White fish reduces cardiovascular risk factors in patients with metabolic syndrome: the WISH-CARE study, a multicenter randomized clinical trial.
OBJECTIVE
Reduction of cardiovascular risk with high consumption of fish in diet is still a matter of debate, and concerns about heavy metal contamination have limited consumption of oily fish. We aimed to evaluate the effect of regular ingestion of white fish on cardiovascular risk factors in patients with metabolic syndrome.


RESULTS
Multicenter randomized crossover clinical trial including 273 individuals with metabolic syndrome. An 8-week only-one dietary intervention: 100 g/d of white fish (Namibia hake) with advice on a healthy diet, compared with no fish or seafood with advice on a healthy diet. Outcomes were lipid profile, individual components of the metabolic syndrome, serum insulin concentrations, homeostasis model of insulin resistance, serum C-reactive protein and serum fatty acid levels. We found a significant lowering effect of the intervention with white fish on waist circumference (P < 0.001) and diastolic blood pressure (P = 0.014). A significant lowering effect was also shown after the dietary intervention with fish on serum LDL concentrations (P = 0.048), whereas no significant effects were found on serum HDL or triglyceride concentrations. A significant rise (P < 0.001) in serum EPA and DHA fatty acids was observed following white fish consumption. Overall adherence to the intervention was good and no adverse events were found.


CONCLUSIONS
In individuals with metabolic syndrome, regular consumption of hake reduces LDL cholesterol concentrations, waist circumference and blood pressure components of the metabolic syndrome.


BACKGROUND
White Fish for Cardiovascular Risk Factors in Patients with Metabolic Syndrome Study, Registered under ClinicalTrials.gov Identifier: NCT01758601.
Department of Clinical Nutrition and Obesity, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: cvazquezma@gmail.com.
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Vázquez
Department of Clinical Nutrition and Obesity, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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JI
Botella-Carretero
Department of Preventive Medicine, School of Medicine, University of Valencia, Valencia, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Corella
Department of Surgical Cardiology, Hospital Universitario Son Espases, Instituto Universitario de Investigación en Ciencias de la Salud de la Universitat de les Illes Balears, Palma de Mallorca, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Fiol
Division of Endocrinology, Santiago de Compostela University, Santiago de Compostela, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Lage
Hospital General de Valencia, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Lurbe
Department of Medicine, Hospital Universitario "Juan XXIII", Universitat Rovira i Virgili, Tarragona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Richart
Department of Endocrinology, Hospital Josep Trueta, Girona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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JM
Fernández-Real
Unidad de Lípidos y Arteriosclerosis, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Fuentes
Department of Endocrinology, Instituto Social de la Marina, Servicio Sanitario de Asistencia Remota de Ibermutuamur, Madrid, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Ordóñez
Department of Obesity, Hospital Universitario La Paz, Madrid, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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de Cos
Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, Reus, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Salas-Salvadó
Division of Endocrinology, Hospital Son Dureta, Universitat Illes Balears, Palma de Mallorca, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Burguera
Department of Internal Medicine, Hospital Clínic, Barcelona, Spain; Department of Medicine, Universidad de Barcelona, Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Estruch
Unit of Lipids, IDIBAPS Hipertensión, Lípidos y Riesgo Cardiovascular, Hospital Clínic, Barcelona, Spain; Department of Medicine, Universidad de Barcelona, Hospital Clínic, Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Ros
Department of Biochemistry, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Pastor
Division of Endocrinology, Santiago de Compostela University, Santiago de Compostela, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
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Casanueva
D000368:Aged; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004032:Diet; D005227:Fatty Acids / Q000097:blood; D005260:Female; D005399:Fishes; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008460:Meat; D024821:Metabolic Syndrome / Q000097:blood* / Q000178:diet therapy; D008875:Middle Aged; D012307:Risk Factors; D017747:Seafood; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D005227:Fatty Acids; D007328:Insulin; D014280:Triglycerides; D002097:C-Reactive Protein
Blood pressure; Cardiovascular risk; LDL cholesterol; Metabolic syndrome; Waist circumference; White fish