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