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 Academic Article uri icon

abstract

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

authors

  • Martinez-Gonzalez, Miguel
  • Sala‐Vila, Aleix
  • Guasch‐Ferré, Marta
  • Hu, Frank B
  • Sánchez‐Tainta, Ana
  • Bulló, Mònica
  • Serra‐Mir, Mercè
  • López‐Sabater, Carmen
  • Sorlí, Jose V
  • Arós, Fernando
  • Fiol, Miquel
  • Muñoz, Miguel A
  • Serra‐Majem, Luis
  • Martínez, J Alfredo
  • Corella, Dolores
  • Fitó, Montserrat
  • Salas‐Salvadó, Jordi
  • Martínez‐González, Miguel A
  • Estruch, Ramón
  • Ros, Emilio
  • Pérez‐Heras, A
  • Viñas, C
  • Casas, R
  • de Santamaría, L
  • Romero, S
  • Sacanella, E
  • Chiva, G
  • Valderas, P
  • Arranz, S
  • Baena, JM
  • García, M
  • Oller, M
  • Amat, J
  • Duaso, I
  • García, Y
  • Iglesias, C
  • Simón, C
  • Quinzavos, Ll
  • Parra, Ll
  • Liroz, M
  • Benavent, J
  • Clos, J
  • Pla, I
  • Amorós, M
  • Bonet, MT
  • Martin, MT
  • Sánchez, MS
  • Altirriba, J
  • Manzano, E
  • Altés, A
  • Cofán, M
  • Valls‐Pedret, C
  • Doménech, M
  • Gilabert, R
  • Bargalló, N
  • González, R
  • Molina, C
  • Márquez, F
  • Babio, N
  • Sorli, M
  • García Roselló, J
  • Diaz‐López A, A
  • Martin, F
  • Tort, R
  • Isach, A
  • Costa, B
  • Cabré, JJ
  • Fernández‐Ballart, J
  • Ibarrola‐Jurado, N
  • Alegret, C
  • Martínez, P
  • Millán, S
  • Piñol, JL
  • Basora, T
  • Hernández, JM
  • Toledo, E
  • Buil‐Cosiales, P
  • Ruiz‐Canela, M
  • Sanjulián, B
  • Díez‐Espino, J
  • Extremera‐Urabayen, V
  • García‐Arellano, A
  • Zazpe, I
  • Basterra‐Gortari, FJ
  • Goñi, E
  • Razquin, C
  • Serrano‐Martínez, M
  • Bes‐Rastrollo, M
  • Gea, A
  • Martínez‐Lapiscina, EH
  • Nuñez‐Córdoba, JM
  • Arroyo‐Azpa, C
  • García‐Pérez, L
  • Villanueva‐Tellería, J
  • Cortés‐Ugalde, F
  • Sagredo‐Arce, T
  • García de la Noceda‐Montoy, Mª D
  • Vigata‐López, Mª D
  • Arceiz‐Campo, Mª T
  • Urtasun‐Samper, A
  • Gueto‐Rubio, Mª V
  • Churio‐Beraza, B
  • Lamuela‐Raventós, Rosa M
  • Castellote‐Bargallo, AI
  • Medina‐Remón, A
  • Tresserra‐Rimbau, A
  • Carrasco, P
  • Ortega‐ Azorín, C
  • Asensio, EM
  • Osma, R
  • Barragán, R
  • Francés, F
  • Guillén, M
  • González, JI
  • Saiz, C
  • Portolés, O
  • Giménez, FJ
  • Coltell, O
  • Guillem‐Saiz, P
  • Quiles, L
  • Pascual, V
  • Riera, C
  • Pages, MA
  • Godoy, D
  • Carratalá‐Calvo, A
  • Martín‐Rillo, MJ
  • Llopis‐Osorio, E
  • Ruiz‐ Baixauli, J
  • Bertolín‐Muñoz, A
  • Salaverría, I
  • del Hierro, T
  • Algorta, J
  • Francisco, S
  • Alonso, A
  • San Vicente, J
  • Sanz, E
  • Felipe, I
  • Alonso Gómez, A
  • Loma‐Osorio, A
  • García‐Valdueza, M
  • Moñino, M
  • Proenza, A
  • Prieto, R
  • Frontera, G
  • Ginard, M
  • Fiol, F
  • Jover, A
  • García, J
  • Covas, MI
  • Tello, S
  • Vila, J
  • Schröder, H
  • De la Torre, R
  • Muñoz‐Aguayo, D
  • Elosúa, R
  • Marrugat, J
  • Ferrer, M
  • Álvarez‐Pérez, J
  • DíazBenítez, E
  • Bautista‐Castaño, I
  • Maldonado‐Díaz, I
  • Sánchez‐Villegas, A
  • Castro, I
  • Henríquez, P
  • Ruano, C
  • Ortiz, AP
  • Sarmiendo de la Fe, F
  • Simón‐García, C
  • Falcón‐Sanabria, I
  • Macías‐Gutiérrez, B
  • Santana‐Santana, AJ
  • Gomez‐Gracia, E
  • Fernández‐Crehuet, J
  • Benítez Pont, R
  • Bianchi Alba, M
  • Wärnberg, J
  • Gómez‐Huelgas, R
  • Martínez‐González, J
  • Velasco García, V
  • de Diego Salas, J
  • Baca Osorio, A
  • Gil Zarzosa, J
  • Sánchez Luque, JJ
  • Vargas López, E
  • Ruiz‐Gutierrez, V
  • Jurado Ruiz, E
  • Montero Romero, E
  • García García, M
  • Lapetra, J
  • Leal, M
  • Martínez, E
  • Santos, JM
  • Ortega‐Calvo, M
  • Román, P
  • José García, F
  • Iglesias, P
  • Corchado, Y
  • Mayoral, E
  • Lama, C
  • Pintó, X
  • de la Cruz, E
  • Galera, A
  • Soler, Y
  • Trias, F
  • Sarasa, I
  • Padres, E
  • Figueras, R
  • Solanich, X
  • Pujol, R
  • Corbella, E
  • Cabezas, C
  • Vinyoles, E
  • Rovira, MA
  • García, L
  • Flores, G
  • Verdú, JM
  • Baby, P
  • Ramos, A
  • Mengual, L
  • Roura, P
  • Yuste, MC
  • Guarner, A
  • Rovira, A
  • Santamaría, MI
  • Mata, M
  • de Juan, C
  • Brau, A
  • Marti, A
  • Mitjavila, MT
  • Portillo, MP
  • Sáez, G
  • Tur, J

publication date

  • January 13, 2016

has subject area