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Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study

BMJ 2020; 368 doi: (Published 04 March 2020) Cite this as: BMJ 2020;368:m456
  1. Zhi-Hao Li, doctoral student1,
  2. Wen-Fang Zhong, doctoral student1,
  3. Simin Liu, professor2,
  4. Virginia Byers Kraus, professor3,
  5. Yu-Jie Zhang, postdoctoral fellow1,
  6. Xiang Gao, professor4,
  7. Yue-Bin Lv, assistant research fellow5,
  8. Dong Shen, doctoral student1,
  9. Xi-Ru Zhang, doctoral student1,
  10. Pei-Dong Zhang, postdoctoral fellow1,
  11. Qing-Mei Huang, masters student1,
  12. Qing Chen, masters student1,
  13. Xian-Bo Wu, professor1,
  14. Xiao-Ming Shi, research fellow5,
  15. Dong Wang, professor6,
  16. Chen Mao, professor1
  1. 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
  2. 2Departments of Epidemiology, Medicine, and Surgery, and Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
  3. 3Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
  4. 4Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
  5. 5National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
  6. 6School of Health Services Management, Southern Medical University, Guangzhou, Guangdong, China
  1. Correspondence to: C Mao maochen9{at}
  • Accepted 15 January 2020


Objectives To evaluate the associations of habitual fish oil supplementation with cardiovascular disease (CVD) and mortality in a large prospective cohort.

Design Population based, prospective cohort study.

Setting UK Biobank.

Participants A total of 427 678 men and women aged between 40 and 69 who had no CVD or cancer at baseline were enrolled between 2006 and 2010 and followed up to the end of 2018.

Main exposure All participants answered questions on the habitual use of supplements, including fish oil.

Main outcome measures All cause mortality, CVD mortality, and CVD events.

Results At baseline, 133 438 (31.2%) of the 427 678 participants reported habitual use of fish oil supplements. The multivariable adjusted hazard ratios for habitual users of fish oil versus non-users were 0.87 (95% confidence interval 0.83 to 0.90) for all cause mortality, 0.84 (0.78 to 0.91) for CVD mortality, and 0.93 (0.90 to 0.96) for incident CVD events. For CVD events, the association seemed to be stronger among those with prevalent hypertension (P for interaction=0.005).

Conclusions Habitual use of fish oil seems to be associated with a lower risk of all cause and CVD mortality and to provide a marginal benefit against CVD events among the general population.


  • Contributors: Z-HL and W-FZ are joint first authors, contributed to the statistical analyses, and had primary responsibility for writing the manuscript. Z-HL and W-FZ contributed equally to this article. CM, DW, X-MS, and X-BW directed the study. Y-JZ, Y-BL, DS, X-RZ, and QC contributed to the data cleaning. CM, SL, VBK, XG, P-DZ, and Q-MH contributed to the analysis or interpretation of the data. CM ( and DW ( contributed equally to this work and should be considered co-corresponding authors. All authors critically reviewed the manuscript for important intellectual content. CM is the study guarantor. The corresponding author (CM) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This work was supported by the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2019), Construction of High-level University of Guangdong (G619339521 and G618339167), US National Institutes of Health/National Institute on Ageing (P30-AG028716), and National Natural Science Foundation of China (81973109). The funders had no role in the study design or implementation; data collection, management, analysis, or interpretation; manuscript preparation, review, or approval; or the decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: support from the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme, Construction of High-level University of Guangdong, US National Institutes of Health/National Institute on Ageing, and National Natural Science Foundation of China for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The UK Biobank received ethical approval from the research ethics committee (REC reference for UK Biobank 11/NW/0382) and participants provided written informed consent.

  • Data sharing: The UK Biobank data are available from the UK Biobank on request (

  • The lead author (CM) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Dissemination to participants and related patient and public communities: The results of the research will be disseminated to the public through broadcasts, popular science articles, and newspapers.

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