Fish consumption and risk of subclinical brain abnormalities on MRI in older adults

Virtanen, Jyrki K.; Siscovick, David S.; Longstreth, W. T.; Kuller, Lewis H.; Mozaffarian, Dariush

doi:10.1212/01.wnl.0000324414.12665.b0

Cited by 87 publications

(67 citation statements)

References 43 publications

(55 reference statements)

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“…lar Health Study, which found that the consumption of fish at least 3 times a week based on dietary questionnaires was associated with a lower risk of subclinical vascular brain abnormalities. 24 Fatty acids are integral components of biological membranes, and influence membrane fluidity, ion transport, and other functions. 25 The neuronal cell membrane is no exception; the CNS has the highest concentration of phospholipids in the body.…”

Section: Discussionmentioning

confidence: 99%

Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

et al. 2012

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Objective: Higher dietary intake and circulating levels of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been related to a reduced risk for dementia, but the pathways underlying this association remain unclear. We examined the cross-sectional relation of red blood cell (RBC) fatty acid levels to subclinical imaging and cognitive markers of dementia risk in a middleaged to elderly community-based cohort. Methods:We related RBC DHA and EPA levels in dementia-free Framingham Study participants (n ϭ 1,575; 854 women, age 67 Ϯ 9 years) to performance on cognitive tests and to volumetric brain MRI, with serial adjustments for age, sex, and education (model A, primary model), additionally for APOE ⑀4 and plasma homocysteine (model B), and also for physical activity and body mass index (model C), or for traditional vascular risk factors (model D). Results:Participants with RBC DHA levels in the lowest quartile (Q1) when compared to others (Q2-4) had lower total brain and greater white matter hyperintensity volumes (for model A: ␤ Ϯ SE ϭ Ϫ0.49 Ϯ 0.19; p ϭ 0.009, and 0.12 Ϯ 0.06; p ϭ 0.049, respectively) with persistence of the association with total brain volume in multivariable analyses. Participants with lower DHA and -3 index (RBC DHAϩEPA) levels (Q1 vs Q2-4) also had lower scores on tests of visual memory (␤ Ϯ SE ϭ Ϫ0.47 Ϯ 0.18; p ϭ 0.008), executive function (␤ Ϯ SE ϭ Ϫ0.07 Ϯ 0.03; p ϭ 0.004), and abstract thinking (␤ Ϯ SE ϭ Ϫ0.52 Ϯ 0.18; p ϭ 0.004) in model A, the results remaining significant in all models. Conclusion:Lower RBC DHA levels are associated with smaller brain volumes and a "vascular" pattern of cognitive impairment even in persons free of clinical dementia. Neurology ® 2012;78:658-664 GLOSSARY AD ϭ Alzheimer disease; BMI ϭ body mass index; DHA ϭ docosahexaenoic acid; DM ϭ diabetes mellitus; EPA ϭ eicosapentaenoic acid; LM-d ϭ delayed recall components of the Logical Memory test; NP ϭ neuropsychological; PAI ϭ physical activity index; PUFA ϭ polyunsaturated fatty acid; RBC ϭ red blood cell; SBP ϭ systolic blood pressure; SCI ϭ silent cerebral infarct; SIM ϭ Similarities test; TCBV ϭ total cerebral brain volume; THV ϭ temporal horn volume; VR-d ϭ delayed recall component of the Visual Reproductions test; WMHV ϭ white matter hyperintensity volume.Higher fish intake has been associated with a reduced risk of cardiovascular mortality 1,2 and stroke.3 While several large epidemiologic studies 4,5 have shown an association between the estimated intake of fatty fish and a lower risk for dementia, some other investigations have failed to confirm such a protective association. 6 One possible reason for these inconsistent results is the limited ability of dietary recall surveys and food frequency questionnaires to quantify blood levels of fatty acids. 7,8 In the Framingham original cohort, participants in the top quartile of plasma phosphatidylcholine docosahexaenoic acid (DHA) levels had 37% and 47% lower risks of Alzheimer disease (AD) and all-cause dementia, respectively.9 Red blood ...

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Section: Discussionmentioning

confidence: 99%

Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

et al. 2012

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“…e1 The Cardiovascular Health Study (n 5 2,465, 59% women, average age 75 years) reported less likelihood of subclinical infarcts, defined as ischemic lesions $3 mm in diameter, for participants who ate fatty, nonfried fish more frequently. 26 In a previous study with 192 men and women (average age 78 years), the mean decrease in total brain volume was 20.45% and 20.98% per year in subjects without and with dementia, respectively, over an average of 2 years follow-up. 27 Interestingly, they also found that the slope of the cross-sectional relationship between age and brain volumes in subjects without dementia was similar to the longitudinal rate of change.…”

mentioning

confidence: 84%

Higher RBC EPA + DHA corresponds with larger total brain and hippocampal volumes

et al. 2014

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Objective: To test whether red blood cell (RBC) levels of marine omega-3 fatty acids measured in the Women's Health Initiative Memory Study were related to MRI brain volumes measured 8 years later.Methods: RBC eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and MRI brain volumes were assessed in 1,111 postmenopausal women from the Women's Health Initiative Memory Study. The endpoints were total brain volume and anatomical regions. Linear mixed models included multiple imputations of fatty acids and were adjusted for hormone therapy, time since randomization, demographics, intracranial volume, and cardiovascular disease risk factors. Results:In fully adjusted models, a 1 SD greater RBC EPA 1 DHA (omega-3 index) level was correlated with 2.1 cm 3 larger brain volume (p 5 0.048). DHA was marginally correlated (p 5 0.063) with total brain volume while EPA was less so (p 5 0.11). There were no correlations between ischemic lesion volumes and EPA, DHA, or EPA 1 DHA. A 1 SD greater omega-3 index was correlated with greater hippocampal volume (50 mm 3 , p 5 0.036) in fully adjusted models. Comparing the fourth quartile vs the first quartile of the omega-3 index confirmed greater hippocampal volume (159 mm 3 , p 5 0.034). Aging is associated with increased risk of dementia and cognitive impairment, with exponentially increasing prevalence expected in the next several decades. 1 Based on data from the Framingham study, a middle-aged woman in North America of European descent has approximately 20% risk of developing dementia of some type in her lifetime, which usually involves Alzheimer disease (AD). Conclusion:2 Reduced brain volume is an important part of the pathology of AD, and hippocampal atrophy is frequently observed before symptomatic impairment. Omega-3 fatty acids (FAs) from marine sources could have an important role in maintaining brain structure and function with advancing age. Approximately 30% to 40% of FAs in gray matter of the cortex are docosahexaenoic acid (DHA), 4 and this FA is particularly concentrated in synaptic membranes. 5 However, in white matter, DHA constitutes only 4% of total FAs. 6Patients with AD have been reported to have decreased serum, brain, and neuronal DHA and/or eicosapentaenoic acid (EPA) compared with controls without dementia. 7-11 DHA levels within plasma phosphatidylcholine, in the highest quartile, were associated with a 40% to 50%

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“…It also seems to have beneficial effects in reducing myocardial infarction, but the effects on stroke is less clear [83,84]. Among older adults, modest consumption of fish (not fried fish) was associated with lower prevalence of subclinical infarcts and white matter abnormalities on magnetic resonance images [85]. These data support the benefit of lifestyle modification.…”

Section: Dietary Habitsmentioning

confidence: 90%

Treatment of Risk Factors to Prevent Stroke

Aoki

Uchino

2011

Neurotherapeutics

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Much of the decline in stroke incidence and mortality for the past several decades in Western countries has been attributed to better treatment of risk factors. Many epidemiological studies and clinical trials confirmed the importance of managing hypertension. Comparative trials of anti-hypertensive drugs or drug classes have not yielded clear results, but blood pressure variability may play an important role beyond the absolute value of blood pressure. Diabetes therapy remains a conundrum. Although diabetes is clearly a risk factor for ischemic stroke, treatment trials targeting different glycemic goals have not indicated that glucose lowering results in stroke prevention. Trials focused on insulin resistance are ongoing and they may be able to help establish the management of diabetes/impaired glucose tolerance. Evidence for treatment of dyslipidemia has contrasted science to diabetes mellitus. Dyslipidemia has not been strongly or consistently linked to ischemic stroke but the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed the impact of statin treatment in stroke prevention. The results of clinical trials investigating dabigatran and rivaroxaban clearly indicate alternative strategies to vitamin K antagonists in stroke prevention for persons with atrial fibrillation. Evidence for stroke prevention by life style modification, treating metabolic syndrome, sleep disordered breathing, lipoprotein (a), hyperhomocysteinemia, and coagulation disorders are also discussed.

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Fish consumption and risk of subclinical brain abnormalities on MRI in older adults

Cited by 87 publications

References 43 publications

Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

Higher RBC EPA + DHA corresponds with larger total brain and hippocampal volumes

Treatment of Risk Factors to Prevent Stroke

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