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Benefits of fatty fish on dementia risk are stronger for those without APOE 4

From the Jean Mayer USDA Human Nutrition Research Center on Aging (Drs. Huang and Tucker), Tufts University, Boston, MA; Department of Mental Health (Drs. Zandi and Carlson), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology (Dr. Fitzpatrick), University of Washington, Seattle, WA; University of Pittsburgh (Dr. Kuller), Pittsburgh, PA; Department of Medicine (Dr. Fried), Johns Hopkins University, Baltimore; Department of Public Health Sciences, (Dr. Burke), Wake Forest University School of Medicine, Winston-Salem, NC.

Address correspondence and reprints requests to Tina L. Huang, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Dietary Assessment & Epidemiology Research Program, 9th Floor, 711 Washington Street, Boston, MA 02111; e-mail: tina.huang{at}tufts.edu

Objective: To compare associations of lean fish vs fatty fish (tuna or other fish) intake with dementia, Alzheimer disease (AD), and vascular dementia (VaD) and in relation to APOE 4 status in the Cardiovascular Health Cognition Study (CHCS).

Methods: Fish intake was assessed by food frequency questionnaires. Incident dementia, AD, and VaD were determined through a series of cognitive tests, physician's assessment, and committee consensus. We used Cox proportional hazards regression to calculate hazard ratios of dementia, AD, and VaD with lean fried fish, fatty fish, or total fish intake, which were then stratified by the presence of APOE 4.

Results: Although consumption of lean fried fish had no protective effect, consumption of fatty fish more than twice per week was associated with a reduction in risk of dementia by 28% (95% CI: 0.51 to 1.02), and AD by 41% (95% CI: 0.36 to 0.95) in comparison to those who ate fish less than once per month. Stratification by APOE 4 showed this effect to be selective to those without the 4 allele. Adjustment by education and income attenuated the effect.

Conclusion: In the Cardiovascular Health Cognition Study, consumption of fatty fish was associated with a reduced risk of dementia and Alzheimer disease for those without the APOE 4 allele.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.com and scroll down the Table of Contents for the November 8 issue to find the title link for this article.

For a full list of participating CHS investigators and institutions, see "About CHS: Principal Investigators and Study Sites" at http://www.chs-nhlbi.org.

T.L.H. was supported by NIH grant T32-MH14592 and NIH/NIDDK grant T32 DK75610, a grant from the Charles A. King Trust, Bank of America, Co-Trustee (Boston, MA), and by the USDA Agricultural Research Service under contract no. 53-3K06-5-10. The research reported in this article was supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01 HC-15103 from the National Heart, Lung, and Blood Institute, and grant AG15928 from the National Institute on Aging.

Disclosure: The authors report no conflicts of interest.

Received March 28, 2005. Accepted in final form July 19, 2005.

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