Codex nutrient reference value update for EPA+DHA

GOED remains confident that an appropriately scoped review will demonstrate a relationship between EPA+DHA and cardiovascular mortality

Earlier this year in Nutraceutical Business Review (Vol. 3, Number 1), following the 37th session of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU), GOED reported that the discussion on establishing a Nutrient Reference Value–Non-Communicable Disease (NRV-NCD) for EPA+DHA had met with some unanticipated resistance.

Some delegates opined that it was premature to establish an NRV-NCD because, among other issues, the relationship between EPA+DHA and mortality from coronary heart disease (CHD) had not been sufficiently characterised.

The lack of consensus about the scientific substantiation resulted in many country delegates recommending a third-party review of the science supporting the cardiovascular benefits. It was decided that a review would be conducted by the World Health Organization (WHO) Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health.

As part of the review process, on 18 October, WHO opened a public consultation seeking input on the scoping of a review for polyunsaturated fatty acids (PUFAs), including EPA and DHA. Comments were requested on key questions developed in PICO format (Population, Intervention, Comparator, Outcome) as a result of the guideline scoping phase of the development process, which is thought to have occurred during the ninth meeting of the WHO NUGAG Subgroup on Diet and Health.1

The public consultation was open until 8 November, at which time the compiled input was provided to the WHO NUGAG Subgroup on Diet and Health for review and consideration during its 15–18 November 2016 meeting.2

Answers to the consultation questions will be used to guide the development of a systematic review, which will provide the evidence base for the potential formulation of an EPA+DHA recommendation. This recommendation, in turn, will become part of the discussion by the CCNFSDU as it considers establishing an NRV-NCD for EPA+DHA.

In the absence of an update from the WHO NUGAG Subgroup on Diet and Health, many believe there’s unlikely to be a substantive discussion on this agenda topic at the upcoming CCNFSDU meeting. The Codex process is multipronged, however, and other parts of the discussion will proceed.

What will be discussed, at least to some extent, is the revised Proposed Draft NRV-NCD for EPA and DHA Long Chain Omega-3 Fatty Acids, a product of the electronic working group (e-WG) led by Russia and Chile.3 Just to be clear about what is happening in the process, CCNFSDU is going to discuss the merits of establishing an NRV-NCD for EPA and DHA, and then will wait for the scientific assessment to come in later.

It may seem backward to discuss establishing a science-based standard without having the scientific assessment, but the document prepared by Chile and Russia addresses the concerns raised during the last CCNFSDU meeting by those delegations of the opinion that it was premature to establish an NRV-NCD. In addition to concerns that the relationship between EPA+DHA and mortality from CHD had not been sufficiently characterised, other concerns included the following:

  • the evidence was largely based on the consumption of fish and it was not clear whether it was possible to extrapolate this to EPA and DHA
  • not all criteria as per the GP had been met, in particular with regard to the GRADE classification
  • not all recognised authoritative scientific bodies (RASBs) had been considered.

The new discussion document drafted by Chile and Russia makes a convincing argument that the debate should focus objectively on the science and not on hyperbole. For instance, the delegations that believe the cardiovascular benefits are specific to fish and not generalisable to EPA/DHA intake seem to be the ones opposed to supporting a scientific argument with epidemiological evidence.

The irony is that almost all the data on fish intake to justify their argument is derived from epidemiology studies. The latest draft argues effectively against this double standard.

GOED looks forward to the results from the NUGAG review. We remain confident that an appropriately scoped review will demonstrate a relationship between EPA+DHA and cardiovascular mortality.