Food and health

Fish consumption and risk of stroke, coronary heart disease, and cardiovascular mortality in a Dutch population with low fish intake



Fish consumption of at least 1 portion/week is related to lower cardiovascular disease (CVD) risk. It is uncertain whether a less frequent intake is also beneficial and whether the type of fish matters. We investigated associations of very low intakes of total, fatty, and lean fish, compared with no fish intake, with 18-year incidences of stroke, coronary heart disease (CHD), and CVD mortality.


Data were used from 34,033 participants, aged 20–70 years, of the EPIC-Netherlands cohort. Baseline (1993–1997) fish consumption was estimated using a food frequency questionnaire. We compared any fish consumption, <1 portion/week (<100 g) and ≥1 portion/week to non-fish consumption.


During 18 follow-up years, 753 stroke events, 2134 CHD events, and 540 CVD deaths occurred. Among the fish consumers (~92%) median intakes of total, lean, and fatty fish were 57.9, 32.9, and 10.7 g/week, respectively. Any fish consumption compared with non-consumption was not associated with incidences of stroke, CHD, MI, and CVD mortality. Furthermore, consumption of <1 portion/week of total, fatty, or lean fish was not associated with any CVD outcome, as compared with non-consumption. Consumption of ≥1 portion/week of lean fish (HR: 0.70, 95% CI: 0.57–0.86) and of fatty fish (HR: 0.63, 95% CI: 0.39–1.02) were associated with lower incidence of ischaemic stroke.


Baseline fish consumption of <1 portion/week, regardless of the type of fish, was unrelated to incidences of stroke, CHD, and CVD mortality in this Dutch cohort. Consumption of ≥1 portion/week of fatty or of lean fish reduced the incidence of ischaemic stroke.

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The EPIC-NL study was funded by the “Europe against Cancer” Programme of the European Commission (SANCO), the Dutch Ministry of Public Health, Welfare and Sports (VWS), the Dutch Cancer Society, the Netherlands Organisation for Health Research and Development (ZonMW), and the World Cancer Research Fund (WCRF). We thank Statistics Netherlands for follow-up data on causes of death and CVD.

Author contributions

LMH, JP, YTvdS, and IS contributed to the design of the study. LMH and JP were responsible for the statistical analyses and drafted the manuscript. All authors were involved in the interpretation of the data, critically revised the manuscript, and gave final approval.

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Correspondence to I. Sluijs.

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Conflict of interest

JP is financially supported by a restricted grant from Unilever R&D, Vlaardingen, the Netherlands. IS and YTvdS report grants from Unilever R&D, Vlaardingen, the Netherlands, outside the submitted work. The remaining authors declare that they have no conflict of interest.

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Hengeveld, L.M., Praagman, J., Beulens, J.W.J. et al. Fish consumption and risk of stroke, coronary heart disease, and cardiovascular mortality in a Dutch population with low fish intake. Eur J Clin Nutr 72, 942–950 (2018).

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