/45.
Funding
The authors extend their appreciation to the Deanship
of Research and Graduate Studies at King Khalid Univer-
sity for funding this work through Large Research Project
under grant number RGP2/216/45.
Conflict of Interest
Georgian Badicu is serving as one of the Guest Editor
of this journal. We declare that Georgian Badicu was not
involved in the peer review of this article and has no access
to information regarding its peer review. Other authors de-
clare no conflict of interest.
Supplementary Material
Supplementary material associated with this article
can be found, in the online version, at https://doi.org/10.
23812/j.biol.regul.homeost.agents.20243806.367.
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