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Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study.
J Am Heart Assoc 2016; 5(1)JA

Abstract

BACKGROUND

Epidemiological evidence suggests a cardioprotective role of α-linolenic acid (ALA), a plant-derived ω-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω-3 fatty acids (long-chain n-3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all-cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long-chain n-3 polyunsaturated fatty acids (≥500 mg/day).

METHODS AND RESULTS

We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable-adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9-y follow-up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all-cause mortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long-chain n-3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67-1.05) for all-cause mortality, 0.61 (95% CI 0.39-0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29-0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22-1.01) for sudden cardiac death. The highest reduction in all-cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45-0.87]).

CONCLUSIONS

In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all-cause mortality, whereas protection from cardiac mortality is limited to fish-derived long-chain n-3 polyunsaturated fatty acids.

CLINICAL TRIAL REGISTRATION

URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639.

Authors+Show Affiliations

Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain (A.S.V.) Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (F.B.H.).Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain (A.T., M.A.M.G.).Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Spain (C.S.).Department of Preventive Medicine, University of Valencia, Spain (J.V.S., D.C.).Department of Cardiology, University Hospital of Alava, Vitoria, Spain (F.A.).Institute of Health Sciences, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain (M.F.).Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain (M.A.M., M.F.).Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain (L.S.M.).Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain (A.M.).Department of Preventive Medicine, University of Valencia, Spain (J.V.S., D.C.).Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain (M.A.M., M.F.).Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain (A.T., M.A.M.G.).Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (R.E.).Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26813890

Citation

Sala-Vila, Aleix, et al. "Dietary α-Linolenic Acid, Marine Ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención Con DIeta MEDiterránea (PREDIMED) Study." Journal of the American Heart Association, vol. 5, no. 1, 2016.
Sala-Vila A, Guasch-Ferré M, Hu FB, et al. Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study. J Am Heart Assoc. 2016;5(1).
Sala-Vila, A., Guasch-Ferré, M., Hu, F. B., Sánchez-Tainta, A., Bulló, M., Serra-Mir, M., ... B, . (2016). Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study. Journal of the American Heart Association, 5(1), doi:10.1161/JAHA.115.002543.
Sala-Vila A, et al. Dietary α-Linolenic Acid, Marine Ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención Con DIeta MEDiterránea (PREDIMED) Study. J Am Heart Assoc. 2016 Jan 26;5(1) PubMed PMID: 26813890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study. AU - Sala-Vila,Aleix, AU - Guasch-Ferré,Marta, AU - Hu,Frank B, AU - Sánchez-Tainta,Ana, AU - Bulló,Mònica, AU - Serra-Mir,Mercè, AU - López-Sabater,Carmen, AU - Sorlí,Jose V, AU - Arós,Fernando, AU - Fiol,Miquel, AU - Muñoz,Miguel A, AU - Serra-Majem,Luis, AU - Martínez,J Alfredo, AU - Corella,Dolores, AU - Fitó,Montserrat, AU - Salas-Salvadó,Jordi, AU - Martínez-González,Miguel A, AU - Estruch,Ramón, AU - Ros,Emilio, AU - ,, AU - B,, Y1 - 2016/01/26/ PY - 2016/1/28/entrez PY - 2016/1/28/pubmed PY - 2016/10/13/medline KW - fatty acid KW - nutrition KW - sudden cardiac death JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 5 IS - 1 N2 - BACKGROUND: Epidemiological evidence suggests a cardioprotective role of α-linolenic acid (ALA), a plant-derived ω-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω-3 fatty acids (long-chain n-3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all-cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long-chain n-3 polyunsaturated fatty acids (≥500 mg/day). METHODS AND RESULTS: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable-adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9-y follow-up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all-cause mortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long-chain n-3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67-1.05) for all-cause mortality, 0.61 (95% CI 0.39-0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29-0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22-1.01) for sudden cardiac death. The highest reduction in all-cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45-0.87]). CONCLUSIONS: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all-cause mortality, whereas protection from cardiac mortality is limited to fish-derived long-chain n-3 polyunsaturated fatty acids. CLINICAL TRIAL REGISTRATION: URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/26813890/Dietary_α_Linolenic_Acid_Marine_ω_3_Fatty_Acids_and_Mortality_in_a_Population_With_High_Fish_Consumption:_Findings_From_the_PREvención_con_DIeta_MEDiterránea__PREDIMED__Study_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.115.002543?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -