Fish consumption is associated with a decreased risk of death among adults with diabetes: 18-year follow-up of a national cohort

Background: There is a paucity of studies examining the beneficial effects of fish consumption on cardiovascular diseases (CVDs) among adults with diabetes, who experience a substantially high risk of CVDs. Methods and results: We analyzed the data of 1136 adults with diabetes mellitus aged 18 years and older who participated in the National Health and Nutrition Examination Survey, 1988–1994, and were followed up through December 31, 2010. We used Cox regression to estimate the adjusted hazard ratios (HRs) for the relative risk across the levels of fish consumption. A total of 698 deaths were recorded at the end of 11,465 person-years follow-up with a mortality rate of 60.88 per 1000 person-years. CVDs were listed as a contributing cause for 326 deaths, thus accounting for 46.4% of total deaths. Stroke-specific mortality rate among patients who ate fish less than once a week was more than twice as high as that among patients who ate fish more than twice a week, 6.23 vs. 2.36 per 1000 person-years, respectively. The corresponding CVD-specific rate was 34.38 vs. 22.99 per 1000 person-years, respectively. The adjusted HRs of death due to stroke were 1.00 (reference), 0.55 (95% confidence interval = 0.28–1.07), and 0.30 (0.11–0.80) among patients who ate fish <1, 1–2, and 2 + times a week, and the corresponding HRs of death due to CVDs were 1.00 (reference), 0.78 (0.60–1.02), and 0.69 (0.50–0.96), respectively. Conclusions: A high consumption of fish was associated with a low risk of death due to CVDs, especially stroke, among adults with diabetes.