title: The prospective association between total and type of fish intake and type 2 diabetes in 8 European countries: EPIC-InterAct Study.
abstract: BACKGROUND
  Epidemiologic evidence of an association between fish intake and type 2 diabetes (T2D) is inconsistent and unresolved.
  
  
  OBJECTIVE
  The objective was to examine the association between total and type of fish intake and T2D in 8 European countries.
  
  
  METHODS
  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.
authors.affiliation: MRC Epidemiology Unit, Cambridge, UK.
authors.forename: Pinal S
authors.initials: PS
authors.lastname: Patel
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.forename: Anneleen
authors.initials: A
authors.lastname: Kuijsten
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.forename: Geertruida J
authors.initials: GJ
authors.lastname: van Woudenbergh
authors.forename: Eva
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authors.lastname: Ardanaz
authors.forename: Pilar
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authors.lastname: Amiano
authors.forename: Larraitz
authors.initials: L
authors.lastname: Arriola
authors.forename: Beverley
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authors.lastname: Balkau
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.forename: Heiner
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authors.lastname: Boeing
authors.forename: Brian
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authors.forename: Francesca L
authors.initials: FL
authors.lastname: Crowe
authors.forename: Blandine
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authors.lastname: de Lauzon-Guillan
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authors.lastname: Fagherazzi
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.forename: Jytte
authors.initials: J
authors.lastname: Halkjaer
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Peter
authors.initials: P
authors.lastname: Nilsson
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schmidt
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Birgit
authors.initials: B
authors.lastname: Teucher
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Tormo
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Claudia
authors.initials: C
authors.lastname: Langenberg
authors.forename: Edith J M
authors.initials: EJ
authors.lastname: Feskens
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D000328:Adult; D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005060:Europe; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005399:Fishes; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017747:Seafood
chemical_list: D004041:Dietary Fats; D015525:Fatty Acids, Omega-3