'Fish intake and risk of cardiovascular disease: Still a controversial public health issue'

The Global Studies Seminar presents “Fish intake and risk of cardiovascular disease: Still a controversial public health issue” by Denison University’s Associate Professor of Global Health Ehab Farag.

The association between fish consumption and cardiovascular disease (CVD) remains controversial despite decades of research. Early studies, including the pioneering work by Kromhout in 1985, suggested a cardioprotective role of fatty fish rich in omega-3 fatty acids. However, recent systematic reviews, such as the 2018 Cochrane meta-analysis, have challenged this evidence, leading to debates about the strength and direction of the relationship. 

Proposed mechanisms for fish’s cardioprotective effects include improved vascular function, reduced inflammation, inhibition of platelet aggregation, and modulation of arrhythmias. Yet, variability in results arises from factors like fish type (fatty, lean, shellfish, fried), preparation methods, and population differences across racial and ethnic groups. Methodological challenges, including dietary assessment inaccuracies, confounding, and contaminants, further complicate the findings. 

His work on the Japanese Public Health Center (JPHC) study highlights the interaction between smoking and fish intake in modifying coronary heart disease (CHD) risk. Expert critiques emphasize the limitations of omega-3 supplement studies versus whole fish consumption. 

Despite uncertainties, moderate fish consumption (1–2 servings per week) is consistent with dietary guidelines and offers potential benefits for CVD prevention. Future research should address dose-response relationships, preparation methods, and population variability to refine dietary recommendations. 

Ehab is a pediatrician who obtained his Doctor of Medicine in 2001, then a Master’s Degree in Public Health and Community Medicine in 2006 from Minia University, Egypt, and Doctor of Philosophy in 2013 from Osaka University, Japan. 

Ehab spent 20 years researching and teaching Global Health in several African, Asian, and American institutes, including Minia University, Egypt; Osaka University, Japan; Calvin University, USA; and several others. Ehab has a strong undergraduate and graduate background in Global Public Health and Epidemiology, which have led to quality research that yielded significant public health recommendations for preventing lifestyle-related diseases. Ehab has put great effort into producing several scientific publications that have exceeded 150 peer-reviewed articles and book chapters. 

In October 2024, Ehab was nominated by Elsevier and Stanford University among the top 2% worldwide scientists in Clinical Medicine and Global Health.