At baseline, mean ± SD fish consumption was 0.3 ± 0.3 servings/d, and EPA+DHA consumption was 0.3 ± 0.2 g/d. Compared with men with lower fish consumption, men with higher fish consumption were more likely to be physically active, have hypercholesterolemia and hypertension, use aspirin and multivitamin supplements, drink more alcohol, and smoke (). Men with higher fish consumption also had higher intake of energy, protein, EPA+DHA, polyunsaturated fatty acids, fiber, fruit, and vegetables and lower intake of saturated fat, monounsaturated fat and trans fat. Similar patterns in baseline characteristics were observed according to intake of EPA+DHA (data not shown).
Age-standardized mean values for baseline characteristics by levels of total fish consumption in 1986 in men in the Health Professionals Follow-up Study1
During 18 y of follow-up, a total of 9715 subjects (24.1%) developed a major chronic disease event. These included 3639 total CVD events, 4690 cancer events, and 1386 deaths from other causes (e.g., pneumonia, kidney or liver disease). In age-adjusted analyses, fish consumption was inversely associated with risk of major chronic disease (P for trend = 0.02; ), but this association was attenuated and no longer significant after adjusting for other risk factors and dietary habits (Models 2 and 3). In fully adjusted multivariable models, compared with fish consumption <1 serving/mo, fish consumption of 1 serving/wk (RR 0.86, 95% CI: 0.75, 0.98) and 2–4 servings/wk (RR 0.85, 95% CI: 0.73, 0.99) was associated with a lower risk of CVD (); fish consumption ≥5 servings/wk was not associated with lower risk. No significant associations were seen between fish consumption and incidence of total cancer (). When quintiles were used instead of predetermined categories for fish consumption, the RR in the highest quintile, compared with the lowest quintile, was 0.96 (95% CI: 0.89, 1.03; P for trend = 0.52) for major chronic disease, 0.99 (95% CI: 0.89, 1.11; P for trend = 0.96) for CVD and 0.95 (95% CI: 0.86, 1.05; P for trend = 0.67) for cancer after multivariate adjustments (model 3). To compare extremes of fish consumption, we also evaluated deciles of fish consumption entered as a continuous variable in the models (). A modest decrease in risk of overall major chronic disease and CVD was found after adjusting for age and CVD risk factors (models 1 and 2), but this was attenuated and no longer statistically significant after adjustments for other dietary habits (Model 3). No significant associations were found with cancer risk, even across extremes of fish intake (deciles).
Relative risk (Cox regression) of major chronic disease, cardiovascular disease (CVD) or cancer on the basis of fish consumption in 40,230 men in the Health Professionals Follow-up Study with no major chronic disease at baseline in 19861
For estimated dietary consumption of EPA+DHA from fish, no significant associations were seen with risk of major chronic disease, total CVD, or cancer after full multivariable adjustment (). When evaluated in quintiles, the RR in the highest quintile was 0.97 (95% CI: 0.90, 1.04; P for trend = 0.37) for major chronic disease, 0.97 (95% CI: 0.87, 1.09; P for trend = 0.93) for CVD and 1.00 (95% CI: 0.90, 1.11; P for trend = 0.60) for cancer, after multivariate adjustments. Decile analyses were also not significant ().
Table 3 Relative risk (Cox regression) of major chronic disease, cardiovascular disease (CVD), or cancer on the basis of eicosapentaenoic acid + docosahexaenoic acid (EPA+DHA) intake in 40,230 men in the Health Professionals Follow-up Study with no major chronic (more ...)
We also separately evaluated different types of fish consumed, including tuna fish, dark meat fish, and other fish (). After adjustment for age, risk factors, and other nutrients, significant associations with major chronic disease were generally not seen, except for a modest inverse association between “other fish” consumption 1 serving/wk, compared with <1 serving/mo, and total major chronic disease and total CVD ().
Consumption of different types of fish and risk of major chronic disease in 40,230 men in the Health Professionals Follow-up Study with no major chronic disease at baseline in 19861
Fish or EPA+DHA consumption and n-6 fatty acid intake were not strongly correlated (r = −0.09 and −0.11, respectively). The multivariate-adjusted RRs for major chronic disease, total CVD and total cancer according to both fish and n-6 fatty acid intakes are shown in . No significant effect modification by n-6 fatty acid intake was seen (P for interactions > 0.10). Results were similar for estimated dietary consumption of EPA+DHA (data not shown). Adjusting for total fat intake did not change the results (data not shown).
Figure 1 Relative risk (RR) of major chronic disease (a), total CVD (b), and total cancer (c) according to both fish and n-6 fatty acid intake in 40,230 men in the Health Professionals Follow-up Study. Adjusted for age (1-y increments), BMI (quintiles); smoking (more ...)