Combined higher frequency fish consumption and healthy lifestyle may lower the triglyceride/HDL-C ratio in middle-aged Japanese males: Anti-atherosclerotic effect of fish consumption

Background: Fish consumption may be associated with a low risk of coronary artery disease. We aimed to investigate whether higher fish consumption results in improved lifestyle behaviors and thus lower triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio––a predictor of atherosclerotic cardiovascular disease (ASCVD). Methods and results: This cross-sectional study included 2947 middle-aged Japanese males with no history of ASCVD or lipid-modifying therapy, who presented at the Health Planning Center of Nihon university hospital between April 2018 and March 2019. We performed an analysis of variance using fish consumption as a categorical variable (0-2 days, 3-4 days, or 5-7 days per week). The serum TG/HDL-C ratio in the 5-7 days fish consumption group was significantly lower than those in the 0-2- and 3-4-days fish consumption groups (p < 0.0001 and p < 0.01, respectively). Multiple regression stepwise analysis revealed that weekly fish consumption negatively and independently determined the TG/HDL-C ratio (β = -0.061, p = 0.001). As fish consumption increased, the proportion of subjects with smoking habits decreased (p = 0.014), those engaging in aerobic exercises and aggressive daily physical activity increased (p < 0.0001 for both), and those with alcohol habit increased (p < 0.0001). In addition, we developed the risk stratification for ASCVD by combining the serum HDL-C level and the serum TG/HDL-C ratio with fish intake. Conclusion: Increased frequency of fish consumption and improved lifestyle behaviors due to daily fish intake may work additively to lower the serum TG/HDL-C ratio. These associations may explain why high fish consumption is associated with a lower risk of ASCVD. Our findings may help physicians and nutritionists in treating patients with heart diseases and metabolic conditions by recommending a high fish diet in middle-aged Japanese males.

Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults

Background and Objective:Fish intake may prevent cerebrovascular disease (CVD), yet the mechanisms are unclear, especially regarding its impact on subclinical damage. Assuming that fish may have pleiotropic effect on cerebrovascular health, we investigated the association of fish intake with global CVD burden based on brain MRI markers.Methods:This cross-sectional analysis included participants from the Three-City Dijon population-based cohort (aged ≥65 years) without dementia, stroke, or history of hospitalized cardiovascular disease, who underwent brain MRI with automated assessment of white matter hyperintensities, visual detection of covert infarcts, and grading of dilated perivascular spaces. Fish intake was assessed through a frequency questionnaire and the primary outcome measure was defined as the first component of a factor analysis of mixed data applied to MRI markers. The association of fish intake with the CVD burden indicator was studied using linear regressions.Results:In total, 1,623 participants (mean age, 72.3 years; 63% women) were included. The first component of factor analysis (32.4% of explained variance) was associated with higher levels of all three MRI markers. Higher fish intake was associated with lower CVD burden. In a model adjusted for total intracranial volume, compared to participants consuming fish <1 per week, those consuming fish 2-3 and ≥4 times per week had a β = -0.19 (95% CI, -0.37; -0.01) and β = -0.30 (-0.57; -0.03) lower indicator of CVD burden, respectively (P trend <0.001). We found evidence of effect modification by age, so that the association of fish to CVD was stronger in younger participants (65-69 years) and not significant in participants aged ≥75 years. For comparison, in the younger age group, consuming fish 2-3 times a week was roughly equivalent (in opposite direction) to the effect of hypertension.Discussion:In this large population-based study, higher frequency of fish intake was associated with lower CVD burden, especially among participants younger than 75 years, suggesting a beneficial effect on brain vascular health before manifestation of overt brain disease.Classification of Evidence:This study provides Class II evidence that in individuals without stroke or dementia, higher fish intake is associated with lower subclinical CVD at MRI.

Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose–response meta-analysis of observational and experimental studies

Context Randomized controlled trials (RCTs) testing supplementation with eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids have failed to provide evidence supporting a suggested inverse association between fish intake and dementia risk. Objective Dose–response analyses were conducted to evaluate associations between fish intake, all-cause dementia or Alzheimer’s Disease (AD), and the effect of EPA/DHA supplementation on cognitive performance. Data Sources PubMed, Scopus and Web of Science databases were searched for original research evaluating either associations between fish intake and dementia or AD, or the impact of EPA and/or DHA supplementation on the risk of cognitive decline. Data Extraction Data were collected on study characteristics and methods; number of cases/deaths (for observational studies); categories of exposure; model covariates; risk estimates from the most-adjusted model; type and dosage of supplementation (from RCTs); fatty acid levels in blood; and differences in cognition test results before and after supplementation. Risk of bias was assessed through the ROBINS-E and RoB2.0 tools for observational and experimental studies, respectively. Data Analysis Weighted mixed-effects models were applied, allowing for the inclusion of studies with 2 levels of exposure. Based on findings with low/moderate risk of bias, fish intake of up to 2 portions (250 g) per week was associated with a 10% reduction (95% confidence interval [CI]: 0.79, 1.02, Ν = 5) in all-cause dementia and a 30% reduction (95% CI: 0.54, 0.89, Ν = 3) in AD risk. Changes in EPA and DHA body status had a positive impact on participants’ executive functions, but not on their overall cognitive performance. Conclusion The protection offered by fish intake against cognitive decline levels off at intakes higher than 2 portions/week and likely relates to the impact of EPA and DHA on the individual’s executive functions, although there remain questions about the mechanisms linking the short- and long-term effects. Systematic Review Registration PROSPERO registration no. CRD42019139528.

Development and Validation of a Cultural-based Food Frequency Questionnaire (FFQ) against 7-day Food Diary (7d FD) to Assess Fish Intake among Elementary School Children

An accurate dietary fish questionnaire can be used to predict dietary intake status of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). The aim of this study was to design and validate a food frequency questionnaire (FFQ) to predict fish consumption of primary school children against a 7-day food diary (7d FD). A cross-sectional study was performed in elementary school in Surakarta, Indonesia. A total of 164 children aged 8 to 12 yo which were recruited using multi-stage random sampling were participated in this study. The FFQ consisted of 38 species of fish including 27 species of fresh fish and 11 species of processed fish. Total median (interquartile range) fish intake determined from the FFQ vs 7d FD was similar of 60 (36-114) g/d and 59 (37-108) g/d, respectively. A very good correlation was found between the FFQ and 7d FD by Spearman’s correlation coefficient test (r=0.965, p=0.0001) with an acceptable of the two methods using non-parametric limit of agreement (95% LoA=-10.907-34.619, median difference=0.011, 95% CI for median difference=-2.408-1.193). The FFQ is acceptable a valid tool to determine fish intake in this group.