Higher EPA/DHA Intakes Associated with Reduced Cardiovascular Deaths in Chinese Adults

January 8, 2014


The Association between Dietary Omega-3 Fatty Acids and Cardiovascular Death: the Singapore Chinese Health Study
Koh , A. S. et al., European J. Preventive Cardiology, in press, 2013
National Heart Centre Singapore, Singapore


This population-based study recruited 63,257 Chinese adults aged 45-74 years (average age of 56 years) and estimated their omega-3 fatty acid intakes as long-chain DHA/EPA derived from fish/seafood or as short-chain alpha-LNA derived from non-marine sources. Omega-3 intakes were determined from food-frequency questionnaires and food composition tables. Cardiovascular deaths (from coronary heart disease and stroke) were monitored during the 14 years of follow-up. Those in the lowest ‘quartile’ (bottom 25 %)with respect to total omega-3 intakes averaged 590 mg/day (as DHA/EPA/LNA combined) while those in the highest ‘quartile’ averaged 1260 mg/day. DHA/EPA combined gave an average intake of 190 and 460 mg/day for the lowest and highest quartiles, respectively, with the corresponding intakes being 400 and 800 mg/day, respectively, for LNA. During follow-up, 4780 cardiovascular deaths were recorded.

After adjusting for multivariate factors (lifestyles, dietary components), those in the highest quartiles for dietary intakes as total omega-3, DHA/EPA, or LNA had significantly lower rates of cardiovascular mortality (by 17, 14, and 19 %, respectively) as compared to those in the lowest quartile for intakes. When evaluating differing intakes of DHA/EPA and LNA with each other, the lowest overall rate of total cardiovascular mortality was found in those with high intakes of DHA/EPA coupled with high intakes of LNA. This group (high DHA/EPA plus high LNA intakes) exhibited a 33 % lower mortality rate as compared to the group with low intakes of both DHA/EPA and LNA.

Dr. Holub's Comments:

The present population-based study indicates that higher intakes of omega-3 fatty acids (both long-chain from fish/seafood plus short- chain mainly from non-marine plant food sources) offer protection against cardiovascular death among individuals without cardiovascular disease at entry. Similar benefits were apparent in those with or without diabetes or hypertension. Based on this particular study alone, the maximal benefit would appear to be generated with DHA/EPA intakes approaching 450-500 mg/day plus intakes of LNA approaching 800 mg/day. Currently in North America, the vast majority of the adult population have surpassed the latter intake of LNA. However, the vast majority fall well short in terms of DHA/EPA intakes with a per capita average being only 125-150 mg/day.

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