Association of fish and long-chain omega-3 fatty acids intakes with total and cause-specific mortality: prospective analysis of 421 309 individuals

J Intern Med. 2018 Oct;284(4):399-417. doi: 10.1111/joim.12786. Epub 2018 Jul 17.


Background: Prevailing dietary guidelines recommend regular fish consumption. However, the associations of fish and long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFAs) intakes with mortality remain unclear.

Objectives: To examine the associations of fish and LCn-3 PUFAs intakes with total and cause-specific mortality.

Methods: A total of 240 729 men and 180 580 women from NIH-AARP Diet and Health Study were prospectively followed-up for 16 years. Dietary intakes were assessed using a validated NIH Diet History Questionnaire.

Results: A total of 54 230 men and 30 882 women died during 6.07 million person-years of follow-up. Higher fish and LCn-3 PUFAs intakes were significantly associated with lower total mortality (P < 0.0001). Comparing the highest with lowest quintiles of fish intake, men had 9% (95% confidence interval, 6-11%) lower total mortality, 10% (6-15%) lower cardiovascular disease (CVD) mortality, 6% (1-10%) lower cancer mortality, 20% (11-28%) lower respiratory disease mortality and 37% (17-53%) lower chronic liver disease mortality, while women had 8% (5-12%) lower total mortality, 10% (3-17%) lower CVD mortality and 38% (20-52%) lower Alzheimer's disease mortality. Fried fish consumption was not related to mortality in men whereas positively associated with mortality from all causes (P = 0.011), CVD and respiratory disease in women. LCn-3 PUFAs intake was associated with 15% and 18% lower CVD mortality in men and women across extreme quintiles, respectively.

Conclusion: Consumption of fish and LCn-3 PUFAs was robustly associated with lower mortality from major causes. Our findings support current guidelines for fish consumption while advice on non-frying preparation methods is needed.

Keywords: AARP diet and health study; cardiovascular disease; long-chain omega-3 fatty acids; marine fish; mortality.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / mortality
  • Alzheimer Disease / prevention & control
  • Animals
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control
  • Cause of Death*
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / prevention & control
  • Feeding Behavior*
  • Female
  • Fishes*
  • Guideline Adherence
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Neoplasms / mortality
  • Neoplasms / prevention & control
  • PUVA Therapy / methods*
  • Prospective Studies
  • Respiratory Tract Diseases / mortality
  • Respiratory Tract Diseases / prevention & control
  • United States