Association Between Type of Dietary Fish and Seafood Intake and the Risk of Incident Type 2 Diabetes

The European Prospective Investigation of Cancer (EPIC)-Norfolk cohort study

  1. Pinal S. Patel, MPHIL1,
  2. Stephen J. Sharp, MSC1,
  3. Robert N. Luben, BSC2,
  4. Kay-Tee Khaw, FRCP2,
  5. Sheila A. Bingham, PHD2,
  6. Nicholas J. Wareham, FRCP1 and
  7. Nita G. Forouhi, FFPH1
  1. 1MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, U.K.;
  2. 2Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K.
  1. Corresponding author: Nita G. Forouhi, nf250{at}


OBJECTIVE To investigate the association between fish and seafood intake and new-onset type 2 diabetes.

RESEARCH DESIGN AND METHODS This was a population-based prospective cohort (European Prospective Investigation of Cancer [EPIC]-Norfolk) study of men and women aged 40–79 years at baseline (1993–1997). Habitual fish and seafood intake (white fish, oily fish, fried fish, and shellfish) was assessed using a semiquantitative food frequency questionnaire and categorized as less than one or one or more portions/week. During a median (interquartile range) follow-up of 10.2 (9.1–11.2) years, there were 725 incident diabetes cases among 21,984 eligible participants.

RESULTS Higher total fish intake (one or more versus less than one portions/week) was associated with a significantly lower risk of diabetes (odds ratio [OR] 0.75 [95% CI 0.58–0.96]), in analyses adjusted for age, sex, family history of diabetes, education, smoking, physical activity, dietary factors (total energy intake, alcohol intake, and plasma vitamin C) and obesity (BMI and waist circumference). White fish and oily fish intakes were similarly inversely associated with diabetes risk, but the associations were not significant after adjustment for dietary factors (oily fish) or obesity (white fish). Fried fish was not significantly associated with diabetes risk. Consuming one or more portions/week of shellfish was associated with an increased risk of diabetes (OR 1.36 [1.02–1.81]) in adjusted analyses.

CONCLUSIONS Total, white, and oily fish consumption may be beneficial for reducing risk of diabetes, reinforcing the public health message to consume fish regularly. Greater shellfish intake seems to be associated with an increased risk of diabetes, warranting further investigation into cooking methods and mechanisms.


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    • Received January 21, 2009.
    • Accepted July 5, 2009.
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  1. Diabetes Care vol. 32 no. 10 1857-1863
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