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

Aleix Sala‐Vila, Marta Guasch‐Ferré, Frank B. Hu, Ana Sánchez‐Tainta, Mònica Bulló, Mercè Serra‐Mir, Carmen López‐Sabater, Jose V. Sorlí, Fernando Arós, Miquel Fiol, Miguel A. Muñoz, Luis Serra‐Majem (+219 others)
2016 Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease  
for the PREDIMED Investigators Background--Epidemiological evidence suggests a cardioprotective role of a-linolenic acid (ALA), a plant-derived x-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine x-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
more » ... ipids 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 PREvenci on con DIeta MEDiterr anea (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. ( J Am Heart Assoc. Values are n (%), except for age, weight, body mass index, and physical activity, expressed as means (95% CI). CHD indicates coronary heart disease; MET-min, minutes at a given metabolic equivalent level (units of energy expenditure in physical activity, 1 MET-min is roughly equivalent to 1 kcal). *Data from n=6997 participants (2979 men and 4018 women). † Data from n=6983 participants (2968 men and 4015 women). Use of insulin, n (%) 79 (4.9) 295 (5.3) 265 (4.9) 109 (6.2) ‡ Values are n (%), except for age, weight, body mass index, and physical activity, expressed as means (95% CI). ALA indicates a-linolenic acid; CHD, coronary heart disease; ISSFAL, International Society for the Study of Fatty Acids and Lipids; LCn-3PUFA, long-chain n-3 (x-3) polyunsaturated fatty acids; MET-min, minutes at a given metabolic equivalent level (units of energy expenditure in physical activity, 1 MET-min is roughly equivalent to 1 kcal). *0.7% energy, as a healthy ALA intake. † A minimum intake of 500 mg/day of combined eicosapentaenoic and docosahexaenoic acids, for primary cardiovascular protection. ‡ P<0.005 compared with participants meeting the recommendation (obtained by the chi-square test or ANOVA, as appropriate). § P<0.005 compared with participants meeting the ALA recommendation (obtained by the chi-square test or ANOVA, as appropriate). || Data from n=6997 participants (2979 men and 4018 women). ¶ Data from n=6983 participants (2968 men and 4015 women). || Determined by 12 questions on food consumption frequency and 2 questions on food intake habits characteristic of the Mediterranean diet (each question scored 0 or 1). Values are n (%) or means (95% CI). ALA indicates a-linolenic acid; ISSFAL, International Society for the Study of Fatty Acids and Lipids; LCn-3PUFA, long-chain n-3 (x-3) polyunsaturated fatty acids. *0.7% of total energy intake. † A minimum intake of 500 mg/day of combined eicosapentaenoic acid and docosahexaenoic acid, for primary cardiovascular protection. ‡ P<0.005 compared with participants meeting the recommendation (obtained by the chi-square test or ANOVA, as appropriate). § P<0.005 compared with participants meeting the ALA recommendation (obtained by the chi-square test or ANOVA, as appropriate). || Otherwise stated, values in g/day. ¶ Sum of uncanned fatty fish; lean fish; smoked/salted fish; molluscs; shrimp, prawn, and crayfish; octopus, baby squid, and squid; fatty fish canned in oil; and fatty fish canned in salted water. # Determined by 12 questions on food consumption frequency and 2 questions on food intake habits characteristic of the Mediterranean diet (each question scored 0 or 1).
doi:10.1161/jaha.115.002543 pmid:26813890 pmcid:PMC4859371 fatcat:yjxnd2wff5fxxdpgfljwyhkjje