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Evaluating the Effects of Omega-3 Polyunsaturated Fatty Acids on Inflammatory Bowel Disease via Circulating Metabolites: A Mediation Mendelian Randomization Study.

Xiaojing Jia, Chunyan Hu, Xueyan Wu, Hongyan Qi, Lin Lin et al.
Other Metabolites 2023 13 인용
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Study Design

연구 유형
Observational Study
대상 집단
None
중재
Evaluating the Effects of Omega-3 Polyunsaturated Fatty Acids on Inflammatory Bowel Disease via Circulating Metabolites: A Mediation Mendelian Randomization Study. 95%
대조군
None
일차 결과
inflammation markers
효과 방향
Mixed
비뚤림 위험
Unclear

Abstract

Epidemiological evidence regarding the effect of omega-3 polyunsaturated fatty acid (PUFA) supplementation on inflammatory bowel disease (IBD) is conflicting. Additionally, little evidence exists regarding the effects of specific omega-3 components on IBD risk. We applied two-sample Mendelian randomization (MR) to disentangle the effects of omega-3 PUFAs (including total omega-3, α-linolenic acid, eicosapentaenoic acid (EPA), or docosahexaenoic acid (DHA)) on the risk of IBD, Crohn's disease (CD) and ulcerative colitis (UC). Our findings indicated that genetically predicted increased EPA concentrations were associated with decreased risk of IBD (odds ratio 0.78 (95% CI 0.63-0.98)). This effect was found to be mediated through lower levels of linoleic acid and histidine metabolites. However, we found limited evidence to support the effects of total omega-3, α-linolenic acid, and DHA on the risks of IBD. In the fatty acid desaturase 2 (FADS2) region, robust colocalization evidence was observed, suggesting the primary role of the FADS2 gene in mediating the effects of omega-3 PUFAs on IBD. Therefore, the present MR study highlights EPA as the predominant active component of omega-3 fatty acids in relation to decreased risk of IBD, potentially via its interaction with linoleic acid and histidine metabolites. Additionally, the FADS2 gene likely mediates the effects of omega-3 PUFAs on IBD risk.

요약

EPA is highlighted as the predominant active component of omega-3 fatty acids in relation to decreased risk of IBD, potentially via its interaction with linoleic acid and histidine metabolites.

Full Text

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Article

Evaluating the Effects of Omega-3 Polyunsaturated Fatty Acids on Inflammatory Bowel Disease via Circulating Metabolites: A Mediation Mendelian Randomization Study

Xiaojing Jia 1,2,†, Chunyan Hu 1,2,†, Xueyan Wu 1,2,†, Hongyan Qi 1,2, Lin Lin 1,2, Min Xu 1,2, Yu Xu 1,2, Tiange Wang 1,2, Zhiyun Zhao 1,2, Yuhong Chen 1,2, Mian Li 1,2, Ruizhi Zheng 1,2, Hong Lin 1,2, Shuangyuan Wang 1,2, Weiqing Wang 1,2, Yufang Bi 1,2, Jie Zheng 1,2,3,* and Jieli Lu 1,2,*

  1. 1 Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  2. 2 Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  3. 3 MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK

* Correspondence: [email protected] (J.Z.); [email protected] (J.L.) † These authors contributed equally to this work.

Citation: Jia, X.; Hu, C.; Wu, X.; Qi, H.; Lin, L.; Xu, M.; Xu, Y.; Wang, T.; Zhao, Z.; Chen, Y.; et al. Evaluating the Effects of Omega-3 Polyunsaturated Fatty Acids on Inflammatory Bowel Disease via Circulating Metabolites: A Mediation Mendelian Randomization Study. Metabolites 2023, 13, 1041. https:// doi.org/10.3390/metabo13101041

Academic Editor: Ashley J. Snider

Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

Abstract: Epidemiological evidence regarding the effect of omega-3 polyunsaturated fatty acid (PUFA) supplementation on inflammatory bowel disease (IBD) is conflicting. Additionally, little evidence exists regarding the effects of specific omega-3 components on IBD risk. We applied twosample Mendelian randomization (MR) to disentangle the effects of omega-3 PUFAs (including total omega-3, α-linolenic acid, eicosapentaenoic acid (EPA), or docosahexaenoic acid (DHA)) on the risk of IBD, Crohn’s disease (CD) and ulcerative colitis (UC). Our findings indicated that genetically predicted increased EPA concentrations were associated with decreased risk of IBD (odds ratio

  1. 0.78 (95% CI 0.63–0.98)). This effect was found to be mediated through lower levels of linoleic acid and histidine metabolites. However, we found limited evidence to support the effects of total omega-3, α-linolenic acid, and DHA on the risks of IBD. In the fatty acid desaturase 2 (FADS2) region, robust colocalization evidence was observed, suggesting the primary role of the FADS2 gene in mediating the effects of omega-3 PUFAs on IBD. Therefore, the present MR study highlights EPA as the predominant active component of omega-3 fatty acids in relation to decreased risk of IBD, potentially via its interaction with linoleic acid and histidine metabolites. Additionally, the FADS2 gene likely mediates the effects of omega-3 PUFAs on IBD risk.
  2. 1. Introduction

Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders affecting the gastrointestinal tract, and its prevalence has increased worldwide, reaching up to 0.5% of the general population in the western world [1,2]. The two primary types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC), each with different clinical and histopathological characteristics [3]. The economic burden of IBD is substantial, with over €4.6 billion in annual medical costs in Europe and US$6 billion in the USA, putting a strain on healthcare systems and resources [2]. To alleviate this burden, a comprehensive approach is needed, including the development of preventive care to delay the progression of this disease. Omega-3 polyunsaturated fatty acids (PUFAs) are commonly used nutritional supplements and show beneficial effects on coronary heart disease [4] and asthma [5]. Due

Metabolites 2023, 13, 1041. https://doi.org/10.3390/metabo13101041 https://www.mdpi.com/journal/metabolites

to their anti-inflammatory properties, PUFAs have been proposed as potential targets for preventing and treating autoimmune diseases [6]. Omega-3 PUFAs can be quantified based on a shift in the signal induced by the position of the omega-3 double bond. The sum of concentrations of α-linolenic acid, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and other omega-3 PUFAs is expressed as total omega-3 fatty acids. Long-chain omega-3 PUFAs (EPA and DHA) are derived from α-linolenic acid through a series of elongation, desaturation, and β-oxidation events during fatty acid metabolism. The fatty acid desaturase 2 (FADS2) gene encodes delta-6 desaturase and plays a key regulatory role in this metabolism process [7].

In randomized controlled trials (RCTs), EPA and DHA have often been combined as the active components of omega-3 fatty acids and consumed together, despite their distinct molecular functions and clinical impacts [8]. Daily supplementation with EPA and DHA were reported to be effective in reducing the clinical relapse of CD [9]. However, in the large-scaled vitamin D and omega 3 trial (VITAL) with approximately five years of randomized follow-up, fish oil containing EPA and DHA did not significantly reduce the rate of a composite outcome consisting of rheumatoid arthritis, IBD, autoimmune thyroid disease, and all other autoimmune diseases [10]. Moreover, there was a lack of detailed information on IBD in this study. Additionally, observational studies did not provide convincing and consistent evidence of the relationship between dietary intakes of omega-3 PUFAs and the risk of IBD [11–13]. Information on usual diet relied on self-reported dietary questionnaires, which may produce errors or bias in recall. The existing evidence makes it challenging to confirm the causal effect of omega-3 PUFAs on IBD; and identify the key supplement among the omega-3 PUFA component (α-linolenic acid, EPA, and DHA) that may exhibit the protective effect.

Mendelian randomization (MR) is an approach that could estimate causal effect of an exposure on an outcome and overcome issues related to residual confounding or reverse causality [14]. Moreover, this method allows for investigating the effects of each omega-3 PUFA component on IBD, which may be challenging to achieve in an RCT setting. Recently, He et al. reported that total omega-3 fatty acid had a protective effect against increased UC risk instead of CD [15], but the evidence on IBD was not addressed. In addition, their analysis involved only 21 omega-3 instruments after eliminating SNPs associated with potential confounders and outcomes, which might have reduced the power of the analysis. More critically, some instruments in key regulatory genes such as FADS2 gene were eliminated, which may have important influences on the reliability of the findings. Meanwhile, there remains a knowledge gap in evaluating the separate biological effects of α-linolenic acid, EPA, and DHA, with their metabolic mechanisms being unexplored.

In this study, we aimed to explore the effects of omega-3 PUFAs (i.e., total omega-3, α-linolenic acid, EPA, and DHA) on the risk of IBD and its subtypes, and the potential metabolic pathways linking omega-3 PUFAs with IBD. Given the central role of the FADS2 gene in omega-3 PUFAs’ metabolism, further analyses in this specific region were essential through genetic colocalization. This approach allowed us to assess whether there were shared causal variants within the FADS2 gene region that could influence both omega-3 PUFAs and IBD risk [16].

2. Materials and Methods

  1. 2.1. Study Design

A schematic overview of the study design was detailed in Figure 1. We employed the univariable MR analysis to assess whether total omega-3 fatty acid, α-linolenic acid, EPA, and DHA showed causal effects on IBD and its subtypes (CD and UC), using summary-level data from publicly available genome-wide association studies (GWASs). Colocalization analysis was further conducted in the FADS2 gene region to test for pleiotropic effect and investigate the underlying mechanisms. A bidirectional MR analysis was applied to estimate the effect of genetic liability to IBD on omega-3 PUFAs. Mediation MR analysis

pleiotropic effect and investigate the underlying mechanisms. A bidirectional MR analysis was applied to estimate the effect of genetic liability to IBD on omega-3 PUFAs. Mediation

IBD. All datasets were publicly available, and ethical approval was acquired for all original studies.

estimated the effect of potential metabolites linking omega-3 PUFAs with the IBD. All datasets were publicly available, and ethical approval was acquired for all original studies.

Figure 1. Study design of this MR study.

Figure 1. Study design of this MR study.

  1. 2.2. Data Sources and Genetic Instruments for Omega-3 PUFAs
  1. 2.2. Data Sources and Genetic Instruments for Omega-3 PUFAs

Single-nucleotide polymorphisms (SNPs) associated with total omega-3 fatty acid were derived from UK Biobank, which collected deep genetic and phenotypic data from approximately 500,000 individuals aged between 40 and 69 [17]. Genetic associations of α-linolenic acid, EPA, and DHA were obtained from a GWAS meta-analysis in 8866 participants of European ancestry from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium [18]. Details of the data sources and sample sizes of the exposures are listed in the Table S1.

Single-nucleotide polymorphisms (SNPs) associated with total omega-3 fatty acid were derived from UK Biobank, which collected deep genetic and phenotypic data from approximately 500,000 individuals aged between 40 and 69 [17]. Genetic associations of α-linolenic acid, EPA, and DHA were obtained from a GWAS meta-analysis in 8866 participants of European ancestry from the Cohorts for Heart and Aging Research in

In this study, the genetic variants that showed robust association with total omega-3 fatty acid (with genetic association p value < 5 × 10−8) and showed independence (with linkage disequilibrium (LD) r2 < 0.01 in European ancestry) were selected as candidate instruments. Given the limited sample size of the α-linolenic acid, EPA, and DHA GWASs, a slightly more relaxing threshold (p < 5 × 10−6) was used to select instruments for these exposures. After harmonization with outcome data and removing palindromic or mismatching alleles, 42 independent SNPs for total omega-3 fatty acid, 12 independent SNPs for α-linolenic acid, 23 independent SNPs for EPA, and 6 independent SNPs for DHA were selected as instruments (Figure S1). One SNP was selected to represent the effect of each omega-3 PUFA in the FADS2 region (rs174564 for total omega-3 fatty acid, rs174547 for α-linolenic acid, rs174538 for EPA, and rs174555 for DHA; all these SNPs are in strong LD to each other (LD r2 > 0.7), which represents the same signal in this region).

  1. 2.3. Outcome Data Sources
  2. 2.4. Metabolite Data Sources
  3. 2.5. Statistical Analysis
  1. 2.5.1. Two-Sample MR Analysis
  2. 2.5.2. Mediation MR Analysis Linking EPA with IBD via Metabolites

We further estimated the mediation effects of circulating metabolites linking EPA with IBD risk. We used a novel analytical pipeline that integrated mediation MR with metabolite set enrichment analyses. First, we used a two-step MR approach to: (1) assess the causal

effect of EPA on 974 potential metabolites (step 1) that have publicly available GWAS datasets in the IEU OpenGWAS database, which selected 237 metabolites with FDR < 0.05; and (2) estimate the effect of 237 metabolites on IBD (step 2), which further selected 211 metabolites associated with both EPA and IBD as candidate mediation metabolites. Second, we performed the metabolite set enrichment analysis on the 211 selected candidate metabolites, which aimed to select key metabolites enriched in certain metabolic pathways (Figure S1). For the metabolites that showed evidence of enrichment in the enrichment analysis, we further performed multivariable MR (MVMR) to determine their mediation effects on IBD which was adjusted for the effect of EPA [27]. We used IVW as our main approach to estimate the effect of EPA on the metabolites (β1). Additionally, MVMR was applied to estimate: (1) the effect of each metabolite on risk of IBD with adjustment for the genetic effect of EPA (β2); and (2) the direct effect of EPA on IBD with adjustment for each mediator individually (βdirect). To calculate the indirect mediation effect of EPA on IBD outcome, we used the difference of coefficients method as our main method, i.e., the casual effect of EPA on outcomes via metabolites (βtotal − βdirect). The total effect was the estimate of EPA on IBD in univariable MR (βtotal). Thus, the proportion of the total effect mediated by each metabolite was separately estimated by dividing the indirect effect by the total effect ((βtotal − βdirect)/βtotal). Standard errors were derived by using the delta method, using effect estimates obtained from 2SMR analysis.

Univariable, bidirectional, and multivariable MR analyses were considered significant with a 2-sided p ≤ 0.05. Metabolites associated with omega-3 PUFAs or IBD were considered significant with an FDR < 0.05. Enrichment analysis was performed using the online MetaboAnalyst software (version 5.0, Mcgill University, Montreal, QC, Canada; https:// www.metaboanalyst.ca, accessed on 17 November 2022) [28]. All analyses were performed using ‘TwoSampleMR’ and ‘MR-PRESSO’ package in R Software 3.6.0.

3. Results

We selected 42, 12, 23, and 6 SNPs as instruments to proxy life-long effect of total omega-3 fatty acid, α-linolenic acid, EPA, and DHA, respectively. In bidirectional MR, there were 117, 89, and 62 independent instruments incorporated for IBD, CD, and UC, respectively. Mean F statistics of the exposures ranged from 29.82 to 262.21 indicating that the MR estimates were not likely to be influenced by weak instrument bias (Table S2).

  1. 3.1. Genetically Predicted Omega-3 PUFAs on Risk of IBD (Including CD and UC)

Table 1 shows the effects of omega-3 PUFAs on IBD risks. Considering total omega-

  1. 3 fatty acid as a whole, little evidence indicated its protective effect on IBD risk (odds ratio (OR) of IVW, 0.94; 95% confidence interval (CI), 0.82–1.07). Meanwhile, higher concentrations of α-linolenic acid showed a potential effect on increasing risk of IBD, although the evidence was weaker due to the wide confidence interval (OR of IVW, 1.54; 95% CI, 0.72–3.29). In contrast, genetically increased levels of EPA showed a causal effect on the lower risk of IBD (OR of IVW, 0.78; 95% CI, 0.63–0.98). There was little evidence for the presence of heterogeneity (Cochran’s Q-test Ph = 0.10), pleiotropy (MR-Egger intercept Pintercept = 0.97), or any outliers (MR-PRESSO P of global test = 0.099). Estimated effect was consistent using the weighted median approach (OR, 0.59; 95% CI, 0.45–0.78). However, there was little evidence to support the effect of DHA on IBD (OR of IVW, 1.05; 95% CI, 0.86–1.28).

The results of the primary MR analyses of CD and UC are presented in Figure 2. Results of sensitivity analyses are listed in Table S3. In consistent with the IBD results, there was little evidence to support the effects of total omega-3 fatty acid, α-linolenic acid, and DHA on the risk of CD and UC (Figure 2A,B,D). Meanwhile, increased levels of genetically proxied EPA still showed a strong effect on a lower risk of CD (OR of IVW, 0.67; 95% CI, 0.50–0.91), but with little effect on UC (OR of IVW, 0.88; 95% CI, 0.68–1.14) (Figure 2C).

Table 1. Two-sample Mendelian randomization estimations showing the effect of omega-3 PUFAs on inflammatory bowel disease.

Methods Estimate Heterogeneity Pleiotropy

Exposure No. of SNPs

MR-PRESSO P Total omega-3 fatty acid

MR Egger int P

OR 95% CI P Q Ph

42 IVW 0.94 (0.82, 1.07) 0.35 232.9 <0.001 0.06 <0.001 MR-Egger 0.83 (0.69, 0.99) 0.05 Weighted median 0.85 (0.80, 0.92) <0.001

MR-PRESSO outlier test

0.88 (0.81, 0.95) 0.003 α-linolenic acid

12 IVW 1.54 (0.72, 3.29) 0.26 46.7 <0.001 0.65 <0.001

MR-Egger 1.40 (0.58, 3.39) 0.48 Weighted median 1.42 (0.89, 2.28) 0.14

MR-PRESSO outlier test

1.24 (0.79, 1.95) 0.38 EPA 23 IVW 0.78 (0.63, 0.98) 0.03 30.8 0.099 0.97 0.099 MR-Egger 0.78 (0.45, 1.34) 0.37 Weighted median 0.59 (0.45, 0.78) <0.001

MR-PRESSO outlier test

NA NA NA DHA 6 IVW 1.05 (0.86, 1.28) 0.65 21.6 <0.001 0.56 0.012

MR-Egger 1.20 (0.75, 1.93) 0.49 Weighted median 1.12 (0.98, 1.28) 0.09

MR-PRESSO outlier test

, x FOR PEER REVIEW

1.11 (0.99, 1.25) 0.43

Abbreviations: CI, confidence interval; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; Egger int, egger intercept; IVW, inverse variance weighted; MR, Mendelian randomization; OR, odds ratio; PUFAs, polyunsaturated fatty acids; Ph, p-value for heterogeneity.

Figure 2. Cont.

Metabolites 2023, 13, 1041 7 of 16

Figure 2. Causal effects of omega-3 polyunsaturated fatty acids on inflammatory bowel disease as a whole, on Crohn’s disease, and ulcerative colitis or via the FADS2 gene cluster. Univariable causal effects of (A) total omega-3, (B) α-linolenic acid, (C) EPA, and (D) DHA on investigated outcomes (light shades of blue, orange and green). Causal effects of each fatty acid on investigated outcomes via the FADS2 gene (blue, orange and green). Abbreviations: ALA, α-linolenic acid; CD, Crohn’s disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; FADS2, fatty acid desaturase 2; IBD, inflammatory bowel disease; UC, ulcerative colitis.

Figure 2. Causal effects of omega-3 polyunsaturated fatty acids on inflammatory bowel disease as a whole, on Crohn’s disease, and ulcerative colitis or via the FADS2 gene cluster. Univariable causal effects of (A) total omega-3, (B) α-linolenic acid, (C) EPA, and (D) DHA on investigated outcomes (light shades of blue, orange and green). Causal effects of each fatty acid on investigated outcomes via the FADS2 gene (blue, orange and green). Abbreviations: ALA, α-linolenic acid; CD, Crohn’s disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; inflammatory bowel disease; UC, ulcerative colitis.

3.2. Sensitivity Analysis in FADS2 Gene Region

As shown in the leave-one-out analyses, the MR estimates of omega-3 PUFAs on IBD, CD, and UC were mainly driven by SNP effects in the FADS2 gene region (rs174564 for total omega-3 fatty acid, rs174547 for α-linolenic acid, rs174538 for EPA, and rs174555 for DHA) (Figure S2). As shown in Figure 2, the MR results of the single FADS2 SNP showed the causal effects of total omega-3 fatty acid, EPA, and DHA on lower risk of IBD. The ORs (95% CI) were 0.85 (0.79–0.92), 0.59 (0.43–0.80), and 0.53 (0.37–0.75), respectively. On the contrary, α-linolenic acid showed a strong effect on the increasing risk of IBD (OR, 26.82; 95% CI, 5.40–133.20).

As for IBD subtypes, the FADS2 gene showed a stronger effect on lowering the risk of CD (ORs (95% CI) were 0.78 (0.71–0.86) for total omega-3, 0.38 (0.25–0.57) for EPA, and 0.35 (0.23–0.55) for DHA) but was absent for UC. Meanwhile, a FADS2 single-SNP in α-linolenic acid had a positive effect on increasing CD risk (OR, 186.12; 95% CI, 23.46–1476.40), but with less effect on UC risk.

Aligning with the MR estimates of a single-SNP in the FADS2 region, we observed compelling evidence of colocalization for α-linolenic acid with CD (colocalization probability, 98.90%), but with little evidence for UC (colocalization probability, 2.61%; Figure 3A). A similar pattern of colocalization evidence was observed for EPA (colocalization probability of CD, 98.80%; colocalization probability of UC, 2.44%; Figure 3B), as well as DHA (colocalization probability of CD, 94.50%; colocalization probability of UC, 6.56%; Figure 3C). Collectively, colocalization analyses further supported distinct effects of omega-3 PUFAs on CD and UC.

Metabolites 2023, 13, 1041 Figure 3C). Collectively, colocalization analyses further supported distinct effects of8 of 16 omega-3 PUFAs on CD and UC.

Figure 3. Regional association plots of α-linolenic, eicosapentaenoic, and docosahexaenoic acids with Crohn’s disease and ulcerative colitis in the FADS2 region. (A) Regional plots of α-linolenic acid and Crohn’s disease and ulcerative colitis in the FADS2 region without conditional analysis. (B) Regional plots of eicosapentaenoic acid and Crohn’s disease and ulcerative colitis in the FADS2 region without conditional analysis. (C) Regional plots of docosahexaenoic acid and Crohn’s disease and ulcerative colitis in the FADS2 region without conditional analysis. This figure was obtained from http://locuszoom.org/. Abbreviations: FADS2, fatty acid desaturase 2.

3.3. Effects of Genetic Liability to IBD, CD, and UC on the Levels of Omega-3 PUFAs

We further estimated whether genetic liability to IBD was a causal factor on changing levels of omega-3 PUFAs using bidirectional MR. There was little evidence to suggest the causal effect of genetic liability to IBD and CD on omega-3 PUFAs by using the IVW method (Table 2). However, genetic liability to UC showed an effect on lowering levels of DHA (β −0.05 (95% CI −0.09, −0.002)).

Table 2. Bidirectional Mendelian randomization estimates for causal effects of genetic liability to IBD, CD, and UC on the levels of omega-3 PUFAs.

Outcome

IVW Heterogeneity Pleiotropy Beta 95% CI P Q Ph MR Egger

Exposure No. of SNPs

No. of SNPs

MRPRESSOP IBD 117

int P

Total omega-3 fatty acid

105 −0.002 (−0.012, 0.009) 0.76 200.7 <0.001 0.86 <0.001 α-linolenic acid 39 −0.001 (−0.004, 0.001) 0.36 35.9 0.57 0.94 0.416

EPA 39 0.001 (−0.019, 0.020) 0.92 57.9 0.02 0.87 0.009 DHA 39 −0.010 (−0.059, 0.040) 0.71 47.7 0.13 0.69 0.036

Total omega-3 fatty acid

CD 89

83 0.004 ( 0.005, 0.013) 0.39 174.5 <0.001 0.28 <0.001 α-linolenic acid 28 −0.001 (−0.003, 0.001) 0.28 28.7 0.38 0.41 0.463

EPA 28 0.011 (−0.005, 0.026) 0.17 46.4 0.01 0.85 0.012 DHA 28 0.029 ( 0.011, 0.070) 0.15 39.3 0.06 0.81 0.090

Total omega-3 fatty acid

UC 62

53 0.005 (−0.018, 0.008) 0.45 131.0 <0.001 0.27 <0.001 α-linolenic acid 27 0.002 (−0.001, 0.004) 0.23 28.5 0.34 0.34 0.446

EPA 27 −0.005 (−0.021, 0.010) 0.50 26.5 0.44 0.38 0.088 DHA 27 −0.045 (−0.089, −0.002) 0.04 26.7 0.42 0.61 0.095

Abbreviations: CI, confidence interval; CD, Crohn’s disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; Egger int, Egger intercept; IBD, inflammatory bowel disease; IVW, inverse variance weighted; MR, Mendelian randomization; PUFAs, polyunsaturated fatty acids; Ph, p-value for heterogeneity; UC, ulcerative colitis.

3.4. Mediation MR of EPA, Metabolites, and IBD Risk

Given that genetically predicted increased EPA had significant benefit on lowering IBD risks, we further estimated whether there were some metabolites or metabolic pathways linking the EPA with IBD risk. For 211 candidate mediation metabolites (selected by the two-step MR described in the Section 2), metabolite set enrichment analysis indicated that α-linolenic acid and linoleic acid metabolism, and methylhistidine metabolism were the top two metabolic pathways that have been significantly enriched (Figure 4). DHA, linoleic acid, and histidine were major metabolites determined in the two pathways, respectively.

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Figure 4. Metabolite set enrichment analysis of 211 selected candidate metabolites associated with both EPA and risk of IBD. The figure shows a graphical representation of the pathway-associated metabolite sets by enrichment analysis in the effect of EPA on IBD. Abbreviations: EPA, eicosapentaenoic acid; IBD, inflammatory bowel disease.

Figure 4. Metabolite set enrichment analysis of 211 selected candidate metabolites associated with both EPA and risk of IBD. The figure shows a graphical representation of the pathway-associated

The effect of EPA on each intermediate metabolite (linoleic acid, DHA, and histidine) is shown in Figure 5A, higher levels of EPA were associated with lower linoleic acid (β, −0.51; 95% CI −0.91, −0.11), higher DHA (β, 0.61; 95% CI 0.27, 0.95), and lower histidine (β, −0.10; 95% CI −0.17, −0.03). The effect of each intermediate metabolite on IBD risk was separately adjusted for the EPA effect in the MVMR model, presented as β with 95% CI and was shown in Figure 5B. Linoleic acid and histidine showed effects on increasing risk of IBD, although the result for histidine was with a wide confidence interval. Figure 5C displays the proportion of the mediation effect of EPA on IBD explained by each intermediate metabolite separately. Linoleic acid explained 58.33% (95% CI 32.97%, 83.69%) of the total effect of EPA on IBD, while DHA explained 50.00% (95% CI 25.76%, 74.24%). Histidine explained 66.67% (95% CI 43.34%, 90.00%) of the total effect. Given the large proportion of mediation of these intermediate metabolites, the direct effects of EPA on IBD were massively attenuated after conditioning on each of the intermediate metabolites (Figure 5B).

taenoic acid; IBD, inflammatory bowel disease.

The effect of EPA on each intermediate metabolite (linoleic acid, DHA, and histidine) is shown in Figure 5A, higher levels of EPA were associated with lower linoleic acid (β, −0.51; 95% CI −0.91, −0.11), higher DHA (β, 0.61; 95% CI 0.27, 0.95), and lower histidine (β, −0.10; 95% CI −0.17, −0.03). The effect of each intermediate metabolite on IBD risk was separately adjusted for the EPA effect in the MVMR model, presented as β with 95% CI and was shown in Figure 5B. Linoleic acid and histidine showed effects on increasing risk of IBD, although the result for histidine was with a wide confidence interval. Figure 5C displays the proportion of the mediation effect of EPA on IBD explained by each intermediate metabolite separately. Linoleic acid explained 58.33% (95% CI 32.97%, 83.69%) of the total effect of EPA on IBD, while DHA explained 50.00% (95% CI 25.76%, 74.24%). Histidine explained 66.67% (95% CI 43.34%, 90.00%) of the total effect. Given the large propor-

Metabolites

Metabolites 2023, 13, 1041 10 of 16

Figure 5. Estimates for the metabolites that mediated the effect of EPA on the risk of IBD. (A) MRestimated effects of EPA on each intermediate metabolite (linoleic acid, DHA, and histidine) separately, presented as β with 95% CI. (B) MR-estimated effects of each intermediate metabolite separately on IBD after MVMR adjustment for EPA, presented as β with 95% CI. (C) MR-estimated effects of indirect effects of each intermediate metabolite separately, by using the difference of coefficients method with delta method-estimated 95% CIs. MR-estimated proportions mediated (%) are presented with 95% CIs. The sum of proportions mediated (%) were higher than 100%, due to the strong correlation among these intermediate metabolites (linoleic acid, DHA, and histidine). Abbreviations: CI, confidence interval; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; IBD, inflammatory bowel disease; linoleic acid, linoleic acid; MR, Mendelian randomization; MVMR, multivariable Mendelian randomization.

Figure 5. Estimates for the metabolites that mediated the effect of EPA on the risk of IBD. (A) MRestimated effects of EPA on each intermediate metabolite (linoleic acid, DHA, and histidine) separately, presented as β with 95% CI. (B) MR-estimated effects of each intermediate metabolite separately on IBD after MVMR adjustment for EPA, presented as β with 95% CI. (C) MR-estimated effects of indirect effects of each intermediate metabolite separately, by using the difference of coefficients method with delta method-estimated 95% CIs. MR-estimated proportions mediated (%) are presented with 95% CIs. The sum of proportions mediated (%) were higher than 100%, due to the strong correlation among these intermediate metabolites (linoleic acid, DHA, and histidine). Abbreviations: CI, confidence interval; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; IBD, inflammatory bowel disease; linoleic acid, linoleic acid; MR, Mendelian randomization; MVMR, multivariable Mendelian randomization.

4. Discussion

4. Discussion

The present study employed a comprehensive analysis using MR to strengthen the inferences regarding the effects of different omega-3 PUFAs (including total omega-3, αlinolenic acid, EPA, and DHA) on IBD risk. We provided evidence supporting that increased levels of EPA are causally associated with a lower risk of IBD and CD, but the effect on UC is relatively weaker. The mediation MR analysis further suggested that EPA may influence IBD via α-linolenic acid, linoleic acid and methylhistidine metabolism pathways. Linoleic acid and histidine were estimated to mediate the effect of EPA on IBD. However, we found limited evidence to support the effects of total omega-3, α-linolenic acid, and DHA on the risk of IBD. Furthermore, leave-one-out, single-locus, and colocalization analyses indicated that the effects of omega-3 PUFAs on IBD were massively driven by SNP effects in the FADS2 gene region. Therefore, desaturation steps during omega-3 PUFAs’ biosynthesis might play a critical role in the relationship between omega-3 PUFAs and IBD. Meanwhile, higher genetic liability to UC might be associated with lower levels of DHA, potentially indicating a weaker absorption or abnormal metabolism of omega-3 PUFAs in UC. Collectively, our results suggest that supplementation with EPA (rather than α-linolenic acid or DHA) might be a more effective strategy to prevent the onset of IBD, especially CD, rather than UC with high probability of weak absorption or abnormal metabolism on omega-3 PUFAs. These findings shed light on the potential differential impacts of specific omega-3 PUFAs on IBD risk and highlight the importance of considering individual PUFA components in designing prevention strategies for this complex disease.

The present study employed a comprehensive analysis using MR to strengthen the inferences regarding the effects of different omega-3 PUFAs (including total omega-3, αlinolenic acid, EPA, and DHA) on IBD risk. We provided evidence supporting that increased levels of EPA are causally associated with a lower risk of IBD and CD, but the effect on UC is relatively weaker. The mediation MR analysis further suggested that EPA may influence IBD via α-linolenic acid, linoleic acid and methylhistidine metabolism pathways. Linoleic acid and histidine were estimated to mediate the effect of EPA on IBD. However, we found limited evidence to support the effects of total omega-3, α-linolenic acid, and DHA on the risk of IBD. Furthermore, leave-one-out, single-locus, and colocalization analyses indicated that the effects of omega-3 PUFAs on IBD were massively driven by SNP effects in the FADS2 gene region. Therefore, desaturation steps during omega-3 PUFAs’ biosynthesis might play a critical role in the relationship between omega-3 PUFAs and IBD. Meanwhile, higher genetic liability to UC might be associated with lower levels of DHA, potentially indicating a weaker absorption or abnormal metabolism of omega-3 PUFAs in UC. Collectively, our results suggest that supplementation with EPA (rather than α-linolenic acid or DHA) might be a more effective strategy to prevent the onset of IBD, especially CD, rather than UC with high probability of weak absorption or abnormal metabolism on omega-3 PUFAs. These findings shed light on the potential differential

Previous systematic reviews and meta-analysis of RCTs have not yielded firm recommendations regarding the usefulness of omega-3 PUFAs in treating IBD [29,30]. In a study that included 19 RCTs, the results showed no significant benefits of omega-3 PUFA supplementation in maintaining remission of disease [29]. Another study of 9 RCTs, found insufficient data to support the routine use of omega-3 fatty acids for the maintenance of remission in CD and UC [30]. Similarly, a prospective investigation in the Nurses’ Health Study cohort reported that the risk of IBD was not influenced by long-term intake of omega3 PUFAs [31]. Meanwhile, our findings showed weak evidence of protective effects of genetically predicted higher total omega-3 fatty acid against the risk of IBD and its subtypes (both CD and UC) by using MR analysis. In spite of the known anti-inflammatory properties of omega-3 PUFAs, attributed to their ability to reduce the production of cytokines [32,33] and C-reactive protein (CRP) [34], the available data provided less convincing evidence to support the use of omega-3 PUFAs in the prevention or treatment of IBD. One plausible explanation for these findings is that total omega-3 fatty acid comprises various fatty acids with different carbon chain lengths, bond saturation, and diverse biochemical mechanisms [35]. This complexity may lead to an overall effect of total omga-3 fatty acid that is diminished or challenging to decipher in relation to IBD and its subtypes. Hence, the specific roles and effects of individual omega-3 PUFAs, such as EPA and DHA, need to be explored more comprehensively to understand their potential benefits in IBD management.

α-linolenic acid serves as a substrate for other essential omega-3 PUFAs in the body. In our study, genetically predicted α-linolenic acid levels showed a trend toward an increased risk of IBD, although the statistical power of the analysis was relatively low. Observational studies have also provided inconclusive evidence regarding the relationship between α-linolenic acid and IBD. For instance, a case-control study has reported higher dietary αlinolenic acid intakes in newly diagnosed UC patients compared with healthy controls [12]. However, in consistent with our findings, previous studies did not find any association between higher dietary intake of α-linolenic acid and an increased risk of IBD [36,37]. Well powered studies are needed to investigate the effect of α-linolenic acid on IBD and other autoimmune diseases in the future.

EPA and DHA are the main components of long-chain omega-3 fatty acids, which are derived from α-linolenic acid through a series of elongation and desaturation steps and βoxidation. The beneficial effects of EPA and DHA have been investigated as a combination or as part of omega-3 supplementation in observational studies and experimental trials. However, the distinct effects of EPA and DHA on the risk of IBD have been relatively unexplored. In our study, we conducted separate evaluations and found evidence suggesting that increased levels of EPA were associated with a lower risk of IBD and CD.

Interestingly, our findings indicate that EPA might play a more important role than DHA in relation to IBD risk. Although direct comparative studies on the effects of EPA and DHA on IBD risk are limited, other research has provided insights that align with our results [38]. In twenty-one asthmatic adults, EPA reduced the production of interleukin1b and tumor necrosis factor from alveolar macrophages to a much greater extent than DHA [39]. Meanwhile, the Cardiovascular Health Study reported that plasma phospholipid EPA, but not DHA, was associated with lower concentrations of CRP [40]. These findings, when integrated with our results, suggest that EPA may be more relevant for prevention of IBD.

We further demonstrated that the protective effect of EPA on risk of IBD was mainly influenced by α-linolenic acid, linoleic acid, and methylhistidine metabolism pathways. These findings are consistent with a previous study that has indicated that krill oil, rich in omega-3 PUFAs, exerts an inhibitory effect on histidine metabolism, leading to attenuated intestinal inflammation [41]. Moreover, significantly increased levels of histidine have been found in IBD patients compared to controls, which implied an association between histidine and an increased risk of IBD [42]. Therefore, EPA might reduce IBD risk through the regulation of histidine levels. Additionally, since there is competition for shared enzymes and metabolic substrates in the synthesis of omega-3 and omega-6 PUFAs, EPA

might also influence the levels of linoleic acid. A previous study indicated that higher levels of linoleic acid, which are involved in the production of proinflammatory mediators, were found in IBD patients compared with controls, thereby implicating an increased risk of IBD [43]. Lower levels of linoleic acid might mediate the protective effects of EPA and IBD. In this study, we showed the causal effects of EPA on α-linolenic acid, linoleic acid, and methylhistidine metabolic pathways and three key metabolites (DHA, linoleic acid, and histidine). These results provide valuable insights into the metabolic mechanism through which EPA influences IBD risk.

Collectively, the increased risk of IBD is primarily associated with higher levels of α-linolenic acid or lower levels of EPA, as the differences in desaturation steps driven by the FADS2 gene will lead to changes in both upstream α-linolenic acid and downstream EPA concentrations [7]. Thus, the role of the FADS2 gene is crucial and merits further investigation.

Our study also revealed a massive influence of FADS2 variants on IBD and CD, but not on UC. Furthermore, we found robust colocalization evidence between omega-3 PUFAs and CD in the FADS2 gene region, but little colocalization evidence for UC. These findings suggest that the key link between omega-3 PUFAs and IBD is driven by effects in the FADS2 gene cluster. Several lines of evidence support our observations and indicate that the FADS2 gene is associated with inflammation [44] and CD risk [45,46]. For instance, the FADS2 gene regulated immune functions and showed colocalization evidence on PUFAs and CD (posterior probability = 0.94) [45]. In addition, integrated data from metabolomics profiling and experiments revealed the role of FADS2 against chronic inflammation among CD patients [47]. Therefore, FADS2 is a crucial gene linking omega-3 PUFAs and IBD risk, particularly in the case of CD.

Despite the protective role on CD, our study provided little evidence to support the effect of omega-3 PUFAs on UC risk. Previous epidemiological studies also indicated that an increasing dietary intake of EPA or DHA had no association with a decreased risk or maintenance of remission in UC [37,48]. It is possible that inadequate supplementation or absorption resulted in lower concentrations of fatty acids in UC patients, thereby limiting their ability to trigger protective effects. For example, the inflamed colonic mucosa of patients with UC was linked to a significant decrease in EPA [49]. Similarly, a significant reduction in DHA derivatives was observed in active inflammatory UC [50]. As our bidirectional MR analysis showed, genetic liability to UC had an effect on decreased concentrations of DHA. Therefore, whether it is rational for UC patients to increase supplementation of fish oil or enhance intestinal absorption ability is worth further investigation. In contrast, He et al. recently reported that total omega-3 fatty acid had no causal effect on CD, but decreased UC risk using MR [15]. We believe the discrepant association observed for UC in our study compared with theirs was partly driven by the different instrument selection process. After applying a similar instrument selection as our study, He et al. further eliminated SNPs associated with potential confounders between total omega-3 fatty acid and outcomes. This selection process eliminated over half of the genetic variants from the instrument list for total omega-3 fatty acid. He et al. claimed that this selection was used to satisfy the second assumption of MR (exchangeability). However, this assumption suggested that the instruments are not associated with common causes (confounders) of the instrument–outcome association. MR estimates are generally less susceptible to confounders because human DNA is stable across the life course. Therefore, excluding SNPs associated with confounders between total omega-3 and IBD (e.g., body mass index) will reduce the power of the analysis rather than satisfying the exchangeability assumption of MR. In fact, such an overly stringent selection resulted in the deprivation of genetic variants in the FADS2 region. As mentioned above, the FADS gene cluster plays a central role on PUFAs’ metabolism, where genetic effects in the FADS2 region massively influenced the MR estimates of omega-3 PUFAs on IBD and its subtypes. The effects of total omega-3 fatty acid were found to potentially increase IBD risks after removing the FADS2 instrument (Figure S2). In summary, the previously reported effect of total omega-3 fatty acid on a

lower risk of UC was methodologically arguable and did not align with the evidence from our MR study and other observational studies.

There were several strengths of the present study. First, our study comprehensively explored the causal effects of the different components of omega-3 PUFAs on IBD risk by using a robust MR setting, which reduced bias from residual confounding and excluded reverse causality. Current data contributed to produce informed recommendations based on the relative importance of EPA in preventing IBD. Second, our investigation of the metabolic pathways involving linoleic acid and histidine metabolites provided valuable insights into the mechanisms underlying the effect of EPA on IBD risk, which may have implications for future clinical practice. Third, our findings suggest that supplementation policies should consider the different subtypes of IBD, as EPA demonstrated a significant effect on reducing the risk of CD but not UC, and genetic liability to UC was associated with lower concentrations of DHA. Additionally, we used colocalization methods to thoroughly explore the possibility of a single shared effect signal in the FADS2 gene region, thus validating the underlying mechanism linking omega-3 PUFAs with CD.

However, there were some limitations that should be considered when interpreting our findings. First, we used different data sources for the exposure variables. The genetic instruments for total omega-3 were obtained from the UK Biobank study, while instruments for α-linolenic acid, EPA, and DHA were derived from the CHARGE Consortium. Although both datasets involved participants with European ancestry, there could still be potential biases introduced by using different sources. Second, we assumed that the relationships between omega-3 fatty acids and IBD risk were linear. Non-linear relationships were not taken into consideration and further investigation is needed to explore potential non-linear effects. Finally, although we used univariable MR analyses to estimate the effect of each fatty acid, we were unable to directly estimate the effect of EPA-to-DHA ratio. The EPA-toDHA ratio is considered important in the clinical application of fish oil, and its potential impact on IBD risk merits further exploration.

5. Conclusions

In conclusion, our comprehensive MR analyses identified that EPA was the key component among the omega-3 PUFAs that may exhibit a protective effect on IBD and CD, but not on UC. There was little evidence to support the effect of total omega-3, α-linolenic acid, or DHA on IBD risks. We also provided novel insights into the underlying mechanisms of EPA, which may influence IBD via α-linolenic acid, linoleic acid and methylhistidine metabolic pathways. Furthermore, the FADS2 gene is likely to be a core gene that mediates the effects of omega-3 PUFAs on IBD risk. Based on these findings, our study recommended the supplementation or dietary intake of EPA, rather than α-linolenic acid or DHA, might be beneficial for preventing the onset of IBD. The proposed mediators have provided novel insights into the underlying mechanisms of EPA. More well powered epidemiological studies and clinical trials are needed to explore the potential benefits of high EPA concentration or EPA/DHA in IBD and its subtypes. Moreover, further research is needed to investigate the role of histidine metabolites in the context of IBD.

Supplementary Materials: The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/metabo13101041/s1, Figure S1: Selection process for the data included in the study; Figure S2: Leave one out plots of the causal effects of omega-3 polyunsaturated fatty acids on inflammatory bowel disease, Crohn’s disease, and ulcerative colitis showing inverse variance weighted estimates after omitting each SNP; Table S1: Data sources of genome-wide association studies included in the Mendelian randomization analysis; Table S2: Statistics used to assess instrument strength; Table S3: Sensitivity analyses used to assess causal effects of omega-3 polyunsaturated fatty acids on the risk of Crohn’s disease, and ulcerative colitis.

Author Contributions: Conceptualization, J.L., Y.B. and J.Z.; formal analysis, X.J., C.H. and X.W.; writing—original draft preparation, X.J.; writing—review and editing, H.Q., L.L., M.X., Y.X., T.W., Z.Z., Y.C., M.L., R.Z., H.L., S.W., W.W., J.Z. and J.L. All authors have read and agreed to the published version of the manuscript.

Funding: This research was funded by the National Natural Science Foundation of China (grant numbers 81930021, 81970728, 81970691, 82170819, 82370810, and 21904084); Shanghai Outstanding Academic Leaders Plan (grant number 20XD1422800); Shanghai Medical and Health Development Foundation (grant number DMRFP_I_01); Clinical Research Plan of SHDC (grant numbers SHDC2020CR3064B and SHDC2020CR1001A); Science and Technology Committee of Shanghai (grant numbers 20Y11905100 and 19411964200); Clinical Research Project of Shanghai Municipal Health Commission (grant number 20214Y0002); Ministry of Science and Technology of China (grant number 2022YFC2505202); and Innovative research team of high-level local universities in Shanghai. J.Z. was funded by the Academy of Medical Sciences (AMS) Springboard Award; the Wellcome Trust; the Government Department of Business; Energy and Industrial Strategy (BEIS); the British Heart Foundation and Diabetes UK (grant number SBF006\1117); and the Vice-Chancellor Fellowship from the University of Bristol.

Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable.

Data Availability Statement: The summary statistics of total omega-3 fatty acid were obtained from UK Biobank study at https://doi.org/10.1186/s12916-022-02399-w, accessed on 6 November 2022, and instruments for α-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid were derived from Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium at https://www. chargeconsortium.com/main/results, accessed on 6 November 2022. Genetic association estimates for inflammatory bowel disease were obtained from the study by the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC) at https://doi.org/10.1038/ng.3760, accessed on 6 November 2022. The full summary statistics of the circulating metabolites were derived from the IEU OpenGWAS database at https://gwas.mrcieu.ac.uk/, accessed on 6 November 2022.

Acknowledgments: The authors thank all investigators for the publicly available summary data. Conflicts of Interest: The authors declare no conflict of interest.

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Figures

Figure 1

Study design overview for a Mendelian randomization analysis evaluating the causal effects of omega-3 polyunsaturated fatty acids on inflammatory bowel disease through circulating metabolite mediators.

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Figure 2

Directed acyclic graph or causal framework illustrating the mediation Mendelian randomization approach used to assess omega-3 PUFA effects on IBD via circulating metabolites.

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Figure 3

Primary Mendelian randomization results showing the estimated causal effect of omega-3 PUFA supplementation on inflammatory bowel disease risk, addressing conflicting epidemiological evidence.

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Figure 4

Mediation analysis results identifying circulating metabolites that may mediate the relationship between omega-3 polyunsaturated fatty acids and inflammatory bowel disease outcomes.

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Figure 5

Publication metadata for the omega-3 PUFA and IBD Mendelian randomization study, received August 2023 and published September 2023 in Metabolites.

Figure 6

Supplementary Mendelian randomization analysis (Figure 6) examining specific omega-3 fatty acid subtypes or individual metabolite pathways in relation to inflammatory bowel disease susceptibility.

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Figure 7

Supplementary Mendelian randomization analysis (Figure 7) examining specific omega-3 fatty acid subtypes or individual metabolite pathways in relation to inflammatory bowel disease susceptibility.

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Figure 8

Supplementary Mendelian randomization analysis (Figure 8) examining specific omega-3 fatty acid subtypes or individual metabolite pathways in relation to inflammatory bowel disease susceptibility.

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Figure 9

Supplementary Mendelian randomization analysis (Figure 9) examining specific omega-3 fatty acid subtypes or individual metabolite pathways in relation to inflammatory bowel disease susceptibility.

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Figure 10

Supplementary Mendelian randomization analysis (Figure 10) examining specific omega-3 fatty acid subtypes or individual metabolite pathways in relation to inflammatory bowel disease susceptibility.

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Figure 11

Sensitivity analysis plot (Figure 11) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 12

Sensitivity analysis plot (Figure 12) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 13

Sensitivity analysis plot (Figure 13) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 14

Sensitivity analysis plot (Figure 14) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 15

Sensitivity analysis plot (Figure 15) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 16

Sensitivity analysis plot (Figure 16) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 17

Sensitivity analysis plot (Figure 17) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 18

Sensitivity analysis plot (Figure 18) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 19

Sensitivity analysis plot (Figure 19) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 20

Sensitivity analysis plot (Figure 20) from the omega-3 PUFA and IBD Mendelian randomization study, testing the robustness of causal estimates under different analytical assumptions.

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Figure 21

Forest plot or scatter plot (Figure 21) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 22

Forest plot or scatter plot (Figure 22) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 23

Forest plot or scatter plot (Figure 23) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 24

Forest plot or scatter plot (Figure 24) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 25

Forest plot or scatter plot (Figure 25) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 26

Forest plot or scatter plot (Figure 26) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 27

Forest plot or scatter plot (Figure 27) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 28

Forest plot or scatter plot (Figure 28) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 29

Forest plot or scatter plot (Figure 29) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 30

Forest plot or scatter plot (Figure 30) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 31

Forest plot or scatter plot (Figure 31) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 32

Forest plot or scatter plot (Figure 32) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 33

Forest plot or scatter plot (Figure 33) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 34

Forest plot or scatter plot (Figure 34) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 35

Forest plot or scatter plot (Figure 35) presenting individual SNP-level estimates for the association between genetically predicted omega-3 PUFA levels and inflammatory bowel disease risk.

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Figure 36

Leave-one-out or funnel plot analysis (Figure 36) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 37

Leave-one-out or funnel plot analysis (Figure 37) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 38

Leave-one-out or funnel plot analysis (Figure 38) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 39

Leave-one-out or funnel plot analysis (Figure 39) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 40

Leave-one-out or funnel plot analysis (Figure 40) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 41

Leave-one-out or funnel plot analysis (Figure 41) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 42

Leave-one-out or funnel plot analysis (Figure 42) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 43

Leave-one-out or funnel plot analysis (Figure 43) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 44

Leave-one-out or funnel plot analysis (Figure 44) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 45

Leave-one-out or funnel plot analysis (Figure 45) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 46

Leave-one-out or funnel plot analysis (Figure 46) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 47

Leave-one-out or funnel plot analysis (Figure 47) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 48

Leave-one-out or funnel plot analysis (Figure 48) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 49

Leave-one-out or funnel plot analysis (Figure 49) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 50

Leave-one-out or funnel plot analysis (Figure 50) assessing potential pleiotropy and outlier influence in the omega-3 PUFA and IBD Mendelian randomization framework.

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Figure 51

Metabolite-specific mediation result (Figure 51) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 52

Metabolite-specific mediation result (Figure 52) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 53

Metabolite-specific mediation result (Figure 53) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 54

Metabolite-specific mediation result (Figure 54) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 55

Metabolite-specific mediation result (Figure 55) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 56

Metabolite-specific mediation result (Figure 56) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 57

Metabolite-specific mediation result (Figure 57) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 58

Metabolite-specific mediation result (Figure 58) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 59

Metabolite-specific mediation result (Figure 59) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 60

Metabolite-specific mediation result (Figure 60) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 61

Metabolite-specific mediation result (Figure 61) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 62

Metabolite-specific mediation result (Figure 62) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 63

Metabolite-specific mediation result (Figure 63) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 64

Metabolite-specific mediation result (Figure 64) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 65

Metabolite-specific mediation result (Figure 65) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 66

Metabolite-specific mediation result (Figure 66) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 67

Metabolite-specific mediation result (Figure 67) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 68

Metabolite-specific mediation result (Figure 68) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 69

Metabolite-specific mediation result (Figure 69) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 70

Metabolite-specific mediation result (Figure 70) quantifying the proportion of the omega-3 PUFA effect on IBD that operates through a particular circulating metabolite pathway.

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Figure 71

Subgroup or stratified analysis (Figure 71) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 72

Subgroup or stratified analysis (Figure 72) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 73

Subgroup or stratified analysis (Figure 73) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 74

Subgroup or stratified analysis (Figure 74) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 75

Subgroup or stratified analysis (Figure 75) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 76

Subgroup or stratified analysis (Figure 76) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 77

Subgroup or stratified analysis (Figure 77) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 78

Subgroup or stratified analysis (Figure 78) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 79

Subgroup or stratified analysis (Figure 79) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 80

Subgroup or stratified analysis (Figure 80) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 81

Subgroup or stratified analysis (Figure 81) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 82

Subgroup or stratified analysis (Figure 82) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 83

Subgroup or stratified analysis (Figure 83) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 84

Subgroup or stratified analysis (Figure 84) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 85

Subgroup or stratified analysis (Figure 85) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 86

Subgroup or stratified analysis (Figure 86) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 87

Subgroup or stratified analysis (Figure 87) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 88

Subgroup or stratified analysis (Figure 88) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 89

Subgroup or stratified analysis (Figure 89) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 90

Subgroup or stratified analysis (Figure 90) from the Mendelian randomization study, examining omega-3 PUFA effects separately for Crohn's disease and ulcerative colitis.

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Figure 91

Supplementary statistical plot (Figure 91) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 92

Supplementary statistical plot (Figure 92) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 93

Supplementary statistical plot (Figure 93) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 94

Supplementary statistical plot (Figure 94) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 95

Supplementary statistical plot (Figure 95) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 96

Supplementary statistical plot (Figure 96) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 97

Supplementary statistical plot (Figure 97) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 98

Supplementary statistical plot (Figure 98) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 99

Supplementary statistical plot (Figure 99) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 100

Supplementary statistical plot (Figure 100) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 101

Supplementary statistical plot (Figure 101) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 102

Supplementary statistical plot (Figure 102) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 103

Supplementary statistical plot (Figure 103) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 104

Supplementary statistical plot (Figure 104) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 105

Supplementary statistical plot (Figure 105) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 106

Supplementary statistical plot (Figure 106) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 107

Supplementary statistical plot (Figure 107) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 108

Supplementary statistical plot (Figure 108) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 109

Supplementary statistical plot (Figure 109) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 110

Supplementary statistical plot (Figure 110) providing additional evidence on the causal pathway between omega-3 polyunsaturated fatty acids and inflammatory bowel disease through circulating metabolites.

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Figure 111

Extended analysis figure (Figure 111) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 112

Extended analysis figure (Figure 112) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 113

Extended analysis figure (Figure 113) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 114

Extended analysis figure (Figure 114) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 115

Extended analysis figure (Figure 115) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 116

Extended analysis figure (Figure 116) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 117

Extended analysis figure (Figure 117) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 118

Extended analysis figure (Figure 118) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 119

Extended analysis figure (Figure 119) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 120

Extended analysis figure (Figure 120) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 121

Extended analysis figure (Figure 121) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 122

Extended analysis figure (Figure 122) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 123

Extended analysis figure (Figure 123) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 124

Extended analysis figure (Figure 124) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 125

Extended analysis figure (Figure 125) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 126

Extended analysis figure (Figure 126) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 127

Extended analysis figure (Figure 127) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 128

Extended analysis figure (Figure 128) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 129

Extended analysis figure (Figure 129) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 130

Extended analysis figure (Figure 130) from the omega-3 PUFA and IBD study, presenting results for additional metabolite mediators or alternative instrument variable selections.

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Figure 131

Robustness check (Figure 131) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 132

Robustness check (Figure 132) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 133

Robustness check (Figure 133) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 134

Robustness check (Figure 134) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 135

Robustness check (Figure 135) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 136

Robustness check (Figure 136) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 137

Robustness check (Figure 137) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 138

Robustness check (Figure 138) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 139

Robustness check (Figure 139) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 140

Robustness check (Figure 140) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 141

Robustness check (Figure 141) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 142

Robustness check (Figure 142) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 143

Robustness check (Figure 143) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 144

Robustness check (Figure 144) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 145

Robustness check (Figure 145) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 146

Robustness check (Figure 146) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 147

Robustness check (Figure 147) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 148

Robustness check (Figure 148) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 149

Robustness check (Figure 149) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 150

Robustness check (Figure 150) from the mediation Mendelian randomization analysis, validating the omega-3 PUFA and IBD causal pathway using weighted median or MR-Egger methods.

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Figure 151

Metabolomic pathway visualization (Figure 151) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 152

Metabolomic pathway visualization (Figure 152) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 153

Metabolomic pathway visualization (Figure 153) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 154

Metabolomic pathway visualization (Figure 154) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 155

Metabolomic pathway visualization (Figure 155) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 156

Metabolomic pathway visualization (Figure 156) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 157

Metabolomic pathway visualization (Figure 157) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 158

Metabolomic pathway visualization (Figure 158) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 159

Metabolomic pathway visualization (Figure 159) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 160

Metabolomic pathway visualization (Figure 160) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 161

Metabolomic pathway visualization (Figure 161) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 162

Metabolomic pathway visualization (Figure 162) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 163

Metabolomic pathway visualization (Figure 163) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 164

Metabolomic pathway visualization (Figure 164) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 165

Metabolomic pathway visualization (Figure 165) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 166

Metabolomic pathway visualization (Figure 166) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 167

Metabolomic pathway visualization (Figure 167) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 168

Metabolomic pathway visualization (Figure 168) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 169

Metabolomic pathway visualization (Figure 169) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 170

Metabolomic pathway visualization (Figure 170) mapping the intermediary role of specific circulating metabolites in the omega-3 PUFA and inflammatory bowel disease relationship.

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Figure 171

Additional MR analysis (Figure 171) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 172

Additional MR analysis (Figure 172) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 173

Additional MR analysis (Figure 173) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 174

Additional MR analysis (Figure 174) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 175

Additional MR analysis (Figure 175) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 176

Additional MR analysis (Figure 176) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 177

Additional MR analysis (Figure 177) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 178

Additional MR analysis (Figure 178) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 179

Additional MR analysis (Figure 179) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 180

Additional MR analysis (Figure 180) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 181

Additional MR analysis (Figure 181) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 182

Additional MR analysis (Figure 182) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 183

Additional MR analysis (Figure 183) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 184

Additional MR analysis (Figure 184) exploring dose-response relationships or nonlinear effects of omega-3 PUFA levels on IBD risk.

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Figure 185

Regional association plot (Figure 185) showing genetic loci associated with omega-3 fatty acid levels, including alpha-linolenic, eicosapentaenoic, and docosahexaenoic acids in relation to Crohn's disease and ulcerative colitis.

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Figure 186

Supplementary figure (Figure 186) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 187

Supplementary figure (Figure 187) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 188

Supplementary figure (Figure 188) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 189

Supplementary figure (Figure 189) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 190

Supplementary figure (Figure 190) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 191

Supplementary figure (Figure 191) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 192

Supplementary figure (Figure 192) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 193

Supplementary figure (Figure 193) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 194

Supplementary figure (Figure 194) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 195

Supplementary figure (Figure 195) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 196

Supplementary figure (Figure 196) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 197

Supplementary figure (Figure 197) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 198

Supplementary figure (Figure 198) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 199

Supplementary figure (Figure 199) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 200

Supplementary figure (Figure 200) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 201

Supplementary figure (Figure 201) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 202

Supplementary figure (Figure 202) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 203

Supplementary figure (Figure 203) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 204

Supplementary figure (Figure 204) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 205

Supplementary figure (Figure 205) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 206

Supplementary figure (Figure 206) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 207

Supplementary figure (Figure 207) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 208

Supplementary figure (Figure 208) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 209

Supplementary figure (Figure 209) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 210

Supplementary figure (Figure 210) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 211

Supplementary figure (Figure 211) from a comprehensive Mendelian randomization study with over 200 analyses examining omega-3 polyunsaturated fatty acid effects on inflammatory bowel disease via circulating metabolite mediators.

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Figure 212

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 213

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

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Figure 214

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 215

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 216

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 217

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 218

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

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Figure 219

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 220

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 221

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 222

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 223

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

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Figure 224

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 225

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 226

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 227

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 228

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 229

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 230

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 231

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 232

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 233

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

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Figure 234

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 235

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 236

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 237

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 238

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 239

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 240

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 241

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 242

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 243

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 244

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 245

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 246

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 247

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 248

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 249

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 250

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 251

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 252

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

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Figure 253

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

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Figure 254

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

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Figure 255

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

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Figure 256

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

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Figure 257

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 258

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 259

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 260

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 261

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 262

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 263

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 264

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 265

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 266

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 267

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 268

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 269

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 270

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 271

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 272

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 273

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 274

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 275

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 276

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 277

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 278

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 279

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 280

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 281

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 282

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 283

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 284

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 285

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 286

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 287

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 288

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 289

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 290

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 291

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 292

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 293

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 294

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 295

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 296

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 297

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 298

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 299

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 300

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 301

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 302

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 303

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 304

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 305

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 306

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 307

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 308

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 309

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 310

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 311

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 312

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 313

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 314

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 315

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 316

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 317

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 318

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 319

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 320

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 321

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 322

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 323

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 324

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 325

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 326

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 327

Scatter plot depicting the causal effect estimates of individual genetic instruments for alpha-linolenic acid (ALA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 328

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of alpha-linolenic acid (ALA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 329

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of alpha-linolenic acid (ALA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 330

Leave-one-out sensitivity analysis for the causal relationship between alpha-linolenic acid (ALA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 331

Mediation analysis diagram illustrating the potential pathway through which alpha-linolenic acid (ALA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 332

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 333

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 334

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 335

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 336

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 337

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 338

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 339

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 340

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 341

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 342

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 343

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 344

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 345

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 346

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 347

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 348

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 349

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 350

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 351

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 352

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 353

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 354

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 355

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 356

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 357

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 358

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 359

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 360

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 361

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 362

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 363

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 364

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 365

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 366

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 367

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 368

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 369

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 370

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 371

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 372

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 373

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 374

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 375

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 376

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 377

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 378

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 379

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 380

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 381

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 382

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 383

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 384

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 385

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 386

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 387

Scatter plot depicting the causal effect estimates of individual genetic instruments for eicosapentaenoic acid (EPA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 388

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of eicosapentaenoic acid (EPA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 389

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 390

Leave-one-out sensitivity analysis for the causal relationship between eicosapentaenoic acid (EPA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 391

Mediation analysis diagram illustrating the potential pathway through which eicosapentaenoic acid (EPA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 392

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 393

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 394

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 395

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 396

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 397

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 398

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 399

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 400

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 401

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 402

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 403

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 404

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 405

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 406

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 407

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 408

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on inflammatory bowel disease (IBD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 409

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 410

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and inflammatory bowel disease (IBD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 411

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence inflammatory bowel disease (IBD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 412

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 413

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 414

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 415

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 416

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 417

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 418

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 419

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 420

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 421

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 422

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 423

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 424

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 425

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 426

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 427

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on Crohn's disease (CD), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 428

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on Crohn's disease (CD). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 429

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and Crohn's disease (CD). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 430

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and Crohn's disease (CD). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 431

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence Crohn's disease (CD) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 432

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 433

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 434

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 435

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 436

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 437

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 438

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 439

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 440

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 441

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 442

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 443

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 444

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 445

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 446

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 447

Scatter plot depicting the causal effect estimates of individual genetic instruments for docosahexaenoic acid (DHA) on ulcerative colitis (UC), assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 448

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of docosahexaenoic acid (DHA) on ulcerative colitis (UC). Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 449

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of docosahexaenoic acid (DHA) and ulcerative colitis (UC). Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 450

Leave-one-out sensitivity analysis for the causal relationship between docosahexaenoic acid (DHA) and ulcerative colitis (UC). Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 451

Mediation analysis diagram illustrating the potential pathway through which docosahexaenoic acid (DHA) may influence ulcerative colitis (UC) risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 452

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on IBD and its subtypes, assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 453

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on IBD and its subtypes. Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 454

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and IBD and its subtypes. Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

Figure 455

Leave-one-out sensitivity analysis for the causal relationship between total omega-3 fatty acids and IBD and its subtypes. Sequentially removing each genetic instrument and recalculating the pooled estimate indicates the robustness of the overall finding to any single influential variant.

chart

Figure 456

Mediation analysis diagram illustrating the potential pathway through which total omega-3 fatty acids may influence IBD and its subtypes risk via circulating metabolites. Direct and indirect effects are quantified using two-step Mendelian randomization, highlighting metabolites that may partially mediate the observed association.

diagram

Figure 457

Scatter plot depicting the causal effect estimates of individual genetic instruments for total omega-3 fatty acids on IBD and its subtypes, assessed using Mendelian randomization. Each point represents a single SNP, with the slope reflecting the overall causal estimate.

chart

Figure 458

Forest plot summarizing the individual and pooled Mendelian randomization estimates for the effect of total omega-3 fatty acids on IBD and its subtypes. Each horizontal line represents the causal estimate from a single genetic variant, with the diamond indicating the combined effect across multiple MR methods.

forest_plot

Figure 459

Funnel plot evaluating potential directional pleiotropy in the Mendelian randomization analysis of total omega-3 fatty acids and IBD and its subtypes. Asymmetry in the distribution of individual SNP estimates around the overall effect size may indicate the presence of pleiotropic bias.

chart

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