The Prospective Association Between Total and Type of Fish Intake and Type 2 Diabetes in 8 European Countries: EPIC-InterAct Study

Design: This was a case-cohort study, nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, with 3.99 million person-years of follow-up, 12,403 incident diabetes cases, and a random subcohort of 16,835 individuals from 8 European countries. Habitual fish intake (lean fish, fatty fish, total fish, shellfish, and combined fish and shellfish) was assessed by country-specific dietary questionnaires. HRs were estimated in each country by using Prentice-weighted Cox regression models and pooled by using a random-effects meta-analysis.

Results: No overall association was found between combined fish and shellfish intake and incident T2D per quartile (adjusted HR: 1.00; 95% CI: 0.94, 1.06; P-trend = 0.99). Total fish, lean fish, and shellfish intakes separately were also not associated with T2D, but fatty fish intake was weakly inversely associated with T2D: adjusted HR per quartile 0.97 (0.94, 1.00), with an HR of 0.84 (0.70, 1.01), 0.85 (0.76, 0.95), and 0.87 (0.78, 0.97) for a comparison of the second, third, and fourth quartiles with the lowest quartile of intake, respectively (P-trend = 0.06).

Conclusions: These findings suggest that lean fish, total fish, and shellfish intakes are not associated with incident diabetes but that fatty fish intake may be weakly inversely associated. Replication of these findings in other populations and investigation of the mechanisms underlying these associations are warranted. Meanwhile, current public health recommendations on fish intake should remain unchanged.

Citing Articles

Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions.

Martemucci G, Khalil M, Di Luca A, Abdallah H, DAlessandro A Metabolites. 2024; 14(6).

PMID: 38921462 PMC: 11206163. DOI: 10.3390/metabo14060327.

Intake of different types of seafood and meat and risk of type 2 diabetes in women: a prospective study supported by a dietary intervention in mice.

Myrmel L, Oyen J, Brantsaeter A, Fjaere E, Haugvaldstad K, Birkeland K Sci Rep. 2024; 14(1):8950.

PMID: 38637574 PMC: 11026463. DOI: 10.1038/s41598-024-59491-9.

Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies.

Neuenschwander M, Stadelmaier J, Eble J, Grummich K, Szczerba E, Kiesswetter E BMC Med. 2023; 21(1):404.

PMID: 37968628 PMC: 10652524. DOI: 10.1186/s12916-023-03093-1.

The Effects of Omega 3 and Omega 6 Fatty Acids on Glucose Metabolism: An Updated Review.

Egalini F, Guardamagna O, Gaggero G, Varaldo E, Giannone B, Beccuti G Nutrients. 2023; 15(12).

PMID: 37375575 PMC: 10301273. DOI: 10.3390/nu15122672.

Types of diet, obesity, and incident type 2 diabetes: Findings from the UK Biobank prospective cohort study.

Boonpor J, Petermann-Rocha F, Parra-Soto S, Pell J, Gray S, Celis-Morales C Diabetes Obes Metab. 2022; 24(7):1351-1359.

PMID: 35373896 PMC: 9325356. DOI: 10.1111/dom.14711.

References

Djousse L, Biggs M, Lemaitre R, King I, Song X, Ix J . Plasma omega-3 fatty acids and incident diabetes in older adults. Am J Clin Nutr. 2011; 94(2):527-33. PMC: 3142727. DOI: 10.3945/ajcn.111.013334. View

Margetts B, Pietinen P . European Prospective Investigation into Cancer and Nutrition: validity studies on dietary assessment methods. Int J Epidemiol. 1997; 26 Suppl 1:S1-5. DOI: 10.1093/ije/26.suppl_1.s1. View

Welch A, Lund E, Amiano P, Dorronsoro M, Brustad M, Kumle M . Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2003; 5(6B):1273-85. DOI: 10.1079/PHN2002404. View

Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M . Standardization of the 24-hour diet recall calibration method used in the european prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr. 2000; 54(12):900-17. DOI: 10.1038/sj.ejcn.1601107. View

. Correcting for multivariate measurement error by regression calibration in meta-analyses of epidemiological studies. Stat Med. 2009; 28(7):1067-92. PMC: 2930206. DOI: 10.1002/sim.3530. View

Kaushik M, Mozaffarian D, Spiegelman D, Manson J, Willett W, Hu F . Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus. Am J Clin Nutr. 2009; 90(3):613-20. PMC: 2728645. DOI: 10.3945/ajcn.2008.27424. View

Vang A, Singh P, Lee J, Haddad E, Brinegar C . Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab. 2008; 52(2):96-104. DOI: 10.1159/000121365. View

Riboli E, Hunt K, Slimani N, Ferrari P, Norat T, Fahey M . European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr. 2003; 5(6B):1113-24. DOI: 10.1079/PHN2002394. View

Everett C, Frithsen I, Player M . Relationship of polychlorinated biphenyls with type 2 diabetes and hypertension. J Environ Monit. 2010; 13(2):241-51. DOI: 10.1039/c0em00400f. View

10.

Rohrmann S, Linseisen J, Becker N, Norat T, Sinha R, Skeie G . Cooking of meat and fish in Europe--results from the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr. 2002; 56(12):1216-30. DOI: 10.1038/sj.ejcn.1601494. View

11.

Mitri J, Muraru M, Pittas A . Vitamin D and type 2 diabetes: a systematic review. Eur J Clin Nutr. 2011; 65(9):1005-15. PMC: 4066381. DOI: 10.1038/ejcn.2011.118. View

12.

Montonen J, Jarvinen R, Heliovaara M, Reunanen A, Aromaa A, Knekt P . Food consumption and the incidence of type II diabetes mellitus. Eur J Clin Nutr. 2005; 59(3):441-8. DOI: 10.1038/sj.ejcn.1602094. View

13.

Slimani N, Deharveng G, Unwin I, Southgate D, Vignat J, Skeie G . The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr. 2007; 61(9):1037-56. DOI: 10.1038/sj.ejcn.1602679. View

14.

Villegas R, Xiang Y, Elasy T, Li H, Yang G, Cai H . Fish, shellfish, and long-chain n-3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women. Am J Clin Nutr. 2011; 94(2):543-51. PMC: 3142729. DOI: 10.3945/ajcn.111.013193. View

15.

Langenberg C, Sharp S, Forouhi N, Franks P, Schulze M, Kerrison N . Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia. 2011; 54(9):2272-82. PMC: 4222062. DOI: 10.1007/s00125-011-2182-9. View

16.

Patel P, Sharp S, Luben R, Khaw K, Bingham S, Wareham N . Association between type of dietary fish and seafood intake and the risk of incident type 2 diabetes: the European prospective investigation of cancer (EPIC)-Norfolk cohort study. Diabetes Care. 2009; 32(10):1857-63. PMC: 2752921. DOI: 10.2337/dc09-0116. View

17.

Riboli E, Kaaks R . The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997; 26 Suppl 1:S6-14. DOI: 10.1093/ije/26.suppl_1.s6. View

18.

Wareham N, Jakes R, Rennie K, Schuit J, Mitchell J, Hennings S . Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2003; 6(4):407-13. DOI: 10.1079/PHN2002439. View

19.

Djousse L, Gaziano J, Buring J, Lee I . Dietary omega-3 fatty acids and fish consumption and risk of type 2 diabetes. Am J Clin Nutr. 2010; 93(1):143-50. PMC: 3001602. DOI: 10.3945/ajcn.110.005603. View

20.

Chen Y, Huang C, Tsai K, Yang R, Yen C, Yang C . Methylmercury induces pancreatic beta-cell apoptosis and dysfunction. Chem Res Toxicol. 2006; 19(8):1080-5. DOI: 10.1021/tx0600705. View