1. “Healthy aspects of white fish” FAO-WHO Report on the risks and benefits of fish consumption
Edel O. Elvevoll
Professor, Food Science and Technology
The Norwegian College of Fishery Science
Faculty of Biosciences, Fisheries and Economics (BFE)
UiT The Arctic University of Norway

2. Change in diet over the last decades
Highly caloric
Rich in refined sugar and saturated fat
Low in dietary fiber, proteins, marine lipids, vitamins and minerals
Physical activity – absent
Increase in life style related diseases
Nutrition in health maintenance
Fish consumption and CVD risk reduction
Meat consumption and adverse health
effect

3. FAO/WHO expert consultation on the risks and benefits of fish consumption (2010)
Review data on nutrient and specific chemical (MeHg and DLCs) contaminant levels in a range of fish species
Review recent scientific literature covering the risks and benefits of fish consumption
Consider risk-benefit assessments for specific end-points of benefits and risks

4. Getting information on health effects of food
Observational (Epidemiological) studies
Segment of population observed
Fish as part of an overall complex diet
Fish intake associated with diseases
Indication of correlation
Confounding factors
In vitro (test tube) studies
Highest level of evidence
Firm control of diet, study length, type of subjects, etc.
Expensive
Impossible to conduct on some diseases
Extrapolation to humans is limited
Can exert tight control over experimental conditions
Insights into designing human studies
Hardest to extrapolate to humans
Important in early phases
Can give directions
Human intervention studies, Clinical trials
Animal Studies

5. Fish consumption has a significantly beneficial effect on prevention of CHD mortality (2004)
Meta-analysis, observational, individuals
Inverse association between fish consumption and CHD mortality rates
Fish meal once a week, reduced risk of CHD death by 15 %
May be further reduced with additional consumption
7% decrease with per additional serving per week
13 different studies
He, K., et al., Circulation, 2004

6. Fish consumption and CHD mortality (2012)
Seventeen cohorts
participants
Average follow-up period of 15.9 years.
Compared to no or 1-3 servings (à 105g)/month the pooled relative risk (RR) of fish intake on CHD mortality showed a reduction of
16% for low fish intake (1 serving/week)
21% for moderate fish intake (2–4 servings/week)
17% for high fish intake (5 servings/week)
15 g/d increment of fish intake decreased the risk of CHD mortality by 6%
Zheng et al (2012) Pub Health Nutr., 15 (04)

7. Relative Risk of Cardiac Death Total risk reduction = 36%
1.2
1.0
0.8
0.6
0.4
0.2
EPA+DHA Intake (mg/d)
Total risk reduction = 36%
(95% CI= 20 to 50%; p<0.001)
250 mg/day
(~ 2 g/week)
Mozaffarian & Rimm. JAMA 2006

8. Dioxins dioxine like PCB
Polychlorinated dibenzo-p-dioxins
Polychlorinated dibenzofurans
Industrial by product
Metal industry
Paper industry
Diffuse emissions
Leaded gasoline
Chemical industry
Polychlorinated biphenyls
Produced commercially since 1929
Used in:
Plastic industry
Softeneres
Paint
Banned in 1980
Still exist in some products

9. Health effects of chronic consumption
Carcinogenic
Reproduction disturbances
Impaired immune system
Neurotoxic effect
2,3,7,8 TCDD – the most toxic
TEQ – toxic equivalent

10. Classification of the content of EPA + DHA by dioxin content in 76 fin fish and shellfish species

11. Estimated changes in mortality per million people from consuming fish with different dioxin and EPA plus DHA contents at one, two, four and seven 100 g servings per week
Mean population body weight 60 kg. The numbers in the upper row in each cell (red) are estimates of lives lost from dioxin exposure, prepared using upper-bound estimates of risk. The numbers in the lower row in each cell (green) are the estimates of lives saved due to reduction in coronary heart disease risk from EPA + DHA intake.
Yellow shaded cells represent the estimates where the net effect is negative; lives lost are greater than lives saved.

12. Neurodevelopmental benefits to offspring of women of childbearing age who consume fish
3.5 y
Hibbeln et al, Lancet 2007

13. Mercury Naturally occuring element Non degradable
Large scale industrial poisonings
Minamata, Japan
Iraq
Epidemiological studies
Faroe Islands – language, attention and memory
Seychells islands – no adverse effects
Neurodevelopment
CVD
TWI MeHg: 1.3 µg/kg bw (EFSA 2012)

14. Classification of the content of EPA plus DHA by total mercury content in 96 fin fish and shellfish species

15. Estimated changes in child IQ resulting from the child’s mother having consumed fish with different methylmercury and EPA plus DHA contents at one, two, four and seven servings per week
Fish serving size 100 g. Maternal body weight was assumed to be 60 kg.
Numbers in the upper row in each cell (red) are IQ points lost from methylmercury exposure. Number in the lower row in each cell (green) is the estimate of IQ points gained from DHA.
Yellow shaded cells represent the estimates where the net effect on child IQ is negative.

16. FAO/WHO advice to member states:
An important food source of energy, protein and a range of essential nutrients
Emphasize the benefits of fish consumption on reducing mortality from coronary heart disease (and the risks of mortality from coronary heart disease associated with not eating fish) for the general adult population
Emphasize the net neurodevelopmental benefits to offspring of women of childbearing age who consume fish, particularly pregnant women and nursing mothers, and the neurodevelopmental risks to offspring of women of childbearing age who do not consume fish 16

17. Fish, much more …. Protein Zinc Iron Selenium Iodine Calcium Vitamin D
EPA
Vitamin D
Protein
Vitamin A
Vitamin B12
DHA
Zinc
Iron
Selenium
Iodine
Calcium

18. Lean fish like cod – unique food - Other nutrients
High quality protein
Contains all essential amino acids
Peptides and bioactive components
Taurine
Best source for some vitamins
Vit D and B12
Contribute with Vit A and other B-vitamins
Good source for minerals and micronutrients
Selenium and Iodide
Contributes with other minerals like Zn, Ca, Mg

19. Digestion: Proteins  Peptides  Amino acids
Proteins  enzyme hydrolysis  peptides and amino acids
Enzymes: endopeptidases & exopeptidases
peptides or pieces of proteins
Different peptides are shown to have different effects
Blood pressure attenuation or anti- hypertensive effect
Antioxidative effect
Anti-obesity effects

20. Dietary Protein Sources and Risk of Coronary Heart Disease in Women – displace?
Nurses’ Health Study (26 y)
84 136 women ( y)
Diet assessed every 4 years
Intakes of red meat and high-fat dairy associated with elevated risk of CHD
Intakes of poultry, fish, and nuts associated with lower risk
1 serving per day of fish 24% lower risk of CHD compared to red meat
Bernstein, AM., et al (2010) Circulation 122:

21. Taurine Free sulfonated amino acid Marker of seafood consumption
Intervention studies in animals and humans have suggested
that protective effect may act through several mechanisms
Reduce blood cholesterol
Reduce pro - inflammatory products
Antioxidative properties
Suppress atherosclerosis
Platelet aggregation
Improved cardiac performance

22. Taurine supplementation Human intervention
Levels comparable to a diet high in seafood
Randomized, double-blind, parallel intervention trial
110 healthy individuals
7 weeks, fish pâté
Reduced total cholesterol (- 4 %) and LDL (- 8%)
HDL increased (+ 6%)
More trials needed
-0.40
-0.30
-0.20
-0.10
0.00
0.10
0.20
0.30
Total Cholesterol
HDL-C
Without TAU 1g n-3 PUFA
With TAU 1 g n-3 PUFA and 420 mg taurine
Control
Changes in serum lipids (mmol/l) *
* Significantly different from the control group
LDL-C
Elvevoll et al., Atherosclerosis 2008

23. Animal model (Apoliopoprotein E-deficient mice (apoE-/-))
Determination of plaque burden
Photo: Larsen, R.

24. Dietary intake of cod and scallop reduces atherosclerotic burden in female apolipoprotein E-deficient mice fed a Western-type high fat diet for 13 weeks
Atherosclerotic lesions
Jensen et al. Nutrition & Metabolism (2016) 13:8

25. Mice fed cod-scallop compared to chicken experienced:
reduced atherosclerotic burden
reduced body weight gain
reduced serum leptin concentration
reduced serum glucose concentration
Beneficial effect of marine proteins compared to chicken proteins

26. Consumption of Lean Fish Reduces the Risk of Type 2 Diabetes (T2DM)
N= women
Risk ratios and 95% CI for intake of 75 and 100 g lean fish per day were 0.71 (0.51, 0.98) and 0.67 (0.46, 0.98), respectively.
There was no effect of intake of fatty fish, fish products, total fish or use of cod liver oil supplements on the risk of T2DM.
Rylander et al (2014) PLoS ONE 9(2): e doi: /journal.pone

27. May 2018
We found no protective effect of fatty fish eating or fish oil supplements on atherosclerotic plaque formation or plaque area in a general population.
Lean fish consumption was associated with a reduced risk for plaque in cross-sectional analysis, suggesting that the beneficial effects of fish consumption on atherosclerosis may be mediated through other mechanisms than n-3 PUFAs.

28. Thank you for your attention
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