Effect of Dietary Docosahexaenoic Acid Levels on Respiratory
Transcription
Effect of Dietary Docosahexaenoic Acid Levels on Respiratory
Sciknow Publications Ltd. American Journal of Nutrition and Food Science ©Attribution 3.0 Unported (CC BY 3.0) AJNFS 2015, 2(2):21-25 DOI: 10.12966/ajnfs.04.01.2015 Effect of Dietary Docosahexaenoic Acid Levels on Respiratory Functions in Heart Mitochondria in Rats Norihiro Yamada1,*, Jun Shimizu2 1 Food and Nutrition study major, Department of Life Science, Tsu City College, 157 Ishinden-Nakano, Tsu City, Mie 514-0112, Japan. Department of Clinical Dietetics and Human Nutrition , Faculty of Pharmaceutical Sciences, Josai University, 1-1 Keyaki-dai, Sakado-shi, Saitama 350-0295, Japan. 2 *Corresponding author (Email: nyamada@tsu-cc.ac.jp) Abstract –Docosahexaenoic acid (C22:6 n-3, DHA) has been attracting attention due to its beneficial effects on several lifestyle-related diseases. However, an excessive intake of DHA has been suggested to decrease the percentage of linoleic acid (C18:2 n-6, LA) in cardiolipin (CL) in heart mitochondria, which may reduce oxygen consumption by and cytochrome-c activity in these mitochondria. Therefore, we examined the effects of dietary DHA levels on the respiratory functions of heart mitochondria in rats. Animals were fed a diet that had 22.6 % (energy percent, en %) of its total energy from lipids for two weeks. Dietary 1ipids were adjusted to a polyunsaturated fatty acid / saturated fatty acid ratio of 1.0 and contained different levels of DHA (en % : 0.0, 1.8, 3.7, 6.5, and 8.6). The proportion of LA in the CL fraction of heart mitochondria decreased in response to dietary DHA levels. On the other hand, the O2 consumption rate and cytochrome-c oxidase activity in heart mitochondria were unaffected by the supplementation with DHA. In the present study, dietary DHA levels in rats were 3-fold higher than the maximum levels practically obtained in humans. These results suggested that the respiratory functions of heart mitochondria were not adversely affected, even when DHA was consumed at the maximum practically ingestible amount for humans. Keywords –Docosahexaenoic acid, Linoleic acid, Respiratory function, State 3 respiration, Cytochrome-c oxidase 1. Introduction Docosahexaenoic acid (C22:6 n-3, DHA) has been attracting attention due to its anti-atherogenic, anti-thrombotic, and cancer-preventing effects (Holub, 2009, Phang, et al. 2013, Kato, et al. 2007). On the other hand, the excessive dietary intake of DHA has been reported to increase the amount of lipid peroxides (Saito, et al. 1996, Yamada, et al. 1997). Furthermore, the excessive intake of DHA has been suggested to decrease the percentage of linoleic acid (C18:2 n-6, LA) in cardiolipin (CL) in heart mitochondria. Cortie and Else reported that DHA was incorporated into CL in heart mitochondria at the expense of LA (Cortie & Else, 2012). Decreases in the percentage of LA in the CL fraction of the heart have been associated with reductions in cytochrome (cyt) c oxidase activity and respiratory rates in the heart mitochondria of rats fed diets containing 40 percent of its energy (en %) from sardine oil (Yamaoka, et al. 1988). On the other hand, previous studies demonstrated that dietary DHA did not affect the respiratory functions of isolated cardiac mitochondria in rats at intake levels practically applicable to humans (Kobayashi, et al. 1996, Khairallah, et al. 2012). Among several kinds of phosphatides, CL has been shown to play an important role in the respiratory functions of heart mitochondria. CL primarily exists in the inner leaflet of the inner mitochondrial membrane (Schlame & Haldar, 1993) and has been referred to as the signature phosphor lipid of mitochondria (Claypool & Koehler, 2012). CL has four acyl chains (Schlame & Haldar, 1993), and the fatty acid composition of CL in heart mitochondria is tightly regulated by its high level of tetra-LA (4×LA) molecular species, which have high affinity for cytochrome-c (Cortie & Else, 2012). Although previous studies have examined the effects of dietary fish oil or DHA on heart mitochondrial respiratory functions, the findings obtained were inconsistent. The excessive intake of DHA has recently been attracting interest because it is often used as a dietary supplement. Pharmacological levels of DHA are 2.5 en %, and Dietary Reference Intakes for Japanese (2010) established that the dietary goal for total fat intake was approximately 20~30 en % for males and females aged over 1 year old (Khairallah, et al. 2012, Ministry of Health, Labour and Welfare of Japan; 2009). The aim of the present study was to examine the effects of different levels of dietary DHA (0~8.6 en %) under the condition of 22.6 en % total lipids on changes in the fatty acid composition of the CL fraction of and respiratory functions in rat heart mitochondria. 22 American Journal of Nutrition and Food Science (2015) 21-25 2. Materials and Methods The mitochondrial pellet obtained was washed twice with buffer A. 2.1. Experimental animals, diet, and rearing method Five-week-old male Sprague-Dawley rats (Clea Japan Inc., Tokyo) were reared in individual stainless steel apartment cages in a room (23±1℃, humidity 50±10%) with a 12-hour light/12-hour dark cycle (lights on from 8:00 to 20:00). They were fed a basal diet for 1 week and were given the test diets for 2 weeks. In order to prevent the oxidation of dietary lipids, the diets were given at 17:00 and the remains were removed at 9:00 the next morning. Animals had free access to water. Animal care and experiments were approved by the Animal Committee of Tezukayama University. The basal diet was composed of 20% casein, 0.3% DL-methionine, 60% sucrose, 3.5% mineral mixture (AIN-76TM), 1.0% vitamin mixture (AIN-76TM), 0.2% choline bitartrate, 5% cellulose powder, and 10% lipids (lard; Hayashi Chemicals Co., Ltd., Tokyo, Japan). Test lipids were prepared by mixing coconut oil (Hayashi Chemicals Co., Ltd., Tokyo), LA (Extra linoleic-90; LA content of 90%, Nippon Oil & Fat Co., Ltd., Tokyo), and DHA (DHA-95E; DHA content of 95%, Harima Chemicals Inc., Tokyo). Table 1 shows the composition of the major fatty acids in the test lipids, the en % of DHA, and the P/S and n-3/n-6 ratios. Table 1. Fatty acid compositions of experimental Lipids (%) DHA level (energy%) Fatty acids 0.0 1.8 3.7 6.5 2.3. Isolation of CL and analysis of fatty acid composition The lipid fraction of the heart was extracted by the method of Folch et al. (1957). The heart mitochondrial CL fraction was separated by two-dimensional Silica Gel thin-layer chromato graphy. Total phospholipid fractions were separated by Kiesel-gel (Merck, Darmstadt) 60G using a solvent system petroleum ether: diethylether: acetic acid (80:20:1), and the CL fraction was separated by Kiesel-gel 60H using a solvent system of chloroform: methanol: water (65:25:4), respectivel y. Lipid fractions were visualized by spraying with Rhodamine 6G (Kanto Chemical Co., Inc., Tokyo). After scraping the CL spot on the plate, the lipids were extracted with achloro form: methanol (1:1) mixture. After hydrolysis in 1/2 N NaOH methanol at 120℃ for 60 minutes, the CL fraction mixture was subjected to methylation according to the method of Metcalfe and Schmitz (Metcalfe & Schmitz, 1961), and the fatty acid composition was analyzed by gas chromatography (GC) using a 12A gas chromatograph (Shimadzu Co., Ltd., Kyoto). The conditions used for GC were as follows; column 0.25 mm × 40 m, a stainless steel capillary column coated with Rascot Silar-5CP (Chromatotec Ltd., Tokyo); column temperature, 200℃; inlet temperature, 250℃, and carrier gas, N2. Fatty acids were identified by comparing retention times with that of each standard fatty acid compound (Sigma Chemical Co., Ltd., St. Louis). 8.6 C8:02.82.4 2.5 2.2 2.4 C10:0 2.82.7 2.7 2.6 2.9 C12:0 25.024.0 24.2 24.8 25.7 C14:0 9.39.6 9.7 10.3 10.4 C16:0 5.15.3 5.3 5.7 5.8 C18:0 1.71.8 1.6 1.8 1.8 C18:1 7.67.1 6.3 5.6 4.6 C18:2 n-6 LA 46.838.7 30.516.9 6.7 C20:5 n-3 EPA- 0.4 0.8 1.3 1.7 C22:6 n-3 DHA- 8.0 16.5 28.8 38.1 LA level (energy%)10.5 8.7 6.8 3.8 P/S ratios1.031.031.04 0.99 0.95 n-3/n-6* 0.000.220.571.785.91 1.5 *n-3/n-6 = (EPA+DHA)/LA 2.2. Preparation of heart mitochondria After being reared on the test diets for two weeks, rats were anesthetized with sodium pentobarbital (50mg/kg body weight) and the heart was excised immediately. The heart was washed in cooled buffer A (220mM mannitol, 70mM sucrose, 10mMTris, 0.1mM EDTA, and 0.2% BSA) at pH 7.2. Approximately 1.0 g of the heart was minced and gently homogenized in 2 ml of buffer a containing 2 mg protease (Nagase, Nagase Chemtex Corp., Osaka) at 4 ℃ . The homogenate was left to stand for 5 min at 4 ℃ with the addition of 8 ml of buffer A. After centrifugation of the homogenate at 500 × g for 10 min at 4℃, the supernatant obtained was again centrifuged at 5,000 ×g for 10 min at 4℃. 2.4. Measurement of respiratory control Respiratory control and ADP/O ratios were measured according to the method reported by Hagiwara (Hagiwara, 1961). The composition of the reaction solution was 5mM potassium phosphate (pH 7.4), 187.5mM mannitol, 62.5mM sucrose, 0.2mM EDTA・2K, 10mM KCl, 5mM MgCl2, and 10mMTris-HCl buffer (pH 7.4). Ten millimolar succinate was used as the substrate. After equilibration of the medium at 25℃, 100μl of the mitochondrial suspension was added and the ratio of O2 consumption was measured using a Clarke-type electrode (Rank Brothers, Ltd., Cambridge). State 3 respiration was induced by the addition of 234 nmol ADP. Total protein concentrations were measured in heart mitochondria by Lowry’s method (Lowry, et al. 1951). 2.5. Enzyme assays The activity of cyt-c-oxidase (EC1.9.3.1) was measured in heart mitochondria by the method of Orii and Okunuki (1965). Cytochrome-c type III from the horse heart was purchased from Sigma Chemical Co., Ltd. (St. Louis). Oxidation by reduced cyt-c-oxidase was determined from decreases in absorbance at 550 nm. F1-F0-ATPase (EC 3.6.7.3) activity was measured by the method of Kagawa (1974). ATP was purchased from Wako Pure Chemical Ind. Co., Ltd. (Osaka). American Journal of Nutrition and Food Science (2015) 21-25 2.6. Statistical analysis Data obtained from experiments were expressed as the mean ± SEM. Significant intergroup differences in the means were performed by a one-way ANOVA and the Steel-Dwass test for multiple comparisons using the statistical software package R (Version 2.8.1, http://www.r-project.org/). Significance was confirmed at the level ofp<0.05. 3. Results 3.1. Fatty acid composition of phospholipids in the heart CL fraction Data are shown in Table 2. The proportions of C16:0, C18:0, and C18:1 in the CL fraction of the heart increased slightly when the diet contained DHA at or greater than 6.5 en %. The proportion of LA (C18:2 n-6) was significantly lower in the group fed the diet with 3.7 en % DHA than in the 0 en % DHA group, and decreased further as DHA levels in the 23 dietincreased. No significant differences were observed in the proportion of arachidonic acid (C20:4 n-6) up to 6.5 en % DHA, but was significantly higher in the 8.6 en % DHA group than in the other groups. The proportions of eicosapentaenoic acid (C20:5 n-3, EPA) n-3 and DHA increased as the DHA level was elevated in the diet. The proportion of DHA was significantly higher in the DHA groups with 6.5 or greater en % DHA than in the 0 en % DHA group. The P/S ratio decreased as the DHA level in the diet increased. The n-3/n-6 ratio in the CL fraction was significantly higher in the group with 8.6 en % DHA than in the 4 other groups. 3.2. Respiration and oxidative phosphorylation in isolated intact heart mitochondria No significant intergroup difference was observed in State 3 respiration by heart mitochondria with the DHA supplementation (Figure), or in State 4 respiration, respiratory control ratio (RCR), or the ADP/O ratio (Table 3) Table 2. Fatty acid composition of cardiolipin fraction from hearts of rats fed experimental diets for 14 days 1. DHA level(energy%) Fatty acids 0.0 1.8 3.7 6.5 8.6 C16:0 3.67±0.58a5.29±0.48ab5.53±0.97ab7.42±1.03b7.97±1.46b C18:0 2.99±0.51a3.69±0.34a4.38±0.70a5.98±0.96a11.16±2.60b C18:1 5.23±0.33a6.16±0.56a5.13±0.26a6.59±0.81a9.02±0.81b C18:2 n-6 78.33±2.05a71.63±1.69ab64.48±4.21bc55.90±3.65c41.12±6.05d C20:4 n-6 1.21±0.08a0.94±0.06a0.85±0.08a1.26±0.10a2.59±0.48b C20:5 n-3 0.07±0.02a0.13±0.02a0.16±0.04a0.39±0.07b0.57±0.09c C22:6 n-3 0.71±0.08a1.63±0.23ab2.12±0.22ab4.61±0.20b12.11±2.23c P/S ratios9.57±1.18a6.67±0.70b4.21±0.74bc3.12±0.57c3.04±0.82c n-3/n-6 ratios0.02±0.00a0.03±0.00a0.04±0.00a0.10±0.00a0.36±0.10b 1 Means±SEM of 9 rats. Means in the same row not sharing a common superscript letters are significantly different (p<0.05). Table 3. State 4 respiration, RC, ADP/O, and F1F0-ATPase activity in isolated heart mitochondria of rats fed experimental Diets for 14 days1 DHA level(energy%) Items 0.0 1.8 3.7 6.5 8.6 State 4233.7±2.3 31.5±1.2 30.1±1.5 32.7±2.2 31.5±2.7 n atom O2/min•mg protein RCR35.61±0.174.87±0.415.23±0.314.96±0.335.31±0.40 ADP/O 2.78±0.11 3.29±0.15 3.14±0.11 3.05±0.13 2.71±0.10 F1F0-ATPase 777±18778±23801±41767±13786±22 Pi4nmol/min/mg protein 1 Means±SEM of 9 rats. Means in the same row not sharing a common superscript letters are significantlydifferent(p<0.05). 24 American Journal of Nutrition and Food Science (2015) 21-25 2 The substrate used was 5mM succinate. RCR, respiratory control ratio. 4 Pi, phosphoric acid 3 3.3. Cyt-c-oxidase and F1-F0-ATPase activities in heart mitochondria Cyt-c-oxidase activity was slightly lower in the group with 6.5 en % DHA than in the 0 en % DHA group (p<0.05), and no significant difference was observed among the other groups (Figure). F1-F0-ATPase activity was unaffected by the DHA supplementation (Table 3). Figure. State 32 Respiration and Cytochrome cOxidase-Specific Activities in Heart Mitochondria of Rats Fed Experimental Diets for 14 days1. 1 Means±SEM of 9 rats. Means in the bar not sharing acommon superscript letters are significantly different (p<0.05). 2 The substrate used was 5mM succinate. 4. Discussion In the present study, we investigated the effects of dietary DHA from a low (0 en %) to a high level (8.6 en %) on respiratory functions in the heart mitochondria of Sprague-Dawley rats. Our results demonstrated that the dietary administration of high levels of DHA (8.6 en %) did not affect respiratory functions in heart mitochondria. Previous findings on the effects of dietary DHA on respiratory functions in heart mitochondria have been inconsistent, and this has been attributed to differences in the fatty acid composition of the source of dietary lipids, lipid administration levels, and durations of the intake of experimental diets. Yamaoka et al. previously reported that feeding rats a 20% corn oil (CO, containing 60.9% LA) or sardine oil (SO, containing 19.7 % EPA and 8.3 % DHA) diet for 30 days led to State 3 respiration and cyt-c-oxidase activity being 27.6% and 51.9% lower, respectively, in the SO group than in the CO group (Yamaoka, et al. 1988). Kobayashi et al. fed rats a diet containing 17.5~31.5 en % total fat lipids, such as safflower, soybean, and fish oil (FO), and found that heart mitochondrial cyt-c-oxidase activity was not affected by FO (Kobayashi, et al. 1996). Khairallah et al. also reported that supplementation with DHA had no effects on respiratory functions in cardiac mitochondria when rats were fed a diet with 14 en % total fat and 5.75 en % DHA for 10 weeks (Khairallah, et al. 2012). In the present study, a decrease was observed in LA in the heart CL fraction in conjunction with elevations in dietary DHA levels; the percentage of LA was 45% lower in the 8.6 en % DHA group than in the 0 en % DHA group. On the other hand, State 3 respiration, State 4 respiration, RCR, the ADP/O ratio, and cyt-c-oxidase and F1-F0-ATPase activities in heart mitochondria were not affected by dietary DHA supplementation. Khairallah et al. proposed that high levels of tetra-LA CL were not essential for normal mitochondrial functions if they were replaced with very-long chain n-3 or n-6 polyunsaturated fatty acids (Khairallah, et al. 2012). Our results were supported by these findings. F1-F0-ATPase activity was not affected by the DHA supplementation. F1F0-ATPase has been shown to exhibit high binding affinity for CL (Eble, et al. 1990, Haines 2009). Yamaoka et al. previously reported that F1-F0-ATPase activity was significantly higher in the SO group than in the CO group (Yamaoka, et al. 1988). Although the P/S ratio of dietary lipids was fixed at 1.0, the ratio of CL decreased inversely with dietary DHA levels, and was mainly attributed to DHA not being preferentially incorporated into CL than LA. The fatty acid composition results showed that LA was preferentially incorporated into CL. In the 8.6 en % DHA group, the proportion of LA in the diet was only 6.7%, whereas that in CL was 41.1 %. Otsuka et al. examined ten-year trends in fish, shellfish, EPA, and DHA intakes according to birth cohorts in community-dwelling middle-aged and elderly men and woman between 1997 and 2010 in Japan (Otsuka, et al. 2013), and reported that the habitual maximum intake of EPA + DHA per day was 4.097g/day, which corresponded to an intake of 36.9 kcal/day. Dietary Reference Intakes for Japanese (2010) established dietary reference intakes for energy of between 1450 and 3000 kcal/day in individuals over 18 years of age (Ministry of Health, Labour and Welfare of Japan; 2010). If the total energy intake each day is 1450 kcal, the above maximum intake of total EPA + DHA is approximately 2.5 en %. Khairallah et al. reported pharmacological levels of DHA equivalent to 2.5 en % (Khairallah, et al. 2012). Therefore, we considered the realistic maximum intake of total EPA + DHA in humans to be approximately 2.5 en %. Dietary Reference Intakes for Japanese (2010) set the dietary goal for total fat intake to approximately 20~30 en % in adults, while that in the United States is 20~35 en % (Ministry of Health, Labour and Welfare of Japan; 2010); therefore, dietary total fat supply needs to be between 20 and 35 en %. Yamaoka et al. (1988) used a diet with an en% total fat of 40.1%, but this lipid content was high American Journal of Nutrition and Food Science (2015) 21-25 for humans. Kobayashi et al. and Khairallah et al. used diets with fat levels that were approximately applicable to humans (Kobayashi, et al. 1996, Khairallah, et al. 2012). In the present study, we supplied 22.6 en % total fat containing several levels of DHA (0~8.6 en %). Therefore, our experimental conditions were applicable to human nutrition. The results of the present study suggested that an excessive supply of DHA did not affect respiratory functions in heart mitochondria because LA was preferentially incorporated into CL over DHA in the presence of a certain level of LA in the diet. 5. Conclusion We herein demonstrated that supplementation with more than 3-fold the realistic maximum intake of DHA by humans (8.6en%) did not reduce heart mitochondrial respiratory functions. These results suggested that DHA supplementation is safe for heart mitochondrial respiratory functions under conditions applicable to humans. Furthermore, since we employed highly purified DHA, our results are valuable from the viewpoint of observing the main effects of DHA. References Claypool, S. M., & Koehler, C.M. (2012).The complexity of cardiolipin in health and disease.Trends.Biochem. Sci., 37(1), 32-41. Cortie, C.H., & Else, P.L1. (2012). Dietary docosahexaenoic Acid (22:6) incorporates into cardiolipin at the expense of linoleic Acid (18:2): analysis and potential implications. Int. J. Mol. Sci., 13(11), 15447-15463. Eble, K.S., Coleman, W.B., Hantgan, R.R., & Cunningham, C.C. (1990).Tightly associated cardiolipin in the bovine heart mitochondrial ATP synthase as analyzed by 31P nuclear magnetic resonance spectroscopy.J. Biol. Chem., 265(32), 19434-1940. Folch, J., Lees, M., & Sloane-Stanley, G.H. (1957). A Simple Method for the Isolation and Purification of Total Lipids from Animal Tissues. J. Biol. Chem., 226, 497-509. Hagiwara, B. (1961). Respiratory Control of Mitochondria.Kosokagaku Sinpojyumu (Symposium for Enzyme Chemistry) (in Japanese), 15, 312-319. Haines, T.H. (2009). A new look at Cardiolipin. BiochimBiophysActa., 1788(10), 1997-2002. 25 Holub B. J. (2009). Docosahexaenoic acid (DHA) and cardiovascular disease risk factors. Prostaglandins Leukot Essent Fatty Acids, 81, 199-204. Kagawa,Y. (1974) Dissociation and Reassembly of the Inner Mitochondrial Membrane. In. “Methods in Membrane Biology,Vol.1”,eds. Korn, E.D., New York,pp.233,Plenum. Kato, T., Kolenic, N., & Pardini, R.S. (2007). Docosahexaenoic acid (DHA), a primary tumor suppressive omega-3 fatty acid, inhibits growth of colorectal cancer independent of p53 mutational status. Nutr. Cancer, 58(2), 178-87. Khairallah, R.J., Kim, J., O'Shea, K.M., O'Connell, K.A., Brown, B.H., Galvao, T., Daneault, C., Des Rosiers, C., Polster, B.M., Hoppel, C.L., and Stanley, W.C. (2012).Improved mitochondrial function with diet-induced increase in either docosahexaenoic acid or arachidonic acid in membrane phospholipids.PLoS One., 7(3), e34402. Kobayashi, T., Shimizugawa, T., Fukamizu, Y., Huang, M.Z., Watanabe, S., & Okuyama, H. (1996). Assessment of the Possible Adverse Effects of Oils Enriched with n-3 Fatty Acids in Rats-Peroxisomal Proliferation, Mitochondrial Dysfunction and Apoplexy. J. Nutr. Biochem.,7, 542-548. Lowry, O. H., Rosebrough, N.J., Farr, A. L., & Randall, R. J. (1951).Protein Measurement with the Folin Phenol Reagent.J. Biol. Chem., 193, 265-275. Metcalfe, L.D., & Schmitz, A.A. (1961).The Rapid Preparation of Fatty Acid Esters for Gas Chromatographic Analysis. Anal.Chem., 33, 636-364. Ministry of Health, Labour and Welfare of Japan. (2009). Dietary Reference Intakes for Japanese 2010. Otsuka, R., Kato, Y., Imai, Ando, F., Shimokata, H. (2013). Ten-year Trends in Fish, Shellfish, Eicosapentaenoic Acid, and Docosahexaenoic Acid Intake According to Birth Cohorts in Community-dwelling Middle-aged and Elderly Men and Women. Jpn. J. Nutr.Diet., 71(4), 185-195. Orii, Y., & Okunuki,K. (1965).Studies of Cytochrome.a. J. Biochem., 58,561-568. Phang, M., Lincz, L.F., & Garg, M.L. (2013).Eicosapentaenoic and docosahexaenoic acid supplementations reduce platelet aggregation and hemostatic markers differentially in men and women. J. Nutr., 143(4), 457-463. Saito, M., Kubo, K., & Ikegami, S. (1996). An Assessment of Docosahexaenoic Acid (DHA) Intake with Special Reference to Lipid Metabolism in Rats. J. Nutr. Sci.Vitaminol., 42, 195-207. Schlame, M., &Haldar, D. (1993).Cardiolipin Is Synthesized on the Matrix Side of the Inner Membrane in Rat Liver Mitochondria. J. Biol. Chem., 268(1):74-79. Yamaoka, S., Urade, R., &Kito, M., (1988). Mitochondrial Function in Rats is Affected by Modification of Membrane Phospholipids with Dietary Sardine Oil. J. Nutr., 118, 290-296. Yamada, N., Kobatake, Y., Ikegami, S., Takita, T., Wada, M., Shimizu, J., Kanke, Y., & Innami, S. (1997). Changes in Blood Coagulation, Platelet Aggregation, and Lipid Metabolism in Rats Given Lipids Containing Docosahexaenoic Acid. Biosci. Biotech. Biochem., 28, 103-108.