Seafood Choices Balancing Benefits and Risks (2007) / Chapter Skim
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Appendix B Data Tables
Appendix B Data Tables
Pages 297-682
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From page 297... ...
B Data Tables Studies on Women, Infants, and Children 298 Studies on Adult Chronic Diseases 494 Recommendations for Seafood and EPA/DHA Consumption 678 FDA and US EPA Safety Levels in Regulations and Guidance 680 Note: Abbreviations/acronyms included in the following data tables are included in the Glossary (see Appendix A)
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From page 298... ...
Cod- 16-20 and Controlled Mean age about 27-31 years liver oil weeks Helland, Trial Oslo, Norway supplement gestation 2001 Normotensive without proteinuria, through had uncomplicated term pregnan- pregnancy cies, randomly taken from another study investigating the influence of omega-3 fatty acids on fetal, neonatal, and child development Another group had moderate preeclampsia
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From page 299... ...
. Cod-liver oil group: "The pressure increase was significant in N 10 mL/day both groups, but no significant differences in the constrictory response or in the proporCorn oil group: tions of preparations displaying dilatatory 10 mL/day responses were observed when compared to appropriate control groups." "Neither preeclampsia nor dietary supple mentation with cod-liver oil had any sig nificant effect on the vasoactive response to PGF2α in umbilical cord arteries." continued
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From page 300... ...
EPA/DHA Until 38th et al., Controlled Aged 18-39 years for fish oil group supplement week 1995 Trial Aged 16-40 for placebo group gestation; Leeds, UK enroll Multigravida with a history of one ment time or more small babies, a history unspecified of proteinuric or nonproteinuric pregnancy-induced hyperten sion, or a history of unexplained stillbirth Primigravida with abnormal uterine arcuate artery Doppler blood flow at 24 weeks gestation Bulstra- Randomized Pregnant women (n=63) EPA 12-14 Ramakers, Controlled Groningen, Netherlands supplement weeks ges1995 Trial Birth weight below the 10th percen- tation until tile in association with pregnancy- delivery induced hypertension or chronic renal disease, or with placenta abnormalities
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From page 301... ...
DHA, 2 mg tocopherol/ml) "No differences were seen between the Olive oil group: groups in proportions of women with a 1 g; 72% oleic acid and 12% systolic blood pressure above 140 mmHg or LA/capsule a systolic blood pressure above 90 mmHg, 4 capsules/day although the proportion of women with dia stolic above 90 mmHg tended to be lower in Control = no capsule the fish oil group compared to the olive oil group (RR=0.48, p=0.07)
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From page 302... ...
0 SEAFOOD ChOICES TABLE B-1a Continued Timing of Author Study Type Subjects Exposure Exposure Schiff Controlled Pregnant women (n=16) Fish-oil 32-34 et al., Trial Aged 25-34 years supplement weeks 1993 Nulliparous through Nonsmokers, no history of hyper- the next tension, coagulation disorders, 21 days thrombocytopenia, or chronic vascular, renal, or other disease Olsen and Randomized Pregnant women (n=5022)
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From page 303... ...
. 0.10 g vitamin C; 0.36 g halibut liver oil In primiparae, the OR for hypertension was not significant when comparing the treat ment to the control group (OR=0.862, 95% CI 0.73-1.02)
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From page 304... ...
0 SEAFOOD ChOICES TABLE B-1a Continued Timing of Author Study Type Subjects Exposure Exposure Clausen Cohort Pregnant women (n=3133) Fatty acids 17-19 et al., Mean age 29.8 years from food weeks 2001 51.8% nulliparous gestation Representing all socioeconomic until after classes delivery Aker University Hospital, Oslo, Norway No pregestational diabetes or twin/ triplet pregnancies
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BMI, systolic blood pressure for 20 weeks' Mean = ≤12.0, 12.0-15.0, gestation, nullipara and energy: >15.0 Statistically significant ORs for preeclampTertiles of monounsaturated sia, comparing the highest group to the fatty acids (%energy) lowest group of fatty acid intakes, were Mean = ≤10.5, 10.5-13.0, observed for polyunsaturated fatty acids >13.0 (p=0.01)
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From page 306... ...
= normotensive, composition delivery or et al., nonproteinuric women in maternal within 2 1999 Pregnant women and umbili- hours after Mean age about 27 years cal platelets birth Curacao and umbili cal arteries and veins
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From page 307... ...
0.14±0.10 ALA; 0.16±0.07 EPA; 2.33±0.58 DHA No other significant differences were found Cases = 4.16±1.51 LA; for LA, ALA, EPA, or DHA. 0.21±0.11 ALA; 0.17±0.07 EPA; 1.97±0.30 DHA Mean fatty acid composi tion in umbilical veins (in mol%)
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From page 308... ...
= normotensive erythrocytes delivery 1995 Pregnant women fatty acid Mean age 28.6-31.2 years profiles White (n=17 in preeclamptic group, n=23 in non-preeclamptic group) Seattle, Washington About 21% Medicaid recipient
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From page 309... ...
. After adjusting for parity and pre-pregnancy BMI, the OR of preeclampsia for the lowest tertile of the sum of long-chain omega-3 fatty acids, compared to the highest tertile of long-chain omega-3 fatty acids was 7.63 (95% CI 1.43-40.63)
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From page 310... ...
= normal preg- fatty acid pregnancy 1991 nant women analysis ControlsB (n=10) = nonpregnant women Aged 20-40 years Term (pregnant women)
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From page 311... ...
. 90.60±6.68 total PUFA, 62.93±4.69 LA, 12.81±0.87 No other significant differences between the AA, 3.68±0.99 ALA, plasma polyunsaturated fatty acid levels in 1.08±0.33 EPA, 10.40±0.94 the three groups were found.
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From page 312... ...
12 weeks Baylor College of Medicine postpartum History of a depressive episode in the postpartum period, not suf fering from a current depressive episode No psychotropic medications within 2 weeks of baseline, history of nonreponse to two or more antidepressants, serious comorbid medical or psychiatric illness, or significant risk of dangerousness to self or others Llorente Randomized Pregnant women (n=89) Algae- Within a et al., Controlled Aged 18-42 years derived week of 2003 Trial No chronic medical condition, no triglyceride delivery to dietary supplements other than supplement 4 months vitamins, no smoking, who had after not been pregnant >5 times delivery Planned to breastfeed infants exclu sively for at least 4 months Part of a larger cohort study on effects of DHA on breastfeeding mothers and their infants Hibbeln Review Summary of three cohorts DHA and depletion Salem, 1995
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From page 313... ...
APPENDIX B Amount Results Conclusion* Fish oil group: Trial was terminated because of a high re- N 2960 mg fish oil/day lapse rate observed after enrolling only seven 173 mg EPA and 123 mg participants.
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From page 314... ...
SEAFOOD ChOICES TABLE B-1b Continued Timing of Author Study Type Subjects Exposure Exposure Timonen Cohort Live female births (n=2968) Seafood Previous et al., Live male births (n=2721)
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. After adjusting for alcohol intake, smok ing, physical inactivity, and marital status, women who ate fish rarely had a higher OR for depression, compared to women who ate fish regularly.
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From page 316... ...
blood at deliv Mean age around 30 years fatty acid ery, and Caucasian composition 32 weeks Southern Limburg, Netherlands postpartum Fish intake <2 times/week No metabolic, cardiovascular, neurologic, renal, or psychiatric disorders No medications, except for multi vitamins and iron supplements Singleton pregnancy Term delivery No blood transfusions in the perina tal period Gestational age <14 weeks at entry, Caucasian, fish consumption <2 times a week (for Study 2 only) Otto Cohort Pregnant women (n=57)
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. Absolute amount not specified "After delivery, total fatty acids in plasma N/A phospholipids decreased significantly over time in the lactating and nonlactating women (p<0.0001)
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From page 318... ...
Blood 36 weeks 1991 Aged 24-36 years fatty acid gestation, Caucasian composition during Normotensive, normal singleton labor, 6 pregnancies weeks Mayo Clinic, Minnesota postpartum Controls (n=59) = staff and students from the University of Minnesota, aged 19-48 years
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From page 319... ...
." "Total fatty acids increased from 1238.11 mg/L at week 10 to 1867.84 mg/L at week 40 of gestation, and all of the fatty acid families showed a similar course." "The mean amount of total fatty acids in umbilical plasma phospholipids was sub stantially lower (p<0.0001) than all maternal values" for all fatty acid families.
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From page 320... ...
0 SEAFOOD ChOICES TABLE B-1b Continued Timing of Author Study Type Subjects Exposure Exposure Hibbeln, Cross- Pregnancy women (n=14,532) Seafood During 2002 sectional 23 countries pregnancy, 41 different studies unspecified *
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From page 321... ...
APPENDIX B Amount Results Conclusion* Absolute amount not specified "Greater apparent seafood consumption B predicted DHA content of mothers' milk (p<0.006)
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Maastricht, Heerlen, Sittard, southeastern Netherlands White origin, gestational age <14 weeks, normal health, fish consumption <2 times/week No hypertensive, metabolic, cardiovascular, renal, psychi atric, or neurologic disorder Smuts Randomized Pregnant women (n=73) DHA- 24-28 weeks et al., Controlled Mainly African-American enriched egg gestation until 2003a Trial Aged 16-35 years delivery Reachable by telephone Planned to deliver at the Regional Medical Center in Memphis, TN No more than four pregnancies Smuts Randomized Pregnant women (n=291)
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From page 323... ...
margarine 25 g margarine No significant differences in gestational age, 45.36 LA, 14.18 ALA APGAR score, or umbilical plasma DHA concentrations in phospholipids were found Control group (% total fatty between the two groups. acids)
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From page 324... ...
Cod-liver oil 17-19 weeks et al., Controlled Aged 19-35 years supplement gestation until 2001 Trial Oslo, Norway 3 months Single pregnancies, Nulli- or after delivery primipara Intention to breastfeed No supplement of n-3 LCPUFA earlier during the pregnancy No premature births, birth asphyxia, infections, and anomalies in the infants that required special attention
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. 10 mL/day Birth weight was significantly higher in the corn oil group compared to the cod-liver oil group (p<0.05)
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From page 326... ...
Olsen Randomized Pregnant women (n=533) Fish-oil Enrolled at 30 et al., Controlled Mean age 29 years supplement weeks gesta1992 Trial Aarhus, Denmark tion; end time Main midwife clinic, covers a not specified well-defined geographic area No placental abruption in previous pregnancy or serious bleeding in current pregnan cy; no prostaglandin inhibi tors regularly No multiple pregnancy, allergy to fish, and regular intake of fish oil
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From page 327... ...
. In the trial of women with suspected intra uterine growth retardation in the current pregnancy, the mean difference of weight for gestational age was 29 g higher in those randomized to fish oil compared to those randomized to olive oil (p=0.75)
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From page 328... ...
n-3 League of Controlled London supplement Health, Trial Not beyond the 24th week of 1946 pregnancy No physical disease or abnormality People's Randomized Pregnant women (n=5022) Additional Enrolled if League of Controlled London diet, which due date Health, Trial includes hali- more than 16 1942 but liver oil weeks away; until delivery
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From page 329... ...
cium; minute quantities of iodine, manganese, and cop- "No significant effects were seen on the odds per; 0.6 g thiamin/g; 0.1 g of delivering after 40 weeks of gestation." vitamin C; 0.36 g halibut liver oil "No significant effects were seen on average birth weight." "A smaller incidence of prematurely was B revealed among the treated women, and this is particularly significant since about 50% of infant deaths under 1 month are due to prematurely." Weekly intake score for Among primigravida women, 20.1±1.10% B consumption of "the more of those who received additional diet important foodstuffs" such experienced a preterm delivery compared to as milk, butter, wholemeal 23.9±1.10% of those who did not receive bread, fresh vegetables, additional diet. This difference was statisti fatty fish, fruit, eggs, etc.
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From page 330... ...
0 SEAFOOD ChOICES TABLE B-1c Continued Timing of Author Study Type Subjects Exposure Exposure Lucas Cohort Postpartum women (n=491) Cord venous At delivery et al., and their infants sample 2004 Mean age of 23.7 years Inuit 14 coastal villages of Nunavik and southern Quebec Delivered at Tulattavik Health Center (Ungava Bay)
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. fatty acids)
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Seafood From when Secher, Aarhus, Denmark first knew of 2002 Gave birth to singleton, live- pregnancy un born babies without detected til completion malformations of question Had not consumed fish-oil naires at 16 supplements and 30 weeks gestation
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From page 333... ...
; and Quartile 3 = 0.60-0.11 Quartile 4 = 0.11-1.72 No other significant trends were observed for change in birth weight, fetal growth, or length of gestation with seafood intake dur ing the first two trimesters. 0.0, 0.5, 2.0, 4.0, 20.0, 28.0 "Low birth weight, preterm birth, and B serving/28 days intrauterine growth retardation all tended to decrease with increasing fish consumption, Hot fish meal: and mean birth weight, duration of gesta144 g fish/serving tion, and birth weight adjusted for gesta1627 µg n-3 fatty acids/serv- tional age tended to increase with increasing ing fish consumption." Fish sandwich: Low consumption of seafood was a strong 29 g fish/serving risk factor for preterm delivery and low 431 µg n-3 fatty acids/serving birth weight.
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From page 334... ...
venous blood after delivery 1991 Mean age about 27 years sample Faroese (n=62) and Danish women (n=37)
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From page 335... ...
Mean of 5.87±0.12% DHA Mean of 12.07±0.15% AA After controlling for maternal pre-pregnant weight, height, age, parity, marital status, Danish women: smoking, and employment during pregnancy Mean of 0.61±0.051% EPA a significant association was found between Mean of 2.08±0.076% DPA the (3/6) ratio from blood and gestational Mean of 4.65±0.159% DHA age in the Danish women (p=0.02)
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From page 336... ...
SEAFOOD ChOICES TABLE B-1c Continued Timing of Author Study Type Subjects Exposure Exposure Harper Case-control Cases = born to Orkney Island Resident of et al., residents, delivered in Orkney Orkney (a 1991 Islands (n=899) or Aberdeen proxy for (n=116)
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. 4.8% of infants born to Orkney women and 12.2% of infants born to Aberdeen women were below the 10th percentile for birth weight (corrected for gestational age and parity)
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From page 338... ...
African American (19% DHA group; 13% control group) Gestational age >37 weeks Infant birth weight 2500 4200 g No chronic maternal dis orders as well as major congenital anomalies and obvious gastroin testinal or metabolic disorders of the infant
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From page 339... ...
DHA phospholipid fraction by 1%." "Because typical DHA intake associated with fish consumption is well under 1 g/day, changes in fish con sumption will result in IQ effects amounting to a frac tion of a point," but they are not clinically detectable. DHA capsule: There were no significant differences in visual acuity N Algal triacylglyc- (from either the Teller Acuity Card or Sweep VEP)
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From page 340... ...
0 SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Dunstan Randomized Pregnant women (n=83) Fish-oil 20 weeks et al., 2004 Controlled Atopic pregnancies supplement gestation until Trial Western Australia delivery History of doctor diag nosed allergic rhinitis and/or asthma One or more positive skin prick test to house mites; grass pollens; molds; cat, dog, or cockroach extracts Nonsmokers No other medical prob lems, complicated preg nancies, seafood allergy, or >2 fish meals/week Term, healthy infants considered at high risk of allergic disease Jensen Randomized Breast-feeding mothers DHA Delivery et al., 2004 Controlled (n=89 in treatment supplement until 4 months Trial group; n=85 in placebo postpartum group)
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From page 341... ...
APPENDIX B Amount Results Conclusion* Fish-oil group: Breast milk concentrations of DHA, DPA, and EPA N/A 3.7 g/day fish oil were significantly higher (p<0.001)
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From page 342... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Helland Randomized Pregnant women (n=48 Cod-liver oil From 18 et al., 2003 Controlled in cod-liver oil group; supplement weeks of preg Trial n=36 in corn oil group) nancy until 3 Aged 19-35 years months after Oslo, Norway delivery Healthy women with, singleton pregnancy, nulli- or primiparous, intention to breastfeed No supplement of n-3 LCPUFA earlier during pregnancy, premature births, birth asphyxia, general infections, or anomalies in the infants that required special attention
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From page 343... ...
were also higher in the cod-liver oil group Corn oil: compared to the corn oil group, but they were not 10 mL/day significant. 4747 mg LA, 92 mg ALA continued
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From page 344... ...
or ≤11 days of age and currently breastfeeding (breastfeeding group) , birth weight ≥2500 g, 5-minute APGAR score ≥7, ability to tolerate milk-based formula or breast milk, guardian or parent agreement to feed the assigned study formula ad libitum according to the study design No evidence of significant cardiac, respiratory, ophthalmologic, gastro intestinal, hematologic, or metabolic disease; milk-protein allergy; or a maternal medical history known to have proven adverse effects on the fetus, tubercu losis, HIV, perinatal infections, or substance abuse 61-74% European American 60-80% mothers married Mean mother's age about 29 years Mean mother's education about 14 years
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From page 345... ...
. formula: 0.46 g AA/100 g Smiling and laughter was significantly higher in the total fatty acids control group than in the egg-TG group (p=0.05)
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From page 346... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Helland Randomized Pregnant women (n=590) Cod-liver oil 17-19 weeks et al., 2001 Controlled Aged 19-35 years supplement gestation until Trial Oslo, Norway 3 months after Single pregnancies, nulli- delivery or primipara Intention to breastfeed No supplement of n-3 LCPUFA earlier during the pregnancy No premature births, birth asphyxia, infec tions, and anomalies in the infants that required special attention McCann Review Summary of LCPUFA and Ames, observational, RCTs, supplement 2005 other experimental and animal studies
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From page 347... ...
corn length or birth weight between the 2 supplement oil groups. Birth length, head circumference, and placental weight were also similar in the 2 supplement groups." Cod-liver oil: 803 mg of EPA/ 10 mL; 1183 mg DHA/10 mL Corn oil: 0 mg of EPA/ 10 mL; 8.3 mg DHA/10 mL "Evidence from chronic dietary restriction rodent B studies .
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From page 348... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Koletzko Review Studies published in full LCPUFA Prenatal and et al., 2001 or in abstract form supplement postnatal periods Makrides Review Summary of the evidence LCPUFA During and Gibson, supplement pregnancy and 2000 lactation
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From page 349... ...
"It seems prudent for pregnant and lactating women to include some food sources of DHA in their diet." "There appears to be no detectable reduction in plasma B n-3 LCPUFA concentrations during pregnancy, whereas there is a clear decline during the early postpartum period." "Results of randomized clinical studies suggest that n-3 LCPUFA supplementation during pregnancy does not affect the incidences of pregnancy-induced hypertension and preeclampsia without edema." "n-3 LCPUFA supplementation may cause modest increases in the duration of gestation, birth weight, or both." "To date there is little evidence of harm as a result of n-3 LCPUFA supplementation during either pregnancy or lactation." continued
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From page 350... ...
0 SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Leary Cohort Mother-child pairs Diet During et al., 2005 (n=6944) pregnancy, Bristol, England unspecified Avon Longitudinal Study of Parents and Children (ALSPAC)
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From page 351... ...
After adjusting for sex, child's age for blood pressure, 55-68, 68-84, and maternal pregnancy energy intake, there were no >84 significant differences in offspring blood pressure at age Saturated fat (g) 7.5 years based on maternal intake of carbohydrate, 21-27, 27-35, protein, total fat, saturated fat, polyunsaturated fat, >35 monounsaturated fat, calcium, potassium, magnesium, Polyunsaturated protein/carbohydrate or animal protein.
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From page 352... ...
82% White; 18% non-White 80% college or graduate degree Massachusetts Singleton pregnancy, were able to complete forms in English, did not plan to move out of the study area before delivery Project Viva Colombo Cohort Infants (n=70) DHA-enriched 24-28 weeks et al., 2004 Mean gestation 39.29 egg gestation until weeks delivery Mean birth weight 3248.57 g Mean APGAR score (1 min)
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From page 353... ...
breast-feeding duration and age at cognitive testing: Shrimp/lobster/ scallop/clam Each 1 serving/week increase of fish intake increases the (1 serving) VRM score by 4 points (%novelty preference; 95% CI Dark meat fish 1.3-6.7)
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From page 354... ...
level education Breastfeeding Bristol, UK practices: Singleton, term births 15 months Avon Longitudinal Study after birth of Parents and Children (ALSPAC) Infant fish intake: 6 and 12 months after birth Total mercury concentration: Cord blood at birth Sakamoto Cohort Pregnant women (n=63)
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From page 355... ...
: children whose mothers rarely or never ate fish during 1 = Rarely/never pregnancy. 2 = 1+ meal/week Children who ate 1+ fish meals/week had significantly Child fish intake lower odds of low MCDI scores for vocabulary categories (12 comprehension (OR=0.7, 95% CI 0.5-0.8)
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From page 356... ...
Windham, CT ≥4 hours of crib time in the first and second days postpartum No history of chronic hypertension, hyperlip idemia, renal or liver disease, heart disease, thyroid disorders, multiple gestations, or pregnancy-induced complications No drugs that affect the respiration of newborns, such as magnesium sulfate and butorphanol
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From page 357... ...
. of total fatty acids There was a significant group effect for active sleep time (p=0.004)
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From page 358... ...
delivery Aberdeen, Scotland Uncomplicated, full-term pregnancies Perfusion on term placen tas delivered vaginally or by elective Caesarean section from other wise uncomplicated pregnancies Innis Cohort Infants (n=83) Fatty acids in 2 months of et al., 2001 Term blood from age Birth weight 2500-4500 g infants and milk Mean mother's age of 32 from mothers years British Colombia Intend to breast-feed for 3 months, no solid foods for at least the first 4 months after birth No mothers with sub stance abuse, communi cable diseases, meta bolic or physiologic problems, infections likely to influence fetal growth, or multiple births No infants with evidence of metabolic or physical abnormalities
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From page 359... ...
." RBC PE = 6.3-13.0 PC = 1.4-4.6 "There were no significant correlations between the infants' AA status and the ability to discriminate the Infant AA: native or nonnative language contrasts." (g/100 g fatty acids) "There were no significant correlations between the Plasma phospho- infant DHA or AA status at 2 months of age and test lipids = 8.1-15.8 scores for novelty preference, or the job search task, RBC PE = with adjustments for covariates included in the model." 20.2-27.8 PC = 5.6-9.7 Mother's milk: (g/100 g milk fatty acids)
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From page 360... ...
Seafood During preget al., 2001 Mean age of 3.5 years nancy for the Born in last 6 months of mothers and the Avon Longitudinal at 4 weeks, 4 Study of Parents and months, and 6 Children (ALSPAC) months for the enrollment period infants Healthy term infants
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From page 361... ...
." "The amounts of ALA, DHA, and total n-3 fatty acids showed significant downward trends postpartum in both groups, whereas the amounts of EPA and DPA increased significantly after delivery." Oily fish consump- After adjusting for breastfeeding, sex, maternal educa- B tion categories: tion, maternal age, housing tenure, financial difficul1 = Never or rarely ties, maternal smoking, number of older siblings in 2 = Once every household, child care, maternal job status, mother is a 2 weeks vegetarian, mother's fish eating habits: 3 = More than once every "Mothers who ate oily fish at least once every 2 weeks 2 weeks during pregnancy were more likely to have children who achieved foveal steroacuity than were the mothers White fish = cod, who never ate oily fish (OR=1.57, 95% CI 1.00-2.45) ," haddock, plaice, but this was not significant.
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From page 362... ...
Placental tissue Within 20 et al., 1997 Mean weight of 566 g lipids minutes of Delivered vaginally or delivery by elective caesarean section Uncomplicated pregnancies Nonsmokers Al et al., Cohort Pregnant women (n=110) Maternal 10, 14, 18, 1995 Aged 19-43 years venous and um- 22, 26, 30, Maastricht, Netherlands bilical vein fatty 32, 34, 36, Caucasian acid profiles 38, 40 weeks Singleton pregnancy gestation; DBP <90 mmHg after delivery; No metabolic, cardiovas- 6 months after cular, neurological or delivery renal disorder
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From page 363... ...
during pregnancy, but the rise in total fatty acids became less pronounced towards the end of gesta tion (p<0.0001) ." Total fatty acids increased from 1238.11 mg/L at week 10 to 1867.84 mg/L at week 40 of gestation, and all of the fatty acid families showed a similar course.
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From page 364... ...
acid content postmortem Died within 3 days of from frontal birth and occipital Toronto, Canada brain lobes and Infants died from in- cerebellum trapartum asphyxia, congenital heart disease, sudden infant death syndrome, diaphrag matic hernia, and accidental causes Infants were of normal body weight and weight for length, with the exception of two infant males; infants had nor mal head circumference, with the exception of one infant male No infections or gastro intestinal disorders, apparently normally nourished, and growing reasonably well until the time of death Bjerve Case-control Cases = adults (n=156) Seafood and 10 weeks for et al., 1993 Controls = normal human dietary DHA adults and 1 serum stored at –80 and AA intake year for the degrees C preterms Aged >40 years Nord-Trondelag, Norway Previously undiagnosed diabetic patients Preterm infants (n=21)
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From page 365... ...
APPENDIX B Amount Results Conclusion* "Postnatal brain growth, expressed as wet weight of N/A brain tissue, increased during the postpartum period, but was not as rapid as intrauterine brain growth." "In contrast to the fatty acid components, postpartum levels of LA increased 4-fold relative to prenatal levels; postpartum brain levels of AA do not differ from those observed in brain during the third trimester." "Chain elongation-desaturation of AA and LA to longer-chain homologues does not occur at maximal rates for several weeks postnatally or, alternatively, that these long-chain homologues if synthesized in extracere bral tissues may not be directed into synthesis of brain tissue during this early period of infant development." Number of fish "After controlling for age, gender, BMI, alcohol intake, B meals per week: and smoking, there was a statistically significant positive <2, 2, 3, and ≥4 correlation based on individual observations between Mean AA intake increasing number of fish meals and the concentra of these groups: tion of plasma phospholipid EPA (p<0.001)
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From page 366... ...
Birth weight appropri ate for gestational age, able to receive enteral feedings, free of major neonatal morbidity by day 10 Makrides Cross- Male infants (n=16) Human milk Within 48 et al., 1994 sectional Female infants (n=19)
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From page 367... ...
." ALA, 0.0 g/100 g n-3>C18 "Rod electroretinogram amplitude was significantly lower for Group A relative to the human milk-fed Formula B: infants and Group C and related to plasma DHA and 20.8 g/100 g AA, total n-3 LCPUFA (p<0.0001) ." 0.0 g/100 g n-6 > C18, 2.7 g/100 g ALA, 0.0 g/100 g n-3>C18 Formula C: 20.4 g/100 g AA, 0.1 g/100 g n-6 > C18, 1.4 g/100 g ALA, 1.0 g/100 g n-3>C18 Breast-feeding Erythrocyte fatty acid composition of tissues were sig- B index = length nificantly lower in total saturated fatty acids (p<0.05)
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From page 368... ...
and milk weeks of birth Greater Glasgow Health formula Board area Died within 43 weeks of birth Previously well infants who died suddenly in the home, "cot deaths" Martinez, Cross- Infants born at different PUFA supple- After infant 1992 sectional gestational ages and mentation and died (they died died soon after birth of PUFA-enriched shortly after acute causes that were formula birth) not related to the cen tral nervous system Not fed but mothers well nourished Infants nourished in utero and after birth
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From page 369... ...
APPENDIX B Amount Results Conclusion* Breast milk or the "Breast fed infants had greater concentrations of DHA N/A formula milks in their cerebral cortex phospholipids than either SMA Gold Cap the mixed fed group or the older SMA and CGOST and/or White groups." Cap, Cow and Gate Premium, "No significant differences in phospholipid fatty acid or Osterfeed content of cerebral cortex were found between the age comparable SMA and CGOST groups." Prenatal fatty acid "Long-chain fatty acids accumulate in the human brain B amounts not during the brain's growth spurt unless a serious imbal specified ance in the supply of LA and ALA occurs." "The active formation of synaptic structures and den dritic arborizations increases significantly between 31 weeks of gestation and term." "It seems highly desirable to enrich parenteral lipids and milk formulas with DHA to provide between 0.5% and 1% of total fatty acids similar to those in human milk." "A total n-6/n-3 fatty acid ratio between 5 and 7 seems appropriate according to our analysis of human milk from others consuming complete, balanced Mediterra nean diets rich in fish." continued
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From page 370... ...
0 SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Kodas Animal 2 generations of female ALA-deficient Control group: et al., 2004 Wistar rats diet Control diet at birth to 60 days after birth Deficient group: Deficient diet at birth to 60 days after birth Diet reversed group 1: Control diet at day of birth until 60 days after birth Diet reversed group 2: Deficient diet until day 7 of life and then control diet from day 7 to day 60 of life Diet reversed group 3: Deficient diet until day 14 of life and then control diet from day 14 to day 60 of life Diet reversed group 4: Deficient diet until day 21 of life and then control diet from day 21 to day 60 of life
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From page 371... ...
The fatty acid composition of phosphatidylserine in the hippocampus of 2-month-old rats was as follows: AA was not significantly different among the different diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the defi cient group (p<0.05) ; n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05)
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From page 372... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Korotokova Animal Pregnant Sprauge-Dawley n-6:n-3 diet, n-3 10 days before et al., 2004 rats diet, and n-6 delivery diet 10-16 days of lactation, dam fed water with ovalbumin or just water
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From page 373... ...
APPENDIX B Amount Results Conclusion* n-6:n-3 diet (in In the pups not exposed to ovalbumin: B mol%)
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From page 374... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Levant Animal Adult female Long-Evans LCPUFA- Control diet: et al., 2004 rats deficient diet Day 1 of preg nancy until end of study Deficient diet: Day 1 of preg nancy until postnatal day 21. Postnatal day 21, half on deficient diet were changed to remedia tion diet and half stayed on deficient diet
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From page 375... ...
; results were similar between the deficient diet 0.3275 kg/5 kg group and the remediation diet group. diet from sun flower oil and In the test of amphetamine-stimulated locomotor 0.0225 kg/5 kg activity, the deficient diet group exhibited 144% of the diet from fish oil activity of the control group (p<0.05)
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From page 376... ...
SEAFOOD ChOICES TABLE B-1d Continued Timing of Author Study Type Subjects Exposure Exposure Neuringer Animal Adult female rhesus n-3-deficient 2 months et al., 1986 monkeys diet before con ception and throughout pregnancy * B = Evidence of a benefit; N = Evidence of no association or no clear association; N/A = A conclusion is not available; these data are presented for background information only; A = Evidence of an adverse effect.
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From page 377... ...
APPENDIX B Amount Results Conclusion* Semipurified diet: At all ages, animals of the "deficient group had consid- N/A Deficient in n-3 erably lower levels of n-3 fatty acids in tissue phospho fatty acids lipids than their controls." Safflower oil was sole fat source Based on the occipital cortex, perinatal 22:5n-6 High n-6:n-3 ratio (p<0.01)
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From page 378... ...
supplement of preg Trial John of God Hospital nancy until Subiaco, Western delivery Australia With confirmed allergy No smoking, other medi cal problems, compli cated pregnancies, seafood allergy; normal dietary intake did not exceed two meals of fish per week
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From page 379... ...
2.6 g olive oil 26 g/day oleic acid There was a significant association found between CD34+ in cord blood and AEDS (OR=3.93; 95% CI 1.05-14.64, p=0.042) at one year of age; however, there were no significant associations found for food allergy, moderate severe AEDS, asthma, chronic cough, or recurrent wheeze.
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From page 380... ...
nancy until John of God Hospital delivery Subiaco, Western Australia Physician-diagnosed allergic rhinitis and/or asthma Allergic to house dust mites, grass pol lens, molds, cat, dog, feathers, and cockroach and/or asthma No medical problems, no smoking, no compli cated pregnancies, no seafood allergy; normal diet did not exceed two meals of fish per week Dunstan Randomized Pregnant women (n=83) Fish-oil 20 weeks et al., 2003b Controlled Atopic women supplement of preg Trial Booked for delivery at St.
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From page 381... ...
in B Four 1 g fish oil neonates whose mothers received fish-oil supplements in capsules/day pregnancy compared to the placebo group. 3.7 g of n-3 PUFA 56.0% as DHA There were no significant differences in IFN-γ levels and 27.7% as in cord plasmas or in IgE in plasma between the two EPA groups.
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From page 382... ...
SEAFOOD ChOICES TABLE B-1e Continued Timing of Author Study Type Subjects Exposure Exposure Hawkes Randomized Women (n=120) DHA Day 3et al., 2002 Controlled Aged 20-42 years, mean supplement week 12 Trial about 30 years postpartum Delivered full-term single ton infants, intended to breast-feed ≥12 weeks Adelaide, South Australia No known history of inflammatory disorders, not currently taking anti-inflammatory medication or fish-oil supplements Excluded women who had ceased lactating by 4 weeks postpartum
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From page 383... ...
APPENDIX B Amount Results Conclusion* Asked to limit fish "There was no significant difference between the dietary N and seafood groups in mean rank concentrations of IL-6 or TNF-α intake to a in the aqueous phase of milk" at 4 weeks postpartum.
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From page 384... ...
SEAFOOD ChOICES TABLE B-1e Continued Timing of Author Study Type Subjects Exposure Exposure Hodge Randomized Boys and girls (n=39) Omega-3 diet 6 months et al., 1998 Controlled Aged 8-12 years and omega-6 Trial Sydney, Australia diet Asthmatic with a history of episodic wheeze in the last 12 months, AHR to histamine
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From page 385... ...
APPENDIX B Amount Results Conclusion* Omega-3 diet "There was no significant change in spirometric func- N group: tion, dose-response ratio to histamine or asthma severity Canola oil and score at either 3 or 6 months in either group." canola-based margarines and salad dress ings to replace usual oils and margarines Supplement capsules = 0.18 g EPA and 0.12 g DHA/capsule 4 capsules/day = 1.20 g omega-3/ day Omega-6 diet group: Sunflower oil and sunflower oil based marga rines and salad dressings to re place usual oils and margarines Supplement capsules = 0.45 g safflower oil, 0.45 g palm oil, 0.10 g olive oil/capsule No EPA or DHA continued
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From page 386... ...
SEAFOOD ChOICES TABLE B-1e Continued Timing of Author Study Type Subjects Exposure Exposure Newson Cohort Children (n=1238 with Cord blood and 20 weeks et al., 2004 cord blood fatty acid maternal blood of preg data and eczema at red cell fatty nancy and at 18 to 30 months data; acid analysis delivery n=2945 with mater nal blood fatty acid data and eczema data; n=2764 with maternal blood fatty acid data and wheezing data) Bristol, England Avon Longitudinal Study of Parents and Children (ALSPAC)
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From page 387... ...
, as was the ratio of ALA:sum of n-3 products 0.23 EPA, (OR=0.86, 95% CI 0.75-0.99) ; and 0.60 DPA, 2.02 DHA, No other significant associations were found between 11.46 LA, and fatty acid exposure and transient infant wheeze, later 5.88 AA onset wheeze, or persistent wheeze.
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From page 388... ...
SEAFOOD ChOICES TABLE B-1f Studies on Visual Acuity: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula Timing of Author Study Type Subjects Exposure Exposure Simmer, Cochrane 9 Randomized Controlled LCPUFA2005 Review Trials supplemented formula Gibson Review Randomized Controlled DHAet al., 2001 Trials (11 on preterm supplemented and 10 on term infants) formula Involving healthy preterm infants fed preterm formula Involving healthy term infants fed formulas from near birth Systematic literature review Uauy Review Summary of Random- LCPUFAet al., 2001 ized Controlled Trials supplemented on preterm and term formula infants
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From page 389... ...
on VEP acuity have been reported in some studies, whereas other studies have failed to detect a benefit of LC-PUFA supplementation." There is evidence supporting "the view that dietary B essential fatty acid supply affects visual development of preterm and term infants." continued
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From page 390... ...
0 SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure SanGiovanni Meta- Studies done in industrial- DHAet al., 2000a analysis ized countries supplemented Healthy, term infants formula Randomized studies: DHA supplemented (n=114) DHA-free (n=87)
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From page 391... ...
Based on behavioral tests of visual acuity, the non-randomized studies showed a significant dif ference in the estimates for those fed human milk vs. those fed unsupplemented formula at 2 months of age (p≤0.0005)
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From page 392... ...
SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure SanGiovanni Meta- 5 original papers (4 pro- DHAet al., 2000b analysis spective trials) supplemented 4 review chapters formula Preterm infants Randomized studies: DHA-supplemented/ behavioral-based (n=48 at 2 months; n=70 at 4 months)
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From page 393... ...
APPENDIX B Amount Results Conclusion* Based on behavioral tests of visual acuity, the B randomized comparisons (between those fed DHA supplemented formula and those fed unsupplement ed formula)
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From page 394... ...
North Dallas area, TX 95% White No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia, or infection; presence of a congenital malformation or infec tion; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit
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From page 395... ...
. fatty acids as DHA and 0.72% as AA There was a trend of better stereoacuity in the sup plemented group compared to the commercial group at 9 months (p=0.12)
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From page 396... ...
SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure Birch Randomized Infants (n=65) AA/DHA- 6 weeks of age et al., 2002 Controlled Healthy, term, singleton supplemented to 52 weeks Trial births formula of age Birth weight appropriate for gestational age Weaned from breast feeding at 6 weeks of age Dallas area, TX Mean maternal age about 30 years 75-78% White Majority of mothers with at least a college degree No family history of milk protein allergy; genetic or familial eye disease; vegetarian or vegan maternal dietary patterns; maternal metabolic disease, anemia, or infection; presence of a congenital malformation or infec tion; jaundice; perinatal asphyxia; meconium aspiration; or any perinatal event that resulted in placement in the neonatal intensive care unit
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From page 397... ...
, week 26 (p<0.001) , fatty acids as DHA and week 52 (p<0.001)
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From page 398... ...
, formula-fed teral intake of Multi-center study (16 375 kJ/kg/day neonatal centers in reached North America) Not small for gestational Term age or >24 days postna- formulas: tal age when full enteral After hospital feeds ≥375 kJ/kg/day discharge until were achieved 57 weeks of No necrotizing enterocoli- age tis or other gastrointes tinal disease, impaired visual or ocular status, or a history of underly ing disease or congeni tal malformation that could interfere with growth Reference group = term infants whose mothers anticipated breast feeding for at least 4 months
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From page 399... ...
Preterm formula 3 = DHA+AA formula (0.33% fatty acids as DHA, 0.60% fatty acids as AA) Term formula = no AA or DHA Breast-fed term infants = no solid foods during the study unless other wise instructed by their physicians continued
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From page 400... ...
00 SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure Van Wezel- Randomized Infants (n=42) AA/DHA- 2-3 weeks Meijler Controlled Preterm, admitted to neo- supplemented after birth et al., 2002 Trial natal intensive- or high- formula until weighing care unit of hospital 3000 g Birth weight <1750 g Leiden, Netherlands Mothers not breast-feeding Normal neurological ex amination throughout the neonatal period Repeated ultrasound of the brain being normal or showing, at most, minor abnormalities No abnormalities of the central nervous system; abnormal neurological examination or occur rence of seizures; any systemic disease with potential negative influ ence on future growth or development; serious nutritional or gastro intestinal problems preventing initiation of enteral feeding after the first week postpartum or complete enteral feeding after the third week postpartum; reti nopathy of prematurity grade 3 or more
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From page 401... ...
0 APPENDIX B Amount Results Conclusion* Supplemented preterm There were no significant differences found in N formula: Flash VEP at 3 and 12 months between the two 4.4 g fat/100 mL groups.
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From page 402... ...
LCPUFA- Within the et al., 1999 Controlled Mean age about 33 weeks supplemented first 2 days of Trial Enrolled the 2nd day of formula enteral feed enteral feeding ing, then for Healthy, appropriate 30 days weight for gestational age Premature Free of respiratory, meta bolic or neurological disease; malformations; infections; intrauterine asphyxia Fed by digestive route within the first 7 days of life
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From page 403... ...
: birth weight, and maternal smoking, there were no 16.8% LA, 1.5% significant differences in VEP between any of the ALA groups at 16 or 34 weeks of age. DHA formula (% total fatty acids)
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From page 404... ...
0 SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure <8 days of age Carlson Randomized Infants (n=119) AA/DHAet al., 1999 Controlled supplemented until about 12 Trial formula months of age Infants fed supplemented formula near birth received commercial formula from term less 3 months until 12 months of age; infants fed supplemented formula near term received commercial formula from term less 3 months to term less 1 month, and then supplemented formula until 12 months of age
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From page 405... ...
and a trend toward higher acuity at no EPA or DHA 6 months (p<0.07) ." Supplemented formula Infants supplemented at birth "also had higher 0.13% DHA and acuity than those supplemented at term at 2 months 0.40% AA from egg (p<0.05)
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From page 406... ...
DHA- 24 hours et al., 1996a Controlled Born at term (37-43 supplemented after birth; Trial weeks) formula end point not Birth weight 747-1275 g specified Memphis, TN Predominantly Black No growth retardation in utero and no medical problems likely to influ ence long-term growth and development Mothers education mean of about 12 years
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From page 407... ...
; the association was not statistically significant at 26 weeks. Formula with "Term infants fed formulas with added AA and B AA+DHA = DHA had higher grating acuity at 2 months of age 2 g AA/100 g total but not at 4, 6, 9, or 12 months of age compared fatty acids; 0.1 g with infants fed an unsupplemented formula." DHA/100 g total fatty acids Formula with out DHA = 2.2 g ALA/100 g total fatty acids continued
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From page 408... ...
2 months from No intraventricular or expected term periventricular hem- of 48±1 week orrhage > grade 2; a post-menstrual history of maternal co- age caine or alcohol abuse; congenital anomalies likely to affect long term growth and devel opment; or intrauterine growth retardation Full enteral feeding of 418 kJ/kg/day by 6 weeks of age and tolerated en teral feeding thereafter Carlson Randomized Infants (n=67) EPA/DHA- Preterm et al., 1993 Controlled Birth weight 748-1398 g supplemented formula from Trial Mean gestational age 29 formula (marine when infant weeks oil)
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From page 409... ...
. of total fatty acid Between 6 and 12 months visual acuity plateaued." Marine-oil supple mented formula = 0.20% DHA and 0.06% EPA of total fatty acids Commercially avail- Visual acuity development was significantly higher in B able standard the marine-oil group compared to the control group formula contained at 2 months (p<0.014)
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From page 410... ...
supplemented until 6 months Trial Born 27-33 weeks formula (soy/ of age gestation marine oil) Birth weight 1000-1500 g No respirator treatment for more than 7 days or congenital infections; gross congenital mal formations; retinopathy of prematurity; or grade III or IV intra cranial hemorrhages Lauritzen Review Summary of the literature DHAet al., 2001 (animal, observational, supplemented RCTs)
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From page 411... ...
: LA = 20.8/20.3 ALA = 2.7/2.8 EPA+DHA = 0.0/0.1 "Observational studies in general show better retinal B function in breast-fed infants than in infants fed formula without DHA, but approximately half of the intervention studies show no effect." Animal studies do offer evidence that DHA plays a role in retinal function, but these results cannot eas ily be extrapolated to humans. 4 RCTs with "preterm infants have all shown a posi tive effect of dietary DHA on visual development;" the results from term infants are not as conclusive.
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From page 412... ...
and ing pregnancy Born in last 6 months of breast milk (mother) the Avon Longitudinal (child)
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From page 413... ...
APPENDIX B Amount Results Conclusion* Oily fish consumption After adjusting for breast-feeding, sex, maternal edu- B categories: cation, maternal age, housing tenure, financial dif1 = Never or rarely ficulties, maternal smoking, number of older siblings 2 = Once every 2 in household, child care, maternal job status, mother weeks being vegetarian, mother's fish-eating habits: 3 = More than once every 2 weeks "Mothers who ate oily fish at least once every 2 weeks during pregnancy were more likely to have White fish = cod, had- children who achieved foveal stereoacuity than were dock, plaice, and the mothers who never ate oily fish (OR=1.57, 95% "fish fingers" CI 1.00-2.45)
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From page 414... ...
University of Mississippi Medical Center Weighed <1500 g at birth and were on full feed ings of at least 60 kcal/ kg without intravenous supplementation Free of major congenital malformations and did not have any ongoing major disease process Discharged at about 1800 g
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From page 415... ...
: LA = 22.4, AA = Based on phosphatidylserine composition of fatty acids None, ALA = 0.6, (in mol%) : LA and DHA were significantly higher EPA = None, DPA = (p<0.005)
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From page 416... ...
SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure Putnam Cohort Infants (n=40) Human milk 3 weeks of age et al., 1982 Enrolled at birth and milk to 6 months Well-baby clinic at the formula of age University of South Florida Medical Clinics Breast milk At least 90% of energy collected from human milk or at 8 weeks formula before sample and infants' collection blood drawn between 4.5 and 6 months of age
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From page 417... ...
: those fed SMA formula; and 15.80±0.61 LA, 0.60±0.03 AA, Infants fed human milk had significantly higher AA 0.80±0.09 ALA, (p<0.01) and significantly lower LA (p<0.001)
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From page 418... ...
SEAFOOD ChOICES TABLE B-1f Continued Timing of Author Study Type Subjects Exposure Exposure Sanders and Cross- Infants (n=18) Human milk 14 weeks of Naismith, sectional Aged 14 weeks and milk age 1979 Fed from birth a modified formula cow's milk formula or had been breast-fed Participated in an earlier study Neuringer Animal Adult female rhesus Diet deficient in 2 months et al., 1984 monkeys n-3 fatty acids before con ception and throughout pregnancy *
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From page 419... ...
. Soy bean oil sole fat source 53.1% LA, 0.0% GLA, 0.3% DGLA, 7.7% ALA, 7.0% n-6:n-3 of total fatty acids
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From page 420... ...
0 SEAFOOD ChOICES TABLE B-1g Studies on Cognitive and Motor Development: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula Timing of Author Study Type Subjects Exposure Exposure Cohen Review Aggregated 8 random- n-3 supplement et al., 2005 ized controlled trials (1 study of maternal dietary supple mentation and 7 studies of formula supplementation) Simmer and Cochrane 11 randomized LCPUFAPatole, 2005 Review controlled trials supplemented formula Simmer, Cochrane 9 randomized controlled LCPUFA2005 Review trials supplemented formula
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From page 421... ...
DHA phospholipid fraction by 1%." "Because typical DHA intake associated with fish consumption is well under 1 g/day, changes in fish consumption will result in IQ effects amounting to a fraction of a point," but they are not clinically detectable. "No long-term benefits were demonstrated for in- N fants receiving formula supplemented with LCPUFA.
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From page 422... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Gibson Review Randomized controlled LCPUFAet al., 2001 trials (11 on preterm supplemented and 10 on term formula infants) Involving healthy preterm infants fed preterm formula Involving healthy term infants fed formulas from near birth Systematic literature review Uauy Review Summary of random- AA/DHAet al., 2001 ized controlled trials supplemented on preterm and term formula infants Carlson and Review Summary of animal Neural DHA Neuringer, studies and random- accumulation 1999 ized controlled trials Based on a session from the AOCS 1996 meet ing: PUFA in Infant Nutrition: Consensus and Controersies
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From page 423... ...
." "Evidence for a beneficial effect of AA+DHA supple- B mentation on CNS development is strong." "The preliminary information on cognitive develop ment is insufficient to fully establish a relationship between LCPUFA and mental development." Studies in deficient monkeys suggest that "lower B brain accumulation of DHA may influence neural domains such as sensation, motivation or tempera ment, but not cognition." "The most consistent effect identified to date in human and animal studies has been that of look duration and tests of visual attention." "A limited number of behavioral studies in animals and humans address the question of neural DHA ac cumulation and developmental measures other than vision." continued
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From page 424... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Bouwstra Randomized Infants (n=256 to LCPUFA- Birth to 2 et al., 2005 Controlled 446, depending on supplemented months of age Trial assessment) formula Term, healthy Groningen, Netherlands University and Martini Hospitals in Gronin gen and at midwife clinics No congenital disorders that interfered with adequate functioning in daily life; infants from multiple births; infants whose mothers did not have mastery of the Dutch language or suffered from significant illness or disability; adopted or foster infants; or formula-fed infants who had received hu man milk >5 days
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From page 425... ...
APPENDIX B Amount Results Conclusion* Control formula (in "The groups did not show statistically significant N mol%)
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From page 426... ...
age <10 total days of Discharge enteral feeding of formula: >30 mL/kg/day 40 weeks until No congenital ab- 53 weeks post normalities of the menstrual age gastrointestinal tract, hepatitis, hepatic or Term formula: biliary pathology, nec- 53 weeks until rotizing enterocolitis 92 weeks post confirmed before en- menstrual age rollment, or history of underlying disease or congenital malforma tions likely to interfere with evaluation Second phase: Successful completion of the first phase, ≥80% of enteral intake from study formula during hospitalization, and 100% caloric intake from study formula at completion of the first phase
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From page 427... ...
17 mg DHA/100 kcal from tuna fish oil, 34 mg AA/100 kcal from fungal oil 0.3% fatty acids from DHA, 0.6% fatty acids from AA Worldwide human milk: 0.3% DHA and 0.6% AA (weight of fatty acids) continued
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From page 428... ...
African American (19% DHA group; 13% control group) Women plan to breast feed exclusively for ≥4 months Infant gestational age >37 weeks Infant birth weight 2500-4200 g No chronic maternal disorders; major congenital anomalies and obvious gastroin testinal or metabolic disorders of the infant Fewtrell Randomized Infants (n=238)
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From page 429... ...
: or from the Sweep VEP at 4 months of age between 0.8% LA and 41.7% the two groups. DHA by weight 200 mg DHA/day There were no significant differences in mean tran sient VEP latency at 4 and 8 months of age between Control capsule (soy the two groups; but the transient VEP amplitude was and corn oil)
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From page 430... ...
0 SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Bouwstra Randomized Infants (n=397) LCPUFA- Birth to 2 et al., 2003 Controlled Term, healthy supplemented months of age Trial Groningen, Netherlands formula University and Martini Hospitals in Gronin gen and at midwife clinics No congenital disorders that interfered with adequate functioning in daily life; infants from multiple births; infants whose mothers did not have mastery of the Dutch language or suffered from significant illness or disability; adopted or foster infants; or formula-fed infants who had received hu man milk >5 days
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From page 431... ...
. 0.34±0.06 DGLA, 0.34±0.06 AA, After controlling for marital status, family history 1.11±0.35 ALA, of diabetes, gestational age at birth, condition of 0.06±0.04 EPA, perineum, and age at assessment: 0.19±0.11 DHA The control formula group had a significantly higher OR of mildly abnormal general movements at age 3 months when compared to the breast-fed infants (OR=2.03; p=0.039)
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From page 432... ...
supplemented until discharge Trial Preterm formula Birth weight <1750 g Nottingham and Leicester, UK No congenital malformation known to affect neurodevelopment Mothers decided not to breast-feed by 10 days of age; tolerated enteral feeds at that time (for randomized groups) Social class 1 or 2 (19% in controls; 26% in LCPUFA group; 33% in breast-fed group)
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From page 433... ...
were also higher in the codCorn oil: liver oil group compared to the corn oil group, but 10 mL/day they were not significant. 4747 mg LA, 92 mg ALA LCPUFA- There were no significant differences in KPS quo- N supplemented tients at 9 months of age and neurological status formula (g/100 g at 9 or 18 months of age between the two formula fat)
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From page 434... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Van Wezel- Randomized Infants (n=42) AA/DHA- 2-3 weeks Meijler Controlled Preterm, admitted to supplemented after birth until et al., 2002 Trial neonatal intensive- formula weighing 3000 g or high-care unit of hospital Birth weight <1750 g Leiden, Netherlands Mothers not breast-feeding Normal neurological ex amination throughout the neonatal period Repeated ultrasound of the brain being normal or show ing, at most, minor abnormalities No abnormalities of the central nervous system; abnormal neurological examina tion or occurrence of seizures; any systemic disease with potential negative influence on future growth or development; serious nutritional or gastro intestinal problems preventing initiation of enteral feeding after the first week post partum or complete enteral feeding after the third week post partum; retinopathy of prematurity grade 3 or more
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From page 435... ...
APPENDIX B Amount Results Conclusion* Supplemented pre- There were no significant differences found in Bayley N term formula: MDI and PDI at 3, 6, 12, or 24 months between the 4.4 g fat/100 mL two groups.
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From page 436... ...
or ≤11 days of age and currently breast feeding (breast-feeding group) , birth weight ≥2500 g, 5-minute APGAR score ≥7, ability to tolerate milk-based formula or breast milk, guardian or parent agreement to feed the assigned study formula ad libitum according to the study design No evidence of sig nificant cardiac, respiratory, ophthal mologic, gastrointes tinal, hematologic, or metabolic disease; milk-protein allergy; or a maternal medi cal history known to have proven adverse effects on the fetus, tuberculosis, HIV, perinatal infections, or substance abuse 61-74% European American 60-80% mothers married Mean mothers' age about 29 years Mean mothers' educa tion about 14 years
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From page 437... ...
Egg-derived triglyceride supplemented preterm formula: 0.45 g AA/100 g total fatty acids No detected EPA 0.14 g DHA/100 g total fatty acids Control formula: No detected AA, EPA, DHA continued
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From page 438... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure O'Connor Randomized Infants (n=470) Fish oil/fungal In hospital et al., 2001 Controlled Preterm oil and egg- formula from Trial Birth weight 750-1800 g derived triglyc- within 72 hours Cleveland, OH; Kansas eride/fish oil- of first enteral City, MO; Little Rock, supplemented feeding until AR; Nottingham and formulas term-corrected Leeds, UK; Louisville, age KY; Portland, OR; New York, NY; Post-discharge Santiago, Chile formula from White (n=81 controls; term-corrected n=80 fish/fungal; n=85 age until 12 egg-TG)
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From page 439... ...
: 17.50±0.90 LA, 2.50±0.30 ALA, 0.41±0.00 AA, no EPA, 0.24±0.01 DHA Post-discharge control: 19.1±1.1 LA, 2.4±0.2 ALA, no AA, EPA, DHA Post-discharge AA+DHA (fish/fun gal oil) : 19.50±0.70 LA, 2.40±0.20 ALA, 0.43±0.01 AA, no EPA, 0.16±0.01 DHA Post-discharge AA+DHA (egg-TG/ fish oil)
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From page 440... ...
supplemented months of age Trial Healthy, term, singleton formula pregnancies, appropri ate size for gestational age Nottingham and Leicester, UK Mean maternal age about 27 years 93.5% married About 70% with no higher school qualifications
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From page 441... ...
APPENDIX B Amount Results Conclusion* Enfamil + iron The mean Bayley MDI score at 18 months was B significantly higher in the DHA/AA-supplemented Enfamil + iron + formula group than in the control formula group 0.35% DHA (p<0.05)
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From page 442... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Scott Randomized Infants (n=274) AA/DHA- Those randomet al., 1998 Controlled Healthy, full-term supplemented ized, formula Trial Kansas, MO; Portland, formula from first week OR; Seattle, WA after delivery No prematurity, intra uterine growth re- Those exclu tardation, congenital sively breast anomalies, 5-minute feeding, breast APGAR score <7, milk for first or other significant 3 months and perinatal medical then supple complications mentation with Similac + iron Solid food supplementation at 4 months Willatts Randomized Infants (n=44)
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From page 443... ...
DHA formula group (fish oil) : After controlling for maternal education and site, 0.2wt% DHA when comparing all four groups, the vocabulary comprehension score at 14 months was significantly DHA+AA formula lower in the DHA formula group compared to the group (egg yolk breast-feeding group (p=0.017)
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From page 444... ...
DHA- Preterm formula Werkman, Controlled Mean gestational age supplemented from 3 days to 1996 Trial about 28 weeks formula 2 months of age Birth weight 747-1275 g Predominantly Black Term formula Memphis, TN from 2 months Mean mothers' educa- to 12 months tion about 12 years of age No need for mechani cal ventilation at that time; intraventricular hemorrhage > grade 2; retinopathy of prematurity > stage 2; surgery for necrotizing enterocolitis; weight < the fifth percentile for gestational age; history of maternal substance abuse
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From page 445... ...
. All in g/100 g total At 12 months of age, the DHA-supplemented group B fatty acids had statistically more number of looks to famil iar (p<0.05)
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From page 446... ...
LCPUFA- Within 3 days et al., 1995 Controlled Mothers' mean age = supplemented until 4 months Trial about 30 years formula of age Gestational age between 37-42 weeks, weight at birth appropriate for gestational age Milan, Italy APGAR score better than 7 at 5 minutes, absence of disease
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From page 447... ...
: and the breast-feeding group. 11.10 LA, 0.70 ALA Human milk (g/100 g fat)
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From page 448... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure McCann Review Summary of observa- DHA status and Ames, tional, RCTs, other and LCPUFA2005 experimental and animal supplemented studies formula Bryan Review Summary of the litera- PUFA from et al., 2004 ture (all designs) breast milk or formula Jacobson, Review Mostly 2 prospective LCPUFA1999 longitudinal studies supplemented Detroit study on effects formula of prenatal exposure to alcohol Michigan study of effects of pre- and postnatal exposure to PCBs
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From page 449... ...
RCTs in humans have often shown no effect of "LCPUFA supplementation on cognitive or behav ioral performance and some reviewers have consid ered that, overall, the evidence was insufficient to conclude that LCPUFA supplementation benefited development." "There is moderate evidence that PUFAs, and long- B chain omega-3 PUFAs in particular, from either breast milk or supplemented infant formula, are beneficial in the development of visual acuity and cognitive performance in infants." "There is very limited empirical evidence, due to the small number of extant studies, for the beneficial ef fects of PUFAs, and omega-3 PUFAs in particular, on cognitive performance in older children." "Evidence suggest that omega-3 PUFAs may have a role in the control of the symptoms of neurological disorders such as ADHD and dyslexia." "Any comparisons between breastfed and supple- B mented groups should include measures of maternal IQ and quality of parenting on which these groups tend to differ." "Animal and human studies indicating a relation between LCPUFA supplementation and enhanced visual acuity and shorter visual fixations may, in fact, represent relatively independent effects of supple mentation on both acuity and cognitive processing speed." continued
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From page 450... ...
Fatty acids in 2 months of age et al., 2001 Term blood from Birth weight 2500- infants and milk 4500 g from mothers Mean mothers' age 32 years British Columbia Intend to breast-feed for 3 months, no solid foods for at least the first 4 months after birth No mothers with sub stance abuse, commu nicable diseases, meta bolic or physiologic problems, infections likely to influence fetal growth, or multiple births No infants with evidence of metabolic or physi cal abnormalities
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From page 451... ...
1 = Rarely/never than the children whose mothers rarely or never ate 2 = 1+ meal/week fish during pregnancy. Child fish intake cat- Children who ate 1+ fish meals/week had significant egories (12 months ly lower odds of low MCDI scores for vocabulary of age)
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From page 452... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Kodas Animal 2 generations of female ALA-deficient Control group: et al., 2004 Wistar rats diet Control diet at birth to 60 days after birth Deficient group: Deficient diet at birth to 60 days after birth Diet reversed group 1: Control diet at day of birth until 60 days after birth Diet reversed group 2: Deficient diet until day 7 postpartum and then control diet from day 7 to day 60 postpartum Diet reversed group 3: Deficient diet until day 14 postpartum and then control diet from day 14 to day 60 postpartum Diet reversed group 4: Deficient diet until day 21 postpartum and then control diet from day 21 to day 60 postpartum
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From page 453... ...
The fatty acid composition of phosphatidylserine in the hippocampus of 2-month-old rats was as follows: AA was not significantly different among the dif ferent diet groups; DHA was significantly higher in the control group and all diet reversed groups compared to the deficient group (p<0.05) ; n-6:n-3 was significantly lower in the control group and all diet reversed groups compared to the deficient group (p<0.05)
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From page 454... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure Levant Animal Adult female Long- AA/EPA/DPA/ Control diet: et al., 2004 Evans rats DHA-deficient Day 1 of preg diet nancy until end of study Deficient diet: Day 1 of pregnancy until postnatal day 21. Postnatal day 21, half on deficient diet were changed to remediation diet and half stayed on deficient diet Chalon Animal Male rats ALA-deficient 2-3 months of et al., 2001 2-3 months old diet age
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From page 455... ...
. Remediation diet: 0.3275 kg/5 kg diet In a test of locomotor activity in a novel environ from sunflower oil ment, the deficient diet group exhibited 187% of the and 0.0225 kg/5 kg activity of the control diet group during the 2-hour diet from fish oil observation (p<0.05)
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From page 456... ...
SEAFOOD ChOICES TABLE B-1g Continued Timing of Author Study Type Subjects Exposure Exposure <12 hours old de la Presa, Animal Newborn male piglets GLA/AA/DHA Birth weight >1 kg Owens, and supplemented to 18 days of <12 hours old Innis, 1999 formula age Delion Animal 2 generations of female ALA-deficient 2 weeks before et al., 1996 Wistar rats diet mating (second generation)
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From page 457... ...
APPENDIX B Amount Results Conclusion* 4 formula diets (all in There were no significant differences in brain weight, B g/100 g)
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From page 458... ...
SEAFOOD ChOICES TABLE B-1h Studies on Allergies: Effects on Infants Supplemented with Omega-3 Fatty Acids in Formula Timing of Author Study Type Subjects Exposure Exposure Calder, 2001 Review Summary of animal Fish-oil studies and human supplement trials Field Review Summary of animal AA/DHAet al., 2001 studies and human supplemented trials formula
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From page 459... ...
In adults and animals, feeding DHA affects T-cell function. However, the ef fect of these lipids on the development and function of the infant's immune system is not known." "The addition of small amounts of DHA and AA (at levels similar to that in human milk)
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From page 460... ...
0 SEAFOOD ChOICES TABLE B-1h Continued Timing of Author Study Type Subjects Exposure Exposure Field Randomized Infants (n=44) AA/DHA- Before day 8 et al., 2000 Controlled Preterm, medically supplemented postpartum Trial stable formula until day 42 Edmonton, AB, Canada postpartum Appropriate weight for gestational age and re ceive 100% daily fluid and energy require ments enterally by day 14 postpartum No major congenital infection, significant neonatal morbidity, or acute illness that precluded feeding by mouth; no mixed feedings or cortico steroids, red cell, and plasma transfusions, or intravenous lipid emulsion beyond day 8 postpartum *
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From page 461... ...
. (% weight of total fatty acids)
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From page 462... ...
SEAFOOD ChOICES TABLE B-1i Studies on ADHD: Effects on Children Supplemented with Omega-3 Fatty Acids in Foods Other Than Exclusively Breast Milk or Infant Formula Experimental Studies in Humans Timing of Author Study Type Subjects Exposure Exposure Richardson, Review Summary of RCTs HUFA 2004 supplement Hirayama Randomized Children (n=40) DHA 2 months et al., 2004*
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From page 463... ...
. Placebo food contain ing olive oil instead of DHA-rich fish oil continued
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From page 464... ...
Aged 7-12 years multiple min Diagnosed with ADHD eral, phytonu No other medication trients, essential or treatment, street fatty acid drugs, other nutri- supplements tional or botanical supplements, co morbid disorders Stevens Randomized Boys and girls (n=47) PUFA 4 months et al., 2003*
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From page 465... ...
A multivitamin, multi mineral, phytonu trients, essential fatty acids (180 mg EPA and 120 mg DHA from salmon oil and 45 mg GLA from borage oil) and phospholipids (soy lecithin)
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From page 466... ...
Trial Northern Ireland Referred to a school for children with specific literacy problems No official diagnosis of ADHD or any other psychiatric disorder; use of fatty acid supplements in last 6 months; consump tion of oily fish >2 times/week; history of any other neurological or major psychiatric disorder or other significant medical problems; not in treat ment for ADHD
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From page 467... ...
APPENDIX B Amount Results Conclusion*
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From page 468... ...
SEAFOOD ChOICES TABLE B-1i Continued Timing of Author Study Type Subjects Exposure Exposure Brue Randomized Boys and girls (n=51) Essential fatty Two 12-week et al., 2001 Controlled Aged 4-12 years acid supplement trials Trial Referred by parents, pediatricians, psychol ogists, psychiatrists, and educators ADHD diagnosed by a physician or psychologist No serious and preexist ing medical or psycho logical condition or taking a stimulant medication other than Ritalin
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From page 469... ...
APPENDIX B Amount Results Conclusion*
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From page 470... ...
0 SEAFOOD ChOICES TABLE B-1i Continued Timing of Author Study Type Subjects Exposure Exposure Voigt Randomized Boys and girls (n=63) Algae-derived 4 months et al., 2001*
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From page 471... ...
APPENDIX B Amount Results Conclusion*
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From page 472... ...
2005. Effects of Omega- Fatty Acids on Mental health.
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From page 473... ...
. No significant differences in blood serum n-3 or n-6 fatty acids were found.
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From page 474... ...
SEAFOOD ChOICES TABLE B-1j Studies on Allergies and Asthma: Effects on Children Supplemented with Omega-3 Fatty Acids in Foods Other Than Exclusively Breast Milk or Infant Formula Timing of Author Study Type Subjects Exposure Exposure Peat Randomized Pregnant women Tuna-fish oil Child's age of et al., 2004 Controlled (n=616) supplement 6 months to 3 Trial Mean age about 29 years years About 47% tertiary educated Sydney, Australia At least one parent or sibling with current asthma or frequent wheeze; fluency in English; a telephone at home; residence within 30 km of the recruitment center No pet at home; veg etarian diet; multiple births; or less than 36 weeks gestation The Childhood Asthma Prevention Study (CAPS)
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From page 475... ...
* Intervention group: At 3 years of age, there were no significant differ- N 500 mg/day tuna ences in prevalence of asthma, wheezing, eczema, fish oil and atopy between the intervention group and the 184 mg omega-3 fatty placebo group.
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From page 476... ...
SEAFOOD ChOICES TABLE B-1j Continued Timing of Author Study Type Subjects Exposure Exposure Denny Review 18 cross-sectional Dietary PUFA et al., 2003 studies 4 case-control studies 3 cohort studies Smit Review All epidemiological Seafood et al., 1999 evidence
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From page 477... ...
on chronic obstructive pulmonary disease (COPD) and asthma, and the results of those that were found showed conflicting results." "It is very difficult to draw any conclusions on the true impact of dietary PUFA intake on respiratory health." "The evidence in this review suggests that diet does play a role in asthma and COPD, but the causality of association cannot be confirmed because of the observational nature of most of the studies." "The findings of several large studies in adults sug- B gest that high fish intake has beneficial effects on lung function." "The relationship between fish intake and respira tory symptoms and clinical disease is less evident." continued
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From page 478... ...
SEAFOOD ChOICES TABLE B-1j Continued Timing of Author Study Type Subjects Exposure Exposure Peat et al., Review Longitudinal cohort Diet 1998* studies and cross sectional studies
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From page 479... ...
; 3. Airway hyperresponsiveness are atopy, family history of asthma, high allergen exposure, and diet (high sodium/magnesium or low omega-3 fatty acid intake)
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From page 480... ...
0 SEAFOOD ChOICES TABLE B-1j Continued Timing of Author Study Type Subjects Exposure Exposure Takemura Case-control Cases = currently Seafood et al., 2002* asthmatic students (n=1673)
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From page 481... ...
compared to those who ate fish 1-2 times/month, there was a significant positive trend with an increase of fish consumption (p for trend = 0.0349)
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From page 482... ...
SEAFOOD ChOICES TABLE B-1j Continued Timing of Author Study Type Subjects Exposure Exposure Hodge et al., Case-control Boys and girls (n=468) Seafood In the past year 1996*
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From page 483... ...
Range of fish intake not reported There was a significant inverse association found between all fish (fresh and frozen) consumption and asthma, allergic rhinoconjunctivitis, and atopic eczema, for the 13- to 14-year-old age group; the same inverse association remained for the 6- to 7 year-old age group, but the association was weaker.
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From page 484... ...
2004. health Effects of Omega- Fatty Acids on Asthma.
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From page 485... ...
* Fish consumption Coastal school children who ate reddish fish (sar- B categories: dine, mackerel, pike)
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From page 486... ...
2000. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants.
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From page 487... ...
American Journal of Clinical Nutrition 44(6)
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From page 488... ...
2004. Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants.
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From page 489... ...
1991. Increased birth weight in northerly islands: Is fish consumption a red herring?
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From page 490... ...
2000. A critical appraisal of the role of dietary long-chain polyunsaturated fatty acids on neural indices of term infants: A randomized, controlled trial.
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From page 491... ...
2001. Growth and development in preterm infants fed long-chain polyunsaturated fatty acids: A prospective, randomized controlled trial.
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From page 492... ...
2004. Maternal and fetal mercury and n-3 polyunsaturated fatty acids as a risk and benefit of fish consumption to fetus.
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From page 493... ...
American Journal of Clinical Nutrition 69(2)
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From page 494... ...
SEAFOOD ChOICES Studies on Adult Chronic Diseases TABLE B-2a Secondary Prevention Studies with Cardiovascular Outcomes Author Study Type Subjects Exposure Hooper Meta- 48 randomized controlled trials n-3 supplement et al., 2006 analysis 41 cohorts Omega-3 intake for ≥6 months in adults Primary and secondary prevention
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From page 495... ...
APPENDIX B Amount Results Conclusion*
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From page 496... ...
SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure Hooper Cochrane 48 randomized controlled trials n-3 supplement or et al., 2005 Review 41 cohorts advice Primary and secondary prevention
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From page 497... ...
, non-fatal myocardial infarction (n=26 RCTs; RR=1.03, 95% CI 0.70-1.50) , sudden death (n=37 RCTs; RR=0.85, 95% CI 0.49-1.48)
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From page 498... ...
Burr et al., Review Review of two randomized controlled Dietary advice 2005 trials (Burr et al., 1989, 2003 below) Secondary prevention Harper and Review Systematic literature review of 14 ran- 6 on fish oil Jacobson, domized controlled trials 2 on fish 2005 Northern Europe, Southern Europe, 5 on ALA suppl.
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From page 499... ...
, the linear regression 1 serving = 100 g model showed that each one serving increase in fish consumption per week reduces one's risk of CHD death by 0.039 (95% CI −0.066 to −0.011) but does not significantly change one's risk of nonfatal MI by (DRR=0.0083, 95% CI −0.012 to 0.028)
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From page 500... ...
00 SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure Leaf et al., Randomized Men and women (n=402) n-3 supplement 2005 Controlled Mean age about 65 years Trial 18 US centers Had a cardioverter defibrillator implant ed because of a history of cardiac ar rest, sustained ventricular tachycardia, or syncope with inductive, sustained ventricular tachycardia or ventricular fibrillation during electrophysiologic studies Follow-up of 12 months Secondary prevention
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From page 501... ...
, New York Heart of an ethyl ester concen- Association class III congestive heart failure, trate of n-3 fatty acids history of myocardial infarction, history of (2.6 g EPA+DHA) prior defibrillator therapies for ventricular tachycardia or ventricular fibrillation, time Placebo: from implanted cardioverter/defibrillator imFour 1 g capsules of olive plant (continuous)
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From page 502... ...
0 SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure Raitt et al., Randomized Men and women (n=200) n-3 supplement 2005 Controlled Mean age about 62 Trial Patients at six medical centers in the United States Receiving an implantable cardioverter defibrillator for an electrocardiogram documented episode of sustained ventricular tachycardia or ventricular fibrillation that was not the result of acute myocardial infarction or a revis ible cause or who had a preexisting implantable cardioverter defibrillator and had received implantable cardio verter/defibrillator therapy for an elec trocardiogram-documented episode of sustained ventricular tachycardia or ventricular fibrillation within the last 3 months No class I or class II antiarrhythmic medications; ≥1 fatty fish meal/week; flaxseed oil, cod-liver oil, or fish-oil supplements in the last month Follow-up of 2 years Secondary prevention
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From page 503... ...
. However, among those with qualified arrhyth mia at the time of study entry, those assigned to fish oil had significantly greater incidence of ventricular tachycardia or ventricular fibrilla tion treated by the implantable cardioverter defibrillator compared to those assigned to placebo (p=0.007)
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From page 504... ...
Primary prevention
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From page 505... ...
: 8% of energy enriched with After 5 weeks on the trans fatty acids diet, the oleic acid least squares mean plasma C-reactive protein levels were significantly higher than after 5 Diet 3 (LMP diet) : 8% of weeks on the carbohydrate diet, the oleic diet, energy enriched with and the trans fatty acid + stearic acid diet lauric (L)
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From page 506... ...
Secondary prevention
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From page 507... ...
and week or take up to 3 g sudden deaths (p=0.02) compared to those of fish oil as a partial or who did not receive fish advice.
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From page 508... ...
Recent MI Follow-up of 3.5 years (about 38,418 person-years) Secondary prevention
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From page 509... ...
* n-3 fatty acids group = After adjusting for age, sex, complications B 1 g/day after myocardial infarction, smoking habVitamin E group = 300 its, history of diabetes mellitus and arterial mg/day hypertension, total blood cholesterol, HDL Combination group cholesterol, fibrinogen, leukocyte count, and Control group claudication intermittens: Those who received n-3 fatty acids had a significantly lower relative risk of death, nonfatal MI, and nonfatal stroke at 9 months, 12 months, and 42 months of follow-up than the controls (RR=0.76, 95% CI 0.60-0.97 at 9 months, RR=0.79, 95% CI 0.63-0.98 at 12 months, and RR=0.85, 95% CI 0.74-0.98 at 42 months)
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From page 510... ...
21,147 person-years of follow-up Secondary prevention
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From page 511... ...
* Fish advice = eat at least After adjusting for myocardial infarction, an- N 2 portions of fatty fish gina, hypertension at baseline; x-ray evidence each week and as much of cardiomegaly, pulmonary congestion or other fish as they could pulmonary edema at baseline; and treatment with β-blockers, other anti-hypertensives, manage (using fish oil capsule as a partial or digoxin/antiarrhythmics, or anticoagulants: total replacement if necessary)
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From page 512... ...
No contraindications to the dietary supplements; were able to provide informed written consent, had no unfavorable short-term outlook (e.g., overt congestive heart failure, cancer, etc.) 42 months of follow-up Gruppo Italiano per lo Studio della So pravivivenza nell'Infarto miocardico Prevenzione (GISSI trial)
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From page 513... ...
* Fish oil = 850-880 mg When compared to the corn oil group, N EPA+DHA/capsule there were no significant associations found between fish oil and fatal cardiac events Control = same amount in and resuscitations, nonfatal cardiac events, corn oil revascularization, total mortality, time to first event, or cardiac event or revascularization.
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From page 514... ...
Secondary prevention Burr et al., Randomized Men (n=2033) Dietary advice Aged <70 years 1989 Controlled Trial South Wales, UK From those admitted to 21 hospitals for acute MI No diabetes, those awaiting cardiac surgery, or those who already intended to eat one of the intervention diets 2 years of follow-up The Diet and Reinfarction Trial (DART)
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From page 515... ...
. Compared to the placebo group, the fish oil group also had lower relative risks of ventricular ectopic beats (>8/minute and >3 consecutively)
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From page 516... ...
SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure He et al., Meta- 13 cohort studies from 11 independent Seafood 2004b analysis studies English language 222,364 participants 3032 coronary heart disease deaths Average of 11.8 years of follow-up Primary prevention
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From page 517... ...
* Categories of fish intake: Based on pooled relative risks of CHD mortal- B 1 = Never-<1 time/month ity, those who ate fish 1 time/week, 2-4 times/ week, and ≥5 times/week had significantly 2 = 1-3 times/month 3 = 1 time/week lower risk of CHD mortality than those who 4 = 2-4 times/week never ate fish (RR=0.85, 95% CI 0.76-0.96; 5 = ≥5 times/week RR=0.77, 95% CI 0.66-0.89; RR=0.62, 95% CI 0.46-0.82, respectively)
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From page 518... ...
SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure Whelton Meta- 14 cohort studies Seafood et al., 2004 analysis 5 case-control studies Conducted in adult humans English language Published before May 2003 Primary and secondary prevention
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From page 519... ...
consumed little amount of fish had a significantly lower risk of or no fish coronary heart disease mortality compared to those who ate no fish; in seven cohort studies Level of fish consumption: no significant associations were found between <2, 2-<4, ≥4 portions per fish consumption and coronary heart disease week mortality. Based on pooled estimates from a random effects model, those who ate any fish (pooled RR=0.83, 95% CI 0.76-0.90)
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From page 520... ...
1999 Sample size and length of follow-up varied between studies Primary prevention
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From page 521... ...
N showed a significant inverse relationship between fish intake (g/day) and risk of coro nary heart disease (p for trend <0.05 and p for trend = 0.04, respectively)
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From page 522... ...
Aged 40-59 years Japan (Iwate Prefecture, Akita, Nagano, Okinawa) The Japan Public Health Center-based Study Cohort I No myocardial infarction, angina pecto ris, stroke, or cancer at baseline 477,325 person-years of follow-up Primary prevention
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From page 523... ...
than those in the 1st quintile. However, there were no significant associations found between n-3 intake and coronary heart disease, total MI, sudden cardiac death, or fatal coronary events when comparing the 3rd quintile to the 1st quintile.
|
From page 524... ...
Free of atrial fibrillation at baseline Follow-up of 12 years Primary prevention
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From page 525... ...
* Categories of fish intake After adjusting for age, gender, race, educa- B (tuna/other or fried tion, diabetes, BMI, prevalent coronary heart fish/fish sandwich)
|
From page 526... ...
Free from CVD at baseline Follow-up of 9.3 years Primary prevention
|
From page 527... ...
. There were no other significant associations found between the other categories of tuna/other fish intake and the risk of death from total IHD, arrhythmic IHD, or nonfatal MI; and Those who ate fried fish/fish sandwiches ≥3 times/week had a significantly higher RR of nonfatal MI death than those who ate fried fish/fish sandwiches <1 time/month (RR=2.30, 95% CI 1.18-4.46)
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From page 528... ...
Aged 30-70 years Copenhagen County, Denmark general population MONICA 1 = born in 1922, 1932, 1942, or 1952; examined in 1982 MONICA 2 = born in 1927, 1937, 1947, or 1957; examined in 1987 MONICA 3 = born in 1922, 1932, 1942, 1952, or 1962; examined in 1992 No CHD in the preceding 5 years before enrollment (fatal or nonfatal CHD as an end point) 52,607 person-years of follow-up for men 48,596 person-years of follow-up for women Primary prevention
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From page 529... ...
. No other significant differences were found between categories of fish consumption and all-cause mortality, CHD mortality and mor bidity, and CHD mortality.
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From page 530... ...
0 SEAFOOD ChOICES TABLE B-2a Continued Author Study Type Subjects Exposure Hu et al., Cohort Women (n=84,688) Seafood 2002 Aged 30-55 years Nurses living in the United States Nurses' Health Study Exclude those who left 10 or more items blank on the dietary questionnaire, those with reported total food intakes judged to be implausible, and those who had a history of cancer, angina, myocardial infarction, coronary revas cularization, stroke, or other cardio vascular disease at baseline Follow-up of 16 years Primary prevention
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From page 531... ...
hypercholesterolemia, diabetes, and intake of Shrimp/lobster/scallops = transfat, the ratio of polyunsaturated fat to 3.5 oz (0.32 g saturated fat, and dietary fiber: EPA/DHA) Those in categories 2-5 of fish intake all had Categories of fish intake: significantly lower RR of coronary heart 1 = <1 time/month disease compared to those in category 1 2 = 1-3 times/month (RR=0.79, 95%CI 0.64-0.97; RR=0.72, 95% 3 = 1 time/week CI 0.59-0.88; RR=0.72, 95% CI 0.57-0.91; 4 = 2-4 times/week RR=0.69, 95% CI 0.52-0.93, respectively)
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From page 532... ...
supplement Aged 35 years or older Takayama, Gifu, Japan No history of cancer, stroke, or ischemic heart disease Follow-up of 7 years (201,160 person-years) Primary prevention
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From page 533... ...
: marital status, BMI, smoking status, alcohol Quintile 1 = 46.2 for men, intake, coffee intake, exercise, and history of 36.6 for women hypertension and diabetes mellitus: Quintile 2 = 68.1 for men, 53.9 for women There were no significant associations between Quintile 3 = 86.8 for men, quintiles of fish intake and risk of all-cause 68.8 for women mortality among men or women; Quintile 4 = 111.9 for men, 88.1 for women Men in the 2nd quintile of fish oil intake had Quintile 5 = 157.8 for a significantly lower HR of all-cause mortality men, 122.4 for women than men in the 1st quintile of fish oil intake (HR=0.82, 95% CI 0.67-0.99)
|
From page 534... ...
Primary prevention
|
From page 535... ...
. There were no significant associations between fish intake and other ischemic heart disease mortality or stroke mortality or between n-3 fatty acid intake and other ischemic heart disease mortality.
|
From page 536... ...
excluding Alaska, Hawaii, and reservation lands of American Indians National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study No history of heart disease at baseline No unknown baseline fish consumption, systolic blood pressure, serum cholesterol concentration, history of diabetes, cigarette smoking status, alcohol intake, body mass index, history of heart disease, nonrecreational physical activity, or educational attainment Average follow-up of 18.8 years Primary prevention Oomen Cohort Men Seafood et al., 2000 Aged 50-69 years Finland (n=1088)
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From page 537... ...
No other compari sons between categories of fish consumption, and all-cause, cardiovascular disease, or noncardiovascular disease, mortality were significant; There were no significant associations found between fish intake and all-cause, cardiovas cular disease, and noncardiovascular disease mortality among Black men, White women, or Black women; and There were no significant associations found between fish intake and incidence of coronary heart disease among White or Black men or women. Finland fish consumption: After adjusting for age, BMI, cigarette smok- N 1 = 0-19 g/day ing, and intake of energy, vegetables, fruit, 2 = 20-39 g/day alcohol, meat, butter, and margarine, there 3 = ≥40 g/day were no significant associations found between total fish consumption and the risk of 20-year Italy fish consumption: CHD mortality in any of the three countries.
|
From page 538... ...
Primary prevention
|
From page 539... ...
. After combining the higher quartiles of fish consumption, those who ate fish ≥1 per week had a significantly lower relative risk of sud den death than those who ate fish only <1 per month (RR=0.44, 95% CI 0.22-0.86)
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From page 540... ...
Primary prevention Rodriquez Cohort Men (n=3310) Seafood et al., 1996 Aged 45-68 years Oahu, Hawaii Japanese ancestry Current smokers Honolulu Heart Program Free of CHD, stroke, cancer at baseline Follow-up of 23 years Primary prevention
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From page 541... ...
* Categories of fish intake: After controlling for baseline age and educa- B 1 = 0 g/day tion, religion, systolic blood pressure, serum 2 = 1-17 g/day cholesterol, number of cigarettes smoked per 3 = 18-34 g/day day, BMI, presence or absence of diabetes, 4 = ≥35 g/day presence or absence of electrocardiographic abnormalities, and daily intake of energy, cholesterol, saturated, monounsaturated, and polyunsaturated fatty acids, total protein, car bohydrate, alcohol, iron, thiamine, riboflavin, niacin, vitamin C, beta carotene, and retinol: Those who consumed fish had a lower relative risk of death from MI, CVD, CHD, and all causes.
|
From page 542... ...
Primary prevention
|
From page 543... ...
; Those in the 2nd and 4th categories of fish intake had a significantly lower RR of nonfatal MI than those in the 1st category (RR=0.62, 95% CI 0.39-1.00 and RR=0.67, 95% CI 0.46-0.97, respectively) ; Those in the 5th category of fish intake had a significantly lower relative risk of fatal CHD than those in the 1st category (RR=0.54, 95% CI 0.29-1.00)
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From page 544... ...
Aged 64-87 years for men Aged 64-85 years for women Rotterdam, Netherlands All patients of the same general practice Follow-up of 17 years Primary prevention Salonen Cohort Men (n=1833) Seafood et al., 1995 Aged 42, 48, 54, or 60 years Eastern Finland Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD)
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From page 545... ...
* Fish intake = yes or no After adjusting for age, gender, prevalence of B MI and angina pectoris, systolic blood pres sure, total cholesterol, smoking, alcohol and energy intake/body weight, those who ate fish had a significant lower RR of CHD mortal ity than those who did not eat fish (RR=0.51, 95% CI 0.29-0.89)
|
From page 546... ...
California Non-Hispanic White Adventists The Adventist Health Study No history of heart disease or diabetes at baseline; almost no current smokers (although some past smokers) Follow-up of 6 years Primary prevention
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From page 547... ...
; however there was no significant association found between fish n-3 consumption and risk of mortality from cancer. Categories of fish intake: After stratifying for age, sex, smoking, exer- N 1 = None cise, relative weight, and high blood pressure, 2 = 0 |
From page 548... ...
Free of CHD at baseline Follow-up of 20 years Primary prevention
|
From page 549... ...
* Categories of fish intake: After adjusting for age, systolic blood pres- B 1 = 0 g/day sure, serum total cholesterol, cigarette smok2 = 1-14 g/day ing, subscapular skinfold thickness, physical 3 = 15-29 g/day activity, energy intake, dietary cholesterol, 4 = 30-44 g/day prescribed diet, and occupation: 5 = ≥45 g/day Those in category 4 of fish intake had a significantly lower RR of death from coronary heart disease than those in the 1st category (RR=0.36, 95% CI 0.14-0.93)
|
From page 550... ...
= free of confirmed CVD Men Aged 40-84 years US physicians Physicians' Health Study Free of MI, stroke, transient ischemic attacks, or cancer at baseline 2-by-2 factorial design to receive aspirin, beta carotene, both active drugs, or both placebo 17 years of follow-up (time from study enrollment to sudden death = 0.7-16.9 years) Primary prevention
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From page 551... ...
. After adjusting for assignment to aspirin and beta carotene treatment or placebo, BMI, history of diabetes, history of hypertension, history of hypercholesterolemia, alcohol consumption, frequency of vigorous exercise, parental history of myocardial infarction be fore the age of 60, trans unsaturated fatty acid and monounsaturated fatty acid levels: The RR of sudden death was significantly lower for those in the 3rd and 4th quartiles of n-3 fatty acids (RR=0.19, 95% CI 0.05-0.69 and RR=0.10, 95% CI 0.02-0.48, respectively)
|
From page 552... ...
Men and women Aged <80 years Three tertiary hospitals of Pamplona, Spain No history of angina pectoris, a previous diagnosis of CHD, or other prior diag nosis of major cardiovascular disease Secondary prevention Sasazuki Case-control Cases = first episode of AMI (n=632) Seafood et al., 2001 Controls = residents from same munici palities as the cases (n=1214)
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From page 553... ...
: hyperlipidemia, hypertension, diabetes melLow = <2/week litus, angina pectoris, and obesity: Intermediate = 2-3/week High = 4+/week Men who consumed intermediate and high levels of fish had a significantly lower RR of acute MI compared to those who consumed low levels of fish (RR=0.5, 95% CI 0.3-0.8 and RR=0.6, 95% CI 0.4-0.9, respectively) ; and The relative risks for acute MI based on fish consumption were not significant among women.
|
From page 554... ...
Men and women Aged 25-74 years Married Seattle and suburban King County, WA Free of prior clinical heart disease, major comorbidities, and use of fish-oil supplements On average, 4 months between the date of cardiac arrest and in-person interview Primary prevention
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From page 555... ...
1 = 0 portions/week 2 = >0-<1 portion/week There were no significant associations found 3 = ≥1 portion/week between fresh fish intake and canned fish intake and the risk of AMI. Similar results were found when the model only adjusted for age and sex.
|
From page 556... ...
Women Aged 22-69 years for cases Aged 21-69 years for controls 30 hospitals in northern Italy No chronic or digestive conditions; car diovascular, malignant, hormonal, or gynecological disease; or any disorder that was potentially related to con sumption of alcohol or smoking Primary prevention
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From page 557... ...
. After adjusting for age, area of residence, education, smoking, hyperlipidemia, diabetes, hypertension, BMI, carrots, green vegetables, fresh fruit, meat, ham and salami, butter, total fat score, coffee, and alcohol, the OR for MI was 1.0 for the 2nd tertile of fish intake and 0.8 for the 3rd tertile of fish intake, compared to the 1st tertile, and they were not significant.
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From page 558... ...
2004. Effects of Omega- Fatty Acids on Cardioascular Risk Factors and Intermediate Markers of Cardioascular Disease.
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From page 559... ...
: Eskimo men = 4.38±0.93 Eskimo women = 4.45±0.89 Danish men = 5.11±1.16 Danish women = 5.31±1.32 α-lipoproteins (g/L±SD) : Eskimo men = 4.02±1.39 Eskimo women = 3.91±1.41 Danish men = 2.78±0.82 Danish women = 3.64±0.94 Practice Center, Boston, MA)
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From page 560... ...
Follow-up of 4-25 years Bouzan Meta- 5 cohort studies Seafood et al., 2005 analysis 1 case-control study He et al., Meta- 9 cohorts (from 8 studies) Seafood 2004a analysis English language
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From page 561... ...
. There were no significant associations found between fish consumption and hemorrhagic stroke.
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From page 562... ...
SEAFOOD ChOICES TABLE B-2b Continued Author Study Type Subjects Exposure Mozaffarian Cohort Men and women (n=4778) Seafood Aged ≥65 years et al., 2005 4 US communities From Medicare eligibility lists Free of known cerebrovascular disease at baseline Cardiovascular Health Study (CHS)
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From page 563... ...
* Categories of tuna/ After adjusting for age, sex, education, diabetes, B other fish intake: coronary heart disease, smoking status, pack-years 1 = <1 time/month of smoking, aspirin use, BMI, leisure-time physical 2 = 1-3 times/month activity, alcohol use, total caloric intake, systolic 3 = 1-4 times/week blood pressure, LDL-c, HDL-c, triglyceride, and 4 = ≥5 times/week C-reactive protein levels: Categories for fried Those who consumed tuna/other fish 1-4 times/ fish/fish sandwich week had a significantly lower risk of total stroke intakes: and ischemic stroke compared to those who con1 = <1 time/month sumed tuna/other fish <1 time/month (HR=0.74, 2 = 1-3 times/month 95% CI 0.56-0.98 and HR=0.73, 95% CI 0.543 = ≥1 time/week 0.98, respectively)
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From page 564... ...
Aged 34-103 years Nagasaki and Hiroshima, Japan The Life Span Study Atomic bomb survivors and their non exposed controls No prevalent cases of cancer, self reported cases of stroke, ischemic heart disease, and both stroke and ischemic heart disease Follow-up of 16 years
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From page 565... ...
intake and the risk Tertiles of fish intake: of total stroke mortality, when fish intake was defined as never, ≤1 time/week, 2-4 times/week, Low = 11-18 g/day Moderate = 30 g/day and almost daily; however, there was a significant High = 46-65 g/day trend (p=0.046) ; Those who ate broiled fish almost daily had a significantly lower RR of total stroke mortal ity compared to those who never ate broiled fish (HR=0.60, 95% CI 0.37-0.98)
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From page 566... ...
Aged 40-75 years dietary n-3 fatty US health professionals acid intake Health Professional Follow-up Study No previously diagnosed stroke, MI, coronary artery surgery, angina pecto ris, peripheral arterial disease, diabetes mellitus, transient ischemic attack, or other cardiovascular disease Follow-up of 12 years
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From page 567... ...
. The other quintiles also had lower relative 1 = <0.05 g/day risks compared to the 1st quintile, but they were 2 = 0.05-<0.2 g/day not significant; 3 = 0.2-<0.4 g/day 4 = 0.4-<0.6 g/day There were no significant associations found 5 = ≥0.6 g/day between cumulative fish intake and the risk of hemorrhagic stroke; similar results were found for most recent fish intake; Those in the 2nd, 3rd, and 4th quintiles of n-3 PUFA intake had significantly lower RRs of isch emic stroke compared to those in the first quintile (RR=0.56, 95% CI 0.35-0.88; RR=0.63, 95% CI 0.40-0.98; RR=0.54, 95% CI 0.32-0.91, respec tively)
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From page 568... ...
Aged 34-59 years dietary n-3 fatty US nurses acid intake Nurses' Health Study No history of cancer, angina, myocardial infarction, coronary revascularization, stroke, other cardiovascular diseases before baseline; or a history of physi cian-diagnosed diabetes or high serum cholesterol levels Follow-up of 14 years (1,086,261 person-years)
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From page 569... ...
: infarction than the 1st category, they were not 1 = 0.077 g/day significant; 2 = 0.118 g/day 3 = 0.171 g/day There were no significant associations found 4 = 0.221 g/day between fish consumption and total stroke, 5 = 0.481 g/day ischemic stroke, large-artery occlusive infarction, hemorrhagic stroke, subarachnoid hemorrhage, or intraparenchymal hemorrhage; Those in quintile 3 of omega-3 PUFA intake had a significantly lower RR of total stroke (RR=0.69, 95% CI 0.53-0.89) , ischemic stroke (RR=0.67, 95% CI 0.47-0.98)
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From page 570... ...
Primary prevention
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From page 571... ...
* Fresh fish = 0.57 g n-3 After controlling for age, total energy intake, level B fatty acids/100 g of education, BMI, current smoker at recruitment, Salted fish = 0.44 g n-3 average number of cigarettes smoked per day, fatty acids/100 g number of alcoholic drinks consumed per week, Shellfish = 0.36 g n-3 history of diabetes, and history of hypertension: fatty acids/100 g There were no significant associations found beFish and shellfish cat- tween fish consumption and risk of stroke mortal egories (g/week)
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From page 572... ...
National Health and Nutrition Examina tion Survey (NHANES) I No history of stroke at baseline Excluded those with unknown baseline fish consumption, systolic blood pres sure, serum cholesterol level, diabetes history, number of cigarettes smoked, BMI, history of heart disease, or edu cational attainment Average follow-up of 12 years Orencia Cohort Men (n=1847)
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From page 573... ...
Categories of fish After adjusting for age, systolic blood pressure, N consumption: cigarette smoking, serum cholesterol, diabetes, 1 = None ECG abnormalities, table salt use, alcohol intake, 2 = 1-17 g/day iron, thiamine, riboflavin, niacin, vitamin C, beta3 = 18-34 g/day carotene, retinol, total energy, polyunsaturated 4 = ≥35 g/day fatty acids, carbohydrates, and total protein, there were no significant associations found between fish consumption and risk of fatal and nonfatal stroke. continued
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From page 574... ...
Aged 40-84 years dietary n-3 fatty US physicians acid intake Physicians' Health Study No history of MI, stroke, transient ischemic attacks, cancer, liver or renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or nonsteroidal anti-inflammatory agents Follow-up of 4 years
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From page 575... ...
and cardiovascular deaths (RR=2.6, 2 = 1 meal/week 95% CI 1.4-4.8) compared to those who consume fish <1 meal/week; 3 = 2-4 meals/week 4 = ≥5 meals/week No other significant RRs of total myocardial Quintiles of n-3 infarction, nonfatal myocardial infarction, stroke, fatty acids intake cardiovascular deaths, or total cardiovascular (g/week)
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From page 576... ...
Aged 50-69 years Zutphen, Netherlands The Zutphen Study (Dutch contribution to the Seven Countries Study) Free of stroke at baseline Follow-up of 15 years Kromann Cohort Men and women (n=1800)
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From page 577... ...
* Categories of fish Fish consumption (g/day)
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From page 578... ...
Controls (n=473) = no acute stroke, liv- dietary n-3 fatty ing in study area at time of study acid intake Aged 40-85 years Asturias, Spain (a northern region)
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From page 579... ...
. No 2 = 11.3 g/day < x < significant ORs for stroke were found for those 28.7 g/day who consumed 23-45, 46-90, or 91-250 g of 3 = 28.8 g/day ≤ x < fish/day; and 46.5 g/day 4 = ≥46.5 g/day Those who ate >46.5 g of fish/day had a signifi cantly higher OR of cerebral infarction compared Categories of n-3 fatty to those who never ate fish (OR=1.98, 95% CI acid intake: 1.08-3.45)
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From page 580... ...
2004. Effects of Omega Fatty Acids on Cardioascular Disease.
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From page 581... ...
Results from five prospective studies have been less consistent, with one showing no associa tion, one showing a possible inverse association, and three demonstrating a significantly inverse association." "Consumption of fish several times per week reduces the risk of thrombotic stroke but does not increase the risk of hemorrhagic stroke." "Fish consumption was independently, signifi- B cantly, and inversely associated with mortality from all causes, ischemic heart disease, and stroke in both sexes." The statistics for these associations are p<0.001, 0.01 |
From page 582... ...
SEAFOOD ChOICES TABLE B-2c Studies on Lipid Profile Author Study Type Subjects Exposure Dunstan Randomized Women (n=83) n-3 et al., 2003 Controlled Booked for delivery at St.
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From page 583... ...
* Fish oil group: "Levels of n-6 PUFA AA were significantly lower in B 1.0 g fish oil/capsule, the fish oil group (15.02±1.44%, p<0.001)
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From page 584... ...
n-3 1998* Controlled Mean age about 66 years supplement Trial Edinburgh, UK Intermittent claudication on the Edin burgh Claudication Questionnaire An ankle brachial pressure index ≤0.9 in at least one limb No clinical evidence of critical ischemia; unstable angina or a MI within the previous 3 months; severe intercurrent illnesses including severe liver disor ders, malignancy, or epilepsy; concur rent treatment with anticoagulants, other oils, lithium, or phemothiazines; pregnant or actively trying to conceive; already participating in a clinical trial Follow-up of 2 years
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From page 585... ...
was significantly 2 capsules twice/day higher in the polyunsaturated fatty acids group for first 2 weeks, compared to the placebo group (p≤0.01)
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From page 586... ...
n-3 Controlled Mean age of 54 years supplement Trial Patients of the Department of Diabetes (crossover) outpatient clinic (diabetics)
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From page 587... ...
* Fish oil group: There were no significant differences in fasting B 6 g fish oil plasma glucose, insulin, or HbA1c between the two 30% n-3 fatty acids; groups.
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From page 588... ...
SEAFOOD ChOICES TABLE B-2c Continued Author Study Type Subjects Exposure Dunstan et al., Randomized Men (n=40)
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From page 589... ...
+ moderate exer- Relative to no fish and light exercise, fish and mod cise (55-65% of erate exercise (Group 3) significantly lowered serum Vo2max)
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From page 590... ...
Controlled Mean age of 63 (all >40 years, all women Trial postmenopausal) Plasma LDL-cholesterol within the 10th and 90th percentile for their age and sex No medication known to affect plasma li poprotein cencentrations; no endocrine, liver, or kidney disease Nonsmokers, did not consume alcohol regularly Follow-up of 24 weeks National Cholesterol Education Program (NCEP)
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From page 591... ...
, or LDL 4.1±0.2 % energy particle score. from LA 0.7±0.2 % energy Those on the low-fish diet significantly lowered their from ALA total cholesterol, LDL-C, HDL-C, apolipoprotein <0.01 % energy from B, apolipoprotein A-I (p<0.0001)
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From page 592... ...
Aged 25-81 years Apparently healthy Current or retired employees attending a regular health check-up Sacks et al., 1995 Randomized Men and women (n=59) n-3 Controlled Aged 30-75 years supplement Trial Boston, MA Had narrowing of ≥30% lumen diameter of a major coronary artery, a total cho lesterol concentration <250 mg/dL, and triglyceride level <350 mg/dL No congestive heart failure, liver, renal, or serious gastrointestinal disease, insulin dependent diabetes mellitus, current cigarette smoking, or alcohol intake >14 drinks/week Follow-up of 2.4 years
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From page 593... ...
, and a significant decrease in triglycerides acids/capsule among those in the fish oil group (p<0.01; p<0.05 (240 mg EPA, for lipoprotein Lp(a)
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From page 594... ...
Controlled Aged 30-60 years and n-3 Trial Perth, Australia supplements Eating not more than one fish meal/week or drinking more than an average of 30 mL alcohol/day (3 standard drinks) With high-normal blood pressure and elevated serum cholesterol No history of unstable heart, renal, or liver disease, hypercholesterolemia, asthma, or any major allergies Follow-up of 12 weeks
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From page 595... ...
from total fat, % of daily fat from monounsaturated fatty acids or saturated fatty acids, total carbohy30% total energy drate, total protein, or fiber intake. from fat and: 6 = control group 7 = fish (1 fish meal/ day)
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From page 596... ...
SEAFOOD ChOICES TABLE B-2c Continued Author Study Type Subjects Exposure Vandongen Randomized Men (n=120) Seafood et al., 1993 Controlled Aged 30-60 years and n-3 Trial Perth, Australia supplements BMI <33 kg/m2, SBP 130-159 mmHg, DBP 80-99 mmHG, serum cholesterol 5.2-6.9 mmol/L, nonsmoking, not tak ing any medication, no significant illness or allergic disorder Eating ≤1 fish meal and drinking <210 mL alcohol/week Follow-up of 12 weeks
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From page 597... ...
≈3.2 g/day total n-3 fatty acids Salmon (90 g/day) 3.8 g/day total n-3 fatty acids continued
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From page 598... ...
Controlled Aged 30-60 years n-3 supple Trial Adelaide, South Australia mentation Mildly hyperlipidemic and normotensive No history of heart disease, hypertension, bleeding disorders, liver or renal disorders, gout, diabetes, recent cerebrovascular accident, or obesity No steroids, nonsteroidal anti inflammatory drugs, aspirin, beta blockers, allopurinol, or cardiac glycosides No excessive alcohol intake (>40 g/day) or smoked >20 cigarettes/day Follow-up of 8 weeks Hanninen Randomized Men (n=100)
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From page 599... ...
after eating the fish diet for 12 weeks; there were no significant Controls: changes after 12 weeks for those who ate 0.9, 1.5, 1 fish meal/2 weeks and 2.3 fish meals/week. Meals = Finnish There were no significant changes in serum cho freshwater fish lesterol, serum apolipoprotein A-I, hemoglobin, (rainbow trout, thrombocytes, vitamin E, or vitamin A after eating vendace, and the fish diets for 12 weeks.
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From page 600... ...
2004. Effects of Omega- Fatty Acids on Cardioascular Risk Factors and Intermediate Markers of Cardioascular Disease.
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From page 601... ...
* Plasma phospholipids After adjusting for age, sex, waist girth, smoking N = relative percent- status, and alcohol intake: ages of total fatty acids by weight EPA, DHA, EPA+DHA, EPA:AA, and n-3:n-6 are positively associated with total cholesterol Fish and marine (p=0.0001)
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From page 602... ...
n-3 Adult study populations (mean age ≥18 et al., 2002* analysis supplement years)
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From page 603... ...
After adjusting for age, percent males, baseline BP, study design, and fish oil dose: Fish oil decreased SBP and DBP more among those >45 years of age compared to those ≤45 years of age, in populations with males and females compared to those with only males, in those with hypertension compared to those without hypertension, and among those with a BMI >26.8kg/m2 compared to those with BMI ≤26.8 kg/m2, but the differences were not significant. continued
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From page 604... ...
n-3 et al., 1999 Controlled Aged 70-83 years supplement Trial France Diastolic blood pressure <95 mmHg and systolic blood pressure <180 mmHg No metabolic, malignant, or degenerative diseases Follow-up of 42 days Leng et al., Randomized Men and women (n=120)
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From page 605... ...
Control capsule: 600 mg sunflower oil and 600 ppm alpha-tocopherol Polyunsaturated fatty There were no significant differences in systolic blood B acids group: pressure or diastolic blood pressure between the two 280 mg GLA, 45 mg groups at baseline or at 6 months. EPA/capsule 2 capsules twice/day At 24 months systolic blood pressure was signifi for first 2 weeks, 3 cantly lower in the polyunsaturated fatty acids group capsules twice/day compared to the placebo group (150.1±3.5 mmHg vs.
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From page 606... ...
0 SEAFOOD ChOICES TABLE B-2d Continued Author Study Type Subjects Exposure Vandongen Randomized Men (n=120) Seafood et al., 1993 Controlled Aged 30-60 years and n-3 Trial Perth, Australia supplements BMI <33 kg/m2, SBP 130-159 mmHg, DBP 80-99 mmHG, serum cholesterol 5.2-6.9 mmol/L, nonsmoking, not tak ing any medication, no significant illness or allergic disorder Eating ≤1 fish meal and drinking <210 mL alcohol/week Follow-up of 12 weeks
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From page 607... ...
≈3.8 g/day total n-3 fatty acids continued
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From page 608... ...
Controlled Aged 30-60 years n-3 supple Trial Adelaide, South Australia mentation Mildly hyperlipidemic and normotensive No history of heart disease, hypertension, bleeding disorders, liver or renal disor ders, gout, diabetes, recent cerebrovas cular accident, or obesity No steroids, nonsteroidal anti inflammatory drugs, aspirin, beta blockers, allopurinol, or cardiac glycosides No excessive alcohol intake (>40 g/day) or smoked >20 cigarettes/day Follow-up of 8 weeks Dewailly Cohort Men and women (n=426)
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From page 609... ...
Control diet: Continuation of baseline diet Plasma phospholipids After adjusting for age, sex, waist girth, smoking N = relative percent- status, and alcohol intake, no significant associations ages of total fatty were found between EPA, DHA, EPA+DHA, EPA: acids by weight AA or n-3:n-6 and systolic blood pressure or diastolic blood pressure. Fish and marine mammal intake from 24-hour recalls Consumption of traditional and market food stuffs from a food frequency questionnaire continued
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From page 610... ...
2004. Effects of Omega- Fatty Acids on Cardioascular Risk Factors and Intermediate Markers of Cardioascular Disease.
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From page 611... ...
, hormone exposure (for women) , protein, carbohydrate, total fat, saturated fat and polyunsaturated fat, energy, P/S ratio, and NSP intake, the only significant difference in blood pressure was for DBP among women (p=0.02)
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From page 612... ...
SEAFOOD ChOICES TABLE B-2e Studies on Arrhythmia Author Study Type Subjects Exposure Leaf et al., Review Clinical trials (n=6 analyses) n-3 2003 Animal and laboratory studies (for supplement potential mechanisms)
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From page 613... ...
"If there is a family history of sudden cardiac death, then the supplement should be increased to 1 to 2 g of EPA plus DHA." "These n-3 fatty acids are antiarrhythmis and can prevent sudden cardiac death in humans." High n-3 group: There were no significant differences between the B 10 capsules three diet groups in regards to the changes in six 6.6 g/day n-3 PUFA heart rate variability indexes from before to after 3 g EPA/2.9 g DHA supplementation. Low n-3 group: 3 capsules n-3, 7 capsules of olive oil 2 g/day n-3 PUFA 0.9 g EPA/0.8 g DHA Placebo group: 10 capsules Olive oil n-3 fatty acid group: After n-3 polyunsaturated fatty acid treatment, A 5.2 g n-3 PUFA the mean heart rate variability, defined as standard 4.3 g EPA and DHA deviation of all normal RR intervals in 24-hour Holter recording, was significantly higher compared Placebo group: to baseline (124 ms vs.
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From page 614... ...
Platelet et al., 1997 sectional Aged 48-75 years fatty acids; Discharged after MI from Aalborg seafood Hospital, Denmark Echocardiography performed within the first week after MI Left ventricular ejection fraction ≤40% No implanted pacemaker, no permanent tachyarrhythmias, no serious noncardiac disease Using baseline data from Christensen et al., 1996 * B = Evidence of a benefit; A = Evidence of an adverse effect; N = Evidence of no association or no clear association.
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From page 615... ...
, but these differences Fish intake: were not significant. 1 = 0 times/week 2 = 1 time/week The standard deviations of all normal RR intervals 3 = ≥2 times/week in the entire 24-hour recording for those in the first, second, and third tertile of DHA contents in platelets were approximately 98 ms, 116 ms, and 140 ms, respectively.
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From page 616... ...
Controlled Aged 30-60 years n-3 supple Trial Adelaide, South Australia mentation Mildly hyperlipidemic and normotensive No history of heart disease, hypertension, bleeding disorders, liver or renal disor ders, gout, diabetes, recent cerebrovas cular accident, or obesity No steroids, nonsteroidal anti inflammatory drugs, aspirin, beta-block ers, allopurinol, or cardiac glycosides No excessive alcohol intake (>40 g/day) or who smoked >20 cigarettes/day Follow-up of 8 weeks *
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From page 617... ...
. 4 g/day 1.33 g EPA and No other significant associations were found be 0.95 g DHA/day tween the diet groups with regards to the change in PT (ratio)
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From page 618... ...
Diet et al., 1999* Controlled Mean age about 53 years (includes Trial Western Australia seafood)
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From page 619... ...
. Group 3: The change in erythrocyte omega-6 fatty acids from Low-fat diet with baseline to end of intervention were significantly the inclusion of different for both the fish and moderate exercise 1 fish meal daily (Group 3)
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From page 620... ...
Presenting with hyperlipoproteinemias type IIb or IV, associated with at least one further risk factor No severe intercurrent ailments, kidney or renal disease, intestinal malabsorptions, duodenal ulcer nonresponsive to therapy, BMI ≥30, history of vascular or nonvascular brain disease, severe hyperlipidemia needing drug treatment, severe hypertension, myocardial infarction in the preceding 3 months, or unstable angina Follow-up of 1 year
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From page 621... ...
* Control group = From baseline to end of intervention, the fish + N weight-maintaining weight loss diet significantly increased plasma diet phospholipid n-3 fatty acids (p<0.0001)
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From page 622... ...
supplement Trial Aged 18-70 years Stavanger, Norway Outpatient center Has combined hyperlipidemia No dietary supplementation or medication containing omega-3 fatty acids during the run-in period, no antihyperlipemic medication No MI or other serious disease occurring within 3 months of enrollment, known diabetes mellitus, serious psychological disease, known drug or alcohol abuse, pregnancy or lactation Follow-up of 12 weeks Kesavulu et al., Trial Men and women (n=34) n-3 2002 Nonobese, type II diabetic supplement On oral antidiabetic drugs, but not on lipid lowering drugs or antioxidant therapy Normotensive; no other clinical complications other than diabetes, no diabetic complications Follow-up of 3 months
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From page 623... ...
compound with regards to serum glucose, plasma insulin, 85% EPA/DHA plasma proinsulin, insulin:glucose ratio, and proinsulin:glucose ratio. Control: 2 g concentrated ethylester compound 85% corn oil Group 1 diabetics: After combined therapy, fasting blood glucose and B 1 month of glycated hemoglobin were significantly higher in the antidiabetic drugs Group 1 diabetics than in the controls (p<0.001)
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From page 624... ...
granulocyte Aged 39-77 years membranes; Aalborg, Denmark seafood Referred for coronary angiography because of clinical suspicion of CAD; clinically stable No acute myocardial infarction in past 6 months, nonischemic cardiomyopathy, pacemaker, or permanent tachyarrhythmias * Included in Balk E, Chung M, Lichtenstein A, Chew P, Kupelnick B, Lawrence A, DeVine D, Lau J
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From page 625... ...
. 1 = never eating fish 2 = eating fish There were no significant associations found 1 time/month between CRP and LA, ALA, AA, EPA, or DPA 3 = eating fish 2-3 content in granulocyte membranes or between CRP times/month and fish score.
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From page 626... ...
SEAFOOD ChOICES TABLE B-2h Studies on Adult Asthma and Allergies Author Study Type Subjects Exposure Troisi et al., 1995 Cohort Women (n=77,866) Dietary to Aged 30-55 years tal fat and US nurses n-3 intake Nurses' Health Study No diagnosed cancer, CVD, diabetes, em physema, chronic bronchitis, or asthma before or at time of questionnaire Follow-up of 10 years Huang et al., Cross- Men (n=582)
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From page 627... ...
: dence, number of physician's visits, and quintiles of 1 = 51.9 g energy intake: 2 = 62.7 g 3 = 69.9 g There were no significant associations found between 4 = 77.0 g total fat intake, saturated fat intake, or omega-3 fat 5 = 87.4 g intake and the risk of asthma; Quintiles of omega-3 Those in Quintile 3 of monounsaturated fat intake (median) : (median = 28.6 g)
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From page 628... ...
MacLean Review Part of a larger systematic literature Seafood; dietary et al., 2006 review fatty acids Cohorts (n=20 cohorts; 38 articles) 11 different types of cancer
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From page 629... ...
Quantiles of fish intake and n-3 fish oil intake, absolute amount unspecified "For each breast, lung, and prostate cancer, N there were significant associations for both increased and decreased risk and far more estimates that did not demonstrate any association." "No trend was found across many different cohorts and many different categories of omega 3 fatty acid consumption to suggest that omega 3 fatty acids reduce overall cancer risk." continued
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From page 630... ...
0 SEAFOOD ChOICES TABLE B-2i Continued Author Study Type Subjects Exposure Terry et al., Review 7 cohort studies on breast cancer Seafood, n-3 2003 8 cohort studies on prostate cancer supplement, 1 cohort study on endometrial cancer serum 19 case-control studies on breast cancer phospholipids, 9 case-control studies on prostate cancer adipose tissue, 7 case-control studies on endometrial and erythrocyte cancer membrane fatty 5 case-control studies on ovarian cancer acids
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From page 631... ...
APPENDIX B Amount Results Conclusion* "The development and progression of breast N and prostate cancers appear to be affected by processes in which EPA and DHA play important roles." However, "whether the consumption of fish containing marine fatty acids can alter the risk of these cancers or of other hormone-dependent cancers is unclear." "Although there is ample evidence from in vitro and animal studies that these essential fats can inhibit the progression of tumors in various organs, particularly the breast and prostate, the evidence from epidemiologic studies is less clear." "Although most of the studies did not show an association between fish consumption or marine fatty acid intake and the risk of hormone-related cancers, the results of the few studies from populations with a generally high intake of marine fatty acids are encouraging." continued
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From page 632... ...
Recruited from general population Free of cancer at baseline, other than nonmelanoma skin cancer Average follow-up of 4.8 years (2,279,075 person-years)
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From page 633... ...
. The HR for the 2nd, 3rd, and 5th categories of fish intake were also lower compared to the 1st category, but they were not significant; and Every 100 g increase in daily fish intake significantly lowered the HR for colorectal cancer (HR=0.70, 95% CI 0.57-0.87)
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From page 634... ...
English Cohort Men and women (n=37,112) Seafood et al., 2004 Aged 27-75 years Melbourne, Australia The Melbourne Collaborative Cohort Study Deliberately recruited Italian and Greek migrants Free of colorectal cancer, diabetes, a heart attack, or angina at baseline Average follow-up of 9 years
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From page 635... ...
; 3-4 High = Score of ≥5 There were no significant associations found between broiled fish intake and risk of prostate cancer; and Those in the highest category of total fish intake had a significantly higher RR of prostate cancer compared to those in the lowest category (RR=1.77, 95% CI 1.01-3.11)
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From page 636... ...
SEAFOOD ChOICES TABLE B-2i Continued Author Study Type Subjects Exposure Folsom and Cohort Women (n=41,836) Seafood; dietary Demissie, Aged 55-69 years fatty acids 2004 Iowa Iowa Women's Health Study Group 1 = no heart disease or cancer at baseline Group 2 = no cancer at baseline, but a history of myocardial infarction, angina, or other heart disease Follow-up of 442,965 person-years Augustsson Cohort Men (n=47,882)
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From page 637... ...
. No other comparisons for metastatic prostate cancer were significant; There were no significant associations found between total fish consumption and all prostate cancer or advanced prostate cancer; and Each additional 0.5 g/day of marine fatty acids was associated with a RR of 0.76 (95% CI 0.58 0.98)
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From page 638... ...
SEAFOOD ChOICES TABLE B-2i Continued Author Study Type Subjects Exposure Holmes Cohort Women (n=88,647) Seafood et al., 2003 Aged 30-55 years US nurses Nurses' Health Study (NHS)
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From page 639... ...
APPENDIX B Amount Results Conclusion* Categories of fish intake: After adjusting for age, 2-year time period, total N 1 = ≤0.13 servings/day energy intake, alcohol intake, parity and age at 2 = 0.14-0.20 servings/day first birth, BMI at age 18, weight change since 3 = 0.21-0.27servings/day age 18, height in inches, family history of breast 4 = 0.28-0.39 servings/day cancer, history of benign breast disease, age at 5 = ≥0.40 servings/day menarche, menopausal status, age at menopause and hormone replacement therapy use, and duration of menopause: There was no significant association found between fish intake and the risk of breast cancer for the whole cohort or when premenopausal women and postmenopausal women were analyzed separately; and Similarly nonsignificant results were found when fish intake was defined as no intake, <1 serving/ day and ≥1 serving/day.
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From page 640... ...
0 SEAFOOD ChOICES TABLE B-2i Continued Author Study Type Subjects Exposure Stripp et al., Cohort Women (n=23,693) Seafood 2003 Aged 50-64 years Copenhagen and Aarhus, Denmark Diet, Cancer and Health study No diagnosis of cancer at baseline Median follow-up of 4.8 years
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From page 641... ...
6 g/day 75th percentile = 19 g/day 95th percentile = 39 g/day Percentiles of fried fish intake: 5th percentile = 5 g/day 25th percentile = 13 g/day 75th percentile = 30 g/day 95th percentile = 55 g/day Percentiles of boiled fish intake: 5th percentile = 0 g/day 25th percentile = 4 g/day 75th percentile = 11 g/day 95th percentile = 23 g/day Percentiles of processed fish intake: 5th percentile = 2 g/day 25th percentile = 6 g/day 75th percentile = 19 g/day 95th percentile = 40 g/day continued
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From page 642... ...
SEAFOOD ChOICES TABLE B-2i Continued Author Study Type Subjects Exposure Takezaki Cohort Men (n=2798) Seafood et al., 2003 Women (n=3087)
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From page 643... ...
. Those in the middle categories of broiled and boiled fish intake also had lower RR for incident lung cancer than those in the low category but they were not significant; and There were no significant associations found between raw or deep-fried fish intake and the risk of incident lung cancer.
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From page 644... ...
Seafood 2001 Mean age of 55.6 years (baseline) Twin pairs from the Sweden Twin registry Sweden Follow-up of 30 years
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From page 645... ...
Categories of fish intake: After adjusting for age, BMI, physical activity, B 1 = Never/seldom part smoking, and consumption of alcohol, red meat, of diet processed meat, fruit and vegetables, and milk: 2 = Small part of diet 3 = Moderate part of diet Those who never or seldomly ate fish had a 4 = Large part of diet significantly higher RR of all prostate cancers than those who made fish a moderate part of their diet (RR=2.3, 95% CI 1.2-4.5, p<0.05) ; Those who never or seldomly ate fish had a significantly higher RR of prostate cancer deaths than those who made fish a moderate part of their diet (RR=3.3, 95% CI 1.8-6.0, p<0.01)
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From page 646... ...
Seafood 1997 Aged 34-65 years New York and Florida New York University Women's Health Study No use of hormonal medication or pregnancy in preceding 6 months Follow-up of 105,044 person-years
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From page 647... ...
intake and risk of breast cancer; and Those in the "unknown" category of dried fish intake had a significantly lower RR of breast cancer than those in the 1st category (RR=0.77, 95% CI 0.60-0.98)
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From page 648... ...
Seafood 1996 Aged 55-69 years Iowa Iowa Women's Health Study No self-reported history of cancer at baseline or prior use of chemotherapy Follow-up of 7 years (233,261 person-years)
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From page 649... ...
, but they were not significant. Categories of fish intake: After adjusting for age and total energy intake, N 1 = <4 servings/month there were no significant associations found 2 = 4-6 servings/month between intake of all fish or polyunsaturated fat 3 = >6 servings/month and risk of non-Hodgkins lymphoma.
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From page 650... ...
Seafood et al., 1994 Aged 40-75 years US health professionals Health Professionals Follow-up Study No diagnosed cancer at baseline Le Marchand Cohort Men (n=20,316) Seafood Aged <45 years et al., 1994 Permanent resident of Hawaii Nonmilitary Japanese, Caucasian, Filipino, Hawaiian/ part Hawaiian, and Chinese No invasive cancer within 5 years before entry, no diagnosis of prostate cancer earlier than 5 years before interview Median follow-up of 6 years (between entry and diagnosis for cases)
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From page 651... ...
: association found between fish intake and the 1 = 8.4 g/day risk of colon cancer. 2 = 20.9 g/day 3 = 31.0 g/day 4 = 47.8 g/day 5 = 83.4 g/day Quantile of fish intake, After adjusting for age, ethnicity, and income, no N absolute amounts not significant association was found between risk specified of prostate cancer and quantile of fish intake at baseline.
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From page 652... ...
Willett Cohort Women (n=88,751) Seafood et al., 1990 Aged 30-55 years US nurses Nurses' Health Study (NHS)
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From page 653... ...
3 = 1 time/week 4 = 2-4 times/week After adjusting for age and total energy intake: 5 = ≥5 times/week Those in the 4th and 5th quintiles of chicken Quintiles of chicken and and fish intake had significantly lower RR fish intake: of colon cancer compared to those in the 1 = <22 g/day 1st quintile (RR=0.47, 95% CI 0.27-0.81; and 2 = 22-28 g/day RR=0.56, 95% CI 0.34-0.92; respectively) ; and 3 = 29-40 g/day 4 = 41-64 g/day Those in the 2nd and 3rd quintiles of chicken 5 = ≥65 g/day and fish intake also had lower RR of colon cancer compared to those in the 1st quintile (RR=0.75, 95% CI 0.46-1.22; and RR=0.99, 95% CI 0.63-1.54; respectively)
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From page 654... ...
Men in a probability sample of the general population of Norway A roster of male siblings, living in Norway, of migrants to the US Male and female family members of patients interviewed in a Norwegian case-control study of gastrointestinal cancer Follow-up of 11.5 years Pan et al., Case-control Cases = with incident ovarian cancer Seafood; dietary 2004 (n=442) fatty acids Controls = without cancer from eight provinces, except Manitoba (n=2135)
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From page 655... ...
. Serving size=4 oz/week After adjusting for 10-year age group, province N of residence, education, alcohol consumption, Quartiles of fish and fatty cigarette pack-years, BMI, total caloric intake, acid intakes, absolute recreational physical activity, number of live amount unspecified births, menstruation years, and menopause status: There were no significant associations found between fish intake or fatty acid intake (saturated, monounsaturated, or polyunsaturated)
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From page 656... ...
fatty acids Aged 55-69 years Netherlands Based on incident cases of colon cancer Subcohort of Netherlands Cohort Study Follow-up of over 3.3 years Larsson Review Case-control, cohort, and animal studies Seafood; n-3 et al., 2004 supplements * N = Evidence of no association or no clear association; B = Evidence of a benefit; A = Evidence of an adverse effect.
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From page 657... ...
"Increasing evidence from animal and in vitro N studies indicates that n-3 fatty acids, especially the long-chain polyunsaturated fatty acids EPA and DHA, present in fatty fish and fish oils, inhibit carcinogenesis." "The epidemiologic data on the association between fish consumption, as a surrogate marker for n-3 fatty acid intake, and cancer risk are, however, somewhat less consistent." n-3 fatty acids may modify the carcinogenic process by suppressing AA-derived eicosanoid biosynthesis; influencing transcription factor activity, gene expression, and signal transduction pathways; modulating estrogen metabolism; increasing or decreasing the production of free radicals and reactive oxygen species; and influencing insulin sensitivity and membrane fluidity.
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From page 658... ...
Data from Health Professionals Follow up Study and Nurses' Health Study No Parkinson's disease, stroke, or cancer at baseline Follow-up of 2 years
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From page 659... ...
APPENDIX B Amount Results Conclusion* Quintiles of After adjusting for baseline age, length of N polyunsaturated fatty follow-up, smoking, energy intake, alcohol acids, fish n-3 fatty consumption, and caffeine intake: acids, EPA, and DHA; absolute amounts not There were no significant associations found specified between quintiles of polyunsaturated fatty acids, fish n-3 fatty acids, EPA, or DHA and risk of Parkinson's disease.
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From page 660... ...
0 SEAFOOD ChOICES TABLE B-2j Continued Author Study Type Subjects Exposure Morris et al., Cohort Men and women (n=815) Seafood and Aged ≥65 years 2003 (nested in a dietary n-3 fatty randomized Chicago, IL (south-side)
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From page 661... ...
: and fish consumption (1-3 times/months, 1 time/ week, and ≥2 times/week) : 0.37-1.05, 1.06-1.22, 1.23-1.39, 1.40-1.60, 1.61-4.10 There were no significant associations found between fish consumption and risk of incident Categories of fish intake: Alzheimer's disease; Never, 1-3 times/ month, 1 time/week, Those in the 5th quintile of total n-3 fatty acid ≥2 times/week intake had a significantly lower RR of incident Alzheimer's disease than those in the 1st quintile (RR=0.3, 95% CI 0.1-0.7)
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From page 662... ...
-- third wave of study Free of dementia at baseline and living at home Follow-up of 7 years
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From page 663... ...
After adjusting for age, sex, and education, those who ate fish or seafood at least once a week had a lower risk of being diagnosed with dementia in the 7 years of follow-up (HR=0.73, 95% CI 0.52-10.3) , but it was not significant.
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From page 664... ...
dietary fatty acids Aged 30-55 years in NHS Aged 25-42 years in NHS II US nurses living in 11 states Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II)
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From page 665... ...
Those in the 2nd tertile also had a lower ≤9.5 g/day, 9.5-15.0 g/day, RR of total dementia and Alzheimer's disease >15.0 g/day without cerebrovascular disease compared to those in the 1st tertile, but they were not Tertiles of fish intake: significant; and ≤3.0 g/day, 3.0-18.5 g/day, >18.5 g/day No other significant RR were found for total dementia, Alzheimer's disease without cerebrovascular disease, or dementia with a vascular component based on daily intake of total fat, saturated fat, cholesterol, LA and fish. Categories of fish intake: After adjusting for age, total energy, tier at birth, N 1 = <1 time/week and pack-years of smoking: 2 = 1-2.9 times/week 3 = 3-4.9 times/week There were no significant RR of multiple sclerosis based on one unit daily increments Quintiles of total energy, of oleic acid (RR=0.7, 95% CI 0.4-1.4)
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From page 666... ...
Men and women Mean age of 42 years for male cases Mean age of 37.5 years for female cases Montreal, Canada
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From page 667... ...
100 g increments of After adjusting for total energy and BMI, every B intake/day 100 g increase in daily fish intake decreases the (females risk of multiple sclerosis (OR=0.91, 95% CI only)
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From page 668... ...
SEAFOOD ChOICES TABLE B-2j Continued Author Study Type Subjects Exposure Petridou Case-control Cases = with cerebral palsy (n=91) Seafood et al., 1998 Controls = no cerebral palsy, from same study base as the cases (series1 = closest neighbor of similar sex and age as the case; series2 = first neurological patient seen by attending physicians after a visit by the case, with a healthy sibling of similar sex and age as the case)
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From page 669... ...
APPENDIX B Amount Results Conclusion* Categories of fish/fish After adjusting for age of child, sex, maternal N product intake: age at delivery, maternal age at menarche, 1 = <1 time/week maternal chronic disease, previous spontaneous 2 = 1 time/week abortions, persistent vomiting during index 3 = >1 time/week pregnancy, multiple pregnancy, number of obstetric visits, timing of membrane rupture in relation to index delivery, use of general anaesthesia in the index delivery, mode of delivery, abnormal placenta, head circumference, evident congenital malformation, place of index delivery, use of supplementary Fe during index pregnancy, intentional physical exercise during index pregnancy, painless delivery classes, energy intake, cereals and starchy roots, sugars and syrups, pulses and nuts/seeds, vegetables, fruits, meat and meat products, milk and milk products, and oils and fats: Each one weekly serving increase in fish and fish products during pregnancy lowered the odds of having a child with cerebral palsy (OR=0.63, 95% CI 0.37-1.08, p=0.09)
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From page 670... ...
1998. Fish consumption and risk of sudden cardiac death.
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From page 671... ...
1997. Fish consumption, n-3 fatty acids in cell membranes, and heart rate variability in survivors of myocardial infarction with left ventricular dysfunction.
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From page 672... ...
2004b. Accumulated evidence on fish consumption and coronary heart disease mortality: A meta-analysis of cohort studies.
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From page 673... ...
2005. A quantitative analysis of fish consumption and coronary heart disease mortality.
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From page 674... ...
Effects of varying dietary fat, fish and fish oils on blood lipids in a randomized controlled trial in men at risk of heart disease. American Journal of Clinical Nutrition 59(5)
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From page 675... ...
2000. Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands.
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From page 676... ...
1997. Randomized, double blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: The Indian experiment of infarct survival -- 4.
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From page 677... ...
2001. Fatty fish consumption and risk of prostate cancer.
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From page 678... ...
American Diabetes Unspecified Lower risk of diabetes, and protect Association your heart and blood vessels World Health Unspecified To protect against coronary heart Organization disease and ischaemic stroke European Society of General population To offer advice on food choices to Cardiology compose a diet associated with the lowest risk of cardiovascular disease United Kingdom General population and To reduce risk of cardiovascular Scientific Advisory pregnant women disease Committee on Nutrition European Food Safety Unspecified Reach daily intake for LC n-3 PUFA Authority recommended for potential benefits to health National Heart People with coronary Preventing cardiovascular events Foundation of Australia heart disease
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From page 679... ...
EPA+DHA per day, preferably from fatty fish; 1 gram EPA+DHA One per day supplements can be considered with physician consultation EPA+DHA per day as a capsule with 2-4 grams EPA+DHA One per day physician consultation Fish, especially salmon, trout, white (albacore 4 ounces Two per week or bluefin) tuna, mackerel, or other fish that are high in EPA and DHA Fish rich in omega-3 fatty acids, such as Not specified More often salmon, trout, and herring ≤5 ounces Fish, type unspecified One per day Fish Not specified 2–3 per week Fish, type unspecified Equivalent to 200– 1–2 per week 500 mg of EPA+DHA Fish, particularly oily fish Not specified Consumption encouraged Fish Not specified Two per week, one of which should be oil fish (≈450 mg/ day of LCPUFA)
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From page 680... ...
Compliance Policy Guide All fish 1. Staphylococcus aureus -- positive for Compliance Program staphylococcal enterotoxin, or 7303.842 2.
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From page 681... ...
. Compliance Policy Guide All fish Heptachlor and heptachlor epoxide -- 0.3 Sec 575.100 ppm (edible portion)
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From page 682... ...
Compliance Policy Guide, and Compliance Program 7303.842 Clams, mussels and Neurotoxic shellfish poison -- 0.8 ppm National Shellfish oysters, fresh, frozen (20 mouse units/100 grams) brevetoxin-2 Sanitation Program or canned equivalent.
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Key Terms
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