Original articles
The relation between fish consumption, death from all causes, and incidence of coronary heart disease: the NHANES I Epidemiologic Follow-up Study

https://doi.org/10.1016/S0895-4356(99)00149-3Get rights and content

Abstract

Few published data are available on fish consumption and risk of death in women or blacks. This study assesses the level of fish consumption as a risk factor for death from all causes and selected causes, and incidence of coronary heart disease. Participants were members of the NHANES I Epidemiologic Follow-up Study, a longitudinal cohort study of a national sample. Included in this analysis were 8825 white and black women and men aged 25–74 years when examined in 1971 through 1975 who did not report a history of heart disease at that time. Average follow-up for survivors of 18.8 years (maximum 22.1 years). The main outcomes measured were death (all causes, cardiovascular, noncardiovascular, cancer) and incidence of coronary heart disease. Fish consumption at baseline was obtained from a 3-month food frequency questionnaire. White men aged 25–74 years with fish consumption one time/week had an age-adjusted risk of death only about three quarters that of men never consuming fish. This effect persisted after controlling for multiple risk variables (1 time/week relative risk 0.76, 95% confidence interval 0.63–0.91). No additional reduction in risk was seen for consumption >1 time/week (adjusted relative risk 0.85, 95% CI 0.68–1.06). Similar but nonsignificant trends were seen in white and black women, but not black men. In white men, risk of noncardiovascular death but not cardiovascular death was also significantly reduced in those consuming fish once or more a week. No consistent association of fish consumption and coronary heart disease incidence or mortality was seen. White men consuming fish once a week had significantly lower risk of death over a 22-year follow-up than those never consuming fish. This was mostly attributable to reductions in death from noncardiovascular causes. Similar patterns, though not significant, were seen in women. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of fish consumption on noncardiovascular mortality.

Introduction

Fish consumption at moderate levels (approximately once per week) has been associated in prospective cohort studies with reduced sudden cardiac death 1, 2, and reduced coronary heart disease mortality in several reports 1, 2, 3, 4, 5, 6, 7 but not in others 8, 9, 10, 11; it has also been associated with reduced stroke incidence and death [12]. Nonfatal coronary events were not reduced in most studies. Although fish consumption has been suggested to be associated with reduced cancer mortality 13, 14, few prospective cohort studies have examined noncardiovascular and total mortality 1, 3. Possible mechanisms for effects on cardiac death include the possible antiarrhythmic properties of n-3-polyunsaturated fatty acids (n-3-PUFA) from fish oil or of other constituents of fish, and beneficial effects on platelet aggregation, serum triglyceride levels, and blood pressure 1, 2, 3, 13, 14, 15, 16, 17, 18. Mechanisms for effects on noncardiovascular death have also been postulated [14]. Data are largely lacking for women and blacks, although blacks showed the greatest reduction in stroke risk with fish consumption in one study [12]. The epidemiologic follow-up to the first National Health and Nutrition Examination Survey provided an opportunity to test the hypothesis that fish consumption once or more per week compared to no fish consumption is associated with reduced mortality from coronary heart disease, cardiovascular disease, cancer, noncardiovascular disease, and all causes as well as a reduced incidence of coronary heart disease in a large cohort of women and men drawn from a sample of the U.S. population.

Section snippets

Methods

The first National Health and Nutrition Examination Survey (NHANES I) collected data in 1971–1975 on a nationwide, multistage, probability sample of the civilian noninstitutionalized population aged 1–74 years of the U.S., excluding Alaska, Hawaii, and reservation lands of American Indians [19]. Details of the plan, complex sample design, response, and operation were published previously, as were procedures used to obtain informed consent and to maintain confidentiality of obtained information

Results

Table 1 shows the number of deaths by gender, race, and fish consumption frequency. The percent of persons in the analysis reporting any fish consumption was 91.7% compared to 89.7% for those excluded because of missing data for other variables, and 88.1% for those excluded because of a history of heart disease at baseline. The cumulative incidence of death in persons in the analysis was 19.49 per 1000 person-years compared to 22.07 per 1000 person-years among persons excluded because of

Discussion

Possible mechanisms for a beneficial effect of fish consumption on noncardiovascular mortality are uncertain but include a possible role of n-3 fatty acids in reducing synthesis of prostaglandins and leukotrienes from arachidonic acid in colorectal and possibly mammary carcinogenesis 14, 15, 36, 37, 38, 39, 40, 41. Numerous discussions have appeared of possible mechanisms for primary or secondary prevention of coronary heart disease by dietary n-3 polyunsaturated fatty acids 1, 2, 3, 4, 5, 6, 7

Acknowledgements

The NHANES I Epidemiologic Follow-up Study has been developed and funded by these agencies: National Center for Health Statistics; National Institute on Aging; National Cancer Institute; National Center for Chronic Disease Prevention and Health Promotion; National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; National Institute on Alcohol Abuse and Alcoholism; National Institute of Mental Health; National Institute of Diabetes and Digestive and

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