Table 3.
Cause of Death | Quartile of EPA + DHA Intake, g/day |
P for Trend | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Firstb (0–0.082), No. of Deaths | Second (0.083–0.174) |
Third (0.175–0.322) |
Fourth (>0.322) |
||||||||
No. of Deaths | HR | 95% CI | No. of Deaths | HR | 95% CI | No. of Deaths | HR | 95% CI | |||
All causesc | 935 | 785 | 0.95 | 0.86, 1.06 | 667 | 0.87 | 0.78, 0.97 | 650 | 0.82 | 0.73, 0.93 | 0.001 |
No history of CVD or cancer at baseline | 404 | 352 | 0.96 | 0.83, 1.12 | 280 | 0.83 | 0.70, 0.98 | 283 | 0.81 | 0.67, 0.98 | 0.011 |
History of CVD or cancer at baseline | 529 | 433 | 0.92 | 0.80, 1.05 | 383 | 0.84 | 0.72, 0.98 | 362 | 0.81 | 0.69, 0.95 | 0.006 |
CVDd | 228 | 183 | 0.88 | 0.71, 1.08 | 165 | 0.79 | 0.63, 0.99 | 189 | 0.87 | 0.68, 1.10 | 0.158 |
No history at baseline | 129 | 92 | 0.77 | 0.58, 1.02 | 84 | 0.78 | 0.57, 1.05 | 95 | 0.91 | 0.66, 1.27 | 0.799 |
History at baseline | 98 | 91 | 1.01 | 0.74, 1.37 | 80 | 0.81 | 0.58, 1.14 | 93 | 0.82 | 0.57, 1.17 | 0.167 |
Ischemic heart diseasee | 131 | 105 | 0.90 | 0.68, 1.18 | 96 | 0.80 | 0.59, 1.07 | 110 | 0.80 | 0.58, 1.10 | 0.120 |
No history at baseline | 76 | 60 | 0.87 | 0.60, 1.26 | 49 | 0.71 | 0.47, 1.08 | 48 | 0.62 | 0.39, 0.99 | 0.029 |
History at baseline | 54 | 45 | 0.92 | 0.61, 1.40 | 47 | 0.86 | 0.55, 1.35 | 62 | 0.96 | 0.60, 1.52 | 0.812 |
Cancerf | 453 | 390 | 0.94 | 0.82, 1.09 | 332 | 0.82 | 0.70, 0.96 | 304 | 0.77 | 0.64, 0.92 | 0.001 |
No history at baseline | 218 | 202 | 0.98 | 0.80, 1.20 | 162 | 0.81 | 0.65, 1.02 | 166 | 0.79 | 0.62, 1.02 | 0.027 |
History at baseline | 234 | 188 | 0.89 | 0.72, 1.09 | 168 | 0.83 | 0.66, 1.03 | 138 | 0.72 | 0.56, 0.93 | 0.010 |
Lung cancerg | 142 | 97 | 0.81 | 0.62, 1.06 | 82 | 0.72 | 0.53, 0.97 | 90 | 0.77 | 0.56, 1.07 | 0.069 |
No history at baseline | 105 | 76 | 0.84 | 0.62, 1.15 | 63 | 0.69 | 0.49, 0.98 | 79 | 0.89 | 0.62, 1.28 | 0.310 |
History at baseline | 37 | 21 | 0.35 | 0.16, 0.77 | 18 | 0.75 | 0.34, 1.65 | 11 | 0.12 | 0.04, 0.40 | 0.176 |
Hematopoietic cancerh | 48 | 52 | 1.11 | 0.72, 1.72 | 29 | 0.79 | 0.48, 1.32 | 35 | 0.84 | 0.49, 1.45 | 0.396 |
No history at baseline | 28 | 35 | 1.26 | 0.73, 2.18 | 20 | 0.97 | 0.52, 1.83 | 20 | 0.95 | 0.52, 1.90 | 0.736 |
History at baseline | 20 | 17 | 0.72 | 0.32, 1.62 | 9 | 0.64 | 0.12, 0.82 | 14 | 0.55 | 0.21, 1.45 | 0.100 |
Colorectal canceri | 47 | 30 | 0.72 | 0.44, 1.17 | 24 | 0.61 | 0.35, 1.04 | 30 | 0.71 | 0.40, 1.25 | 0.194 |
No history at baseline | 23 | 18 | 0.79 | 0.41, 1.54 | 13 | 0.71 | 0.34, 1.50 | 11 | 0.60 | 0.25, 1.40 | 0.220 |
History at baseline | 24 | 12 | 0.49 | 0.21, 1.12 | 11 | 0.47 | 0.20, 1.10 | 19 | 0.73 | 0.31, 1.74 | 0.414 |
Breast cancerj | 38 | 35 | 1.12 | 0.68, 1.85 | 29 | 1.07 | 0.61, 1.86 | 13 | 0.66 | 0.32, 1.36 | 0.391 |
No history at baseline | 7 | 6 | 1.05 | 0.34, 3.29 | 6 | 1.27 | 0.37, 4.31 | 2 | 0.51 | 0.08, 3.13 | 0.713 |
History at baseline | 30 | 29 | 1.11 | 0.63, 1.94 | 23 | 0.96 | 0.51, 1.79 | 11 | 0.61 | 0.27, 1.39 | 0.297 |
Pancreatic cancerk | 29 | 32 | 1.58 | 0.91, 2.75 | 23 | 1.09 | 0.58, 2.06 | 16 | 0.78 | 0.36, 1.70 | 0.505 |
No history at baseline | 26 | 26 | 1.17 | 0.66, 2.08 | 19 | 0.95 | 0.49, 1.86 | 13 | 0.65 | 0.28, 1.51 | 0.349 |
History at baseline | 3 | 6 | —l | — | 4 | — | — | 3 | — | — | — |
Other cancersf | 133 | 130 | 1.08 | 0.84, 1.40 | 124 | 1.01 | 0.77, 1.33 | 109 | 0.90 | 0.67, 1.23 | 0.485 |
Other causesc | 244 | 205 | 1.02 | 0.84, 1.25 | 161 | 0.92 | 0.73, 1.14 | 150 | 0.84 | 0.64, 1.08 | 0.145 |
Abbreviations: CI, confidence interval; CVD, cardiovascular disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; HR, hazard ratio; MET, metabolic equivalent of task; VITAL, Vitamins and Lifestyle.
a Numbers may not sum to totals because of missing data. All models adjusted for age (as the time scale), sex, race/ethnicity, marital status (married/living together, never married, separated/divorced, widowed, or missing), education (high school graduate or less, some college, or college/advanced degree), body mass index (weight (kg)/height (m)2) at age 45 years (<18.5, 18.5–<25.0, 25.0–29.9, ≥30.0, or missing), average physical activity in the 10 years before baseline (MET-hours/week; tertiles), smoking (never, 1–12.5 pack-years, 12.6–35.0 pack-years, >35.0 pack-years, or missing), average alcohol intake at age 45 years (none, <1 drink/day, 1–2 drinks/day, >2 drinks/day, or missing), total energy intake (kcal/day; continuous), number of servings per day of fruits (quartiles), number of servings per day of vegetables (quartiles), dietary intake of arachidonic acid (g/day; continuous), aspirin use in the past 10 years (none, low, high, or missing), use of nonaspirin nonsteroidal antiinflammatory drugs in the past 10 years (none, low, high, or missing), self-rated health (excellent, very good, good, fair, or poor), sigmoidoscopy in the last 10 years (yes/no), mammogram in the last 2 years (yes/no), prostate-specific antigen test in the last 2 years (yes/no), and current use of cholesterol-lowering medication (yes/no).
b Reference category (HR = 1).
c Results were additionally adjusted for morbidity score (see footnote c of Table 2), percentage of calories derived from trans fat (quartiles), percentage of calories derived from saturated fat (quartiles), years of estrogen therapy (none, <5, 5–9, ≥10, or missing), years of estrogen + progestin therapy (none, <5, 5–9, ≥10, or missing), age at menopause (≤39 years, 40–44 years, 45–49 years, 50–54 years, ≥55 years, or missing), age at death of father (≤59 years, 60–69 years, 70–79 years, 80–89 years, or ≥90 years), and age at death of mother (≤59 years, 60–69 years, 70–79 years, 80–89 years, or ≥90 years).
d Results were additionally adjusted for history of cardiovascular disease (yes/no; defined as history of heart attack, coronary bypass surgery, angioplasty, stroke, congestive heart failure, or diagnosis of angina) family history of heart attack (number of relatives: 0, 1, or ≥2), current use of blood pressure medication (yes/no), percentage of calories derived from trans fat (quartiles), percentage of calories derived from saturated fat (quartiles), years of estrogen therapy (none, <5, 5–9, or ≥10), and years of estrogen + progestin therapy (none, <5, 5–9, or ≥10).
e Results were additionally adjusted for history of ischemic heart disease (yes/no; defined as history of heart attack, coronary bypass surgery, angioplasty, or diagnosis of angina), family history of heart attack (number of relatives: 0, 1, or ≥2), current use of blood pressure medication (yes/no), percentage of calories derived from trans fat (quartiles), percentage of calories derived from saturated fat (quartiles), years of estrogen therapy (none, <5, 5–9, or ≥10), and years of estrogen + progestin therapy (none, <5, 5–9, or ≥10).
f Results were additionally adjusted for history of cancer other than nonmelanoma skin cancer (yes/no), family history of cancer (number of relatives: 0, 1, or ≥2), years of estrogen therapy (none, <5, 5–9, or ≥10), years of estrogen + progestin therapy (none, <5, 5–9, or ≥10), age at menopause (≤39, 40–44, 45–49, 50–54, or ≥55 years), age at menarche (≤11, 12, 13, or ≥14 years), and number of servings of red/processed meat per week (quartiles).
g Results were additionally adjusted for history of lung cancer (yes/no), family history of lung cancer (number of relatives: 0, 1, or ≥2), history of emphysema, chronic bronchitis, or chronic obstructive pulmonary disease (yes/no), years of smoking, and pack-years squared.
h Results were additionally adjusted for history of leukemia/lymphoma (yes/no), family history of leukemia/lymphoma (number of relatives: 0, 1, or ≥2), history of any cancer (yes/no), history of rheumatoid arthritis (yes/no), and history of fatigue/lack of energy (yes/no).
i Results were additionally adjusted for history of colorectal cancer (yes/no), family history of colorectal cancer (number of relatives: 0, 1, or ≥2), history of diabetes (yes/no), years of estrogen therapy (none, <5, 5–9, or ≥10), years of estrogen + progestin therapy (none, <5, 5–9, or ≥10), calcium intake from diet, calcium intake from supplements, and number of servings of red/processed meat per week (quartiles).
j Results were additionally adjusted for history of breast cancer (yes/no), family history of breast cancer (number of relatives: 0, 1, or ≥2), years of estrogen therapy (none, <5, 5–9, or ≥10), years of estrogen + progestin therapy (none, <5, 5–9, or ≥10), age at first birth, history of hysterectomy (none, simple, total), age at menopause (≤39, 40–44, 45–49, 50–54, or ≥55 years), and age at menarche (≤11, 12, 13, or ≥14 years).
k Results were additionally adjusted for history of pancreatic cancer (yes/no), family history of pancreatic cancer (number of relatives: 0, 1, or ≥2), number of servings of red/processed meat per week (quartiles), and history of diabetes (yes/no).
l Hazard ratios and 95% confidence intervals were not calculated because of small numbers of deaths.