AUTHOR=Huang Nian , Wang Fang , Li Shiyang , Zhai Xiaobing , Ma Wenzhi , Liu Keyang , Sheerah Haytham A. , Cao Jinhong , Eshak Ehab S. 

TITLE=Associations of eicosapentaenoic acid and docosahexaenoic acid intakes with cardiovascular and all-cause mortality in patients with diabetes: Result from National Health and Nutrition Examination Survey 1999–2008

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1031168

DOI=10.3389/fcvm.2022.1031168

ISSN=2297-055X

ABSTRACT=Objective: The evidence on eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake status and long-term mortality among people with diabetes is scarce. This study aimed to investigate the relationship of EPA and DHA intake with all-cause and cause-specific mortality in adults with diabetes.
Methods: This study included 2,991 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2008. Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality from all causes, cardiovascular disease (CVD), and coronary heart disease (CHD) in patients with diabetes.
Results: Among 2,991 diabetic patients, the mean age was 61.9 years (55.2% males). During the mean follow-up duration of 9.4 years, a total of 1,091 deaths were documented, of which 273 were due to CVD, including 227 CHD deaths. EPA and DHA intakes were associated with lower mortality risks, especially that of CVD. After adjusting for demographic, major lifestyle factors, overall dietary intake patterns, and history of hypertension and dyslipidemia, the multivariable HRs (95% CIs) of mortality risk comparing Q4 to Q1 of EPA intake were 0.55 (0.33-0.92; P-trend=0.019) for CHD, 0.55 (0.36-0.83; P-trend=0.005) for CVD, and 0.91 (0.70-1.18; P-trend=0.264) for all-cause. The respective HRs (95% CIs) comparing Q4 to Q1 of DHA were 0.60 (0.37-0.98; P-trend=0.051) for CHD, 0.58 (0.38-0.89; P-trend=0.014) for CVD, and 0.92 (0.72-1.18; P-trend=0.481) for all-cause. In subgroup analysis, we found that the association trends of EPA and DHA intakes with death risk remained robust among diabetic patients with older, females, higher BMI and history of dyslipidemia participants with CVD and CHD. 
Conclusions: Higher EPA and DHA intakes were associated with the lower risk of CHD and CVD mortality in USA patients with diabetes. Our study supports the benefits of adequate EPA and DHA intakes in promoting the health of patients with diabetes.