Original articleNo inverse association between fish consumption and risk of death from all-causes, and incidence of coronary heart disease in middle-aged, Danish adults
Introduction
Although fish oil supplements reduce the risk of reinfarction or sudden cardiac deaths in patients with previous heart disease, it is still uncertain whether intake of white or fatty fish protect against coronary heart diasease (CHD). A recent systematic review of all cohort studies examining the relationship between fish intake and CHD mortality identified 11 such studies [1]. Of four studies, which the reviewers judged to be of high quality, the two largest (n = 44,895 and 20,051) were performed in populations at low risk of CHD 2, 3. They found no protective effect of fish consumption. The other two high-quality studies were relative small (n = 852 and 1,822), and included individuals at higher risk 4, 5. They both found an inverse relationship between fish consumption and CHD, suggesting that 40–60 g fish per day is optimal and associated with a risk reduction of 40–60%. The review [1] judged four studies to be of intermediate quality, and they supported that fish consumption is inversely associated with CHD mortality in high-risk populations only 6, 7, 8, 9. Results from a large intervention study of patients with CHD support that increased fish intake lowers mortality in high-risk individuals [10]. However, two recently published studies including men and women in the United States [11] and middle-aged men from Finland, Italy, and The Netherlands [12], respectively, found no association between total fish consumption and CHD mortality or incident cases, while the large Nurses Health study from the United States [13] showed that higher consumption of fish was associated with lower risk of CHD, particularly CHD deaths. In two prospective cohort studies 2, 11 frequent fish consumption have also been associated with a significantly lower risk of death from all-causes, while two other studies have shown no such relationship 4, 14.
In the present study we examine whether intake of fish determine subsequent mortality and incident CHD in middle-aged men and women. Fish consumption has been associated with reduced CHD mortality, mainly in populations with high rates of CHD. Consequently, we also studied potential interactions between fish intake and other risk factors and repeated the analysis to a group with a priori defined high risk of CHD.
Section snippets
Study population
The study is based on data from five population studies conducted at the Copenhagen County Centre for Preventive Medicine (CPM). The CPM has, since 1964, followed different birth cohorts of the population in selected Western suburbs of Copenhagen. For this study we used data from the following birth cohorts: 411 men and 391 women born in 1914 and examined in 1984; 436 men born in 1936 and examined in 1987; 1955 men and 1873 women randomly sampled from four birth cohorts (1922, 1932, 1942, and
Results
After excluding subjects with incomplete data, the study population comprised 4,007 men and 3,533 women (Table 1). At baseline, 48% of men and women reported consumption of fish at least once a week. Frequent fish consumption was positively related to age, diet score, and education, while inversely associated with smoking and sedentary activity in both men and women (Table 2).
Discussion
This cohort study of middle-aged men and women gave no evidence for an inverse relation between intake of all kinds of fish and CHD risk in the overall population. This result is in agreement with six previous cohort studies in populations with low rates (less than 4.5 deaths per 1,000 person-years) of CHD 2, 3, 8, 9, 11, 12, but contrary to the recent findings from the Nurses Health study [13]. In contrast to studies in populations with higher rates of CHD, our study did not show a significant
Acknowledgements
The project was supported by grants from the Danish Medical Research Council. The establishment of the Unit for dietary Studies was financed by the FREJA (Female Researchers in Joint Action) programme, from the Danish Medical Research Council.
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