BMJ 2002;325:932-933 ( 26 October )

Papers

Fish, meat, and risk of dementia: cohort study

Pascale Barberger-Gateau, senior lecturer, Luc Letenneur, researcher, Valérie Deschamps, research fellow, Karine Pérès, research fellow, Jean-François Dartigues, professor, Serge Renaud, researcher. 

INSERM U330, Université Victor Segalen Bordeaux 2, case n°11, 146 rue Léo-Saignat, 33076 Bordeaux Cedex, France

Correspondence to: P Barberger-Gateau Pascale.Barberger-Gateau{at}isped.u-bordeaux2.fr

The role of dietary fat in dementia arouses increasing interest.¹ Fatty acids could be involved through several mechanisms, including atherosclerosis, thrombosis, and inflammation.² We evaluated whether there is a relation between consumption of fish (rich in polyunsaturated fatty acids) or meat (rich in saturated fatty acids) and risk of dementia.

	Participants, methods, and results

Top Participants, methods, and... Comment References

We obtained data from the PAQUID (Personnes Agées QUID) epidemiological study of cognitive and functional ageing (www.healthandage.net/html/min/paquid/entrance.htm). During the third wave of the study (1991-2) investigators visited 1674 people aged 68 and over without dementia and living at home in 75 parishes in southwestern France and recorded their frequency of consumption of meat and fish or seafood: daily, at least once a week (but not every day), from time to time (but not every week), never. Participants were followed up two, five, and seven years afterwards: 1416 (84.6 %) had at least one follow up visit. All the participants who had lost three points or more on the mini-mental state examination since a previous visit or were suspected of having dementia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) were visited by a neurologist to confirm the diagnosis.

We calculated the incidence of dementia per 100 person years. We used a Cox proportional hazards model with delayed entry to estimate the relative risk of dementia, taking into account age, sex, and education (at least the French primary school diploma "Certificat d'Etudes Primaires" versus less education³).

During the seven years of follow up 170 new cases of dementia occurred, including 135 cases of Alzheimer's disease. The table shows a significant trend between increasing consumption of fish or seafood and decreasing incidence of dementia (P for trend=0.0091). Frequency of fish or seafood consumption was higher in the participants with higher education (879/1051 (83.6%) v 262/365 (71.8%) consuming fish at least weekly; P<0.0001). Participants who ate fish or seafood at least once a week had a significantly lower risk of being diagnosed as having dementia in the seven subsequent years (age and sex adjusted hazard ratio 0.66, 95% confidence interval 0.47 to 0.93). When we added education into the model the hazard ratio was almost unchanged (0.73) but the 95% confidence interval (0.52 to 1.03) slightly overlapped 1.00, indicating that the "protective" effect of weekly fish or seafood consumption was partly explained by higher education of regular consumers. Participants who ate fish or seafood at least once a week had a hazard ratio, adjusted for age and sex, of 0.69 for developing Alzheimer's disease in the seven following years, with borderline significance (95% confidence interval 0.47 to 1.01). We found no significant association between meat consumption and risk of dementiaP for trend=0.59; age and sex adjusted hazard ratio for weekly consumers 0.56 (0.26 to 1.20).

View this table: [in this window] [in a new window]   Incidence of dementia according to fish and meat consumption in elderly people in southwestern France

	Comment

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Elderly people who eat fish or seafood at least once a week are at lower risk of developing dementia, including Alzheimer's disease. The Rotterdam study found similar results but had a much shorter follow up (mean 2.1 years).⁴ Given that the first consequences of dementia on everyday living can appear three years before diagnosis,⁵ poor dietary habits could be a consequence rather than a cause of cognitive decline in the Rotterdam participants.

In addition to providing vascular protection, the n-3 fatty acids contained in fish oils could reduce inflammation in the brain and may have a specific role in brain development and regeneration of nerve cells.² Healthy dietary habits acquired in infancy could be associated with achievement of higher education. Highly educated people might also adhere more closely to dietary recommendations on fish consumption.

	Acknowledgments

Contributors: PBG is co-manager of the PAQUID project and developed the concept of the study, contributed to the study design, statistical analyses, and interpretation of data, and wrote the paper. LL contributed to statistical analyses, interpretation of data, and revising the paper critically. VD contributed to the conception, data analysis, and critical review of the paper. KP contributed to data analysis and critical review of the paper. JFD is the other co-manager of the PAQUID project and contributed to the study design, interpretation of the data, and critical review of the paper. SR contributed to the conception, interpretation of the data, and critical review of the paper. All authors approved the final version. PBG is the guarantor.

	Footnotes

Funding: Association pour la Recherche Médicale en Aquitaine (Bordeaux), Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Conseil Général de la Dordogne, Conseil Général de la Gironde, Conseil Régional d'Aquitaine, Fondation de France, France Alzheimer (Paris), Institut National de la Santé et de la Recherche Médicale, Mutuelle Générale de l'Education Nationale, Mutualité Sociale Agricole, Novartis Pharma (France), SCOR Insurance (France).

Competing interests: None declared.

	References

Top Participants, methods, and... Comment References

1.	Grant WB. Dietary links to Alzheimer's disease: 1999 update. J Alzheimer Dis 1999; 1: 197-201.
2.	Kalmijn S. Fatty acid intake and the risk of dementia and cognitive decline: a review of clinical and epidemiological studies. J Nutr Health Aging 2000; 4: 202-207[Medline].
3.	Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo JM, Dartigues JF. Are sex and educational level independent predictors of dementia and Alzheimer's disease? Incidence data from the PAQUID project. J Neurol Neurosurg Psychiatry 1999; 66: 177-183[Abstract/Free Full Text].
4.	Kalmijn S, Launer LJ, Ott A, Witteman JCM, Hofman A, Breteler MMB. Dietary fat intake and the risk of incident dementia in the Rotterdam study. Ann Neurol 1997; 42: 776-782[CrossRef][Web of Science][Medline].
5.	Barberger-Gateau P, Fabrigoule C, Helmer C, Rouch I, Dartigues JF. Functional impairment in instrumental activities of daily living: an early clinical sign of dementia? J Am Geriatr Soc 1999; 47: 456-462[Medline].

(Accepted 7 May 2002)

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Rapid Responses:

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Dietary links to dementia

William B. Grant
bmj.com, 26 Oct 2002 [Full text]

Is it the wine or the fish - or both?

Erik Skovenborg
bmj.com, 29 Oct 2002 [Full text]

The PAQUID study does not show a negative association between n-3 fatty acids and dementia

Roger A Harrison
bmj.com, 29 Oct 2002 [Full text]

Re: Is it the wine or the fish - or both?

Pascale BARBERGER-GATEAU
bmj.com, 29 Oct 2002 [Full text]

Fish and dementia

Alison N Jeffery, et al.
bmj.com, 30 Oct 2002 [Full text]

Shaky ground for fish

Pierre Philippe
bmj.com, 1 Nov 2002 [Full text]

What exactly were the hazard ratios?

Adam Jacobs
bmj.com, 1 Nov 2002 [Full text]

Re: What exactly were the hazard ratios?

Pascale Barberger-Gateau
bmj.com, 4 Nov 2002 [Full text]

Fish and Seafood should be part of our regular meals.

Abdul Karim Al-Sheikhli
bmj.com, 5 Nov 2002 [Full text]

FISH OIL, HOMOCYSTEINE and DEMENTIA

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