Fish Consumption is Associated with a Decreased Risk of Death among Adults with Diabetes, a 15-Year Follow-Up of a National Cohort

Background: Consumption of fish, especially fatty fish with high level of polyunsaturated fatty acids (PUFA), may protect against cardiovascular disease (CVD), but no studies have been conducted to assess this hypothesis among diabetic adults, who experience a substantial risk of CVD. To fill this gap, we describe the CVD - specific mortality of adults with diabetes and assess their relationship with fish consumption. Methodology: We analyzed the data of 1,135 adults aged 19 and older with diabetes who participated in the National Health and Nutrition Examination Survey (1988-1994) as the baseline examination and were followed up through December 31, 2010. With age, sex, race, family income, education attainment, alcohol drinking, cigarette smoking, and health status at baseline included, we used Cox proportional hazards regression to estimate the adjusted hazard ratios (HRs) for the relative risk and compared the risk between participants with different level of fish consumption. Results: A total of 701 deaths were recorded by the end of a 15-year follow-up with a mortality rate of 61.11 per 1000 person year. CVD and stroke were listed as contributing causes for 328, 52 deaths, accounting for 46.4% and 7.4% of the total deaths respectively. Stroke-specific mortality rate among patients who never or rarely ate fish was more than twice as high as that among patients who ate fish more than twice a week, 6.22 vs. 2.38 per 1000 person year.The corresponding CVD-specific mortality rates were 34.54 vs. 22.19 per 1000 person year respectively. After adjusting for covariates, the HRs of dying from stroke were 1.00 (reference), 0.41 (95% confidence interval = 0.20 - 0.87) and 0.28 (0.10 - 0.76) among patients who rare/never, 1-2 times, and more than twice a week. The HRs of dying from CVD were 0.81 (0.61 - 1.08) and 0.67 (0.47 - 0.96), respectively. Further adjustment for dietary supplements of fish oil did not change the estimates, and no significant gender difference was observed. Conclusions: High fish consumption may reduce the risk of dying from CVD, especially, stroke, among diabetic adults