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Explore this test

Test Code 575


Boston Heart Fatty Acid Balance™ Test

Fatty acids are essential to heart health. Balancing fatty acids can improve cholesterol and triglyceride levels, improve immune system function as well as reduce inflammation and rate of heart disease.1,2 The Boston Heart Fatty Acid Balance™ test measures the major fatty acids (FA) for the purposes of cardiovascular disease characterization and management.


  1. Schaefer EJ. Lipoproteins, nutrition, and heart disease. Am J Clin Nutr. 2002;75(2):191-212.
  2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63 (25 Pt B):2960-2984.
Test Details

Test Details

Boston Heart Fatty Acid Balance™ Test

Measures all the major fatty acids in plasma and reports:

  • Saturated Fatty Acid  Index
  • Trans Fatty Acid Index
  • Monounsaturated Fatty Acid Index
  • Unsaturated/Saturated Ratio Index
  • Omega-3 Fatty Acid Index
  • Omega-6 Fatty Acid Index
  • EPA/AA Ratio Index
  • Omega-3/Omega-6 Ratio Index
  • Levels of all the major omega-3 fatty acids including EPA, DHA and ALA as well as the two major omega-6 fatty acids, AA and LA


Gas liquid column chromatography/mass spectrometry (GC/MS) after lipid extraction

Patient Preparation

9 hour fast prior to collection. Patient may drink water only. Fasting includes refraining from supplements, such as fish oil. Non-fasting samples will be rejected.

Preferred Specimen

1.0 mL plasma collected in EDTA plasma separator tube (Pearl Top)

Transport Temperature

Refrigerated (ship on frozen cold packs)


Refrigerated: 7 days

Lab Values

Lab Values

Boston Heart Fatty Acid Balance™ Test

Test Name Optimal Borderline High
Saturated Fatty Acid Index <30.0 30.0 – 33.0 >33.0 %
Trans Fatty Acid Index <0.50 0.50 – 0.70 >0.70 %
Test Name Optimal Borderline Low
Unsaturated/Saturated Ratio >2.25 2.00 – 2.25 <2.00
Omega-3 Fatty Acid Index >4.50 2.50 – 4.50 <2.50 %
Eicosapentaenoic Acid (EPA) >50.0 20.0 – 50.0 <20.0 pg/mL
Docosahexaenoic Acid (DHA) >100.0 60.0 – 100.0 <60.0 pg/mL
Alpha-linolenic Acid (ALA) >30.0 14.0 – 30.0 <14.0 pg/mL
EPA/AA Ratio >0.17 0.07 – 0.17 <0.07
AA/EPA Ratio <5.88 5.88 – 14.29 >14.29
Test Name Low Mid High
Omega-6 Fatty Acid Index <39.0 39.0 – 43.0 >43.0 %
Linoleic Acid (LA) <930.0 930.0 – 1150.0 >1150.0 µg/mL
Arachidonic Acid (AA) <250.0 250.0 – 320.0 >320.0 µg/mL
Omega-3/Omega-6 Ratio < 0.07 0.07 – 0.10 >0.10
Monounsaturated Fatty Acid Index <20.0 20.0-23.0 >23.0 %
Test Details
Clinical Significance

Clinical Significance

Boston Heart Fatty Acid Balance™ Test

  • Saturated Fatty Acid Index Includes:
    • Myristic (14:0)
    • Palmitic (16:0)
    • Stearic (18:0)
      • May raise levels of LDL-C and increases heart disease risk1
  • Trans Fatty Acid Index Includes:
    • Palmitelaidic (16:1n9t)
    • Elaidic (18:1n9t)
    • Linoelaidic (18:2n9t)
      • Markedly increases the risk of heart disease by raising LDL-C and lowering HDL-C2,3
      • Adversely impacts serum lipid levels by:2
      • Decreasing rate of LDL apoB-100 clearance.
      • Increasing rate of HDL apoA-I clearance
  • Monounsaturated Fatty Acid Index Includes:
    • Palmitoleic (16:1n7)
    • Oleic (18:1n9)
      • Beneficial fat that lowers heart disease risk4
      • Enhances LDL apoB-100 clearance relative to saturated fat1
  • Unsaturated/Saturated Ratio Index Includes: 
    • Omega 3 FA (EPA, DHA, ALA)
    • Omega 6 FA (LA, AA, DA)
    • Saturated FA (See Sat FA Index)
      • Increasing polyunsaturated (PUFA) intake lowers LDL-C and decreases heart disease risk5,6
      • Increased intake of PUFA lowers LDL-C by increasing LDL receptor activity.1,7-8


  1. Schaefer EJ. Lipoproteins, nutrition, and heart disease. Am J Clin Nutr. 2002;75(2):191-212.
  2. Mozaff arian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Eng J Med. 2006;354(15):1601-1613.
  3. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Eff ects of diff erent forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Eng JMed. 1999;340(25):1933-1940.
  4. Estruch R, Ros E, Salas-Salvadó J, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290.
  5. Saito Y, Yokoyama M, Origasa H, et al; JELIS Investigators. Eff ects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis. 2008;200(1):135-140.
  6. Maki KC, Bays HE, Dicklin MR. Treatment options for the management of hypertriglyceridemia: strategies based on the best-available evidence. J Clin Lipidol. 2012;6(5):413-426.
  7. Fernandez ML , West KL. Mechanisms by which dietary fatty acids modulate plasma lipids. J Nutr. 2005;135(9):2075-2078.
  8. Superko R, Superko S, Nasir L, Agatston A, Garrett C. Omega-3 fatty acid blood levels: clinical significance and controversy. Circulation. 2013; 128(19):2154-2161.
Lab Values
Treatment Options

Treatment Options

Boston Heart Fatty Acid Balance™ Test

  • Choose poultry without skin, fish, low fat dairy products, and very lean cuts of meats. Replace butter with vegetable oil or tub margarine.
  • Replace foods high in trans fats with trans fat free tub margarine and vegetable oils.
  • Increase intake of olive oil and or canola oil in salads or use more of these oils in cooking.
  • Increase intake of vegetable fats (nuts, seeds, canola, soybean or other oils) and decrease intake of animal fats (fatty meats, cheese, ice cream).
  • Increase intake of oily fish such as salmon, herring, tuna, or mackerel, or take at least two fish oil or pure EPA capsules daily. Use of fish oil capsules has been associated with heart disease risk reduction. Doses of about 6 grams per day of fish oil or 4 grams of concentrated fish oil can also significantly lower triglyceride levels.
Clinical Significance