Fish consumption and risk of myocardial infarction: a systematic review and dose-response meta-analysis suggests a regional difference

P. Oliveira MB, Prieto MA. Health benefits of bluefin tuna consumption: (Thunnus thynnus) as a case study

Consumers are increasingly interested in food products with high nutritional value and health benefits. For instance, fish consumption is linked with diverse positive health benefits and the prevention of certain widespread disorders, such as obesity, metabolic syndrome, or cardiovascular diseases. These benefits have been attributed to its excellent nutritional value (large amounts of high-quality fatty acids, proteins, vitamins, and minerals) and bioactive compounds, while being relatively low-caloric. Atlantic bluefin tuna (Thunnus tynnus) is one of the most consumed species worldwide, motivated by its good nutritional and organoleptic characteristics. Recently, some organizations have proposed limitations on its consumption due to the presence of contaminants, mainly heavy metals such as mercury. However, several studies have reported that most specimens hold lower levels of contaminants than the established limits and that their richness in selenium effectively limits the contaminants' bioaccessibility in the human body. Considering this situation, this study aims to provide baseline data about the nutritional composition and the latest evidence regarding the beneficial effects of Atlantic bluefin tuna consumption. A review of the risk-benefit ratio was also conducted to evaluate the safety of its consumption, considering the current suggested limitations to this species' consumption.

Analysis of Fish-Consumption Benefits and Safety Knowledge in a Population-Based Sample of Polish Adolescents

Inadequate fish consumption is common and may result from multiple reasons, especially in adolescents who are a population at particular risk of the negative consequences of not consuming the recommended amounts of fish. The aim of the study was to analyze the knowledge about fish-consumption benefits and safety in a population-based sample of Polish adolescents. The stratified random sampling was conducted within two stages: sampling of counties from all voivodeships in Poland (being the basic administrative units of Poland) and inviting secondary schools from the drawn counties to obtain a sample representative of all regions of Poland. The Computer-Assisted Web Interview (CAWI) method was applied to gather the data within the study, and a questionnaire concerning knowledge about fish-consumption benefits and safety with 20 true-false statements was applied. Among 1289 participants, the statement with the highest share of correct answers concerned fish being a source of protein (78.9%) and fish-derived fats being health promoting (77.0%). The statement receiving the least correct answers concerned the type of fatty acids found in fish (7.6%) and the risk of polychlorinated biphenyls (PCBs) in fish (20.5%). Participants who were female, older than 18, underweight, living in an urban environment, from a region far away from the sea and from comprehensive schools provided a higher share of correct answers than other subgroups (p < 0.05). Knowledge concerning fish-consumption benefits and safety among Polish adolescents is in many cases inadequate; thus, nutritional education is needed, especially among younger adolescents, those attending vocational schools, males and those living in a rural environment.

Effects of culinary treatments on the lipid nutritional quality of fish and shellfish

Coronary heart disease (CHD) is one of the leading causes of death worldwide. Seafood, especially fish and shellfish, is a healthy food that reduces the risk of CHD. In many regions, seafood is consumed cooked to eliminate potentially pathogenic microorganisms. Although there have been many reports of culinary preparations causing changes in the fatty acid profile of fish and shellfish, this information has not been well organized, and most of it is not associated to CHD. Therefore, this study was conducted to study the effect of culinary treatments of seafood on lipid nutritional quality in relation to promotion/prevention of CHD. In this study, fatty acid profiles of fish and shellfish prepared with different culinary preparations were obtained from published literature. Lipid nutritional quality indices related to promoting/preventing CHD were calculated and analyzed to reveal the effects of culinary treatment on the lipid nutritional quality of fish and shellfish in promoting/preventing of CHD. The information in this article is very useful and can fill the knowledge gap of the effects of culinary preparation on the lipid nutritional quality of fish and shellfish. Such information is very useful for guiding consumers to choose better ways to cook fish and shellfish to reduce the risk of CHD.

The Influence of Dietary Interventions on Arterial Stiffness in Overweight and Obese Subjects

Arterial stiffness is often increased in overweight/obese subjects before the development of hypertension. It is also one of the earliest indicators of increased cardiovascular disease risk and can be considered a good predictor of the development of subclinical cardiovascular dysfunction. Arterial stiffness is a significant prognostic factor influencing cardiovascular risk, which dietary habits can modify. Obese patients should use the caloric-restricted diet because it augments aortic distensibility, diminishes pulse wave velocity (PWV), and increases the activity of endothelial nitric oxide synthases. High intake of saturated fatty acids (SFA), trans fats, and cholesterol, typical for the Western diet, impairs endothelial function and raises brachial-ankle PMV. The replacement of SFA with monounsaturated (MUFA) or polyunsaturated fatty acids (PUFA) derived from seafood and plants diminishes the risk of arterial stiffness. The dairy product intake (excluding butter) decreases PWV in the general population. The high-sucrose diet causes toxic hyperglycemia and increases arterial stiffness. Complex carbohydrates with a low glycemic index (including isomaltose) should be recommended to keep vascular health. The high sodium intake (>10 g/day), particularly associated with low potassium consumption, has a deleterious effect on arterial stiffness (↑ baPWV). Since vegetables and fruits are good sources of vitamins and phytochemicals, they should be recommended in patients with high PMV. Thus, the dietary recommendation to prevent arterial stiffness should be similar to the Mediterranean diet, which is rich in dairy products, plant oils, and fish, with a minimal red meat intake and five servings of fruits and vegetables daily.

Fish intake and risk of cardiovascular events: an analysis of the VITAL cohort

BACKGROUND

Dietary habits with fish consumption have been associated with a lower risk of cardiovascular (CV) disease, based on heterogenous observational studies. Current recommendations suggest eating at least 1-2 fish servings per week for CV prevention.

METHODS

We conducted a retrospective evaluation of a cohort study that enrolled a large primary prevention population to determine the potential benefit of fish intake ≥1.5 serving per week, through a multivariate Cox regression model. The outcomes of interest included all-cause mortality, cardiovascular mortality, MACE (composite endpoint of myocardial infarction, stroke, and death from cardiovascular causes), expanded MACE (MACE plus coronary revascularization), total myocardial infarction (MI), total coronary heart disease (CHD) and total stoke. The estimates were reported using hazard ratio (HR) with 99% confidence intervals (99% CI).

RESULTS

A total of 25,435 patients were evaluated (11,921 individuals ≥1.5 fish servings/week; 13,514 < 1.5 fish servings per week). Intake ≥1.5 servings/week was not independently associated with CV outcomes reduction, such as CV mortality, MI risk MACE, expanded MACE outcomes, CHD or stroke (HR 0.78, 99% CI 0.57-1.07).

CONCLUSION

Fish intake ≥1.5 servings/week was not associated with CV outcomes improvement in this analysis, but potential benefit cannot be ruled out.

The role of the dietary patterns in the cardiovascular disease risk prevention

Cardiovascular diseases (CVD) are a part of a wide group of diseases, which became main threat to the life and health of the population in highly developed countries. To prevent and treat CVD, in addition to implementation of pharmacological methods, there are a number of lifestyle components, including eating habits, that significantly influence the development of these diseases. The dietary patterns strongly correlate with the risk of cardiovascular disease. Modifications of the dietary habits allow to control many parameters such as: body weight, cholesterol/triglyceride levels or blood pressure. Alternative diets are frequently used to reduce the risk of developing a CVD. The main recommended dietary patterns includes Mediterranean diet (MD), the DASH diet (Dietary Approach to Stop Hypertension) and mild variants of vegetarianism. The more controversial nutritional styles includes the ketogenic or vegan diets. Due to various assumptions as well as the mechanisms of action of each diets, an attempt of its evaluation have been made. The aim of our study is to review and analyze the available data on the impact of various nutrition models regarding to cardiovascular diseases risk prevention.

Relations between the Consumption of Fatty or Lean Fish and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis

Fish consumption is associated with a reduced risk of cardiovascular diseases (CVDs) partly ascribed to the high content of long-chain (LC) n-3 PUFAs; however, not all fish types are equally rich in these components. To date, it is not clear whether the beneficial effects of fish consumption are shared by fatty and lean fish. Therefore, the aim of this meta-analysis was to synthesize knowledge regarding the relation between the intake of fatty fish or lean fish and the risk of cardiovascular events and all-cause mortality. We conducted a systematic search in PubMed, Web of Science, and Embase until May 2021 for full text with a prospective design involving humans providing data for the highest compared with the lowest fish consumption categories. Summary risk ratios (RRs) and 95% CIs were estimated using a random-effects model. Out of 1902 articles retrieved from the literature search, 19 reports met the criteria for inclusion in the meta-analysis. Altogether, studies on fatty fish comprised 1,320,596 person-years of follow-up, 20,531 incident coronary heart disease (CHD) cases, 9256 incident CVD cases, and 104,763 total deaths. Studies on lean fish comprised 937,362 person-years of follow-up, 21,636 incident CHD cases, 7315 incident CVD cases, and 16,831 total deaths. An inverse association was present for fatty fish with CHD incidence (RR: 0.92; 95% CI: 0.86, 0.97), CHD mortality (RR: 0.83; 95% CI: 0.70, 0.98), and total mortality (RR: 0.97; 95% CI: 0.94, 0.99). This was not the case for lean fish. The summary estimates for CVD incidence and mortality did not show significant association with both fatty fish and lean fish consumption. The study findings are innovative in highlighting that the health benefits so far linked to fish consumption are, in fact, driven by fatty fish.

Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes: A Systematic Review

IMPORTANCE

Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals.

OBJECTIVE

To assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates.

EVIDENCE REVIEW

PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation.

FINDINGS

A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake.

CONCLUSIONS AND RELEVANCE

This systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.

Inhibition of Fatty Acid Metabolism Increases EPA and DHA Levels and Protects against Myocardial Ischaemia-Reperfusion Injury in Zucker Rats

Long-chain ω-3 polyunsaturated fatty acids (PUFAs) are known to induce cardiometabolic benefits, but the metabolic pathways of their biosynthesis ensuring sufficient bioavailability require further investigation. Here, we show that a pharmacological decrease in overall fatty acid utilization promotes an increase in the levels of PUFAs and attenuates cardiometabolic disturbances in a Zucker rat metabolic syndrome model. Metabolome analysis showed that inhibition of fatty acid utilization by methyl-GBB increased the concentration of PUFAs but not the total fatty acid levels in plasma. Insulin sensitivity was improved, and the plasma insulin concentration was decreased. Overall, pharmacological modulation of fatty acid handling preserved cardiac glucose and pyruvate oxidation, protected mitochondrial functionality by decreasing long-chain acylcarnitine levels, and decreased myocardial infarct size twofold. Our work shows that partial pharmacological inhibition of fatty acid oxidation is a novel approach to selectively increase the levels of PUFAs and modulate lipid handling to prevent cardiometabolic disturbances.

Dietary recommendations for prevention of atherosclerosis

This review aims at summarizing updated evidence on cardiovascular disease (CVD) risk associated with consumption of specific food items to substantiate dietary strategies for atherosclerosis prevention. A systematic search on PubMed was performed to identify meta-analyses of cohort studies and RCTs with CVD outcomes. The evidence is highly concordant in showing that, for the healthy adult population, low consumption of salt and foods of animal origin, and increased intake of plant-based foods-whole grains, fruits, vegetables, legumes, and nuts-are linked with reduced atherosclerosis risk. The same applies for the replacement of butter and other animal/tropical fats with olive oil and other unsaturated-fat-rich oil. Although the literature reviewed overall endorses scientific society dietary recommendations, some relevant novelties emerge. With regard to meat, new evidence differentiates processed and red meat-both associated with increased CVD risk-from poultry, showing a neutral relationship with CVD for moderate intakes. Moreover, the preferential use of low-fat dairies in the healthy population is not supported by recent data, since both full-fat and low-fat dairies, in moderate amounts and in the context of a balanced diet, are not associated with increased CVD risk; furthermore, small quantities of cheese and regular yogurt consumption are even linked with a protective effect. Among other animal protein sources, moderate fish consumption is also supported by the latest evidence, although there might be sustainability concerns. New data endorse the replacement of most high glycemic index (GI) foods with both whole grain and low GI cereal foods. As for beverages, low consumption not only of alcohol, but also of coffee and tea is associated with a reduced atherosclerosis risk while soft drinks show a direct relationship with CVD risk. This review provides evidence-based support for promoting appropriate food choices for atherosclerosis prevention in the general population.

Inverse Association of Poultry, Fish, and Plant Protein Consumption with the Incidence of Cardiovascular Disease

Cardiovascular disease (CVD) remains a major cause of death and disability worldwide and food intake plays an important role in its onset or prevention. It is also well known that consumption of red meat (processed and unprocessed) is associated with an increased incidence of CVD, coronary heart disease (CHD), and premature death. However, little is known about the association of consumption of poultry, fish, and plant protein with the incidence of CVD, CHD, and mortality. Several recent studies, reviews and meta-analyses have shown an inverse association of consumption of these foods with the incidence of CVD, CHD, and death. In order to get a better perspective about the current consumption of these foods, a focused Medline search of the English language literature was conducted between 2010 and 2020 using the terms poultry, fish, plant protein consumption, cardiovascular disease, coronary heart disease, mortality; 28 papers with pertinent information were retrieved. The analysis of data from these papers suggest an inverse relationship between the consumption of these foods and the incidence of de novo CVD or worsening of preexisting CVD. They also demonstrate that the consumption of these foods is still low and that great effort should be made to inform the public about the benefits of switching from red meat to an increased consumption of poultry, fish, and plant protein. All the data from the retrieved papers regarding the consumption of these foods, together with collateral literature, will be discussed in this review.

Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease

IMPORTANCE

The 2015-2020 Dietary Guidelines for Americans recommend multiple healthy eating patterns. However, few studies have examined the associations of adherence to different dietary patterns with long-term risk of cardiovascular disease (CVD).

OBJECTIVE

To examine the associations of dietary scores for 4 healthy eating patterns with risk of incident CVD.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of initially healthy women from the Nurses' Health Study (NHS) (1984-2016) and the NHS II (1991-2017) and men from the Health Professionals Follow-up Study (HPFS) (1986-2012). The dates of analysis were July 25 to December 4, 2019.

EXPOSURES

Healthy Eating Index-2015 (HEI-2015), Alternate Mediterranean Diet Score (AMED), Healthful Plant-Based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI).

MAIN OUTCOMES AND MEASURES

Cardiovascular disease events, including fatal and nonfatal coronary heart disease (CHD) and stroke.

RESULTS

The final study sample included 74 930 women in the NHS (mean [SD] baseline age, 50.2 [7.2] years), 90 864 women in the NHS II (mean [SD] baseline age, 36.1 [4.7] years), and 43 339 men in the HPFS (mean [SD] baseline age, 53.2 [9.6] years). During a total of 5 257 190 person-years of follow-up, 23 366 incident CVD cases were documented (18 092 CHD and 5687 stroke) (some individuals were diagnosed as having both CHD and stroke). Comparing the highest with the lowest quintiles, the pooled multivariable-adjusted hazard ratios (HRs) of CVD were 0.83 (95% CI, 0.79-0.86) for the HEI-2015, 0.83 (95% CI, 0.79-0.86) for the AMED, 0.86 (95% CI, 0.82-0.89) for the HPDI, and 0.79 (95% CI, 0.75-0.82) for the AHEI (P for trend <.001 for all). In addition, a 25-percentile higher dietary score was associated with 10% to 20% lower risk of CVD (pooled HR, 0.80 [95% CI, 0.77-0.83] for the HEI-2015; 0.90 [95% CI, 0.87-0.92] for the AMED; 0.86 [95% CI, 0.82-0.89] for the HPDI; and 0.81 [95% CI, 0.78-0.84] for the AHEI). These dietary scores were statistically significantly associated with lower risk of both CHD and stroke. In analyses stratified by race/ethnicity and other potential risk factors for CVD, the inverse associations between these scores and risk of CVD were consistent in most subgroups.

CONCLUSIONS AND RELEVANCE

In 3 large prospective cohorts with up to 32 years of follow-up, greater adherence to various healthy eating patterns was consistently associated with lower risk of CVD. These findings support the recommendations of the 2015-2020 Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.

Fish Consumption and Coronary Heart Disease: A Meta-Analysis

Epidemiological studies on the impact of fish consumption on coronary heart disease (CHD) incidence have shown inconsistent results. In addition, in terms of CHD mortality, although previous meta-analyses showed that fish consumption reduces the risk of CHD, six newly incorporated studies show that fish consumption has no impact on CHD. Therefore, the results still need to be verified. The purpose of this study is to quantitatively evaluate the impact of fish consumption on CHD incidence and mortality. Relevant studies were identified from PubMed, Web of Science, and Embase databases up to October 2019. The multivariate-adjusted relative risks (RRs) for the highest versus the lowest fish consumption categories and the 95% confidence intervals were computed with a random-effect model. A restricted cubic spline regression model was used to assess the dose–response relationship between fish consumption and CHD incidence and mortality. Forty prospective cohort studies were incorporated into research. Among them, 22 studies investigated the association between fish consumption and CHD incidence (28,261 cases and 918,783 participants), and the summary estimate showed that higher fish consumption was significantly associated with a lower CHD incidence [RR: 0.91, 95% CI: (0.84, 0.97); I² = 47.4%]. Twenty-seven studies investigated the association between fish consumption and CHD mortality (10,568 events and 1,139,553 participants), and the summary estimate showed that higher fish intake was significantly associated with a lower CHD mortality [RR: 0.85, 95% CI: (0.77, 0.94); I² = 51.3%]. The dose–response analysis showed that the CHD incidence and mortality were reduced by 4%, respectively, with a 20 g/day increment in fish consumption. This meta-analysis indicates that fish consumption is associated with a lower CHD incidence and mortality.

Fish consumption and the risk of cardiovascular disease and mortality in patients with type 2 diabetes: a dose-response meta-analysis of prospective cohort studies

We aimed to investigate the association of fish consumption with the risk of coronary heart disease (CHD), stroke and all-cause mortality in patients with type 2 diabetes (T2D). We systematically searched PubMed and Scopus from inception till June 2019. We included prospective cohort studies assessing the relation of fish intake with the risk of CHD, stroke and mortality in patients with T2D. Study-specific results were pooled with the use of a random-effects model. Nine prospective cohort studies with 57,394 diabetic patients were identified. The relative risks for the highest compared with the lowest category of fish consumption were 0.86 (95% CI 0.76, 0.96; I² = 50%, n = 8) for all-cause mortality, and 0.61 (95% CI 0.29, 0.93; I² = 68%, n = 3) for CHD. There was a monotonic inverse association, with a nadir at fish consumption of approximately 2-3 servings/week, in both analyses. A nonsignificant inverse association was found for stroke. In the analysis of all-cause mortality, a nonsignificant inverse association was found in studies that controlled for energy intake, suggesting that the observed inverse association was not an addition effect, but may be due to substituting other foods such as red and processed meat with fish.

Fish Consumption and the Risk of Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies

We aimed to present a comprehensive review of published meta-analyses of prospective cohort studies on the association of fish consumption and the risk of chronic disease. A systematic search was undertaken in Pubmed and Scopus to October 2019 to find meta-analyses of observational studies evaluating the association of fish consumption and the risk of chronic disease. Retrospective and cross-sectional studies and studies with unadjusted risk estimates were excluded. The summary relative risk (SRR) for each meta-analysis was recalculated by using a random-effects model. The methodological quality of included meta-analyses and the quality of the evidence were assessed by the AMSTAR and NutriGrade tools, respectively. A total of 34 meta-analyses of prospective observational studies, reporting SRRs for 40 different outcomes obtained from 298 primary prospective cohort studies, were included. Moderate-quality evidence suggested that each 100-g/d increment in fish consumption was associated with a lower risk of all-cause mortality (SRR: 0.92; 95% CI: 0.87, 0.97), cardiovascular mortality (SRR: 0.75; 95% CI: 0.65, 0.87), coronary heart disease (SRR: 0.88; 95% CI: 0.79, 0.99), myocardial infarction (SRR: 0.75; 95% CI: 0.65, 0.93), stroke (SRR: 0.86; 95% CI: 0.75, 0.99), heart failure (SRR: 0.80; 95% CI: 0.67, 0.95), depression (SRR: 0.88; 95% CI: 0.79, 0.98), and liver cancer (SRR: 0.65; 95% CI: 0.48, 0.87). For cancers of most sites, there was no significant association and the quality of the evidence was rated low and very low. In conclusion, evidence of moderate quality suggests that fish consumption is associated with a lower risk of cardiovascular disease, depression, and mortality and, therefore, can be considered as a healthy animal-based dietary source of protein. Further research is needed for outcomes for which the quality of the evidence was rated low and very low, considering types of fish consumed, different methods of cooking fish, and all potential confounding variables.

Dietary saturated fat and heart disease: a narrative review

The American Heart Association (AHA) recently published a meta-analysis that confirmed their 60-year-old recommendation to limit saturated fat (SFA, saturated fatty acid) and replace it with polyunsaturated fat to reduce the risk of heart disease based on the strength of 4 Core Trials. To assess the evidence for this recommendation, meta-analyses on the effect of SFA consumption on heart disease outcomes were reviewed. Nineteen meta-analyses addressing this topic were identified: 9 observational studies and 10 randomized controlled trials. Meta-analyses of observational studies found no association between SFA intake and heart disease, while meta-analyses of randomized controlled trials were inconsistent but tended to show a lack of an association. The inconsistency seems to have been mediated by the differing clinical trials included. For example, the AHA meta-analysis only included 4 trials (the Core Trials), and those trials contained design and methodological flaws and did not meet all the predefined inclusion criteria. The AHA stance regarding the strength of the evidence for the recommendation to limit SFAs for heart disease prevention may be overstated and in need of reevaluation.