Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.     

Assessing the environment for regulatory change for eicosapentaenoic acid and docosahexaenoic acid nutrition labeling

This review examines issues related to the development of a recommended daily allowance or adequate intake, two of the categories of dietary reference intakes, for the long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs), eicosapentaenoic acid (EPA, 20:5 n-3), and docosahexaenoic acid (DHA, 22:6 n-3). Although some have suggested a dietary intake of two servings of fatty fish per week or supplement intake of 500 mg/day EPA plus DHA, based on evidence from epidemiologic and clinical studies of cardiovascular benefit from regular fish or fish-oil consumption, supplementation with EPA and/or DHA may also have antidepressant and mood-stabilizing effects. Omega-3 PUFA biology is complex and chronic disease outcomes are sometimes difficult to prove, yet the possibility of benefit for a substantial portion of the population from increased omega-3 PUFA intake is a public health issue that must be addressed responsibly and be based on significant scientific evidence.     

A risk-benefit analysis approach to seafood intake to determine optimal consumption

Seafood provides n-3 long-chain PUFA (n-3 LC-PUFA), vitamins and minerals, which are essential to maintain good health. Moreover, seafood is a source of contaminants such as methylmercury, arsenic and persistent organic pollutants that may affect health. The aim of the present study was to determine in what quantities seafood consumption would provide nutritional benefits, while minimising the risks linked to food contaminants. Seafood was grouped into clusters using a hierarchical cluster analysis. Those nutrients and contaminants were selected for which it is known that seafood is a major source. The risk-benefit analysis consisted in using an optimisation model with constraints to calculate optimum seafood cluster consumption levels. The goal was to optimise nutrient intakes as well as to limit contaminant exposure with the condition being to attain recommended nutritional intakes without exceeding tolerable upper intakes for contaminants and nutrients, while taking into account background intakes. An optimum consumption level was calculated for adults that minimises inorganic arsenic exposure and increases vitamin D intake in the general population. This consumption level guarantees that the consumer reaches the recommended intake for n-3 LC-PUFA, Se and I, while remaining below the tolerable upper intakes for methylmercury, Cd, dioxins, polychlorobiphenyls, Zn, Ca and Cu. This consumption level, which is approximately 200 g/week of certain fatty fish species and approximately 50 g/week of lean fish, molluscs and crustaceans, has to be considered in order to determine food consumption recommendations in a public health perspective.     

What Is the Most Effective Way of Increasing the Bioavailability of Dietary Long Chain Omega-3 Fatty Acids—Daily vs. Weekly Administration of Fish Oil?

The recommendations on the intake of long chain omega-3 polyunsaturated fatty acids (n-3 LC-PUFA) vary from eating oily fish (“once to twice per week”) to consuming specified daily amounts of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (“250–500 mg per day”). It is not known if there is a difference in the uptake/bioavailability between regular daily consumption of supplementsvs. consuming fish once or twice per week. In this study, the bioavailability of a daily dose of n-3 LC-PUFA (Constant treatment), representing supplements, vs. a large weekly dose of n-3 LC-PUFA (Spike treatment), representing consuming once or twice per week, was assessed. Six-week old healthy male Sprague-Dawley rats were fed either a Constant treatment, a Spike treatment or Control treatment (no n-3 LC-PUFA), for six weeks. The whole body, tissues and faeces were analysed for fatty acid content. The results showed that the major metabolic fate of the n-3 LC-PUFA (EPA+docosapentaenoic acid (DPA) + DHA) was towards catabolism (β-oxidation) accounting for over 70% of total dietary intake, whereas deposition accounted less than 25% of total dietary intake. It was found that significantly more n-3 LC-PUFA were β-oxidised when originating from the Constant treatment (84% of dose), compared with the Spike treatment (75% of dose). Conversely, it was found that significantly more n-3 LC-PUFA were deposited when originating from the Spike treatment (23% of dose), than from the Constant treatment (15% of dose). These unexpected findings show that a large dose of n-3 LC-PUFA once per week is more effective in increasing whole body n-3 LC-PUFA content in rats compared with a smaller dose delivered daily.     

Poultry Meat and Eggs as an Alternative Source of n-3 Long-Chain Polyunsaturated Fatty Acids for Human Nutrition

The beneficial effects of n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) on human health are widely known. Humans are rather inefficient in synthesizing n-3 LC-PUFA; thus, these compounds should be supplemented in the diet. However, most Western human diets have unbalanced n-6/n-3 ratios resulting from eating habits and the fact that fish sources (rich in n-3 LC-PUFA) are not sufficient (worldwide deficit ~347,956 t/y) to meet the world requirements. In this context, it is necessary to find new and sustainable sources of n-3 LC-PUFA. Poultry products can provide humans n-3 LC-PUFA due to physiological characteristics and the wide consumption of meat and eggs. The present work aims to provide a general overview of the main strategies that should be adopted during rearing and postproduction to enrich and preserve n-3 LC-PUFA in poultry products. The strategies include dietary supplementation of α-Linolenic acid (ALA) or n-3 LC-PUFA, or enhancing n-3 LC-PUFA by improving the LA (Linoleic acid)/ALA ratio and antioxidant concentrations. Moreover, factors such as genotype, rearing system, transport, and cooking processes can impact the n-3 LC-PUFA in poultry products. The use of a multifactorial view in the entire production chain allows the relevant enrichment and preservation of n-3 LC-PUFA in poultry products.     

Nutritional and toxicological aspects of seafood consumption--an integrated exposure and risk assessment of methylmercury and polyunsaturated fatty acids

Seafood consumption is associated with both risks and beneficial effects to human health. Consequently, an integrated exposure assessment of intake of toxic and nutritious agents in seafood is of importance prior to determination of dietary advisories. We have developed a probabilistic model for the estimation of simultaneous intake of methylmercury (MeHg) and long-chain n-3 polyunsaturated fatty acids (LC-n3 PUFAs) from seafood, to estimate the population proportion at risk for exceeding tolerable MeHg intake and not reaching adequate intake of PUFAs. Seafood consumption data was collected among women of childbearing age using a food frequency questionnaire. A database of mercury and fatty acids concentration in seafood was constructed. A Latin Hypercube simulation was used to calculate the intake of MeHg and LC n-3 PUFAs. Eleven percent of the population exceeded the MeHg reference dose of 0.1 μg/kg bw/day, whereas only 44% reached an adequate PUFA intake. A small proportion (3.7%) exceeded the MeHg reference dose while at the same time did not reach an adequate PUFA intake.Furthermore, we simulated two scenarios in which seafood is consumed according to a general recommendation of three servings per week, whereof one serving of oily seafood. The first scenario included seafood with typically low MeHg concentrations (mean 0.056 and 0.027 μg MeHg/g fish in lean and oily species, respectively), and the second included seafood typically high in MeHg concentrations (mean 0.50 and 0.26 μg MeHg/g fish in lean and oily species, respectively). In the “high”scenario, almost 100% of the population exceeded the reference dose, whereas the corresponding proportion was only 5% in the “low” scenario. Overall, the results stress the importance of communicating species specific seafood consumption advisories for women of childbearing age in general and for pregnant women in particular, while at the same time encourage them to consume more seafood.     

‘Designer oils’ low in n-6:n-3 fatty acid ratio beneficially modifies cardiovascular risks in mice

Cardiovascular benefits of dietary n-3 fatty acids have been shown. However, benefits of n-3 fatty acids as part of a high fat, low n-6:n-3 fatty acid ratio diet has not been fully characterized. Aim of this study is to investigate cardiovascular and metabolic benefits of ‘designer oils’ containing a low ratio of n-6:n-3 fatty acids in C57BL/6 mice. Three groups of C57BL/6 mice were fed an atherogenic diet supplemented with either a fish oil- or flaxseed oil-based ‘designer oil’ with an approximate n-6:n-3 fatty acid ratio of 2:1 (treated groups, n = 6 each) or with a safflower oil-based formulation with a high ratio (25:1) of n-6:n-3 fatty acids (control group, n = 6) for 6 weeks. Food intake, body weight, and blood lipid levels were monitored regularly. Fatty acid profile of the heart tissues was assessed. Histological assessment of liver samples was conducted. At the end of the study body weight and food intake was significantly higher in the flax group compared to control. The levels of 20:5n-3 and 22:6n-3 was significantly increased in the heart phospholipids in both flax and fish groups compared to control; tissue 20:4n-6 was significantly reduced in the fish group compared to control. Significant liver pathology was observed in the control group only. Lowering dietary ratio of n-6:n-3 fatty acids may significantly reduce cardiovascular and metabolic risks in mice regardless of the source of n-3 fatty acids.     

Fish consumption, n-3 fatty acids, and colorectal cancer: a meta-analysis of prospective cohort studies

Animal studies show favorable effects of n-3 fatty acids on inflammation and cancer, but results from epidemiologic studies appear to be inconsistent. The authors conducted meta-analyses of prospective cohort studies that evaluated the association between fish consumption or n-3 fatty acids and colorectal cancer incidence or mortality. Random-effects models were used, and heterogeneity between study results was explored through stratified analyses. The pooled relative risks for the highest compared with the lowest fish consumption category were 0.88 (95% confidence interval: 0.78, 1.00) for colorectal cancer incidence (14 studies) and 1.02 (95% confidence interval: 0.90, 1.16) for colorectal cancer mortality (four studies). The pooled relative risks for colorectal cancer incidence were 0.96 (95% confidence interval: 0.92, 1.00) for each extra occurrence of fish consumption per week (seven studies) and 0.97 (95% confidence interval: 0.92, 1.03) for each extra 100 g of fish consumed per week (four studies). Stratified analysis showed that the pooled relative risk for colorectal cancer incidence was more pronounced for women and in studies with a large exposure contrast. In cohort studies, fish consumption was shown to slightly reduce colorectal cancer risk. Existing evidence that n-3 fatty acids inhibit colorectal carcinogenesis is in line with these results, but few data are available addressing this association.     

Food behaviors accounting for the recent trends in dietary fatty acid profiles among Korean adults

BACKGROUND/OBJECTIVESThis study examined the changes in food behaviors of dietary fatty acids over 2007–2018 among Korean adults.SUBJECTS/METHODSThis study used data from the 4th (2007–2009), 5th (2010–2012), 6th (2013–2015), and 7th (2016–2018) Korea National Health and Nutrition Examination Surveys. A total of 46,307 adults aged 19–64 yrs were selected and dietary data were obtained from a single 24-h recall. In the 4th and 7th data, the major food sources for each fatty acid based on the contributing percentage of the food item were compared. The consumption trends in the major food sources were presented as grams per day over 2007–2018 and compared across the survey periods using the multiple regression model.RESULTSFrom 2007 to 2018, for total fat, saturated fatty acid (SFA), and monounsaturated fatty acid, the contribution of animal food sources, including beef, chicken, and eggs increased but plant food sources (e.g., tofu, soybean, and plant oil) decreased. As polyunsaturated fatty acid sources, mayonnaise, eggs, and bread showed higher contributions, whereas soybean and tofu showed lower contributions in the 7th data compared to the 4th data. For n-3 fatty acids, the contribution of fish decreased between the 4th and 7th data. Over 12 yrs, the significant increases in the absolute amount of consumption from animal sources were observed. In contrast, decreases in the consumption from plant sources and fish were seen across the survey periods.CONCLUSIONSIn Korean adults, increases in the intake of dietary fatty acids along with changes in the food behaviors during 2007–2018 have evoked great concern for SFA intake, which is a cardiovascular disease risk factor. Healthy food sources of dietary fatty acids should be emphasized in this population.     

Role of n-3 long-chain polyunsaturated fatty acids in human nutrition and health: review of recent studies and recommendations

Long-chain (LC) n-3 polyunsaturated fatty acids (n-3 PUFAs), in particular docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are nutrients involved in many metabolic and physiological processes, and are referred to as n-3 LCPUFA. They have been extensively studied for their effects in human nutrition and health. This paper provides an overview on metabolism, sources, dietary intake, and status of n-3 LCPUFA. A summary of the dietary recommendations for n-3 LCPUFAs for different age groups as well as specific physiological conditions is provided. Evidence for n-3 LCPUFA in cardiovascular diseases, including new studies, is reviewed. Expert recommendations generally support a beneficial effect of n-3 LCPUFA on cardiovascular health and recommend a daily intake of 500 mg as DHA and EPA, or 1–2 servings of fish per week. The role of n-3 LCPUFA on brain health, in particular neurodegenerative disorders and depression, is reviewed. The evidence for beneficial effects of n-3 LCPUFA on neurodegenerative disorders is non-conclusive despite mechanistic support and observational data. Hence, no definite n-3 LCPUFA expert recommendations are made. Data for the beneficial effect of n-3 LCPUFA on depression are generally compelling. Expert recommendations have been established: 200–300 mg/day for depression; up to 1–2 g/day for major depressive disorder. Recent studies support a beneficial role of n-3 LCPUFAs in reducing the risk for premature birth, with a daily intake of 600–800 mg of DHA during pregnancy. Finally, international experts recently reviewed the scientific evidence on DHA and arachidonic acid (ARA) in infant nutrition and concluded that the totality of data support that infant and follow-on formulas should provide both DHA and ARA at levels similar to those in breast milk. In conclusion, the available scientific data support that dietary recommendations for n-3 LCPUFA should be established for the general population and for subjects with specific physiological conditions.     

The benefit-risk analysis of omega-3 polyunsaturated fatty acids and heavy metals in seven smoked fish species from Siberia

In cold smoked species of genus Coregonus, identified by molecular genetic analysis, contents of fatty acids and heavy metals and arsenic were measured. The highest content of sum of long-chain polyunsaturated fatty acids of omega-3 family (LC-PUFA), namely eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids, 6.53 ± 0.78 mg g⁻¹ wet weight, was characteristic of tugun Coregonus tugun. This is the first quantitative estimation (mg LC-PUFA per g of product) of the nutritive value of smoked fish. Thus, to obtain a daily personal doze of EPA + DHA of 1 g, recommended for prevention of cardiovascular diseases, one needs to consume 153 g of the smoked tugun. Metals contents did not exceed standards for fish meat except Pb in least cisco Coregonus sardinella. Accordingly, values of hazard quotients, which estimate benefit-risk ratio of fish intake, indicate that most of the smoked fish species are safe product for human nutrition, except least cisco regarding Pb content.     

Diet during pregnancy and risk of preeclampsia or gestational hypertension

PURPOSE: We sought to examine associations of first-trimester intake of calcium, n-3 and n-6 fatty acids, trans fatty acids, magnesium, folate, and vitamins C, D, and E with preeclampsia (PE) and gestational hypertension (GH). METHODS: We studied associations of diet with PE or GH among 1718 women in the prospective cohort study Project Viva, using logistic regression and adjusting for maternal age, prepregnancy body mass index, first trimester systolic blood pressure, race/ethnicity, education, and parity. We assessed first-trimester diet using a validated semiquantitative food frequency questionnaire. RESULTS: A total of 59 (3%) women developed PE, and 119 developed (7%) GH. We found a somewhat-lower risk of PE associated with higher intake of the elongated n-3 fatty acids docosahexaenoic and eicosapentaenoic acids (odds ratio [OR] 0.84, 95% confidence interval [95% CI]: 0.69-1.03 per 100 mg/day), fish (OR 0.91, 95% CI 0.75-1.09 per serving/day), and the ratio of docosahexaenoic + eicosapentaenoic to arachadonic acid (OR 0.82, 95% CI 0.66-1.01). We did not observe a lower risk of GH or PE with a greater intake of calcium; vitamin C, D, or E; milk; magnesium; folate; or with lower intake of n-6 or trans fatty acids. CONCLUSIONS: Our results support a potential benefit for elongated n-3 fatty acids in preventing preeclampsia.     

A quantitative analysis of fish consumption and coronary heart disease mortality

Although a rich source of n-3 polyunsaturated fatty acids (PUFAs) that may confer multiple health benefits, some fish contain methyl mercury (MeHg), which may harm the developing fetus. U.S. government recommendations for women of childbearing age are to modify consumption of high-MeHg fish to reduce MeHg exposure, while recommendations encourage fish consumption among the general population because of the nutritional benefits. The Harvard Center for Risk Analysis convened an expert panel (see acknowledgements) to quantify the net impact of resulting hypothetical changes in fish consumption across the population. This paper estimates the impact of fish consumption on coronary heart disease (CHD) mortality and nonfatal myocardial infarction (MI). Other papers quantify stroke risk and the impacts of both prenatal MeHg exposure and maternal intake of n-3 PUFAs on cognitive development. This analysis identified articles in a recent qualitative review appropriate for the development of a dose-response relationship. Studies had to satisfy quality criteria, quantify fish intake, and report the precision of the relative risk estimates. Relative risk results were averaged, weighted proportionately by precision. CHD risks associated with MeHg exposure were reviewed qualitatively because the available literature was judged inadequate for quantitative analysis. Eight studies were identified (29 exposure groups). Our analysis estimated that consuming small quantities of fish is associated with a 17% reduction in CHD mortality risk, with each additional serving per week associated with a further reduction in this risk of 3.9%. Small quantities of fish consumption were associated with risk reductions in nonfatal MI risk by 27%, but additional fish consumption conferred no incremental benefits.     

Intake frequency of fish and serum levels of long-chain n-3 fatty acids: a cross-sectional study within the Japan Collaborative Cohort Study

BACKGROUND: Several investigations have adopted self-reported intake frequency of fish as a surrogate for intake of long-chain n-3 fatty acids, for which protective effects against cancer have been suggested. Whether reported fish consumption reflects the fatty acid intake, however, has to be elucidated. METHODS: We examined the association between intake frequency of fish and serum long-chain n-3 fatty acids (weight percentage of total fatty acids) among 1,257 control subjects (631 men and 626 women), aged 40-79 years, in case-control studies nested in the Japan Collaborative Cohort Study. All the subjects were not fasting when blood was drawn. Serum fatty acids were determined by gas chromatography. RESULTS: In men, intake frequency of fresh fish and dried or salted fish was significantly but weakly correlated with serum levels of eicosapentaenoic (EPA), docosapentaenoic (n-3) (DPA), and docosahexaenoic (DHA) acids; the age-adjusted Spearman correlation coefficients ranged from 0.11 to 0.18. In women, fresh fish consumption was somewhat associated with serum EPA (Spearman correlation coefficient = 0.12) as was dried or salted fish consumption with serum DPA (0.11). A rising trend in geometric means of serum EPA, DPA, and DHA was found with an increasing intake frequency of fresh or dried/salted fish in both sexes. The geometric means adjusted for age and participating institution in the highest intake category were higher than those in the lowest by 7% to 40%. CONCLUSIONS: A population with high self-reported frequency of fish intake, as a group, may have higher bioavailability of long-chain n-3 fatty acids than one with low frequency.     

Inadequate Content of Docosahexaenoic Acid (DHA) of Donor Human Milk for Feeding Preterm Infants: A Comparison with Mother’s Own Milk at Different Stages of Lactation

A cross-sectional single-center study was designed to compare the fatty acids profile, particularly docosahexaenoic acid (DHA) levels, between milk banking samples of donor human milk and mother’s own milk (MOM) for feeding preterm infants born before 32 weeks’ gestation. MOM samples from 118 mothers included colostrum (1–7 days after delivery), transitional milk (9–14 days), and mature milk (15–28 days and ≥29 days). In the n-3 polyunsaturated fatty acids (PUFAs) group, the levels of α-linolenic acid (C18:3 n3) and DHA (C22:6 n3) showed opposite trends, whereas α-linolenic acid was higher in donor human milk as compared with MOM, with increasing levels as stages of lactation progressed, DHA levels were significantly lower in donor human milk than in MOM samples, which, in turn, showed decreasing levels along stages of lactation. DHA levels in donor human milk were 53% lower than in colostrum. Therefore, in preterm infants born before 32 weeks’ gestation, the use of pasteurized donor human milk as exclusive feeding or combined with breastfeeding provides an inadequate supply of DHA. Nursing mothers should increase DHA intake through fish consumption or nutritional supplements with high-dose DHA while breastfeeding. Milk banking fortified with DHA would guarantee adequate DHA levels in donor human milk.     

Possible effects of diets on serum lipids,fatty acids and blood pressure levels in male and female Japanese university students

Objectives  To prepare a dietary recommendation for young Japanese for the prevention of coronary heart disease, we surveyed the dietary habits, serum lipids, serum fatty acids and blood pressure levels among male and female students. Methods  In this study, 175 male and 246 female university students were interviewed for the frequency of consumption of selected food items and the habit of skipping breakfast. Serum fatty acids were analyzed by gas chromatography. Results  The frequencies of consumption of dishes cooked with oil and intake of vegetables were higher in female students than in male students. Serum n-6 polyunsaturated fatty acids were slightly higher in females students than in male students while that of serum n-3 polyunsaturated fatty acids was 6.4% in both sexes. For both males and females, those who skipped breakfast at least once a week were less likely to consume vegetables and fruits than those who did not. Female students who skipped breakfast were also less likely to consume fish and had lower composition of n-3 polyunsaturated fatty acid and higher systolic and diastolic blood pressure levels than males. For female, the intake of milk and dairy products correlated inversely with systolic blood pressure levels and the intake of n-3 polyunsaturated fatty acids correlated inversely with diastolic blood pressure levels. For males, the intake of fruits and consumption of dishes cooked with oil correlated inversely with systolic and diastolic blood pressure levels. Conclusion  Our findings suggest that increased intake of fish, milk and dairy products, fruits and vegetables from early adulthood and a regular dietary pattern are important to reduce the risk factors for coronary heart disease.     

n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review

Historically, epidemiologic studies have reported a lower prevalence of impaired glucose tolerance and type 2 diabetes in populations consuming large amounts of the n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) found mainly in fish. Controlled clinical studies have shown that consumption of n-3 LC-PUFAs has cardioprotective effects in persons with type 2 diabetes without adverse effects on glucose control and insulin activity. Benefits include lower risk of primary cardiac arrest; reduced cardiovascular mortality, particularly sudden cardiac death; reduced triglyceride levels; increased high-density lipoprotein levels; improved endothelial function; reduced platelet aggregability; and lower blood pressure. These favorable effects outweigh the modest increase in low-density lipoprotein levels that may result from increased n-3 LC-PUFA intake. Preliminary evidence suggests increased consumption of n-3 LC-PUFAs with reduced intake of saturated fat may reduce the risk of conversion from impaired glucose tolerance to type 2 diabetes in overweight persons. Reported improvements in hemostasis, slower progression of artery narrowing, albuminuria, subclinical inflammation, oxidative stress, and obesity require additional confirmation. Expected health benefits and public health implications of consuming 1 to 2 g/day n-3 LC-PUFA as part of lifestyle modification in insulin resistance and type 2 diabetes are discussed.     

Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease

BACKGROUND: Higher intakes of fish and n-3 fatty acids are associated with a reduced risk of cardiovascular events and mortality. However, limited data exist on the effect of fish intake on actual measures of progression of coronary artery atherosclerosis. OBJECTIVE: The aim was to examine the association between fish intake and the progression of coronary artery atherosclerosis in women with coronary artery disease. DESIGN: This was a prospective cohort study of postmenopausal women (n = 229) participating in the Estrogen Replacement and Atherosclerosis trial. Usual fish intake was estimated at baseline with a food-frequency questionnaire. Quantitative coronary angiography was performed at baseline and after 3.2 +/- 0.6 (x +/- SD) y to evaluate changes in the mean minimum coronary artery diameter, the mean percentage of stenosis, and the development of new coronary lesions. RESULTS: Compared with lower fish intakes, consumption of > or =2 servings of fish or > or =1 serving of tuna or dark fish per week was associated with smaller increases in the percentage of stenosis (4.54 +/- 1.37% compared with -0.06 +/- 1.59% and 5.12 +/- 1.48% compared with 0.35 +/- 1.47%, respectively; P < 0.05 for both) in diabetic women after adjustments for age, cardiovascular disease risk factors, and dietary intakes of fatty acids, cholesterol, fiber, and alcohol. These associations were not significant in nondiabetic women. Higher fish consumption was also associated with smaller decreases in minimum coronary artery diameter and fewer new lesions. CONCLUSIONS: Consumption of fish is associated with a significantly reduced progression of coronary artery atherosclerosis in women with coronary artery disease.     

The importance of essential fatty acids and the effect of trans fatty acids in human milk on fetal and neonatal development

Breastfeeding has a major impact on public health, since human breast milk is the best food for infants up to six months of age. The lipid fraction in human milk is the main source of energy for the infant and supplies essential nutrients such as fat-soluble vitamins and polyunsaturated fatty acids (PUFA). Essential fatty acids (EFA), specifically linoleic acid (LA, 18:2n-6) and alpha-linolenic acid (ALA, 18:3n-3), are precursors of long-chain polyunsaturated fatty acids (LC-PUFA), including docosahexaenoic (DHA) and arachidonic (ARA) acids. Quality of lipids in secreted milk is precisely related to maternal ingestion. LC-PUFAs protect against allergy and infection and are important for visual and cognitive development in infancy. Industrial food processing has introduced the trans fatty acids (TFA) among the nutrients available to the population. TFA can interfere with the metabolism of essential fatty acids by decreasing LC-PUFA synthesis. It is thus important to raise population awareness on the importance of adequate PUFA consumption and reduced TFA intake during prenatal and postnatal development.     

Dietary Habits,Nutrients and Bone Mass in Spanish Premenopausal Women: The Contribution of Fish to Better Bone Health

The moderate consumption of fish is recommended for a healthy diet and is also a feature of the Mediterranean diet. Fish is a major food group in diets throughout the world, and studies show that fish consumption is associated with a lower risk of a number of conditions. Spain has one of the highest annual per capita consumptions of fish worldwide. As fish is a source of high quality protein; n-3 polyunsaturated fatty acids; vitamins, such as A and D; and minerals, such as selenium, calcium, iodine, magnesium, copper and zinc, nutrients that have positive effects on bone characteristics, it has been proposed that its consumption could improve bone health. In this cross-sectional study, we have investigated the relationship between dietary habits and nutrient intake of 151 Spanish premenopausal women and analyzed the association of fish consumption on bone mass measured by quantitative ultrasound of the phalanges. A higher (P < 0.05) bone mass and vitamin D intake (P < 0.05) was observed in the group with a fish intake of 5–7 servings/week. We conclude that increased fish consumption is helpful in maintaining an adequate bone mass in Spanish premenopausal women.