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Intakes of omega-3 fatty acids and risks of all-cause and cause-specific mortality in people with diabetes: a cohort study based on NHANES 1999–2014

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Abstract

Aims

Intake of omega-3 fatty acids is associated with several health benefits, but the specific benefits in populations with diabetes have yet to be elucidated. Therefore, this study aimed to explore the relationship between intake of omega-3 fatty acids and mortality in people with diabetes.

Methods

This was a prospective cohort study and included 4854 participants with diabetes (mean age, 57.92 years; 50.9% male) from the National Health and Nutrition Examination Survey (1999–2014). Eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid intake were used as alternative markers of omega-3 fatty acids intake and calculated based on the sum of the 24-h dietary recall interviews and dietary supplements. Mortality data were ascertained by linkage to National Death Index records by December 31, 2015. Cox proportional hazard models and restricted cubic spline were used to assess the relationship between EPA and DHA intake and all-cause and cause-specific mortality. Statistical analyses were performed using R 4.2.0 software.

Results

Compared with participants with a lower EPA + DHA intake, participants who had a higher EPA + DHA intake tended to be Non-Hispanic Black; were more likely to be obese; and had higher daily energy intake and family income. During 34,386 person-years of follow-up, 1102 deaths were documented, including 266 cardiovascular disease deaths and 152 cancer deaths. In multivariable regression analyses with adjustment of confounding factors, higher EPA + DHA intake was significantly and linearly related to lower all-cause mortality: there was a 25% reduced risk of all-cause mortality.

Conclusions

Higher omega-3 fatty acid intake was independently related to lower all-cause mortality in individuals with diabetes, suggesting an adequate intake of omega-3 fatty acids may prevent premature death among the population with diabetes.

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Data availability

The NHANES database is available at: https://www.cdc.gov/nchs/nhanes/about_nhanes.htm.

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Acknowledgements

We thank all participants who volunteered as part of the NHANES. We also thank Yuzhuo Wang for her help with research methods.

Funding

This research was funded by the industry prospecting and common key technology key projects of Jiangsu Province Science and Technology Department (Grant No. BE2020721), the National key Research & Development plan of Ministry of Science and Technology of China (Grant No. 2018YFC1314900, 2018YFC1314901), the Industrial and Information Industry Transformation and Upgrading Special Fund of Jiangsu Province in 2021 (Grant No. [2021]92), the Industrial and Information Industry Transformation and Upgrading Special Fund of Jiangsu Province in 2018 (Grant No. [2019]55).

Author information

Author notes

  1. Jing Xie and Zhenwei Wang contributed equally to this work.

Authors and Affiliations

  1. College of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China

    Jing Xie & Naifeng Liu

  2. Department of Cardiology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China

    Zhenwei Wang, Shengjue Xiao & Naifeng Liu

  3. Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

    Junjie Wang, Wei Feng, Tao Shan, Shenqi Jing & Yun Liu

  4. Department of Outpatient, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China

    Tao Shan

  5. Department of Information, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China

    Shenqi Jing

  6. Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China

    Wei Li

  7. Institute of Medical Informatics and Management, Nanjing Medical University, Nanjing, China

    Yun Liu

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  1. Jing Xie
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JX, ZW, JW, WF, TS, and SJ. The first draft of the manuscript was written by ZW, JX, SX, and WL. NL and YL conceived of the study design. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Naifeng Liu or Yun Liu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The NHANES involving human participants were reviewed and approved by the National Center for Health Statistics of the Center for Disease Control and Prevention Institutional Review Board.

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The patients/participants provided their written informed consent to participate in the NHANES.

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Xie, J., Wang, Z., Wang, J. et al. Intakes of omega-3 fatty acids and risks of all-cause and cause-specific mortality in people with diabetes: a cohort study based on NHANES 1999–2014. Acta Diabetol 60, 353–362 (2023). https://doi.org/10.1007/s00592-022-02003-w

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