Seafood omega-3 intake and risk of coronary heart disease death: an updated meta-analysis with implications for attributable burden

Autor: Rebecca E. Engell, Dariush Mozaffarian, Ella Sanman, Stephen S Lim
Rok vydání: 2013
Předmět:
Zdroj: The Lancet. 381:S45
ISSN: 0140-6736
DOI: 10.1016/s0140-6736(13)61299-4
Popis: Background Uncertainty exists in understanding the relation between omega-3 polyunsaturated fatty acids and major cardiovascular outcomes. An updated meta-analysis on the relation between intake of seafood omega-3 fatty acids and the risk of coronary heart disease (CHD) death was undertaken as part of the Global Burden of Disease (GBD) 2010 Study. Methods We conducted an update of an earlier meta-analysis by Mozaffarian and Rimm. Medline and PubMed were searched for articles published between April, 2006, and August, 2012. Randomised clinical trials (RCTs) and observational studies evaluating the effect of omega-3 on CHD death were included. The relative risk per 100 mg/day eicosapentaenoic acid and docosahexaenoic acid (EPA+DHA) was estimated using restricted cubic splines; the estimates were weighted by the inverse variance. The relative risks were used with other data from the GBD 2010 Study to estimate the burden attributable to a diet low in seafood omega-3s. Findings Of the 1085 citations retrieved, 22 studies, including those from previous analyses, with 5 772 809 person-years and 5822 CHD deaths, were included. While the effect of seafood omega-3s was lower in RCTs than in observational studies, this difference was not statistically significant (p=0·057). The effect size based on all studies was 0·89 (95% CI 0·86–0·92) per 100 mg/day EPA+DHA. When the analysis was restricted to RCTs, the effect was 0·95 (95% CI 0·87–1·05) per 100 mg/day EPA+DHA. The global attributable burden of a diet low in seafood was 1·1% of global disability-adjusted life-years (DALYs; 95% CI 0·8–1·5), with 22% of ischaemic heart disease DALYs attributable to low seafood intake. The global burden was reduced by more than half when using the relative risk from RCTs (0·5%, 95% CI −0·5 to 1·4). Interpretation This research makes the connection between relative risks and their health impact at the population level. Our all-study results are comparable to those of Rizos and colleagues, who found a 0·91 (95% CI 0·85–0·98; p=0·01) per 100 mg EPA+DHA reduction in risk of CHD death. Mozaffarian and Rimm report larger results of 0·85 (95% CI 0·79–0·92) per 100 mg EPA+DHA. Our results differ when restricted to RCTs, thereby necessitating a degree of caution when interpreting burden estimates. The differences between previous studies and our all-study and RCT-restricted results illustrate the importance of further research to understand the value of seafood intake. Funding Bill & Melinda Gates Foundation.
Databáze: OpenAIRE
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