 |
 |

CLINICIAN'S CORNER
Fish Intake, Contaminants, and Human Health
Evaluating the Risks and the Benefits
Dariush Mozaffarian, MD, DrPH;
Eric B. Rimm, ScD
JAMA. 2006;296:1885-1899.
Context Fish (finfish or shellfish) may have health benefits and also contain contaminants, resulting in confusion over the role of fish consumption in a healthy diet.
Evidence Acquisition We searched MEDLINE, governmental reports, and meta-analyses, supplemented by hand reviews of references and direct investigator contacts, to identify reports published through April 2006 evaluating (1) intake of fish or fish oil and cardiovascular risk, (2) effects of methylmercury and fish oil on early neurodevelopment, (3) risks of methylmercury for cardiovascular and neurologic outcomes in adults, and (4) health risks of dioxins and polychlorinated biphenyls in fish. We concentrated on studies evaluating risk in humans, focusing on evidence, when available, from randomized trials and large prospective studies. When possible, meta-analyses were performed to characterize benefits and risks most precisely.
Evidence Synthesis Modest consumption of fish (eg, 1-2 servings/wk), especially species higher in the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), reduces risk of coronary death by 36% (95% confidence interval, 20%-50%; P<.001) and total mortality by 17% (95% confidence interval, 0%-32%; P = .046) and may favorably affect other clinical outcomes. Intake of 250 mg/d of EPA and DHA appears sufficient for primary prevention. DHA appears beneficial for, and low-level methylmercury may adversely affect, early neurodevelopment. Women of childbearing age and nursing mothers should consume 2 seafood servings/wk, limiting intake of selected species. Health effects of low-level methylmercury in adults are not clearly established; methylmercury may modestly decrease the cardiovascular benefits of fish intake. A variety of seafood should be consumed; individuals with very high consumption ( 5 servings/wk) should limit intake of species highest in mercury levels. Levels of dioxins and polychlorinated biphenyls in fish are low, and potential carcinogenic and other effects are outweighed by potential benefits of fish intake and should have little impact on choices or consumption of seafood (women of childbearing age should consult regional advisories for locally caught freshwater fish).
Conclusions For major health outcomes among adults, based on both the strength of the evidence and the potential magnitudes of effect, the benefits of fish intake exceed the potential risks. For women of childbearing age, benefits of modest fish intake, excepting a few selected species, also outweigh risks.
Author Affiliations: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; and Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Mass.
RELATED LETTERS
Risks and Benefits of Fish Intake
Michel Lucas and William S. Harris
JAMA. 2007;297(6):585.
EXTRACT
| FULL TEXT
Risks and Benefits of Fish Intake
Tomi-Pekka Tuomainen, Sari Voutilainen, Staffan Skerfving, and Jukka T. Salonen
JAMA. 2007;297(6):585-586.
EXTRACT
| FULL TEXT
Risks and Benefits of Fish IntakeReply
Dariush Mozaffarian and Eric Rimm
JAMA. 2007;297(6):586.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Eating Fish: Health Benefits and Risks
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2006;296(15):1926.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Dietary Fish and {omega}-3 Fatty Acid Consumption and Heart Rate Variability in US Adults
Mozaffarian et al.
Circulation 2008;117:1130-1137.
ABSTRACT
| FULL TEXT
Hypertriglyceridemia.
Oh et al.
NEJM 2008;358:310-310.
FULL TEXT
Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis
Jenkins et al.
CMAJ 2008;178:157-164.
ABSTRACT
| FULL TEXT
The Molecular Basis for Inhibition of BphD, a C-C Bond Hydrolase Involved in Polychlorinated Biphenyls Degradation: LARGE 3-SUBSTITUENTS PREVENT TAUTOMERIZATION
Bhowmik et al.
J. Biol. Chem. 2007;282:36377-36385.
ABSTRACT
| FULL TEXT
Comparison of the effects of fish and fish-oil capsules on the n 3 fatty acid content of blood cells and plasma phospholipids
Harris et al.
Am. J. Clin. Nutr. 2007;86:1621-1625.
ABSTRACT
| FULL TEXT
Role of Docosahexaenoic Acid in Modulating Methylmercury-Induced Neurotoxicity
Kaur et al.
Toxicol Sci 2007;100:423-432.
ABSTRACT
| FULL TEXT
Fish Oil and Prevention of Atrial Fibrillation
Mozaffarian
J Am Coll Cardiol 2007;50:1513-1514.
FULL TEXT
Clinicians' Corner: A Lifestyle Medicine: Approach to Anxiety and Depression in Primary Care
Greenstone
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:167-170.
ABSTRACT
Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors
Hill et al.
Am. J. Clin. Nutr. 2007;85:1267-1274.
ABSTRACT
| FULL TEXT
Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure
Gerard and Gerard
JAMA 2007;297:1057-1058.
FULL TEXT
A Commentary on Lifestyle Medicine Strategies for Risk Factor Reduction, Prevention, and Treatment of Coronary Artery Disease
Greenstone
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:91-94.
ABSTRACT
Risks and Benefits of Fish Intake
Lucas and Harris
JAMA 2007;297:585-585.
FULL TEXT
Risks and Benefits of Fish Intake
Tuomainen et al.
JAMA 2007;297:585-586.
FULL TEXT
Recommending Omega-3 Oils for Patients With Heart Risks
DOC News 2007;4:4-4.
FULL TEXT
Fish Intake: Benefits vs. Risks
Journal Watch Cardiology 2006;2006:2-2.
FULL TEXT
|