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Total (food and supplement) n-3 PUFA intake is associated with lower Coronary Heart Disease mortality, independently of fish intake

Published online by Cambridge University Press:  22 January 2016

M.A.H. Lentjes ,
R.H. Keogh ,
A.A. Welch ,
A.A. Mulligan ,
R.N. Luben  and
K.T. Khaw
M.A.H. Lentjes
Affiliation:
University of Cambridge, Department of Public Health & Primary Care, Cambridge CB1 8RN
R.H. Keogh
Affiliation:
London School of Hygiene and Tropical Medicine, London
A.A. Welch
Affiliation:
University of East Anglia, Department of Population Health & Primary care, Norwich Medical School, Norwich NR4 7TJ
A.A. Mulligan
Affiliation:
University of Cambridge, Department of Public Health & Primary Care, Cambridge CB1 8RN
R.N. Luben
Affiliation:
University of Cambridge, Department of Public Health & Primary Care, Cambridge CB1 8RN
K.T. Khaw
Affiliation:
University of Cambridge, Clinical Gerontology Unit, Cambridge CB2 2QQ
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Abstract

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Fish contains essential polyunsaturated fatty acids (n-3 PUFA) which increase n-3 PUFA concentrations in the cardiac membrane and influence cardio electrophysiology, which might have antiarrhythmic effects and so lower risk of fatal CHD.( Reference London 1 , Reference Mozaffarian 2 ) Clinical trials of n-3 PUFA supplements conducted in high risk populations show no significant benefit,( Reference Chowdhury 3 ) results from observational studies on fish intake show heterogeneous results.( Reference Zheng 4 ) N-3 PUFA containing supplements, mainly cod liver oil, are widely used in the UK and by 24 % in the Norfolk-based European Prospective Investigation into Cancer (EPIC-Norfolk).( Reference Lentjes 5 , Reference Lentjes 6 ) We studied the association between n-3 PUFA Total Nutrient Intake (TNI, i.e. intake from foods and supplements), n-3 PUFA supplement use and fatal CHD in a general population-based cohort.

EPIC-Norfolk recruited men and women, between 39–79 y (N = 25,639) between 1993–1997. Anthropometry was measured. Participants completed a 7-day diet diary, from which n-3 PUFA TNI, energy intake and disaggregated food consumption were determined. Participants were classified into three groups: non-supplement users (NSU), supplement users without n-3 PUFA supplements (SU-n3) and supplement users with n-3 PUFA supplements (SU+n3). General questionnaires ascertained social class, education, smoking, physical activity, alcohol consumption and prevalent diseases. Analyses were based on n = 22,137 with complete data. After a median follow-up of 18 years, 1393 participants died from CHD (ICD 410-414/I20-25). Cox proportional hazards regression was used to analyse differences between supplement groups as well as quintiles (Q5 v Q1) of TNI intake.

SU + n3 (compared to NSU) were more likely to be women, >60 years, and to be non-smokers and alcohol consumers. They reported fewer higher educational qualifications and less physical activity. SU + n3 and SU-n3 had lower self-reported history of myocardial infarction, diabetes or stroke. Differences in median (Med) n-3 sourced intake are shown in the top half of the table. SU + n3 did not have lower risk of fatal CHD; however higher n-3 PUFA intake was associated with a 22 % lower risk of fatal CHD, after adjusting for fish consumption, indicating that other sources than fish are associated with fatal CHD.

* sex, age, smoking, body mass index, alcohol, social class, education, season, physical activity, energy intake, fruit, vegetables, red meat, processed meat, white meat, prevalent diabetes/stroke/myocardial infarction.

Non-fish n-3 PUFA was negatively associated with fatal CHD. The negative confounding observed from fish might be explained by preparation methods( Reference Mozaffarian 7 ) or UK dietary patterns (fish ‘n chips); alternatively, contamination of fish with methylmercury might play a role.( Reference Stern 8 )

References

1. London, B et al. (2007) Circulation 116, e320–e335; 2.Google Scholar
2. Mozaffarian, D et al. (2006) JAMA 296, 1885–1899; 3.Google Scholar
3. Chowdhury, R et al. (2014) Ann. Intern. Med. 160, 398–406; 4.CrossRefGoogle Scholar
4. Zheng, J et al. (2012) Public Health Nutr. 15, 725–737; 5.CrossRefGoogle Scholar
5. Lentjes, MAH et al. (2014) Nutrients 6, 4320–37; 6.Google Scholar
6. Lentjes, MAH et al. (2014) J. Hum. Nutr. Diet.; 7.Google Scholar
7. Mozaffarian, D et al. (2003) Circulation 107, 1372–1377; 8.Google Scholar
8. Stern, AH (2007) Environ. Health 6, 31.CrossRefGoogle Scholar
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