Fish Consumption and EPA+DHA in the US
Fish Type	Consumption, grams/day/ capita	% of total Consumption	% of EPA +      DHA
Tuna	2.63	20.4	0.26
Shrimp	1.63	12.7	0.35
Cod	1.12	8.8	0.19
Salmon	1.02	8.0	1.45
Flounder	0.46	3.6	0.20
Catfish	0.34	2.7	0.18
Haddock	0.25	1.9	0.24
Herring	0.09	0.07	1.5
Mackerel	0.09	0.07	2.0
All Fish	12.83	100	0.50 est

The Life Ahead Valuation of Cardiovascular Risks for Fish and EPA+DHA.  Life Ahead now values the health benefits of fish supplements and three different classes of fish as fried, not fried and lean, and salmon and fatty. Fried fish are accorded no benefits for included EPA+DHA, and are valued on their other nutrient content. The minority that eats mackerel or herring can select the option for salmon.  The table following provides presently estimated risk ratios for CV disease death for varying amounts of these classes:  Risks as for all others in Life Ahead are taken vs. that for the US average population. This assumes an average population consumption of 12.8 grams per day of fish of average 0.5 % content by weight or about 65 daily milligrams of DHA+EPA .  A limiting benefit for any amount of this nutrient is set as a risk factor of 0.5 based an available research  and some conservatism.

This will require about 0.4 gram or 400 milligrams of EPA+DHA per day.  This in turn will require two 3 ounce portions of salmon each week or a daily consumption of either a usual fish oil supplement or three ounces of a usual lean type fish. But as will be shown later, the needed intake of omega fats also can be achieved via intake of fish oil supplements or from linolenic acid.  These values are for a hypothetical average person.  Small women would need less, and large men would need correspondingly more of these nutrients for these estimated health benefits.

 

The research results for the effect of fish on risk of coronary heart disease death are unusually consistent.  The extensive research now published shows an average risk of 0.55 times or a reduction in risk of 45% for about 0.3 gm/day or 300 milligrams/day of DHA+EPA.  Most studies obtained results quite close to this average.  This should leave little question on the health value of eating adequate amounts of fish - the only food that includes useful amounts of these fatty acids.

  

  These are quite substantial benefits for an individual food, and are far larger than those     obtainable from other "Good" foods such as fruits or vegetables.  For example, 1  

  portion per  week of salmon may contribute the cardiovascular risk benefits obtainable  

  from 4 portions per day of fruits or vegetables.  Eating salmon only 1 to 2 times per  

  month appears to contribute usefully to reducing risk  Computed as a single added

  factor, 2 portions of salmon per day over rest of life may contribute 3 more years of average population Well-Days for  a person of age 50. Although this contribution would be less when accomplished as a part of some other health improvements, every health-interested person should achieve a near target intake of omega-3 fatty acids. This is  because these nutrients provide unique short and long term reductions in risk of major disease that may not be achievable  from any other diet or health modification. 

 

The formulas used in Life Ahead for valuation of fish are provided following the tables of the actual research data found. A limiting risk factor for any amount of fish is set at 0.50 because research does not yet confirm any any advantage for higher amounts than about 0.3 -0.4 gram/day of DHA+EPA.

 

About Mercury and PCB's in Fish:  There has been much publicity about the possibly harmful effect of mercury that can be included as a contaminant in fish, and especially in fresh water fish and some farmed salmon. This has discouraged some people from eating any fish.  This publicity has been unwarranted and misleading.

 

First, risks on mercury and PCB's as for other environmental factors are usually identified as deaths per million years of exposure. These risks are in different world and dimension as those identifying risk of health habits. Those warning about these "hazards" have not been forthcoming on specific levels of risk.  One analyst of this quotes:  "If 100,000 people were to eat eight ounces of salmon every week for 70 years we predict that one person will get cancer from PCB's"   In contrast, thousands of persons will die from heart attacks because they did not eat this salmon.

 

Second, the fish eaten in studies A30 through A39 conducted in various parts of the world did measure its effects on death. These populations ate fish that probably included the usual amounts of mercury and PCB's other contaminants still showed very substantial health benefits both to CV and all cause death.   Study A38 investigated the potential harm of a rather high amount of mercury.  Taken by itself, highest blood contents of mercury may increase risk of heart disease death. But the fish involved that included the most mercury still were healthful. This suggests that fish should be far more beneficial than any harm due to this factor.  A FDA advisory said the women pregnant or with young children should not eat more than 7 ounces per week of "High mercury fish" of 0.7-1 part per million.  No harm was indicated for adult consumption of usual fish that has 0.05 to 0.2 parts per million of mercury.  Fish now purchased commercially in stores, restaurants, etc usually is regulated for mercury content.

 

Similarly, much publicity has been given the possibility that sport and other fish from fresh waters and farmed salmon can contain some harmful PCB's.  Again, this risk is based on a few deaths per million of population.  A review of the literature on this found no quantified evidence that harm of this could be of significance vs. the very powerful benefits of small amounts of salmon that can reduce risk of death from the major CV diseases in half.  The risks of a CVD disease death for the average male US population of age 50 just to ages 60 and 70 is about 4.5% and 17% respectively.  Reducing this risk in half would save 2,250 and 8,500 lives per 100,000 men.  In contrast, risks of death from PCB's and most other environmental chemicals are commonly reported as a handful deaths per 100,000 individuals for lifetime exposures.  It will require only two three ounce portions of salmon per week to achieve this benefit, and more salmon than this may not produce much further benefit. Thus for those concerned, there appears to little reason to eat more salmon than this for the purpose of health..  And fish oil supplements appear to have no mercury, PCB's or other known problem agents.  Thus those concerned and those that do not like fish have this equally healthful alternative. And the publicity about mercury and PCB's has stimulated the fish industry to take serious steps to remove these problems that are in progress..

Alpha Linolenic Acid:   The second important omega-3 fat as noted above is Alpha Linolenic Acid.  This fat is not included in useful amounts in most fish, but derives usually in small individual amounts from a wide variety of foods.  It is found in appreciable amounts only from flaxseed (23% by weight), butternuts(9%), walnuts(3-7%), and soybeans(2-3%). It is further included in amounts of a few tenths of a percent in each of a diverse variety of foods. It also is included in good amounts in canola or rapeseed oil, but because of recent controversy about its other possible harmful health effects the option of using canola oil is not valued in Life Ahead.

Observation studies A13, A15, A16, A19, A20 and clinical studies A34, A39, and B1 in Tables A and B include the major available research on coronary  (CHD) or cardiovascular risk.  These confirm in aggregate a highly significant effect of linolenic acid on risk of fatal heart disease. Results from large study A13 for women and from large A15 on both men and women were dose related and confirmed that largest amounts of dietary linolenic reduced risk of CHD about in half.  This was confirmed further in A20 and by risks related to amounts in blood in A19, A34 and A39.  Study A19 that involved strong confounding with other fats found no effect when unadjusted, but a substantial benefit after adjustment.  Study A19 involved both a very high error margin and a small difference in amounts of linolenic. Recognizing this, the A19 result was statistically consistent with results of the majority.

The formula derived that is used in Life Ahead for linolenic acid is appended following the tables. A problem in the analysis is that the methods for measuring dietary linolenic acid probably were not consistent in the different studies. Amounts of linolenic reported on average and for groups were lower in A15 than in A13 and A20.  But the relationship of relative amounts to cardiovascular risk were still quite consistent.  Many foods include small amounts of linolenic acid and derivation of a total amount in a diet is complex. But the overall average result from this research was a risk factor of 0.60 or a 40% reduction in risk for an increase consumption of linolenic acid from 0.6 to 2.5 grams per day.  But note that a 6  times higher amount of linolenic acid for the upper limit was needed to reach the benefit obtained from only 0.3 gram/day of DHA+EPA.  Thus it takes about 6 times the amount of linolenic acid to produce the benefit obtainable from a given amount of  DHA+EPA. The formulas now used in Life Ahead for linolenic acid also are appended to the tables of research results found.

No useful research was found for combinations of EPA+DHA and linolenic acid.  But these two omega-3 factors probably are at least partly and more probably mostly alternates for reducing the same basic risk. Thus they should be viewed in combination. A useful measure of total omega-3 fats is equivalent grams per day  of DHA+EPA plus an accompanying 1/6th  of the grams per day of linolenic acid.  A limiting risk factor of 0.50 is set for use of any combination of these two nutrients.

The healthful targets for Life Ahead Version #3 are set  at 0.4 gram or 400 equivalent mg/day of DHA+EPA with Linolenic added to DHA+EPA at 1/6th of its included grams per day .  This value target is further adjusted for user sex and weight. This adjustment for linolenic acid is a revision of the method used in Life Ahead Version #2. 

It will be best for us achieve the target amount of omega-3's from consumption of both fish and linolenic equivalents from either foods or supplements.  These are quite different chemical entities and there is no assurance that they produce benefits from identical mechanisms. Today's research shows only that each group does produce benefit.  We have no adequate research for their use in combinations.  Life Ahead now uses EPA+DHA equivalents to value the potential of a combination of the two omega-3 nutrient groups, with the total of mg of DHA+EPA plus one sixth equivalent via mg of Linolenic.  Users can use goals of 500 added mg of EPA+DHA, 1000 added or 3 grams of linolenic.

Using Life Ahead:  It will not be convenient for many individuals to estimate their own consumption of omega-3's from EPA+DHA and linolenic from various diets.  Although as mentioned some guides about this will follow, this problem is solved with use of the Life Ahead computer model.  The model calculates amounts of each of these nutrients from any diet entered, adjusts these amounts for sex and body size, and compares amounts taken with needed targets. Thus any person can easily view their actual amounts of these key nutrients eaten and compare this with amounts needed to best protect health and life.

A diet containing target amounts of omega-3's taken over life should add about 1.5 to 2  years of Well-Days to the healthy longevity of an average US 50 year old man or woman.  Larger benefits are potential for those whose regular diets are now quite low in omega-3 fats. The Life Ahead diet analysis will show the potential gains in Well-Days for omega-3 dietary modifications from any present diet and combination of other factors.

Estimating Amounts of EPA+DHA Equivalents:  A first guideline is that a 3 oz portion of salmon will include about 1350 mg of EPA+DHA. For a 500 mg/day or 3500 mg/week target just two portions per week of salmon will supply most of our omega-3 fat need. But most fish includes only a fifth of the EPA+DHA of salmon, and thus even a daily portion of most other fish will fall short of our need.  Fortunately the research suggests that fish oil supplements will provide the computed EPA+DHA benefit.  A typical fish oil supplement includes about 360 DHA+EPA equivalents.  Thus 5-6 such weekly supplements will supply the omega-3 need.  Or 1 portion of salmon plus three of these supplements will suffice.

But it should be better to obtain at least part of our omega-3 need from linolenic acid.  The table following shows the values of linolenic acid in grams and in equivalent milligrams of EPA+DHA equivalents for these included foods. Note that these values refer to amounts per portion of food as identified by in the Life Ahead food library, and are not the usual values per gram of weight. These values all are taken from US Dept of Agriculture data on food composition.  A value equivalent of 1 gram of linolenic acid is taken as that of about 0.166  grams of EPA+DHA. .

Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA
flaxseed oil,  tblsp	7.25 / 1200	potato salad,1/2 cup	0.30 / 50	milk, 3.5%, 8 oz	0.20 / 33	soybeans, 1/2 cup	0.14 / 23
walnuts, 1 oz	2.6 / 430	mayonnaise, 1 tblsp	0.29 / 48	cheeseburger,1 med	0.20 / 33	navy beans, 1/2 cup	0.14 / 23
walnut oil, 1 tblsp	1.4 / 230	pie, 1 slice	0.25 / 42	frankfurter, 1	0.17 / 28	melon, 1/2	0.125 / 68
bean soup, 1 cup	0.50 / 88	margarine,1 tblsp	0.20 / 33	ice cream, 1/2 cup	0.15 / 25	quinoa, 1/2 cup	0.11 / 20
tuna salad, 3oz	0.50 / 83	Italian dressing, 1 tblsp	0.20 / 33	chicken dark, 3oz	0.15 / 25	olive oil, 1 tblsp	0.11 / 20
blue cheese, 1 tblsp	0.50 / 83	lamb, 3oz	0.20 / 33	cheese omelet,  5 oz	0.15 / 25	cheese, 1 oz	0.10 / 17

A richest source of linolenic acid is flaxseed or linseed oil. The seeds per se can be useful if ground adequately, but no good basis for computing effective omega-3 amounts of these was found.  Some doctors and groups have advocated the use of incredibly large amounts of flaxseed oil as a way for obtaining our full need for omega-3's. This probably involves a vast overkill in the use of a dietary nutrient, and may not be a best approach.  Just one tablespoon of flaxseed oil that includes 7.25 grams or 7,250 mg  produces 1200  EPA+DHA equivalents.  Thus the equivalent of just three tablespoons per week will supply the week's full computed need for omega-3's.  The Mediterranean diet  group obtained much of their large benefit by consuming 1.79 grams of total linolenic acid per day or 1.1 grams more than did the control diet group. Yet some guru's and diet supplement marketers have advocated use of multiple tablespoons of flaxseed oil per day.   Sadly, we have no direct population research confirming either the benefit or dose need for flaxseed oil.  No data was found on the harm of it in such large amounts, but this does not confirm that such large amounts are really safe. Large amounts of usually beneficial nutrients are not always better. Beta carotene and Vitamin A are beneficial to amounts of 15,000 and 5,000 IU per day, but harmful in larger amounts. And each added tablespoon of flaxseed oil contributes another 120 fat calories to body weight.  A more sensible use of flaxseed oil would be a maximum of perhaps three tablespoons of the oil per week, and this can be reduced if fish also is eaten.

A concern was raised from two large studies of men that suggested large amounts of Alpha Linolenic Acid increased the risk of prostate cancer.  A problem with this is that the foods highest in ALA tend to be meats and junk foods and other foods high in saturated fats that are known to produce cancer.  The evidence on this is not now sufficient for inclusion of a factor on this in Life Ahead.  But  this does provide a further warning about taking any more flaxseed oil than is shown to be useful. And men and especially those with a risk of prostate cancer might prefer the alternative of meeting targets for omega-3's from DHA and EPA

Walnuts and walnut oil is a next highest content source. Just an ounce of walnuts eaten each day can supply  the needed omega-3 benefit. But a variety of other foods such as bean soup, tuna salad and blue cheese can include useful amounts of linolenic acid. There is no simple way for individuals to know which foods include this nutrient and which foods do not include it in useful amounts.  The amount of linolenic in these above 'other' foods varies from 0.2 grams to 1.17 grams in the 11 Life Ahead demo diets provided in the program.  Thus as noted above, without a computer program such as Life Ahead there is no practical way for an individual - and this includes the health professional - to know how much omega-3 is included in a diet.

There also is no relationship between omega-3 content and the usual "Good" and "Bad" health valuations of food health based only on total or saturated fat.   Life Ahead's multivariable valuation of health benefits shows here and elsewhere that conventional health value ideas of a food that are based only on saturated fat and cholesterol and further for just one cause of death as heart disease can be completely wrong. In contrast, Life Ahead values the combined effect of up to 23 nutrients in a dietary food on up to 15 different causes of major disease and premature death.

Life Ahead users will obtain a valuation in the diet analysis display of how much overall omega-3's are included in any diet entered, and how much more of this nutrient is needed for best health.  The program will also show on option the omega's from any entered food either in the diet or in the health library.  The user then can try alternate additions of omega-3 containing foods with guidance of the above tables (and these values are provided in the program)  to learn how this deficiency can be acceptably corrected. 

Supplements of EPA+DHA:  Research on the benefits of fish oil supplements as in studies A32, A36 and A37 showed benefits similar to those from amounts of EPA+DHA in fish. Thus those that find fish distasteful have the option of using fish supplements which have a benign taste. A popular fish oil supplement of 1.2 grams includes 216 mg of EPA and 144 mg of DHA, or a total of 360 mg or 0.36 gram of the needed nutrients. But other supplements may include differing amounts of EPA and DHA.  Thus Life Ahead provides for entering the actual average amount of EPA+DHA taken per day in milligrams from a supplement. The program values omega-3 factors from fish as the sum of the average amount of EPA+DHA eaten in fish intake plus that eaten in supplements per day.  And omega-3 benefits also are obtainable from the added intake of alpha linolenic acid that can be taken via supplements of flax oil.

Omega-3's and Cancer:  It has long been proposed that omega-3 fats will reduce the risk of cancer.  Dr. Johanna Budwig proposed this in 1951.  And a Dr. Dan Roehm has written extensively about this.  This writer did attempt a brief search on this, but did not find sufficient and consistent research in this review to include a properly quantified cancer benefit for omega-3's in Life Ahead. Age. A large meta analysis of 38 different studies (Maclean, CH, JAMA 2006; 295:403)  found similarly inconsistent results for omega-3 fats on 11 different types of cancer.  This subject is due for further future  study to learn more about why such different results were obtained..  Any benefit of these nutrients for reducing  risk of cancer could add significantly to the herein well confirmed benefits of ometa-3's on cardiovascular diseases

Fish, EPA+DHA and Stroke:  Studies C1 and C10-12 in Table 1 show risks of stroke for both fish intake and omega-3 fatty acid intake. On average, highest amounts of omega-3 fats reduced risk of stroke by about 25%.  Although this is a somewhat  lower reduction in risk than that obtained for coronary disease death, it seems likely the benefits of fish intake are roughly similar for the two different cardiovascular diseases.

Other Polyunsaturated Fats:  Although the omega-3 fats are the most beneficial of the polyunsaturated fats, the full range of polyunsaturated fats appears to be somewhat more beneficial than that estimated from their effect on serum cholesterol. But research found is not adequate to support an effect of polyunsaturated fats in addition to that found for its usually included amounts of omega-3's.

Omega-3 Fats and Cancer:  There are a number of studies showing a protective effect of Omega-3 fats on Cancer.  This factor has not yet been studied for inclusion in Life Ahead. But the benefits of the Omega-e's on Cardiovascular disease is so substantial that any benefits for them from cancer will endorse their use even more strongly.

Effect of Polyunsaturated Fats on Death from All Causes:  The research in Table C following shows a consistent benefit of the included polyunsaturated fats and particularly fish and EPA+DHA on the risks of death from all causes.  This provides a positive confirmation of about a 25% potential risk of death and a confirmed probable increase in life expectancy from the appropriate inclusion of these key factors in our diet.

Identifying an adequacy of omega-3 intake in a diet is a complex problem that up to this time has not been usefully solved. The Life Ahead program does identify conveniently the amounts of both linolenic acid and other omega-3 fats from fish oils in nearly any diet, compares these amounts with desirable goals, and shows both an change in risk of heart disease and a likely loss in Well-Days of life from an any diet deficiency in omega-3 fats vs. healthful targets used regularly over the long term.  And the program provides a variety of acceptable dietary options that individuals can select from to remedy this deficiency.  Download and install the computer program from Download Life Ahead, enter your habits and factors, and try entering a usual daily or weekly diet, and compute your outlook as detailed by the program.  From the result display, access 'Actions for More Well-Days' and then  'Diet Analysis' to bring up the listing of diet nutrients for healthful targets.  This will display your intake of total omega-3 fatty acids vs. targets from both fish and linolenic acids.  Life Ahead may now be be the only available computer program that can develop this valuation from most user diets.  You can learn how the program displays these factors without entering your own health factors simply by running the Demo program for either men or women on one or more optional diets.

 

 THE RESEARCH on HEALTH BENEFITS of OMEGA-s FATTY ACIDS

 

The Research on Omega-3 Fats, EPA+DHA.  A search of the the vast Medline data base on research disclosed no other serious published quantitative analysis of the benefits of omega-3 fatty acids such as that described above.  Conventional health factor reviews usually discuss results of each individual research study, and these results taken individually nearly always are inconsistent and confusing.  This is usually because individual studies can have very large margins of errors that usually are overlooked in this type of review.  Life Ahead reanalyzed the actual data provided in each and all studies found objectively and more quantitatively.  The Tables 1 to 3 appended here summarize actual risk values and their error margins for all useful population type research studies found.  Research on EPA and DHA that considered the benefits of the sum of these two nutrients is shown for observation studies A10-A14 and A17-20 and for clinical studies A31-2 and A36-9 are shown in Table A following.  16 of the 18 different comparisons confirmed reduced risk of CHD or CVD death for the Omega-3's. These reductions in risk often were substantial. It has been suggested that the failure of multivariable comparison A10 could have been due to the fact that most men were fish consumers and omega's were estimated  from fish consumption. The comparison of those eating vs. those not eating fish in this study was consistent with the result of the majority.  Study A35 compared results of EPA+DHA taken in impractically large amounts with similar large amounts of corn oil that in such amounts also could have been beneficial. Thus this was not a true direct valuation of the benefit of EPA+DHA.

 

Study A19 that was based on amounts of EPA and DHA in blood showed a substantial reduction in risk for higher values.  Study A18 found a five fold reduction in risk of sudden coronary death associated with different amounts of EPA+DHA in blood. Clinical study A39 also found a 2/3rds reduction in risk of sudden death (but not for coronary disease per se) for differing amounts of EPA+DHA in blood.  The meta analysis of 11 clinical studies found an average reduction in risk of 30% for fatal CHD and for sudden death for various differences in amounts of EPA+DHA.  And this meta analysis found similar results for EPA+DHA taken in supplements vs. that taken in fish.  Overall, it seems well-confirmed that EPA+DHA taken in the amounts of only a half to one gram per day usually will reduce risk of heart disease death about in half.

 

Some additional studies and risk ratios are referenced in a very extensive summary report on Omega-3 fatty acids research listed in the NIH Office of Dietary Supplements,  http://odp.od.nih.gov/ods.  Some studies therein not included below are not quantitatively useful, or have excessive error margins.

 

 

TABLE  A               EFFECT of POLYUNSATURATED FATS on CORONARY HEART DISEASE

No

Study

Sex

Scope

Risk Ratio

Error Margin

Basis

Diff in Amount

Cause

Notes

TOTAL POLY UNSATURATED FATS

A1

Ascherio, A,  BMJ 1996, 313:84

M

Hlth Professionals Study, N=734

1.04 0.80

0.82-1.33 0.63-1.03

5ths

3.5-7.1% 0.4-0.7%

All CHD

Linoleic Acid Linolenic Acid (key poly-fats)

A2

Hu, FB  N Engl J Med, 1997, 337:1491

W

Nurses Study N= 658

0.83 0.62

0.67-1.02 0.46-0.85

5ths

2.9-6.4% for + 5% of Calories

All CHD

Multivariable adjust Multivar + transfat

n-3 UNSATURATED FATTY ACIDS

OBSERVATION STUDIES

A8

Dolecek,TA World Rev nutr diet 1991, 22:205

M

MRFIT Study of12,900 at high risk for coronary disease, 10 yrs

0.66   0.59

0.41-1.05   P=0.004

5ths linolenic EPA+DHA

0.87-2.8 g/d   0-0.66 g/d

CVD death CVD death

A9

Ascherio A,,Br Med J 1996,313:84

M

734 CHD for 43,750 Health Professionals

0.41

P < 0.01

5ths of Linolenic Acid

0.8-1.5 gms.day

All CHD

Age adjusted rr=1.05 (1.03 on fatal CHD but heavily confounded. Value 0.41 uncertain

A10

Ascherio,A, N Engl J Med 1995,332:977

M

Hlth Professional Study, 1543 events of 45,000

1.14

0.86-1.51

5ths DHA+EPA

0.07-0.98 g/day

All CHD

Multivariable adjust. Unadjusted was similar

A11

Siscovick,TE, 1995 JAMA 274:1363

M&W

334 cases and controls. Univ of Washington

0.5

O.4-0.8

equiv 1 fatty fish/wk

1.5 g, EPA +DHA/wk via fish

CHD cardiac arrest

rr-0.3 (0.2-0.6) for quartiles of polyunsats in blood

A12

Albert, MA JAMA 1998; 279:23

M

133 Sudden coronary deaths of  20,500, Physicians Health Study

1.0 0.58 0.34 0.60 0.43

Base 0.28-1.21 0.15-0.75 0.29-1.27 0.20-0.93

5ths of DHA+EPA

0.3 gm/mo 0.3-2.7 g/mo 2.7-4.9 g/mo 4.0-7.4 g/m >7.4 g/mo

Sudden cardiac death

computed from fish consumption

A13

Hu, FB, Am J of Clin Nutr 1999, 69:890

W

232 events fatal MI, 597 of non-fatal MI on 76,000 Nurses, 10 yrs

1.00 0.99 0.90 0.67 0.55 0.85

Base 0.66-1.48 0.59-1.39 0.42-1.09 0.32-0.94 0.61-1.19

Alpha Linolenic Acid

0.71 gm/d 0.86 0.98 1.12 1.7 1.7

Fatal MI       Non-fatal MI

From foods as oil & vinegar, mayonnaise, margerines,

A14

Rissanen, T, Circulation, 2000, 102:2677

M

194 Events of 1871 men, coronary free

0.56

0.35-0.99

5fths of DHA+EPA

2.1-3.9% of fatty acids

All CHD

Men with avg hair amt of mercury.  risk = 0.33 for men with low mercury

A15

Djousse, L, Am J Clin Nutr 2001, 74:612

M&W

362 events of 2024 men and 123 events of 2382 women. All CHD free, but 1/2 selected were at higher risk

1 0.60 0.54 0.53 0.53 1.0 0.66 0.70 0.49 0.66

Base 0.43-0.83 0.38-0.74 0.38-0.77 0.38-0.74 Base 0.36-1.19 0.39-1.28 0.27-0.89 0.40-1.10

Alpha Linolenic Acid

0.53 0.67 0.78 0.90 1.14 0.46 0.58 0.65 0.76 0.96

All CHD         All CHD

Men         Women

A16

Oomen, CM, Am J Clin Nutr 2001, 74:457

M

98 CHD events of 667 elderly, Zutphen Elderly  Study, 10 yrs

0.97

0.58-1.63

Alpha Linolenic acid

0.4-0.65 est % of energy

All CHD

Diff in amt tested is very small and error margin high. Heavy interaction With TransFats

A17

Hu, FB, JAMA 2002, 287:1815

W

1513 CHD events (484 deaths) of 85,000 Nurses

1.0 0.93 0.78 0.68 0.67 0.61 0.77

Base 0.78-1.09 0.65-0.93 0.56-0.82 0.55-0.81 0.46-0.82 0.58-1.02

5thsof DHA + EPA from fish

0.03%calorie 0.05 0.08 0.14 0.24 0.24 0.24

All CHD

Also rr was lower with larger amt of linoleic acid     no aspirin with aspirin

A18

Albert, CM, N Engl J Med 2002, 346:1113

M

94 men from Physicians Health Study that suffered sudden death

1.0 0.55 0.28 0.19

Base 0.18-1.7 0.17-0.83 0.05-0.71

4ths of DHA+EPA in blood + other

3.58% 4.76% 5.63% 6.87% % in blood

Sudden CHD death vs % of n-3 acids in blood

rr=0.10 in 4th quartile with further adjustments

A19

Singh RB, 2002, Lancet 360:1455

M&W

Case control, 499 experimental vs. 401 controls in India

0.51   0.38

P < 0.001   p < 0.015

diet intervention Linolenic Acid

0.8 vs. 1.8 gm/day

All CHD   Sudden Dtth

A20

Erkkila AT, Am J Clin Nutr 2003, 78:65

M&W

285 men and 130 women with CHD over 5 yrs, Finland

0.44 0.33 0.31 0.82

.11-0.93 .12-0.93 .11-0.87 .31-2.16

linolenic EPA DHA Linoleic

0.7-0.95%est 0.9-2.5%est 0.5-0.9%est 42-53%est % in blood lipids

CVD death    same    same

High Error Margin

A21

Ingeborg, A, J. Nutr,2004 134:919

M&W

Meta Analysis of 5 studies

0.79

0.60-1.04

Linolenic Acid

avg diff in amts cited are uncertain

Fatal CHD

Selection of risks in two studies questionable. rr of 0.5-0.6 possible

CLINICAL STUDIES

A30

Burr, ML, Lancet 1989, 2(8666):757

M

2033 men having had MI, 2 yr all cause death

0.79

Those advised to eat 2-3 portions fatty fish/week

Poorly quantified, lesser effect of fat, fiber.

A31

Singh, RB, Cardiovasc Drugs Ther 1997; 11:485

M&W

122 fish oil (EPA) vs. Placebo, 1 yr 120 alpha-linolenic vs placebo, 1 yr

0.71   0.81

0.48-1.11   0.56-1.2

All had MI at start

1.08 gm/day   2.9 gm/day

both EPA & linolenic showed less arrhythmias,

A32

GISSI (Italy) Lancet 1999; 354:447

M&W

2836 CHD survivors vs. 2828 control, 3-5 years clinical study

0.70

0.56-0.87

quartiles

1 gm/day of n-3 poly fat supplement vs none

A34

Guallar, E, Arteriosclerosis, Thrombosis and Vascular Biology 1999, 19:1111

M&W

639 CHD patients and 700 controls

0.42

0.22-0.81

Alpha Linolenic Acid

quintiles of amounts in blood

further CHD

Adjusted risk of 0.68 may be in error

A35

Dennis, Wt, Am J Clin Nutr 2001, 74:50

M&W

300 Coronary patients assigned to high dose EPA+DHA vs 300 to Corn Oil

1.19

0.76-1.86

EPA+DHA and Corn oil

4 gms/day of each

Fatal and non fatal recurrence

Corn oil also  high in poly-unsats, thus result dubious

A36

Bucher, HC, Am J Med 2000, 112:298

M&W

Meta analysis of 11 randomized studies,  n-3 acids vs. placebo

0.8 0.7 0.7

0.5-1.2 0.6-0.8 0.6-0.9

n-3 acids

various amounts in different studies

MI fatal CHD sudden death

No difference in diet or supplements

A37

Marchioli, R;(GISSI), Circulation 2002, 105:1897

M&W

2836 CHD survivors vs. 2828 control, 3-5 years clinical study

0.67 0.65 0.46

0.56-0.86 0.51-0.82

n-3 fatty acids, presumed DHA+EPA

1 gm/day

CHD death CVD death sudden death

Risk showed little variation over 3-42 mo

A38

Guallar, E, N Engl J Med 2002, 347:1747

M

684 men with first MI in 8 Europe countries & 724 controls

0.8 0.59 2.16

0.53-1.23 0.30-1.19 1.09-4.29

5ths DHA 5ths DHA 5ths mercury

0.1 to 0.44% in tissue 0.11-0.65 ug/g from toenails

unadjusted Adj mercury mercury risk

Risks vs DHA before and after adj for mercury

A39

Lemaitre RN, Am J Clin Nutr 2003, 77:319

M&W

179 coronary free with 179 controls, measurements in blood 2 yrs before event for older persons age 65+

0.32 0.97 0.48 1.07 2.42 1.10

O.13-.78 0.71-1.33 0.24-0.96 0.81-1.41 1.07-5.43 0.83-1.46

EPA+DHA    same Linolenic   same Linoleic   same

2.93.7% bld     same 0.013-0.20     same 18.5-21.2     same

Fatal CHD Nonfatal Fatal CHD NonfatalCHD Fatal CHD NonfatalCHD

FISH INTAKE

A50

Kromhout, D, N Engl J  Med 1985;312:1205

M

Eskimos, Greenland 78 cases of 852

0.51

30+ g fish/ day vs. none (=2.7+ fish per week)

CHD death

20 years followup same w or w/o adjustments

A51

Ascherio,A, N Engl J Med 1995,332:977

M

Hlth Professionals Study, 1543 events of 45,000

1.14   0.74

0.86-1.51   0.44-1.23

6+ wk vs. 1- per month Any fish vs no fish

All CHD

All Cases, adj Use 10+ years No evident dose relationship

A52

Morris, MC; 1995, Am J Epidem 142:166

M

281 events of 20,500 Physicians Health Study

1.0 1.6 1.4 1.2

1.1-2.3 1.0-2.0 0.6-2.2

<1 fish/wk 1 fish/wk 3 fish/wk 5+ fish/wk

MI

See update va Albert, MA(1998)

A53

Kromhout, EJ, Int J of Epidem  1995, 24:340

M&W

58 events of 272, over 17 yrs in Netherlands elderly pop

0.51

0.29-0.89

60% Fish eaters vs 40% non fish eaters

All CHD

No effect on cancer or total mortality.

A54

Daviglus, ML, N Engl J Med 1997; 336:1046

M

430 CHD deaths from 1822 over 30 yrs, Chicago Western Electric Study

1.00 0.88 0.80 0.62

0.60-1.28 0.63-1.22 0.61-1.17 0.40-0.94

0 gm/day 1-17 gm/day 18-34 gm/d 35+ gm/d

All CHD most benefit for non-sudden death

Definition of sudden death may be doubtful

A55

Albert, MA JAMA 1998; 279:23

M

133 Sudden coronary deaths of  20,500, Physicians Health Study

1.0 0.64 0.47 0.51 0.39

Base 0.26-1.58 0.23-0.98 0.25-1.04 0.15-0.96

< 1 /month 1-3 /month 1- <2/week 2- <5/week 5+ /week

Sudden Death  No effect on rr of MI

adjusted values Updates 1995 paper.

A56

Albert, MA, Same Study as above

M

306 CHD deaths of  20,500, Physicians Health Study

1.0 1.18 0.82 0.91 0.81

Base 0.59-2.36 0.45-1.51 0.50-1.66 0.49-1.33

< 1 /month 1-3 /month 1- <2/week 2- <5/week 5+ /week

All CHD death.

Updates of 1995 paper that found no effect

A57

Oomen, CM, 2000, Am J Epidem, 2000, 151:999

M

1,088 Finland; 1097 Italy; 553 Dutch in Seven Countries study

0.66   1.08

0.49-090   0.76-1.53

4ths   4ths

fatty fish   lean fish

CHD mortality

A58

Hu, FB, JAMA 2002, 187:1815

W

1513 CHD events (484 deaths) of 85,000 Nurses

1.00 0.79 0.71 0.69 0.66 0.75 0.59

Base 0.64-0.97 0.58-0.87 0.55-0.88 0.50-0.89 0.49-1.16 0.39-0.90

5ths       mw aspirin w/o aspirin

nill 1-3/ month 1 per week 2-4 / week 5+ /week 5+/wk 5+/wk

All CHD

A59

Hu, FB, Circulation 2003, 107:1852

W

362 events of  5100 Diabetic Women in Nurses Study, CVD free at start

1.0 0.70 0.60 0.64 0.36

Base 0.48-1.03 0.42-0.85 0.42-0.99 0.20-0.66

overall fish con- sumption

<1/month 1-3 per mo 1 per week 2-4 per wk 5+ per wk

All CHD

A60

Erkkila AT, Am J Clin Nutr 2003, 78:1

M&W

285 men and 130 women with CHD over 5 yrs, Finland

1.00 0.64 0.45

Base 0.28-1.47 0.19-1.09

0 gm/day e 30 gm/day e 85 gm/day

ALL CVD

includes stroke but small n's

A61

Mozaffarian D, Circulation 2003, 107:1372

M&W

610 events, 247 fatal of 3910 in US, avg age 72. Other fish is Tuna + broiled, baked; fried fish includes this plus fish sandwiches

0.47 0.32 0.67 1.37 1.54 1.93

0.27-0.82 0.15-0.70 0.42-1.07 0.48-3.90 0.82-2.58 0.91-4.08

Otherfish   same   same FriedFish   same   same

nil to >3 wk   same   same nil to >3 wk  nil to 2 wk nil to >3 wk

All CHD dth Arrhythm dth Non-fatal All CHD dth Arrhythm dth Non-fatal dth

Dose related    same    same    same    same    same

TABLE  B                                               EFFECT of POLYUNSATURATED FATS on STROKE

n-3 UNSATURATED FATTY ACIDS and STROKE

Prospective & Case Control Studies

No

Study

Sex

Scope

Risk Ratio

Error Margin

Basis

Diff in Amount

Cause

Notes

B1

Simon, JA, Stroke, 1995; 26:778, MRFIT study

M

96 high risk men with stoke vs 96 controls, 6.9 yrs

0.72

p<0.05

~linolenic

0.06% in blood

Fatal plus non-fatal stroke

Possible benefits of EPA and DHA

B2

Iso, H, JAMA, 2001. 285:304

W

574 events , 303 ischemic of 80,000 Nurses over 14 years

0.72

0.53-0.99

DHA+EPA from diet

0.23 - 0.24% of energy

All strokes

FISH CONSUMPTION and STROKE

Prospective & Case Control Studies

B10

Keli, SO, Stroke, 1994: 25:328

M

552 men 50-69 yrs in Zutphen Netherlands, over 15 yrs

0.49

0.24-0.99

<20 gm/day vs >20gm/day

All stroke

Avg  consumption very high at 17.9 gm/day

B11

Orencia, Stroke; 1996 27:204

M

76 events of 1847 men in Chicago, IL area.  30 yr risk

1.00 0.94 0.89 1.28

0.43-2.33 0.58-1.51 0.56-1.43 0.76-2.14

No Fish    1-17gm/day 18-34 gm/d 35+ gm/d

Fatal and Non Fatal Stroke

Adj values similar

B12

Gillium RF, Arch Int Med, 1996 156:537

M&W

Sample of M&W from NHANES Study, 12 yrs followup

0.55

0.32-0.93

Fish cons

Never vs 1+/wk

fatal and non-fatal

B13

Iso, H, JAMA, 2001. 285:304

W

574 events , 303 ischemic of 80,000 Nurses

1.0 0.93 0.78 0.73 0.48

Base 0.65-1.34 0.55-1.12 0.47-1.14 0.21-1.06

p for trend = 0.06

< 1/ month 1-3 times/mo 1 per week 2-4 per week 5+ per week

Risk of all Stroke

TABLE  C                                                             EFFECT of OMEGA-3 FATS on CANCER

No

Study

Sex

Scope

Risk Ratio

Error Margin

Basis

Diff in Amount

Cause

Notes

n-3 UNSATURATED FATTY ACIDS and BREAST CANCER

Prospective & Case Control Studies

BREAST CANCER

Hirose, K Int J Cancer 2003, 107:276

W

2325 cases of 19,000 in Japan

0.75

0.75-0.98

Fish Consumption

5/wk vs <3/montxh

Gago-Dominquez, Br J Cancer, 2003, 89L1656

W

314 Events of 35,000 Chinese Women in Singapore

0.74

0.58-0.94

Marine n-3 fats

Top 3 vs Lowest Quartile

n-6 acids at low n-3 acids increased risk substantially

Wakei, K, Cancer Sci 2005, 96:590

W

129 Events of 26,000 in Japan,  7.6 yrs

0.56

0.33-0.94

Fish consumption

top vs low 4th of cons.

TABLE  D                                 EFFECT of POLYUNSATURATED FATS on DEATH from ALL CAUSES

No

Study

Sex

Scope

Risk Ratio

Error Margin

Basis

Diff in Amount

Cause

Notes

n-3 UNSATURATED FATTY ACIDS and ALL-CAUSE DEATH

Prospective & Case Control Studies

D1

Albert, MA JAMA 1998; 279:23

M

1652 all cause deaths of  20,500, Physicians Health Study

1.0 0.79 0.71 0.70 0.73

Base .59-1.0 .55-.91 .54-.89 .55-.96

Fish con- sumption

< 1 /month 1-3 /month 1- <2/week 2- <5/week 5+ /week

Total Mortality

Updates 1995 paper on this study. p = .045

Clinical Studies

D10

Burr, ML Lancet 1989, 2(8666):757

M

2003 who had recovered from MI over 2 years

0.71

0.5-0.9

Fish cons- umption

2-3 portions per wk in fish intake

Total Mortality

No effect on incidence of re-infarction.

D11

GISSI (Italy) Lancet 1999; 354:447

M&W

2836 CHD survivors vs. 2828 control, 305 year clinical study

0.80

0.67-0.96

quartiles

1 gm/day of n-3 poly fat supplement vs none

D12

Bucher, HC, Am J Med 2000, 112:298

M&W

Meta analysis of 11 randomized studies,  n-3 acids vs. placebo

0.80

0.7-0.9

High vs. Low amounts

No difference in diet or supplements