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Fish consumption and myocardial infarction: a second prospective biomarker study from northern Sweden
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Arcum)ORCID iD: 0000-0003-2475-7131
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2011 (English)In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 93, no 1, 27-36 p.Article in journal (Refereed) Published
Abstract [en]

Background: A beneficial role of fish consumption on the risk of myocardial infarction (MI) has been reported, mostly ascribed to n-3 fatty acids. However, fish also contains methylmercury, which may increase the risk of MI.

Objective: Describe how fish consumption and erythrocyte concentrations of mercury (Ery-Hg) and selenium (Ery-Se) are related to the risk of MI, and whether n-3 fatty acids (eicosapentaenoic and docosahexaenoic acid) in plasma phospholipids (P-EPA+DHA) are protective.

Design: This is a case-control study nested within the northern Sweden cohort with prospectively collected data and samples. It comprises 431 cases with an MI after data and sample collection, including 81 sudden cardiac deaths (SCD), and 499 matched controls. Another 69 female cases with controls from a breast cancer screening registry were included in sex-specific analyses.

Results: Odds ratio (OR) for the third tertile versus the first were for Ery-Hg: 0.65 (95% CI: 0.46, 0.91); Ery-Se: 0.75 (95% CI: 0.53, 1.06) and P-EPA+DHA: 0.78 (95% CI: 0.54, 1.11). No association was seen for reported fish consumption. Multivariate modelling did not change these associations significantly. Sex-specific analyses revealed no differences in risk associations for Ery-Hg, but a tendency to a higher protective association with P-EPA+DHA for women. High levels of Ery-Se were associated with increased risk of SCD.

Conclusions: Ery-Hg, a stable biomarker for fish consumption, is associated with a decreased risk of MI. The result indicates a protective effect of fish consumption against MI, even though data on self-reported fish consumption do not reveal any clear protective association.

Place, publisher, year, edition, pages
American Society for Nutrition , 2011. Vol. 93, no 1, 27-36 p.
Keyword [en]
fish consumption, methylmercury, omega-3 fatty acids, selenium, myocardial infarction
National Category
Environmental Health and Occupational Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-33777DOI: 10.3945/ajcn.2010.29408PubMedID: 21048056OAI: oai:DiVA.org:umu-33777DiVA: diva2:318042
Available from: 2010-05-06 Created: 2010-05-06 Last updated: 2017-02-27Bibliographically approved
In thesis
1. Biomarkers of fish consumption and risk of stroke or myocardial infarction
Open this publication in new window or tab >>Biomarkers of fish consumption and risk of stroke or myocardial infarction
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The effect of fish consumption on the risk of cardiovascular disease has been extensively studied. Omega-3 fatty acids present in fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to have beneficial effects through several mechanisms. In addition, selenium, an antioxidant, may be protective. Fish also represents the main human exposure source to the pollutant methylmercury (MeHg), which is associated with elevated cardiovascular risk in previous studies. The aim of this thesis was to evaluate whether MeHg is associated with the risk of myocardial infarction (MI) or stroke, whether EPA+DHA or selenium (Se) have protective associations, and if the overall association between fish consumption and risk of stroke or MI is detrimental or protective.

A prospective incident case-control study design was used to study effects on stroke or MI. Three hundred and sixty-nine cases with twice as many matched controls were included in the study on stroke, while 431 cases with 499 controls participated in the MI study, all from the Northern Sweden Health and Disease Study. The data was collected from health examinations of the population from 1986 until 1999. Also, time trends in burdens of mercury (Hg), lead (Pb) and cadmium (Cd) in erythrocytes (Ery) from 1990 to 1999 were examined. The food frequency questionnaire (FFQ) used in the case-control studies was correlated with measurements of fatty acids in erythrocyte membranes as biomarkers of intake.

In this northern Swedish population, levels of Ery-Hg and Ery-Pb decreased during the 1990´s, but Ery-Cd decreased only in smoking men. No significant associations were found between Ery-Hg or levels of EPA+DHA and the risk of stroke. Men reporting fish consumption >3 meals/week had an elevated risk of stroke. In the MI study, higher levels of Ery-Hg were associated with lower risk of MI. No clear associations were found for reported fish consumption, levels of EPA+DHA or Ery-Se. The validated FFQ has a fair reliability in estimating intake of fatty acids EPA and DHA. However, the low variation in fish consumption in the general population in combination with different versions of the FFQ (with pre-defined, multiple choice alternatives) decreased the reliability of self-reported fish consumption in the case-control studies on risk of stroke or MI.

In conclusion, MeHg has no harmful association regarding the risk of stroke or MI in this population with generally low exposure levels. The protective association regarding risk of MI is probably due to Ery-Hg being a biomarker for consumption of fish, a source of other beneficial nutrients. Thus, in this population the benefits of the nutrients in fish appear to overcome the potential harm of MeHg.

The finding of elevated stroke risk related to high fish consumption in men will be investigated further.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 46 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1356
Keyword
fish consumption, omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, methylmercury, selenium, lead, cadmium, stroke, myocardial infarction, erythrocytes, food frequency questionnaire
National Category
Environmental Health and Occupational Health
Research subject
Epidemiology; hälso- och sjukvårdsforskning; Medicine; biology, Environmental Science; Nutrition
Identifiers
urn:nbn:se:umu:diva-33906 (URN)978-91-7459-008-1 (ISBN)
Public defence
2010-06-04, FORUM-salen, Campus Skeria, Skellefteå, 13:00 (Swedish)
Opponent
Supervisors
Projects
PHIME; Public health impact of long-term, low-level mixed element exposure in susceptible population strata
Available from: 2010-05-21 Created: 2010-05-10 Last updated: 2010-05-21Bibliographically approved

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Wennberg, MariaBergdahl, Ingvar AHallmans, GöranNorberg, MargaretaJansson, Jan-Håkan

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