title: Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study.
abstract: BACKGROUND
  Epidemiological evidence suggests a cardioprotective role of α-linolenic acid (ALA), a plant-derived ω-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω-3 fatty acids (long-chain n-3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all-cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long-chain n-3 polyunsaturated fatty acids (≥500 mg/day).
  
  
  RESULTS
  We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable-adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9-y follow-up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all-cause mortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long-chain n-3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67-1.05) for all-cause mortality, 0.61 (95% CI 0.39-0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29-0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22-1.01) for sudden cardiac death. The highest reduction in all-cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45-0.87]).
  
  
  CONCLUSIONS
  In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all-cause mortality, whereas protection from cardiac mortality is limited to fish-derived long-chain n-3 polyunsaturated fatty acids.
  
  
  BACKGROUND
  URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639.
authors.affiliation: Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain (A.S.V.) Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).
authors.forename: Aleix
authors.initials: A
authors.lastname: Sala-Vila
authors.affiliation: Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).
authors.forename: Marta
authors.initials: M
authors.lastname: Guasch-Ferré
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (F.B.H.).
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain (A.T., M.A.M.G.).
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez-Tainta
authors.affiliation: Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).
authors.forename: Mònica
authors.initials: M
authors.lastname: Bulló
authors.affiliation: Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).
authors.forename: Mercè
authors.initials: M
authors.lastname: Serra-Mir
authors.affiliation: Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Spain (C.S.).
authors.forename: Carmen
authors.initials: C
authors.lastname: López-Sabater
authors.affiliation: Department of Preventive Medicine, University of Valencia, Spain (J.V.S., D.C.).
authors.forename: Jose V
authors.initials: JV
authors.lastname: Sorlí
authors.affiliation: Department of Cardiology, University Hospital of Alava, Vitoria, Spain (F.A.).
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: Institute of Health Sciences, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain (M.F.).
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain (M.A.M., M.F.).
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muñoz
authors.affiliation: Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain (L.S.M.).
authors.forename: Luis
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain (A.M.).
authors.forename: J Alfredo
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: Department of Preventive Medicine, University of Valencia, Spain (J.V.S., D.C.).
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain (M.A.M., M.F.).
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.affiliation: Human Nutrition Unit, Biochemistry Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, and Hospital Universitari de Sant Joan de Reus, IISPV, Reus, Spain (M.G.F., B., J.S.S.).
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain (A.T., M.A.M.G.).
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
authors.affiliation: Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (R.E.).
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain (A.S.V., M.S.M., E.R.).
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.lastname: B
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D004032:Diet; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D031324:Juglans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009753:Nutritive Value; D009754:Nuts; D000069463:Olive Oil; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017747:Seafood; D013030:Spain; D013997:Time Factors; D017962:alpha-Linolenic Acid / Q000008:administration & dosage*
chemical_list: D015525:Fatty Acids, Omega-3; D000069463:Olive Oil; D017962:alpha-Linolenic Acid
keywords: fatty acid; nutrition; sudden cardiac death
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