Fish consumption and coronary heart disease mortality. A systematic review of prospective cohort studies

Abstract

Objectives: To review all prospective cohort studies examining the relationship between ®sh intake and coronary heart disease mortality, and to assess the strength and consistency of their ®ndings. Design: Systematic review of studies based on individual records of ®sh or n-3 polyunsaturated fatty acid consumption and coronary heart disease death. Studies were given scienti®c quality scores and divided into categories of high, intermediate, or insuf®cient quality. Main outcome measure: Coronary heart disease mortality. Results: Eleven studies were identi®ed. The cohorts counted a total of 116 764 individuals. Of four studies judged to be of high quality, the two largest (n 44 895 and 20 051) were performed in populations at low risk of coronary heart disease. They found no protective effect of ®sh consumption. The other two high-quality studies were relatively small (n 852 and 1822) and included individuals at higher risk. They both found an inverse relationship between ®sh consumption and coronary heart disease death, suggesting that 40 ± 60 g ®sh per day is optimal and associated with a risk reduction of 40 ± 60%. Results of four studies of intermediate quality support that ®sh consumption is inversely associated with coronary heart disease mortality in high-risk populations only. Three studies were judged to be of insuf®cient quality to be used for drawing conclusions. Conclusions: Fish consumption is not associated with reduced coronary heart disease mortality in low-risk populations. However, ®sh consumption at 40 ± 60 g daily is associated with markedly reduced coronary heart disease mortality in high-risk populations. The underlying biochemical mechanism is not known and causal inference premature.

Diet and cancer in Mediterranean countries: carbohydrates and fats

“…In our datasets, the continuous OR for an increase of 1 g/week of n-3 PUFA were below unity for all cancers considered, except prostate: 0?7 for oral/pharyngeal and oesophageal cancer, and 0?9 for colon, rectal, breast and ovarian cancer (50) . Together with the favourable effect of fish and n-3 PUFA intake on the cardiovascular system (51,52) , the results from these data indicate that fish is a preferable substitute for meat intake in the Mediterranean diet.…”

A valid semiquantitative food frequency questionnaire to measure fish consumption

“…Increasingly more research is being conducted into the potential health benefits of eating fish, with evidence to suggest that dietary fish may play a protective role in diseases including cardiovascular disease, cancer, asthma and atopy (Caygill et al, 1996;Marckmann and Gronbaek 1999;Kobayashi et al, 1999;Stoneham et al, 2000;Kris-Etherton et al, 2002;Devereux and Seaton, 2003). The mechanism for this benefit has been proposed to be related to the content of omega-3 fatty acids in fish.…”

The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART)

“…Studies suggest that diets low in saturated fat (Hooper et al, 2001) high in fibre (Anderson and Hanna, 1999) and high in fish (particularly fatty fish) (Marckmann & Gronbaek, 2000) are associated with reduced risk of coronary disease. Whether dietary advice to people with coronary disease alters diet and improves long-term survival is unclear.…”