Comparing attitudes to fish consumption between clinical trial participants and non‐trial individuals

Aim: The study aims to investigate attitudes and perceptions influencing fish consumption in a sample of clinical trial participants and compare these perceptions to those expressed by a sample of adults not involved in the trial. Methods: Six semi‐structured focus groups were conducted; three with participants of a weight loss trial which incorporated specific and general fish consumption advice (n = 15) and three with non‐trial participants from the same study population (n = 14). All data were recorded digitally and transcribed verbatim by the moderator. Data analysis was carried out using NVivo (QSR International Pty Ltd, Melbourne, Victoria, Australia). Factors influencing fish consumption were coded into a number of sub‐themes and themes. Results: The main factors that influenced fish consumption were health impact, the cost of consuming fish and seafood products, the physical and sensory characteristics of fish, food preferences of family members, and the culinary positions of fish and seafood. Conclusion: This study highlighted attitudes and perceptions that may influence fish consumption. A clinical trial incorporating dietetic intervention appeared to influence the importance participants placed on nutrition education; however, additional practical strategies may be required to address barriers to consumption such as perceived price and availability.     

Oily fish and fish oil supplements in the prevention of coronary heart disease

Dietary advice for the reduction of coronary heart disease events emphasizes the importance of a low-fat diet and advice on the consumption of oily fish may also be given. This report reviews the evidence linking fish consumption with coronary risk. On the basis of available evidence, a target of two to three portions of oily fish per week (200–400 g, 7–14 oz) is considered reasonable, particularly for secondary prevention. For those who cannot achieve the suggested dietary intake of oily fish, the partial or complete substitution of fish oil supplements may be appropriate. A range of suitable types of fish oil supplements is given, but an awareness of the potential adverse effects of fish oil supplementation is considered important. Further studies are needed to define the role of fish intake in coronary heart disease.     

Review of Food Policy and Consumer Issues of Mercury in Fish

Public health messages regarding seafood consumption are confounded by long standing dietary advice promoting the healthfulness of consuming fish and recent warnings concerning dangerous mercury levels in specified fish. The warnings vary by federal agency and are directed to vulnerable subpopulations, notably women of childbearing age, pregnant women, nursing mothers and young children. The issue of mercury in fish has received considerable media coverage, attention from consumer organizations and public policy review. The net result is an area of seemingly contradictory advice directed to consumers and health professionals on the type and quantity of fish safe to consume. This message that fish is nutritious and healthy is particularly understood by educated and affluent subpopulations who can afford a variety of fish in their diet. This review addresses the contradictory rhetoric and reviews the state and federal agency policy positions. It considers the arguments for and against disclosing mercury-related information and its anticipated impact on the extended health benefits of fish consumption versus the risk to vulnerable subpopulations. The issue of balancing and targeting healthy messages and dietary warnings on fish is important because within the U.S. childbearing population, it is conservatively estimated that 250,000 women may be exposing their fetuses to higher levels of methylmercury than is in federal public health guidelines; two million more may not be consuming enough low-mercury fish.     

Health‐related beliefs and consumer knowledge as determinants of fish consumption

Background: Despite scientific evidence on the positive effects of seafood consumption on human health, the consumption of fish remains below the recommended intake levels for the majority of Europeans. The present study aimed to explore cultural differences in potential determinants of fish consumption: consumers’ knowledge and health‐related beliefs, as well as the relationship between those variables, socio‐demographics and fish consumption frequency, using data from five European countries. Methods: A cross‐sectional consumer survey was carried out in 2004 with representative household samples from Belgium, the Netherlands, Denmark, Poland and Spain. The sample consisted of 4786 respondents, aged 18–84 years, who were responsible for food purchasing and cooking in the household. Results: European consumers had a very strong belief that eating fish is healthy. Consumers’ belief that eating fish is healthy, their interest in healthy eating and objective fish‐related nutrition knowledge, positively, but only weakly, influenced fish consumption frequency. Subjective knowledge was found to be a stronger predictor of fish consumption than the previously noted factors. Age and education contributed, both directly and indirectly through knowledge, to explain fish consumption behaviour. However, the path coefficients in the estimated model were relatively low, which indicates that fish consumption frequency was also determined by factors other than health‐related beliefs and consumers’ knowledge. Conclusions: The findings of the present study suggest that communication should focus on health‐related benefits other than fish consumption alone. Communicating that eating fish is healthy and stressing the health benefits of fish alone, as is still commonly performed (e.g. in generic promotion and other types of public information campaigns) will be insufficient to achieve higher levels of compliance with fish consumption recommendations.     

Review of food policy and consumer issues of mercury in fish

Public health messages regarding seafood consumption are confounded by long standing dietary advice promoting the healthfulness of consuming fish and recent warnings concerning dangerous mercury levels in specified fish. The warnings vary by federal agency and are directed to vulnerable subpopulations, notably women of childbearing age, pregnant women, nursing mothers and young children. The issue of mercury in fish has received considerable media coverage, attention from consumer organizations and public policy review. The net result is an area of seemingly contradictory advice directed to consumers and health professionals on the type and quantity of fish safe to consume. This message that fish is nutritious and healthy is particularly understood by educated and affluent subpopulations who can afford a variety of fish in their diet. This review addresses the contradictory rhetoric and reviews the state and federal agency policy positions. It considers the arguments for and against disclosing mercury-related information and its anticipated impact on the extended health benefits of fish consumption versus the risk to vulnerable subpopulations. The issue of balancing and targeting healthy messages and dietary warnings on fish is important because within the U.S. childbearing population, it is conservatively estimated that 250,000 women may be exposing their fetuses to higher levels of methylmercury than is in federal public health guidelines; two million more may not be consuming enough low-mercury fish.     

Perceived barriers to consumption of fish among Norwegian women

This study aimed to characterize constraints on consumption of fish perceived by consumers in Norway. A random sample of Norwegian women aged 45-69 years answered a self-administered mail questionnaire in 1996 about eating habits, perceived barriers to fish consumption, socioeconomic status, and questions related to health. Altogether, 9407 women answered the questionnaire (response rate: 52.5%). Data were analyzed by means of logistic regression. Limited supply of fish products that satisfy children's wishes reduce at-home fish consumption. People with health problems and those who wish to lose weight are dissatisfied with the range of products offered in the marketplace. Satisfaction with quality and availability of wild lean codfish, especially in inland regions, is lower than for aqua-cultured fat salmon. Neither income nor education or health factors were significantly associated with consumption levels among those who would like to eat more fish. Higher education and income were associated with increased dissatisfaction about fish consumption, but also with reduced perception of most barriers. It is concluded that improvements in the supply of high-quality fresh and processed fish products that satisfy (a) children's wishes, (b) health-oriented family members, and (c) convenience-oriented consumers, will significantly increase at-home consumption of fish.     

Knowledge and barriers relating to fish consumption in older Australians

Among 854 Australians ?51years of age, this cross-sectional survey explored knowledge regarding finfish consumption, sources of information on fish and omega 3 fatty acids, what barriers limit finfish consumption and what factors predict its consumption. The survey consisted of a validated quantitative fish frequency questionnaire with additional questions on barriers and knowledge relating to finfish. Twelve percent of respondents consumed oily fish ?2 times per week. Cost was the most frequently (37%) reported barrier for fresh finfish consumption. In multiple regression analysis, respondents' exposure to multiple sources of information (odds ratio (95% confidence interval): 1.135 (1.01, 1.28), who correctly identified the current recommendations for fish consumption; 1.87 (1.13, 3.07), agreed that fish improves general health; 3.57 (1.13, 11.30), and reported fewer barriers towards canned fish consumption; 0.59 (0.41, 0.84) were more likely to consume ?2 servings of fresh finfish per week. Education and health programs need to be readily available highlighting current recommendations for fish consumption and how targets can be achieved. Meal plans with various finfish/seafood and amounts of omega 3 fatty acids required to achieve recommendations, and within a suitable budget, is likely to be an important strategy to target older consumers to increase consumption.     

Oily fish consumption in young adults: current intakes,knowledge, barriers and motivations

Background: Long chain omega‐3 polyunsaturated fatty acids (n‐3 PUFA) play an important role in the prevention of many health problems, including cardiovascular disease, mental health issues such as depression and neurological malformations during foetal growth. The Scientific Advisory Committee on Nutrition recommends that adults should consume at least two portions of fish per week, one of which (approximately 140 g) should be oily, although there be safe upper levels for intake (SACN, 2004). Despite dietary recommendations, recent surveys suggest only one in four adults eat oily fish regularly and that the average intake in consumers is only 45g week^‐1, approximately one‐third of a portion (Bates et al., 2010). This study aimed to improve understanding of the knowledge, motivations, barriers and information access regarding oily fish in young adults in whom dietary habits may still be developing to inform methods for increasing consumption. Methods: A self‐administered cross‐sectional survey was used to collect data from students at the University of Bristol [n = 112, mean (SD) age 20.9 (2.6) years, 75% female]. The survey was developed from two previously validated questionnaires to assess current fish intake, knowledge, motivations, barriers and information access in relation to oily fish consumption . The survey was delivered via the University of Bristol Online Survey system. A chi‐squared test was used to test for differences between groups and Spearman's rank correlation coefficient was used to identify associations. Alpha was set at <0.05. Results: Only 36.6% of participants met the dietary recommendation of eating ≥1 portion of oily fish per week. Where oily fish was eaten, the average portion size was below recommended levels at 106 g. A large proportion of participants lacked specific awareness of the intake recommendations (48.8%) and safe upper levels for women (68.8%) and men (70.5%). Neither the frequency of consumption of oily fish, nor the meeting the dietary recommendation significantly differed by overall knowledge level (χ² = 18.166, d.f. = 15, P = 0.254; χ² = 1.913, d.f. = 3, P = 0.591, respectively). The main motivational drivers for fish consumption were liking the taste (77.3%) and knowing the associated health benefits (69.1%). The perceived high price (36.8%), unpleasant smell (38.9%) and dislike of taste (30.5%) were the main reported barriers to consuming oily fish. Other key barriers included a dislike of bones (21.5%) and difficulty with preparation and cooking (19.6%). A dislike of the taste was strongly negatively associated with consumption behaviour (r = ‐0.372, P = 0.004). Wholly or partially following a vegetarian diet was negatively associated with fish consumption and in turn n‐3 PUFA intake (r = ‐0.286, P = 0.31). The types of information participants said they would most like to receive on fish were recipes (38.4%), details of health benefits (30.4%) and tips on cooking and preparation methods (29.5%). Online routes such as e‐mail prompts were the preferred channel of communication for this information. Discussion: Lack of awareness of the dietary recommendations and health benefits of fish has also been noted in previous studies (Burger, 2008). Previous studies have also reported similar barriers to oily fish consumption (Jones & Cornu, 1994). Together, these findings indicate a need to increase understanding of specific key issues around oily fish intake in young people. They suggest a value of health promotion strategies including electronic routes, that address cost, taste, smell, convenience and preparation and cooking issues including recipes and vegetarian sources of n‐3 PUFA alternatives. Conclusions: Oily fish consumption in young people may be facilitated by using electronic methods to target barriers to consumption, gaps in knowledge and awareness around fish consumption. References: Bates, B., Lennox, A. & Swan, G. (2010) National Diet and Nutrition Survey: Headline Results From Year 1 of the Rolling Programme 2008/2009. http://www.food.gov.uk/science/dietarysurveys/ndnsdocuments/ndns0809year1 (accessed on 1 July 2010). Burger, J. (2008) Fishing, fish consumption, and awareness about warnings in a university community in central New Jersey in 2007 & comparisons with 2004. Environ. Res. 108 , 107–116. Jones, S.D. & Cornu, K. (1994) The assessment of oily fish intake in two clinic populations. J. Hum. Nutr. Diet. 7 , 141–145. SACN (2004) Scientific Advisory Committee on Nutrition. Advice on Fish Consumption: Benefits & Risks. London: TSO.     

Benefits of habit‐based informational interventions: a randomised controlled trial of fruit and vegetable consumption

Objective : To assess the effectiveness of a habit‐based intervention delivered by e‐mail or sms in improving fruit and vegetable consumption among young adults. Methods : An eight‐week randomised controlled trial compared the effectiveness of three different types of message content (habit‐based messages; food‐group messages; general healthy eating messages) and two delivery methods (e‐mail versus sms) on habit strength and consumption of fruits and vegetables in 71 undergraduate participants. Results : A significant message content by time interaction indicated that the habit‐based intervention improved fruit consumption over the eight‐week period. Vegetable consumption significantly increased over the intervention period regardless of message content. Delivery method did not influence these results. Conclusion : Messages based on a habit framework can be utilised to improve fruit consumption in young adults. Furthermore, simply reminding young adults to be conscious of their food choices may be sufficient to improve their overall vegetable consumption.     

Fish in the diet: A review

Fish plays a useful role in a healthy and balanced diet, and its consumption has long been associated with several health benefits. Fish provides a variety of nutrients, including protein and long‐chain omega‐3 polyunsaturated fatty acids (n‐3 PUFAs), as well as micronutrients including selenium, iodine, potassium, vitamin D and B‐vitamins. Intakes of some of these micronutrients, including iodine and vitamin D, are low in some population groups in the UK, which makes fish a valuable contributor to intakes of these. The long‐chain n‐3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present in oil‐rich fish and fish oil, have been suggested to be associated with beneficial health outcomes. In this paper, we review the evidence associating fish and long‐chain n‐3 PUFAs with various health outcomes. Evidence from observational studies shows a protective effect of fish intake on risk of cardiovascular disease (CVD; including stroke). Eating at least two portions of fish per week has been associated with a 23–25% lower risk of death from coronary heart disease (CHD) compared with those eating no or very little fish; eating fish once a week has been associated with a 15% lower risk of CHD death. Fish intake seems only moderately associated with lower risk of stroke, with results from meta‐analyses showing a risk reduction of between 6% and 18% in those eating fish 2–4 times per week compared with those eating none. There have been some inconsistencies in study findings relating to fish intake and risk of CVD. Differences in habitual fish intakes of the study populations may account for some of this inconsistency. Evidence from randomised controlled trials (RCTs) on the effect of long‐chain n‐3 PUFA supplementation on CVD risk has come mainly from secondary prevention studies and is inconsistent. While early studies support a protective effect, recent studies do not support the hypothesis that long‐chain n‐3 PUFA supplementation is beneficial in secondary prevention of CVD. Different study outcomes have been influenced by variations in study design and the characteristics of the study populations. Furthermore, the increased use of modern treatments for cardiovascular risk factors (e.g. statins) may not have been sufficiently controlled for in more recent studies. Treatment doses of long‐chain n‐3 PUFA also varied substantially between studies, ranging from 0.3 to 6.9 g/day. Current evidence suggests that there is no association between fish consumption and risk of type 2 diabetes. We also found no evidence to suggest that fish intake has a protective effect on several types of cancer (pancreas, prostate, bladder, stomach and ovaries). However, studies do suggest that maternal fish intake during pregnancy may reduce the risk of eczema and asthma in her baby, the evidence being somewhat more consistent for eczema. There may also be a link between fish intake during infancy and childhood and the risk of developing asthma and eczema later in childhood, although the evidence is inconsistent and more studies are needed to clarify the situation. The long‐chain fatty acid DHA is crucial for development of the brain and the central nervous system in early life. While studies suggest that fish intake in early life contributes to cognitive development, supplementation with EPA and DHA does not seem to have a beneficial effect on cognitive function in childhood. The European Food Safety Authority (EFSA) suggests that pregnant and breastfeeding women increase their intake of preformed DHA by 100–200 g/day in addition to the suggested average intake level of long‐chain n‐3 PUFA for adults (250 mg EPA + DHA combined). EFSA proposes that an intake of 1–2 portions of oil‐rich fish per week should be compatible with an adequate DHA supply during pregnancy and lactation. There is some evidence to suggest that higher fish intake, dietary DHA intake and DHA levels in the blood among older adults may be positively associated with a lower risk of dementia and Alzheimer's disease (AD). In some prospective studies, risk of AD and dementia in those having the highest fish intake, or the highest blood DHA levels, was about half that of those who ate a little or no fish or had a low blood DHA level. In one prospective study, eating fish once a week was associated with a 60% lower risk of AD compared with those who rarely or never ate fish. However, some studies have found no association, and more evidence will be needed to draw reliable conclusions. Fish intake may be associated with slower cognitive decline, but the evidence is very limited and more studies are needed. Data from RCTs do not suggest that long‐chain n‐3 PUFA supplements are effective in preventing cognitive decline. There is some evidence from cohort and cross‐sectional studies that fish intake may be associated with better bone health, but not all studies have found such an association. Oil‐rich fish, in particular, is an important dietary source of vitamin D, which is important for bone health, and fish consumed with soft bones are a good source of calcium, which is the most abundant mineral in the skeleton. When making recommendations on fish intake, consideration has to be given to the sustainability of fish supplies. Much work has been done already to ensure that fish stocks are not depleted and more efforts will be required to ensure supplies of fish for future generations. Overall, it is evident that including fish in the diet is associated with several health benefits. The extent to which long‐chain n‐3 PUFA per se contributes to these various effects has yet to be established. It is likely that other components in fish, such as selenium, potassium, vitamin D or B‐vitamins, and other dietary aspects (i.e. foods typically eaten with fish or foods displaced by fish) contribute to the positive health effects.     

Low fruit and vegetable consumption is associated with low knowledge of the details of the 5‐a‐day fruit and vegetable message in the UK: findings from two cross‐sectional questionnaire studies

Background

This project aimed to understand the details of the 5‐a‐day fruit and vegetable (FV) message (which foods are included, portion sizes, the need for variety, reasons for consumption) least known by UK consumers, and most associated with low FV consumption.

Methods

Study 1 assessed FV consumption, knowledge of the details of the message, and relationships between these, using a short questionnaire administered face‐to‐face to an opportunity sample of one large UK city. Study 2 assessed the same variables using a comprehensive postal questionnaire administered across the UK to a representative population sample.

Results

Five hundred and seven respondents completed Study 1 and 247 respondents completed Study 2. The majority of individuals in both studies were aware of the 5‐a‐day message and could recount this correctly. In both studies, however, knowledge of the details of the message was low, and lower knowledge was associated with lower FV consumption. Respondents had lowest knowledge of the details of the message related to portion sizes and the need for variety. However, FV consumption was not independently associated with knowledge of any one aspect of the message.

Conclusions

These findings suggest that, although most of the UK population sampled were aware of the 5‐a‐day FV message and could recount this correctly, details of the 5‐a‐day FV message were not well known, and that FV consumption was related to this knowledge. These findings suggest that strategies to increase FV consumption will benefit from increasing UK consumers’ knowledge of the details of the 5‐a‐day FV message.     

Eating fish for two

This article is based on the British Nutrition Foundation's Annual Lecture 2013, which focused on maternal fish consumption and the effects of methylmercury (MeHg) on fetal development, with respect to current guidance and policy on fish consumption during pregnancy. Fish makes a valuable contribution to nutrient intakes across the globe and is the primary protein source for many individuals, particularly those in the developing world. Populations with a high fish consumption, such as in the Republic of the Seychelles, have a greater exposure to MeHg, which is present in varying amounts in all fish. MeHg is a toxic pollutant, which is known to impair neurodevelopment. The dose of MeHg from fish consumption, however, needed to impair neurodevelopment is unknown. Current UK and US guidance on fish consumption during pregnancy tend to focus more on avoiding risks rather than highlighting the benefits that can be obtained from eating fish. Such recommendations have been mainly based on data arising from epidemiological studies in the Faroe Islands, where MeHg exposure was largely from pilot whale consumption. Although small adverse effects on child development have been reported in data from the Faroe Islands, data from the ongoing Seychelles Child Development Studies have shown no adverse effects of pre‐natal MeHg exposure from high maternal fish consumption (9–12 meals containing fish per week) on developmental outcomes. Instead these data suggest that nutrients, including long‐chain polyunsaturated fatty acids (LC‐PUFAs), provided by fish may offer a beneficial effect and attenuate or modify any effects of MeHg on developmental outcomes. Recent expert consultations have concluded that the health benefits of fish consumption outweigh the risks posed by MeHg exposure and have argued the need for improved education and guidance to highlight the importance of consuming nutrients, including LC‐PUFAs, from fish for optimal child development and to encourage fish consumption during pregnancy.     

‘Do not eat fish more than twice a week’. Rational choice regulation and risk communication: Uncertainty transfer from risk assessment to public

Regulators try to change consumers' behaviour by issuing advice. This regulatory approach is built on a particular, normative theory of social action that assumes that individuals are unable to make rational decisions when they have imperfect knowledge about risk, and that this deficiency can be overcome by advice that offers them proper information. This paper examines the question, can a regulatory tool based on rational choice theory be efficient in reducing risky behaviours? After considering the debate within the risk-communication community about the use of this kind of a regulatory tool, we analyse (using the example of fish consumption advice) the risk assessment that the advice is derived from. Then we analyse the public response to the advice through the implementation of a five-month experiment among 200 French households. We show that individuals did not change their consumption to comply with the advice. We conclude that the advice transfers the initial uncertainty onto consumers turning it into ambiguity and complexity.     

Consumer perspectives about weight management services in a community pharmacy setting in NSW,Australia

Background Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia’s obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers’ needs is vital to the development of any new services or the evaluation of existing services. Objective To explore Australian consumers’ perspectives regarding weight management services in the community pharmacy setting, including their past experiences and willingness to pay for a specific pharmacy‐based service. Design An online cross‐sectional consumer survey was distributed through a marketing research company. The survey instrument comprised open‐ended and closed questions exploring consumers’ experiences of and preferences for weight management services in pharmacy. It also included an attitudinal measure, the Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale. Setting and participants A total of 403 consumers from New South Wales, Australia, completed the survey. Results The majority of respondents had previously not sought a pharmacist’s advice regarding weight management. Those who had previously consulted a pharmacist were more willing to pay for and support pharmacy‐based services in the future. Most consumers considered pharmacists’ motivations to provide advice related to gaining profit from selling a product and expressed concerns about the perceived conflicts of interest. Participants also perceived pharmacists as lacking expertise and time. Conclusion Although Australian consumers were willing to seek pharmacists’ advice about weight management, they perceived several barriers to the provision of weight management services in community pharmacy. If barriers are addressed, community pharmacies could be a viable and accessible setting to manage obesity.     

An analysis of potato consumption habits and diet quality among adults and children in the UK

Many people are confused about the nutritional role of potatoes in a healthy, balanced diet. Starchy foods are often under‐regarded by the public and maligned by proponents of low carbohydrate diets, yet carbohydrate should supply around 50% of dietary energy, preferably from sources such as potatoes, pulses and wholegrains. Potatoes provide significant quantities of shortfall micronutrients, yet they do not count as vegetables in 5 A DAY targets. To provide balanced advice, research is needed on potato consumption and its possible nutritional consequences. Therefore we analysed individual dietary records from the National Diet and Nutrition Survey 2008–2012 to investigate potato consumption patterns and associations with nutrient intakes. We hypothesised that high consumption of potatoes would be associated with higher total intakes of potassium, B vitamins and fibre. Across the whole population, potatoes provided 7% of energy, 15% of potassium, 13% of dietary fibre (non‐starch polysaccharide) and vitamin C, 14% of vitamin B₆, 10% of folate, 8% of magnesium and 6% of iron. Both very low and very high consumption of potatoes (Q1 and Q5) was associated with lower energy and nutrient intakes, compared with average consumers. Lower micronutrient intakes were most pronounced in Q5 (mean 14.8% energy from potatoes), although Q1 had lowest intakes of potassium, vitamin B₆ and thiamin. Food intakes suggest a less healthy, varied dietary pattern among high potato consumers. Conversely, low consumers of potatoes had lower intakes of potassium, thiamin and vitamin B₆ (all found in potatoes) despite an apparently health‐conscious dietary pattern that included higher consumption of fruit, vegetables and fish. Our study suggests that based on current habits, a broad range of potato consumption is compatible with good nutrition, while high reliance on potatoes may be associated with an unbalanced diet. To help raise intakes of shortfall nutrients such as potassium and fibre, consumption of potatoes could be encouraged alongside existing healthy eating messages relating to vegetables, fruit and wholegrain foods.     

Epidemiologic confirmation that fruit consumption influences mercury exposure in riparian communities in the Brazilian Amazon

Since deforestation has recently been associated with increased mercury load in the Amazon, the problem of mercury exposure is now much more widespread than initially thought. A previous exploratory study suggested that fruit consumption may reduce mercury exposure. The objectives of the study were to determine the effects of fruit consumption on the relation between fish consumption and bioindicators of mercury (Hg) exposure in Amazonian fish-eating communities. A cross-sectional dietary survey based on a 7-day recall of fish and fruit consumption frequency was conducted within 13 riparian communities from the Tapajós River, Brazilian Amazon. Hair samples were collected from 449 persons, and blood samples were collected from a subset of 225, for total and inorganic mercury determination by atomic absorption spectrometry. On average, participants consumed 6.6 fish meals/week and ate 11 fruits/week. The average blood Hg (BHg) was 57.1 +/- 36.3 microg/L (median: 55.1 microg/L), and the average hair-Hg (HHg) was 16.8 +/- 10.3 microg/g (median: 15.7 microg/g). There was a positive relation between fish consumption and BHg (r = 0.48; P<0.0001), as well as HHg (r =0.34; P<0.0001). Both fish and fruit consumption entered significantly in multivariate models explaining BHg (fish: beta = 5.6, P<0.0001; fruit: beta = -0.5, P = 0.0011; adjusted model R2 = 36.0%) and HHg levels (fish: beta = 1.2, P<0.0001; fruit: beta = -0.2, P = 0.0002; adjusted model R2 = 21.0%). ANCOVA models showed that for the same number of fish meals, persons consuming fruits more frequently had significantly lower blood and HHg concentrations. For low fruit consumers, each fish meal contributed 9.8 microg/L Hg increase in blood compared to only 3.3 microg/L Hg increase for the high fruit consumers. In conclusion, fruit consumption may provide a protective effect for Hg exposure in Amazonian riparians. Prevention strategies that seek to maintain fish consumption while reducing Hg exposure in fish-eating communities should be pursued.     

Fish fatty acids and cardiovascular diseases--an update

Epidemiologic observational research shows that higher intake of fish fatty acids is associated with a lower risk of fatal heart disease and sudden death, but this effect is not observed with non-fatal heart disease. Currently available trials with clinical endpoints provide no convincing evidence that supplementation with fish oil prevents cardiovascular disease. The theory that fish fatty acids can prevent cardiac arrhythmias is not supported by the trials performed in patients with life-threatening cardiac arrhythmias. For the specific group of patients who have previously experienced a ventricular tachycardia and who have not been prescribed an anti-arrhythmia medication for this, there are indications that the intake of fish oil might even lead to a slightly increased risk ofsevere cardiac arrhythmias. However, other subgroups of patients, such as patients with a recent myocardial infarction may benefit from taking fish oil to prevent cardiac arrhythmias. The advice of the Health Council of the Netherlands to eat fish twice per week, of which fatty fish once per week, or to take 450 mg of the combination eicosapentaenic acid (EPA) and docosahexaenic acid (DHA) per day remains justifiable until the results from current studies become available. However, patients with a ventricular arrhythmia who do not receive specific anti-arrhythmic medication should be careful about taking fish oil capsules.     

Factors affecting consumers’ decisions on the use of nutraceuticals: a systematic review

There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers’ decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers’ decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers’ lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.