Effects of fatty fish vs lean fish and cardiovascular disease.
Fatty fish, lean fish and total cardiovascular disease (CVD).
Data from one cohort examining men only was found (Virtanen JK [14]). No significant effect of dark meat fish consumption on total cardiovascular disease was found at any level of consumption. No data was provided about lean fish consumption.
| Author | Cohort name | Cases | End point | Relative Risk (RR) for fatty fish | Relative Risk (RR) for lean fish |
|---|---|---|---|---|---|
| 14) Virtanen JK (2008) | The Health Professionals Follow-up Study | 3,639 | Risk | RR = 1.10 (0.93-1.29; P = 0.35). | - |
Fatty fish, lean fish and coronary heart disease.
Data about fatty fish consumption was provided by 8 cohorts, including 6,876 + X cases (no amount of cases was defined in one subcohort: Hu FB [14]).
And data about lean fish consumption was provided by 5 cohorts, including 5,054 cases.
Results: Significant protective effects of fatty fish consumption were found in 2 European subcohorts (Oomen CM [1] among Italian men only; Bjerregaard LJ
[34] among men only). In the first subcohort, this effect was found at any level of consumption. A significant protective effect in the latter subcohort was found at
intake levels of 7-11 g (0.5 serving/week) and up. No other associations were found at any level of consumption.
No effects from lean consumption were found at any level of consumption. Effect sizes were identical for fatty fish intake and lean fish intake (RR = 0.93).
Conclusion: Significant protective effects from fatty fish consumption were restricted to findings from 2 European subcohorts, one of which was of very small
size. Inconclusive evidence was found for an association between any level of fatty fish or lean fish consumption and coronary heart disease risk. Inconclusive
evidence was found that effects differ between fatty fish and lean fish consumption.
| Author | Cohort name | Cases | End point | Relative Risk (RR) for fatty fish | Relative Risk (RR) for lean fish |
|---|---|---|---|---|---|
| 46) Manger MS (2010) | The WENBIT | 210 | Risk | No association. | No association. |
| 34) Bjerregaard LJ (2010) | The Diet, Cancer and Health Cohort | 854 men, and 268 women | Risk | Men: HR = 0.67 (0.53-0.85). Women: HR = 0.78 (0.51-1.19). | Men: HR = 1.02 (0.86-1.32). Women: HR = 0.78 (0.51-1.20). |
| 31) Ness AR (2005) | The Boyd Orr Cohort | 298 | Mortality | No association | - |
| 22) Hallgren CG (2001) | The VIP & The MONICA Study | 76 | Risk | OR = 0.85 (0.45-1.62) | OR = 0.76 (0.42-1.36) |
| 15) Morris MC (1995) | The Physician's Health Study | 279 | Risk | RR = 1.1 (0.6-2.3; P = 0.62) | - |
| 14) Bernstein AM (2010) | The Nurses' Health Study (women without type 2 diabetes) | 3,162 | Risk | RR = 0.92 (0.82-1.02; P = 0.13) | RR = 0.91 (0.75-1.11; P = 0.74) |
| 14) Hu FB (2003) | The Nurses' Health Study (women with type 2 diabetes) | Not defined | Risk | RR = 0.38 (0.05-2.75) | - |
| 14) Ascherio A (1995) | The Health Professionals Follow-up Study | 1,543 | Risk | RR = 1.18 (0.95-1.48) | - |
| 1) Streppel MT (2008) | The Dutch part of The Seven Countries Study | 336 | Mortality | HR = 0.88 (0.65-1.19) | HR = 1.03 (0.73-1.45) |
| 1) Oomen CM (2000) | The Finnish and Italian part of The Seven Countries Study | 242 Finland, and 116 Italy | Mortality | Finland: RR = 0.80 (0.51-1.26). Italy: RR = 0.40 (0.19-0.84). | Finland: RR = 1.08 (0.78-1.50; P = 0.63). Italy: RR = 0.80 (0.38-1.66; P = 0.57). |
| Total number of cases: 6,876 for fatty fish, and 5,054 for lean fish | Average RR = 0.93 | Average RR = 0.93 |
Fatty fish, lean fish and stroke
Data about fatty fish consumption was provided by 4 European cohorts, including 2,508 cases. And data about lean fish consumption was provided by 3 European cohorts,
including 2,423 cases.
Results: A significant protective effect of fatty fish consumption was found in one cohort among women only (Myint PK [34]), and a significant protective
effect of lean fish consumption was found in another cohort, which included women only (Larsson SC [42]). No other associations were found. The effect from fatty
fish was found for consumption vs no consumption, while the effect from lean fish was found for consumption ≥ 3 servings/wk. Average RR's are 0.94 for fatty fish
and 0.74 for lean fish.
Conclusion: Few effects were found. Inconclusive evidence was found for an association between fatty fish, or lean fish consumption and stroke.
| Author | Cohort name | Cases | End point | Relative Risk (RR) for fatty fish | Relative Risk (RR) for lean fish |
|---|---|---|---|---|---|
| 42) Larsson SC (2011) | The Swedish Mammography Cohort | 1,680 | Risk | RR = 0.94 (0.68-1.29; P = 0.57) | RR = 0.67 (0.49-0.93; P = 0.07) |
| 34) Myint PK (2006) | The EPIC-Norfolk Study | 217 men, and 204 women | Risk | Men: RR = 0.88 (0.65-1.19; P = 0.41). Women: RR = 0.69 (0.51-0.94; P = 0.02). | No significant association |
| 31) Ness AR (2005) | The Boyd Orr Cohort | 83 | Mortality | No association | - |
| 22) Wennberg M (2007) | The MONICA Study | Fatty fish: 195 men, and 129 women. Lean fish: 194 men, and 128 women. | Risk | Men: OR = 1.29 (0.95-1.83; P = 0.06). Women: OR = 0.82 (0.58-1.15). | Men: OR = 1.23 (0.94-1.62; P = 0.14). Women: OR = 0.98 (0.74-1.30; P = 0.91). |
| Total number of cases: 2,508 for fatty fish, and 2,423 for lean fish | Average RR = 0.94 | Average RR = 0.74 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 14) Virtanen JK (2008) | The Health Professionals Follow-up Study | 40,230 men aged 40-75 and free of major chronic disease. (USA) | 18 (1986-2004) | 3,639? | Primary CVD incidence (fatal or nonfatal MI and fatal or nonfatal stroke) | Dark meat fish (such as mackerel, salmon, sardines, bluefish, and swordfish) |
RR = 1.10 (0.93-1.29; P = 0.35) for the highest vs lowest quartile of consumption. Amount specific data (servings): < 1/mo: RR = 1. 1-3/mo: RR = 0.96 (0.89-1.04). 1/wk: RR = 1.00 (0.91-1.11). ≥ 2/wk: RR = 1.10 (0.93-1.29). | Age, BMI, smoking, physical activity, history of diabetes, hypertension or hypercholesterolemia, first-degree family history of MI before age 60, first degree family history of colon cancer, aspirin use, multivitamin use, glycemic load, and intakes of protein, fiber, trans fat, saturated fat, n-6 fatty acids, alpha-linolenic acid, red meat, total calories, and alcohol. |
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| 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | See variables | Coronary events | Fatty fish (not defined) |
Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | See variables | Coronary events | Lean fish (not defined) |
|
Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 76? | Coronary death | Fatty fish (not defined) | No association was found (data not shown). | Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 76? | Coronary death | Lean fish (not defined) | No association was found (data not shown). | Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 298? | Stable angina with angiographic progression of CAD | Fatty fish (not defined) | No association was found (data not shown). | Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 46) Manger MS (2010) | The Western Norway B Vitamin Intervention Trial (WENBIT) | 2,412 men and women aged > 18, and undergoing coronary angiography for suspected CAD and/or aortic valve stenosis. Nearly 90% of the participants used statins. | 1999-2004 to 2006 | 298? | Stable angina with angiographic progression of CAD | Lean fish (not defined) | No association was found (data not shown). | Age, sex, left venticular ejection fraction, diabetes mellitus, hypertension, current smoker, acute coronary syndrome, and current use of statins. |
The association did not change after additional adjustment for BMI, serum triglycerides, previous AMI, previous PCI, previous CABG, previous cerebrovascular disease or carotid artery stenosis, previous peripheral arterial disease, extend of CAD, current us of beta-blockers, current use of angiotensin-converting enzyme inhibitors, and dietary intakes of saturated fatty acids, n-6 fatty acids, fiber, alpha-linolenic acid, thiamine, riboflavin, and tocopherol. 42) Levitan EB (2010) | The Swedish Mammography Cohort | 36,234 women without HF, MI, or diabetes. | 1998-2006 | 651 | Heart failure events (hospitalization for or death from hf) | Fatty fish (herring/mackerel, and salmon/whitefish/char) |
|
Age, education, BMI, physical activity, cigarette smoking, living alone, postmenopausal hormone use, total energy intake, alcohol intake, fiber intake, sodium intake, intake of red or processed meat, family history of MI, history of hypertension, and history of high cholesterol. |
42) Levitan EB (2009) | The Cohort of Swedish Men | 39,367 men aged 45-79, without a history of cancer, heart failure, MI, or diabetes. | 1998-2004 | See variables | Heart failure incidence (hospitalization for or death from HF) | Fatty fish (herring/mackerel and salmon/whitefish/char) |
|
Age, BMI, physical activity, energy, alcohol, fibre, sodium, and red or processed meat consumption, education, family history of MI, cigarette smoking, marital status, history of hypertension, and high cholesterol. |
34) Bjerregaard LJ (2010) | The Diet, Cancer and Health Cohort | 54,226 subjects (25,573 men and 28,653 women) aged 50-64, and without acute coronary syndrome or cancer. | (Denmark) 7.6 | (1993-97 to 2003) 854 men, and 268 women | Acute coronary syndrome (excluding sudden deaths without symptoms of coronary origin) | Fatty fish (herring, mackerel, salmon/trout/char, caviar [Danish]) |
|
Fatal MI: Associations with fatal MI (175 cases) were similar, but the CIs were wider and not significant (data not shown). Effect modification: Stratification according to intake of fish oil capsules did not significantly change the risk estimates (data not shown). Education, smoking, alcohol intake, BMI, history of diabetes mellitus, systolic blood pressure, serum cholesterol, physical activity, dietary intake of fruits and vegetables, total energy intake, dietary intake of saturated fat, mononunsaturated fat, and polyunsaturated fat, and menopausal status. |
34) Bjerregaard LJ (2010) | The Diet, Cancer and Health Cohort | 54,226 subjects (25,573 men and 28,653 women) aged 50-64, and without acute coronary syndrome or cancer. | (Denmark) 7.6 | (1993-97 to 2003) 854 men, and 268 women | Acute coronary syndrome (excluding sudden deaths without symptoms of coronary origin) | Lean fish (tuna, sardines, plaice/flounder, col/pollack, garfish, cod roe, and shrimps) |
|
Fatal MI: Associations with fatal MI (175 cases) were similar, but the CIs were wider and not significant (data not shown). Effect modification: Stratification according to intake of fish oil capsules did not significantly change the risk estimates (data not shown). Education, smoking, alcohol intake, BMI, history of diabetes mellitus, systolic blood pressure, serum cholesterol, physical activity, dietary intake of fruits and vegetables, total energy intake, dietary intake of saturated fat, mononunsaturated fat, and polyunsaturated fat, and menopausal status. |
31) Ness AR (2005) | The Boyd Orr Cohort | 4,028 people (1,995 men, and 2,033 women) from England and Scotland. | average 37 | (1948 to 2000) 298? | CHD mortality | Oily fish (not defined) | No association was found with consumption of oily fish (no data shown). | Age, energy, sex, childhood family food expenditure, father's social class, district of residence as a child, period of birth, season when studied as a child, and Townsend score for current address or place of death. |
22) Hallgren CG (2001) | The Västerbotten Intervention Programme | & The MONICA Study 36,405 Swedish men and women. | (Nested case-control study) 1985-1994 | 76 | Myocardial infarction incidence | Fatty fish (not defined) | OR = 0.85 (0.45-1.62) for ≥ 1 vs < 1 meal/week. | Unadjusted. |
Cases were matched to controls by sex, age, date of health survey, and geographical region. 22) Hallgren CG (2001) | The Västerbotten Intervention Programme | & The MONICA Study 36,405 Swedish men and women. | (Nested case-control study) 1985-1994 | 76 | Myocardial infarction incidence | Lean fish (not defined) | OR = 0.76 (0.42-1.36) for ≥ 1 vs < 1 meal/week. | Unadjusted. |
Cases were matched to controls by sex, age, date of health survey, and geographical region. 15) Albert CM (1998) | The Physician's Health Study | 20,551 men aged 40-84, and without a history of MI, stroke, transient ischemic attack, or cancer. | (USA) 11 | (1983-1995) 133? | Sudden cardiac death | Dark meat fish (eg, mackerel, salmon, sardines, bluefish, or swordfish) | RR = 0.98 (0.56-1.70) for consumption ≥ 1 serving/wk vs < 1 serving/month. | Age, aspirin and beta carotene treatment assignment, evidence of CVD, BMI, smoking status, history of diabetes, history of hypertension, history of hypercholesterolemia, alcohol, vigorous exercise, vitamine E, vitamin C, and multivitamin use. |
15) Morris MC (1995) | The Physician's Health Study | 21,185 men aged 40-84, and without a history of MI, stroke, transient ischemic attacks, cancer, liver/renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or NSAID's. | (USA) 4 | (1983-1988) 279 | Fatal and nonfatal myocardial infarction (excluding silent infarctions) | Dark meat fish (e.g., mackerel, salmon, sardines, bluefish, swordfish) |
RR = 1.1 (0.6-2.3; P = 0.62) for the highest vs lowest quartile of consumption. | Amount specific data (meals/week): Rarely/never: RR = 1. 1-3 times/month: RR = 1.2 (0.9-1.5). 1 time/week: RR = 1.0 (0.6-1.5). ≥ 2 times/week: RR = 1.1 (0.6-2.3). Age, aspirin and beta-carotene assignment, smoking, alcohol consumption, obesity, diabetes mellitus, vigorous exercise, parental history of MI, history of hypertension, history of hypercholesterolemia, vitamin supplement use, and saturated fat intake. |
14) Bernstein AM (2010) | The Nurses' Health Study | 84,136 women aged 34-59, and without cancer, diabetes mellitus, angina, myocardial infarction, stroke, or other cardiovascular disease (including coronary artery bypass grafting) | 26 | (1980-2006) 3,162? | Coronary heart disease (nonfatal infarction and CHD death) | Dark fish (not defined) | RR = 0.92 (0.82-1.02; P = 0.13) for consumption 0.07 vs 0.00 servings per day. | Further adjustment for fruit and vegetable intake had no effect on the risk associations. Age, time period, total energy, cereal fiber, alcohol, trans fat, BMI, cigarette smoking, menopausal status, parental history of myocardial infarction, multivitamin use, vitamin E supplement use, aspirin use, and physical exercise. |
14) Bernstein AM (2010) | The Nurses' Health Study | 84,136 women aged 34-59, and without cancer, diabetes mellitus, angina, myocardial infarction, stroke, or other cardiovascular disease (including coronary artery bypass grafting) | 26 | (1980-2006) 3,162? | Coronary heart disease (nonfatal infarction and CHD death) | Light fish (not defined) |
RR = 0.91 (0.75-1.11; P = 0.74) for the highest vs lowest quintile of consumption. | Amount specific data (servings per day): 0.00: RR = 1. 0.04: RR = 0.95 (0.78-1.16). 0.07: RR = 1.05 (0.90-1.23). 0.14: RR = 1.15 (0.98-1.34). 0.29: RR = 0.91 (0.75-1.11). Further adjustment for fruit and vegetable intake had no effect on the risk associations. Age, time period, total energy, cereal fiber, alcohol, trans fat, BMI, cigarette smoking, menopausal status, parental history of myocardial infarction, multivitamin use, vitamin E supplement use, aspirin use, and physical exercise. |
14) Hu FB (2003) | The Nurses' Health Study | 5,103 women with physician-diagnosed type 2 diabetes mellitus. | 1984-96 | ? | CHD incidence | Dark-meat fish (such as mackerel, salmon, sardines, bluefish, or swordfish) | An inverse association: RR = 0.38 (0.05-2.75; No P-value) for consumption ≥ 2 times/wk vs < 1 time/month. | Frequency of consumption was defined in portion units of 3-5 oz. Age, time intervals, smoking status, BMI, alcohol intake, parental history of MI, menopausal status and postmenopausal hormone use, moderate to vigorous activities, usual aspirin use, multivitamin supplement use, vitamin E supplement use, history of hypertension, hypercholesterolemia, duration of diabetes, and hypoglycemic medication. |
14) Ascherio A (1995) | The Health Professionals Follow-up Study | 44,895 male health professionals aged 40-75, and free of CVD. | 6 | (1986-1992) 1,543? | CHD (fatal coronary disease, nonfatal myocardial infarction, and coronary-artery bypass grafting or angioplasty) | Dark-meat fish (such as bluefish) | RR = 1.18 (0.95-1.48). | Age, BMI, smoking habits, alcohol consumption, history of hypertension, history of diabetes, history of hypercholesterolemia, family history of MI, and profession. |
1) Streppel MT (2008) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 1,373 men | 40 | (1960-85 to 2000) See variables | CHD death | Fatty fish (e.g. salmon, mackerel, herring, eel, and sardines) |
|
Energy, alcohol intake, wine use, fruit and vegetable consumption, saturated fat, trans unsaturated fatty acids, cis monounsaturated and polyunsaturated fat intake, serum cholesterol lowering diet, smoking BMI, prevalence of diabetes mellitus, systolic blood presurre, and socioeconomic status. |
1) Streppel MT (2008) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 1,373 men | 40 | (1960-85 to 2000) See variables | CHD death | Lean fish (e.g. codfish, plaice, and pollack fish) |
|
Energy, alcohol intake, wine use, fruit and vegetable consumption, saturated fat, trans unsaturated fatty acids, cis monounsaturated and polyunsaturated fat intake, serum cholesterol lowering diet, smoking BMI, prevalence of diabetes mellitus, systolic blood presurre, and socioeconomic status. |
1) Oomen CM (2000) | The Seven Countries Study | 1,088 Finnish, 1,097 Italian, and 553 Dutch men aged 50-69, and free of CHD. | 20 | (1965-70 to ) 463 | CHD mortality (as primary or secondary cause of death) | Fatty fish (e.g., mackerel, [salted] herring, eel) |
RR = 0.87 (0.59-1.27) for the highest vs lowest tertile of consumption. | Amount specific data: 0: RR = 1. 1-19: RR = 0.57 (0.40-0.80). ≥ 20: RR = 0.87 (0.59-1.27).
Age, BMI, cigarette smoking, and intakes of energy, vegetables, fruit, alcohol, meat, butter, and margarine. |
1) Oomen CM (2000) | The Seven Countries Study | 1,088 Finnish, 1,097 Italian, and 553 Dutch men aged 50-69, and free of CHD. | 20 | (1965-70 to ) See variables | CHD mortality (as primary or secondary cause of death) | Lean fish (e.g., plaice codfish, bream, perch, pike) |
|
Age, BMI, cigarette smoking, and intakes of energy, vegetables, fruit, alcohol, meat, butter, margarine, and fatty fish. |
1) Kromhout D (1985) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 852 men aged 40-59 without CHD. | 20 | (1960-1980) 78? | Death from coronary heart disease | Lean fish (e.g., cod and plaice]) | Lean fish consumption was inversely related to mortality from coronary heart disease (no data shown). | Age, systolic blood pressure, serum total cholesterol, cigarette smoking, subscapular skinfold thickness, physical activity, energy intake, dietary cholesterol, prescribed diet, and occupation. |
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