Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries

Deepa, Mohan; Mente, Andrew; Dehghan, Mahshid; Rangarajan, Sumathy; O’Donnell, Martin; Hu, Weihong; Dagenais, Gilles R.; Wielgosz, Andreas; Lear, Scott A.; Li, Wei; Dı́az, Rafael; Avezum, Álvaro; López‐Jaramillo, Patricio; Lanas, Fernando; Swaminathan, Sumathi; Kaur, Manmeet; Vijayakumar, K.; Mohan, Viswanathan; Gupta, Rajeev; Szuba, Andrzej; Iqbal, Romaina; Yusuf, Rita; Mohammadifard, Noushin; Khatib, Rasha; Yusoff, Khalid; Güleç, Sadi; Rosengren, Annika; Yusufali, Afzalhussein; Wentzel-Viljoen, Edelweiss; Chifamba, Jephat; Dans, Antonio L.; Alhabib, Khalid F; Yeates, Karen; Teo, Koon; Gerstein, Hertzel C.; Yusuf, Salim; Pure, Ontarget; Investigators, Origin Trial

doi:10.1001/jamainternmed.2021.0036

Cited by 88 publications

(85 citation statements)

References 49 publications

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“…As in the present analysis, several large cohort studies have not been able to show any reduced mortality linked to frequent sh consumption (47,48). In line with our results, Engeset et al found a non-linear trend with fatty sh consumption and mortality in the European Prospective investigation into Cancer and Nutrition cohort, which included a part of our sample (48).…”

Section: Discussionsupporting

confidence: 86%

Moderate Consumption of Healthy Nordic Foods is Associated with Reduced Mortality in the Norwegian Women and Cancer Study: a Prospective Cohort Study

Jensen

Braaten

Jacobsen

et al. 2021

Preprint

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BackgroundHigh adherence to healthy Nordic diets may enhance longevity. However, optimal intake levels of healthy Nordic foods are not known. Hence, in a large prospective cohort of women in Norway we examined all-cause mortality in relation to intake of five food groups that are part of a healthy Nordic diet: Nordic fruits and vegetables, fatty fish, lean fish, wholegrain products, and low-fat dairy products. MethodsA total of 87 899 women who completed a food frequency questionnaire between 1996 and 2004 were followed for mortality until the end of 2018. Cox proportional hazards regression models were used to examine the associations between consumption of the Nordic food groups and all-cause mortality. The food groups were examined as categorical exposures, and all but wholegrain products also as continuous exposures in restricted cubic spline models.Results A total of 9 168 women died during the 20-year follow-up. Nordic fruits and vegetables, fatty fish and low-fat dairy products were not linearly associated with mortality (p < 0.05). The optimal intake levels and hazard ratios (HR) and 95% confidence intervals (CI) associated with these intakes were approximately 200 grams/day of Nordic fruits and vegetables (HR 0.84 (95% CI: 0.77–0.90)), 10–20 grams/day of fatty fish (HR 0.98 (95% CI: 0.92–1.03)) and 200 grams/day of low-fat dairy products (HR 0.94 (95% CI: 0.89–0.99)) compared to no consumption. High consumption of fatty fish (≥ 70 grams/day) was associated with increased mortality. Intake of wholegrain products of >120 grams/day was associated with lower mortality (HR 0.92 (95% CI: 0.85–0.99)) compared to < 60 grams per day. Lean fish consumption was not associated with mortality. After stratification by smoking status, the observed association for Nordic fruits and vegetables was only significant in ever smokers with the optimal intake level at 250 grams/day (HR 0.78 (95% CI: 0.71-0.86)).Conclusion Moderate intake of healthy Nordic foods seems to be better than low or high intake, and high consumption either does not add any beneficial effects or can compromise longevity. Stronger inverse associations for Nordic fruits and vegetables were observed in former and current smokers.

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Section: Discussionsupporting

confidence: 86%

Moderate Consumption of Healthy Nordic Foods is Associated with Reduced Mortality in the Norwegian Women and Cancer Study: a Prospective Cohort Study

Jensen

Braaten

Jacobsen

et al. 2021

Preprint

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“…After screening the title and abstract, forty-five studies were selected for full-text evaluation. By full-text examination, twenty-five articles were eventually included for data synthesis with 2,027,512 participants and 103,734 CVD deaths [ 11 , 13 , 14 , 15 , 16 , 17 , 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies, involving 1,267,951 participants and 51,628 CVD deaths, investigated the association between the fish intake and the CVD mortality risk [ 13 , 14 , 15 , 16 , 17 , 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 40 ]. The pooled RR (95% CI) was 0.91 (0.85–0.98) for the highest versus the lowest fish consumption category (I 2 = 70.0%) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Figure 3 a showed the linear and non-linear dose-response analyses between the fish intake and the CVD mortality risk. Ten prospective cohort studies met the requirements for dose-response analysis [ 13 , 15 , 16 , 17 , 18 , 23 , 27 , 29 , 33 , 40 ], and the curvilinear correlation presented a downward trend for the adjusted RR of CVD deaths with the increase of fish consumption from zero to 40 g/d ( p non-linearity < 0.001). The adjusted RR reached a steady value when fish consumption increased beyond 40 g/d.…”

Section: Resultsmentioning

confidence: 99%

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Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

et al. 2021

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Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

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“…Both food items have been independently associated with cardiovascular protection [ 40 , 41 ]. On one hand, a recent pooled analysis of data from four cohort studies indicates that a minimal fish intake of 175 g weekly is associated with lower risk of major CVD and mortality, specifically among patients with prior CVD [ 42 ]. These data are in line with the favorable effects of fish intake on CV outcomes observed in the only interventional study carried out so far, to the best of our knowledge, in patients with overt CVD [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Mediterranean Diet or Low-Fat Diet on Blood Fatty Acids in Patients with Coronary Heart Disease. A Randomized Intervention Study

et al. 2021

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The Mediterranean diet (MD) prevents cardiovascular disease by different putative mechanisms, including modifications in the blood fatty acid (FA) profile. Polytherapy for secondary cardiovascular prevention might mask the effect of MD on the FA profile. This study was aimed to assess whether MD, in comparison with a low-fat diet (LFD), favorably modifies the blood FA profile in patients with coronary heart disease (CHD) on polytherapy. One hundred and twenty patients with a recent history of coronary stenting, randomized to MD or to LFD, completed 3 months of this open-label dietary intervention study. Diet Mediterranean-ness was evaluated using the Mediterranean Diet Adherence Screener (MeDAS) score. Both diets significantly reduced saturated FA (p < 0.01). Putative favorable changes in total n-3 FA (p = 0.03) and eicosapentaenoic acid plus docosahexaenoic acid (EPA + DHA; p = 0.04) were significantly larger with MD than with LFD. At 3 months, in the whole cohort, the MeDAS score correlated inversely with palmitic acid (R = −0.21, p = 0.02), and with palmitoleic acid (R = −0.32, p = 0.007), and positively with total n-3 FA (R = 0.19, p = 0.03), EPA (R = 0.28, p = 0.002), and EPA + DHA (R = 0.21, p = 0.02). In CHD patients on polytherapy, both MD and LFD shift FA blood composition towards a healthier profile, with a more favorable effect of MD on omega−3 levels.

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Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries

Abstract: Mohan and Mente had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 88 publications

References 49 publications

Moderate Consumption of Healthy Nordic Foods is Associated with Reduced Mortality in the Norwegian Women and Cancer Study: a Prospective Cohort Study

Moderate Consumption of Healthy Nordic Foods is Associated with Reduced Mortality in the Norwegian Women and Cancer Study: a Prospective Cohort Study

Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Effects of Mediterranean Diet or Low-Fat Diet on Blood Fatty Acids in Patients with Coronary Heart Disease. A Randomized Intervention Study

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