The low death rate from coronary heart disease among the Greenland Eskimos has been ascribed to their high fish consumption. We therefore decided to investigate the relation between fish consumption and coronary heart disease in a group of men in the town of Zutphen, the Netherlands. Information about the fish consumption of 852 middle-aged men without coronary heart disease was collected in 1960 by a careful dietary history obtained from the participants and their wives. During 20 years of follow-up 78 men died from coronary heart disease. An inverse dose-response relation was observed between fish consumption in 1960 and death from coronary heart disease during 20 years of follow-up. This relation persisted after multiple logistic-regression analyses. Mortality from coronary heart disease was more than 50 per cent lower among those who consumed at least 30 g of fish per day than among those who did not eat fish. We conclude that the consumption of as little as one or two fish dishes per week may be of preventive value in relation to coronary heart disease.

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Within the Zutphen Study dietary surveys using the cross-check dietary history method were carried out in 1960, 1965, 1970, and 1985. Of the 872 men aged 40-59 y examined in 1960, 315 participated in all four surveys. In 1985 a small random sample of 51 men aged 40-59 y was also investigated. Between 1960 and 1985 the consumption of bread, potatoes, and edible fats decreased and the consumption of fruits, pastries, nuts, and alcoholic beverages increased in both the aging cohort and in the two independent samples of middle-aged men examined 25 y apart. These changes were accompanied by a substantial decrease in the intake of monounsaturated fat, polysaccharides, and potassium and a substantial increase in animal protein and alcohol. Small changes were observed in the intake of saturated fatty acids, polyunsaturated fatty acids, dietary cholesterol, and dietary fiber. Since 1960 some changes in a nutritionally desirable direction were observed but the diet of the Zutphen men in 1985 departs substantially from the guidelines for a healthy diet formulated by The Netherlands Nutrition Council in 1986.