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Invited Commentary
March 8, 2021

Fish, Cardiovascular Disease, and Mortality—What Is the Global Evidence?

Author Affiliations
  • 1Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
JAMA Intern Med. 2021;181(5):649-651. doi:10.1001/jamainternmed.2021.0045

Fish and shellfish (hereafter referred to as fish) are major sources of the dietary long-chain ω-3 fatty acids eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3) and also contain other nutrients, such as vitamin D, riboflavin, iodine, calcium, phosphorus, magnesium, potassium, zinc, and iron. The summed results of observational studies of fish intake, randomized clinical trials of fish oil supplements, and associated mechanistic and experimental studies suggest that regular fish consumption may decrease the incidence of myocardial infarction (MI) and coronary heart disease (CHD), with more uncertain effects on stroke, total cardiovascular disease (CVD), or other composite events, such as all-cause mortality.1-3 Yet, these summed findings obscure the inconsistent results of individual clinical trials, which have raised uncertainty and controversy about health benefits. Proposed explanatory factors for the heterogeneity have included dose, type of fish (oily vs white), methods for preparation of fish (baked or grilled vs fried), background fish consumption, underlying participant risk, outcome (eg, fatal CHD vs combined CVD events), and even presence of trace contaminants such as mercury or organic pollutants. In addition, associated behaviors of individuals who eat fish (eg, other dietary factors and socioeconomic status) could overestimate benefits in observational studies.

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