Fish and Seafood Consumption and Omega 3 Intake in French Coastal Populations: CALIPSO Survey

Public Health Nutrition: 12(5), 599–608 doi:10.1017/S1368980008002681

Fish and seafood consumption and omega 3 intake in French coastal populations: CALIPSO survey

Nawel Bemrah*, Ve´ronique Sirot, Jean-Charles Leblanc and Jean-Luc Volatier Directorate of Risk Assessment for Nutrition and Food Safety, French Food Safety Agency, 94701 Maisons Alfort, France

Submitted 4 June 2007: Accepted 16 April 2008: First published online 12 June 2008

Abstract Objective: To describe part of the results of the CALIPSO study, i.e. to provide seafood consumption data on high seafood consumers in France and its contribution to n-3 long-chain (LC) PUFA intake. Design and subjects: A total of 1011 individuals aged 18 years and over, who consumed fish and seafood at least twice weekly, were recruited. A consumption survey and a local ‘total diet study’ were performed to examine seafood consumption, fatty acids composition of seafood and to assess n-3 LC PUFA intake. Setting: The CALIPSO survey was conducted in four French coastal regions (Le Havre, Lorient, La Rochelle and Toulon). Methods: The subjects were questioned about their consumption habits, especially concerning fish and seafood, through a first validated FFQ. A sample of the most consumed seafood products (n 47) was analysed for each region for its fatty acid composition. Fatty acids and especially n-3 LC PUFA intakes in this population were then calculated. Results and conclusions: The average consumption of fresh and frozen fish was found to be 633, 636?5 and 787?8 g/week among men aged 18–64 years, women aged 18–64 years and people over 65 years, respectively. In these population groups, the consumption of crustaceans and molluscs was 270?3, 259?9 and Keywords 279?3 g/week, respectively. The results show that, irrespective of the age group Fish and gender, consumption of fish and seafood twice weekly without excluding Seafood oily fish allowed people to reach the national and international recommended n-3 Consumption LC PUFA intakes and demonstrates the validity of the French recommendations Fatty acids for fish consumption. Omega 3

For many years seafood, i.e. fish, molluscs and crusta- effects on visual and mental health and neurodevelop- ceans, has often been the focus of attention in nutritional ment(5,6). research and recommendations. These products are Nevertheless, at present, the respective mechanism of considered to be an important source of iodine, vitamin action of each of EPA and DHA is debatable. As described D, proteins and fatty acids, especially the n-3 long-chain in the Symposium ‘n-3 fatty acids: recommendations (LC) PUFA, although only half the French population for therapeutics and prevention’ convened by the Insti- follows the recommendation of the French National tute for Human Nutrition of Columbia University on 21 Nutritional-Health Programme to consume fish at least May 2005(7), confusion exists about the recommendations twice a week(1). and the biological link between intake and health. The protective role of n-3 PUFA has been demonstrated Recommended daily intakes (RDI) also vary depending in primary prevention and, above all, secondary preven- on scientific authority. In France, for example, in adult tion of CVD. n-3 LC PUFA might help to reduce mortality males, for a total energy intake (TEI) of 9211 kJ/d from CVD, though not morbidity(2,3). n-3 LC PUFA sup- (2220 kcal/d), the RDI are 500 mg n-3 and n-6 LC PUFA plements might help to reduce cardiovascular risks by including 120 mg DHA. This corresponds to 0?2% of lowering the risk of sudden death of people with a history the TEI for n-3 and n-6 PUFA, and 0?05 % of the TEI for of cardiovascular problems(4). Dietary n-3 LC PUFA and DHA. In the same manner, for French adult females, for a n-3 LC PUFA supplements have been demonstrated to be TEI of 7536 kJ/d (1800 kcal/d), the RDI are 400 mg n-3 linked with n-3 LC PUFA concentrations in blood, plasma, and n-6 LC PUFA including 100 mg DHA. This corre- tissues or human milk, being responsible for beneficial sponds to 0?2 % of the TEI for n-3 and n-6 PUFA, and

*Corresponding author: Email [email protected] r The Authors 2008

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. 600 N Bemrah et al. 0?05 % of the TEI for DHA. The ratio n-6/n-3 should tend Subjects and methods towards 5(8). Then a discussion has got underway on an update of these values. On an international level, the Selection of study zones and subjects International Society for the Study of Fatty Acids and Four French coastal zones have been selected for this Lipids (ISSFAL) recommends a minimal daily intake of survey: Le Havre in Normandy/Baie de Seine, Lorient in 500 mg n-3 LC PUFA (EPA 1 DHA) with regard to the south Brittany, La Rochelle in Gironde/south Charente prevention of CVD(9). In 2004, the Scientific Advisory Maritime and Toulon in the Mediterranean/Var (Fig. 1). Committee on Nutrition (UK) revised the previous Individuals were recruited within a radius of 20–25 km population guideline recommendation about n-3 LC around these points. A total of twenty to twenty-seven PUFA, to make it consistent with the recommendation towns were visited in each zone and the number of indi- for fish consumption by raising it from 0?2to0?45 g/d(5). viduals questioned per town was proportional to the The American Heart Association recommends a daily number of inhabitants published in the 1999 French consumption of 1 g of EPA and DHA for patients with National Institute of Statisctics Survey(18). Individuals were documented CHD(10). Lastly, the Australian Health and randomly recruited using the so-called ‘random route’ Medical Research Council recommended an n-3 LC PUFA method, i.e. choosing the first address at random then by intake of 90 mg/d for adult women and 160 mg/d for door-to-door canvassing every five doors. The first ques- men(11). tions allowed us to determine the person who was selected: The principal dietary sources of a-linolenic acid (ALA), the member of the family whose first name was the first the precursor of n-3 LC PUFA, are vegetable products, in according to the alphabetical order and who used to reg- particular rapeseed oil and soyabean oil. And apart from ularly consume fish and seafood. If the person was not dietary supplements, seafood products remain the major present at home or did not fulfil the selection criteria, it was source of n-3 LC PUFA, since in humans the conversion of the second one and so on. The inclusion criteria were the ALA into these long-chain derivatives is low: it has been age (.18 years), permanent residency in the coastal zone shown that less than 1 % of the ALA is converted into and the consumption of fish and seafood at least twice DHA(12,13). This conversion rate seems to be greater in weekly according to French recommendations. women than in men(14,15). Over and above these criteria, the female population The present study focused on French people con- aged 18–44 years, corresponding to women of child- suming fish and seafood at least twice weekly. This cri- bearing age, was over-represented. The aim was to obtain terion was defined according to the 1999 French national a representative sample of this population and to provide consumption survey INCA results(16) and the recom- data on seafood consumption of this particular group in mendations through the French National Nutritional- view of the effects of consumption of fish on the health of Health Programme, which are the same for the UK(5). The the fetus during pregnancy with regard to the fatty acids median consumption frequency calculated from the individual seafood consumption data in the population of INCA was twice weekly. People selected were living in French coastal zones, which concentrate the ‘high consumers’, as confirmed by a study of the French Food Consumption Observatory carried out in 1996 (unpub- lished data). It appears that fish consumption declines as we move away from the coast, which may partly be explained by widespread self-procurement of seafood by coastal populations. This hypothesis is supported by a 1998 survey of the French Research Center for the Study and Monitoring of Living Standards(17). The CALIPSO study (Consommations ALimentaires de poissons et produits de la mer et Impre´gnation aux e´le´ments traces, PolluantS et Ome´ga 3/Fish and seafood consumption study and exposure to trace elements, pollutants and omega 3) is the first French study on high fish and seafood consumers. The present study provides seafood consumption data of these particular consumers by examining their food consumption habits and ana- lysing the real nutritional benefits of these habits, notably those associated with n-3 LC PUFA with regard to French and international recommendations on n-3 PUFA intake and fish consumption. Fig. 1 Location of the study areas

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. Fish and seafood consumption and omega 3 intake in French coastal populations: CALIPSO survey 601 and contaminants, especially methylmercury, which have and 134 canned products, smoked fish or prepared sea- been addressed in the CALIPSO study(19), and with regard food-based dishes, and pooled to make 138 composite to the particular recommendations for this population(8). samples for fresh and frozen fish, molluscs and crusta- The survey was carried out in all the selected zones ceans, and twenty-one composite samples for canned between October and December 2004. A total of 6379 products, smoked fish or prepared seafood-based dishes. people were contacted and 43 % agreed to participate. Of The sampling and analytical methods have already been these 2768 people, almost 66 % failed to meet the inclu- described in detail elsewhere(25). sion criteria: 24 % said they do not eat any fish or seafood, 34 % did not consume seafood at least twice weekly, 2 % Fatty acid intake did not reside permanently in the town concerned and Fatty acid intakes were calculated by crossing the indi- 3 % were under 18 years of age. In the four zones, a total vidual consumption data from the food consumption of 1011 interviews were carried out (about 250 per zone). survey with the composition data obtained by analysis of The female population was effectively over-represented the representative food samples in the consumption/ (about 2?5 times more than men) and in particular in provisioning sets selected in each study zone. Because of women aged 18–44 years. seasonal unavailability, herring was not sampled during the sampling step of the study, and therefore no herring Consumption survey was analysed. So, for this particular highly consumed The survey involved an interview concerning the fish and species, lipid and fatty acid composition data were taken seafood consumption, eighteen questions about the from French and German food composition data- sociodemographic profile of the participant and twelve bases(26,27). The estimation of these intakes takes into closed questions concerning his or her perception of account a coverage exceeding 90 % of the individual the dietary risks associated with seafood. consumption levels of fish and seafood declared by the For eighty-two fishes, molluscs, crustaceans and sea- populations studied in each of the four zones. food-based dishes, consumption frequencies were collected by an interviewer-administered FFQ. People were Data and statistical analysis asked if they consumed each product once daily, three Fifteen individuals were eliminated because of their or four times weekly, twice weekly, once weekly, two or seafood consumption declarations of more than 5 kg of three times monthly, once monthly, less than once seafood per week (714 g/d) or less than 200 g per week monthly or never. The portion sizes usually consumed (29 g/d). Consequently, the results are presented for 996 were estimated using a validated book of sample photo- individuals. In order to ensure consistency between the graphs(20), and consumptions were assessed by crossing exploitation of the data and the national and/or inter- the frequency and the portion size for each product. national recommendations concerning n-3 PUFA intake, Information was also collected on preservation methods the population was divided into three categories and (fresh, frozen, canned, etc.) and on the usual origin of the one sub-category: male adults (aged 18–64 years, n 243), consumed seafood (commercial and self-provisioning). female adults (aged 18–64 years, n 630), including The FFQ was first validated by a pilot survey by means women of childbearing age (aged 18–44 years, n 344), of 7 d consumption diaries insofar as FFQ are well known and elderly people (aged 65 years or over without dis- for being less precise than questionnaires concerning tinction of gender, n 123). short periods, such as consumption diaries or 24 h recalls. The total fish, mollusc and crustacean consumption data This pilot survey was performed from March 2002 to June were not normally distributed, which is consistent with the 2002 in two of the coastal zones, La Rochelle and Toulon, fact that the subjects are only high seafood consumers and involved sixty-one people aged 15 years or over. corresponding to the distribution upper tail of the seafood Consumptions were recorded using a diary and the FFQ, consumptions of the total French population. Consequently, which was then corrected for the full-scale survey using data have been converted using Box–Cox transformations comparisons between both methods. (not presented) to allow for comparisons between groups using a variance analysis associated with Tukey’s test. Lipid and fatty acid composition of fish and Student’s t-tests were used to check intakes against recom- seafood mendations. All statistical analyses were performed using To estimate lipid and fatty acid intake as precisely as SAS software version 8?2 (SAS Institute Inc., Cary, NC, USA). possible, a local sampling covering mainly consumed fish and seafood (88–100 % of the total local consumption depending on the site) was conducted in each zone, Results based on the methodology of the total diet studies already developed in the French total diet study(21) and recom- Fish and seafood consumption mended by international bodies(22–24). In all, 824 products Table 1 shows that the average consumption of fresh and were sampled, including 690 fresh and frozen products frozen fish excluding canned or smoked products was

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. Downloaded from 602 https://www.cambridge.org/core

Table 1 Consumption of fresh and frozen ﬁsh by high seafood consumers (g/week)

Adult men (18–64 years) Adult women (18–64 years) Older subjects (65 years and over) Women of childbearing age (18–44 years) (n 243) (n 630) (n 123) (n 344)

Fish Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR*

Anchovy 7?735?037?50?010?76?666?922?50?07?63?913?545?00?09?89?689?918?80?07?6 .

28 Sep 2021at16:41:41 Angler fish 14?126?655?00?039?116?938?862?50?042?921?346?093?80?040?713?037?950?00?035?8 Catshark 7?824?250?00?016?910?228?462?50?020?89?021?550?00?020?310?330?762?50?019?5 Cod 92?6 112?0 325?062?581?593?3 102?0 245?062?587?593?693?1231?375?081?386?384?7 218?862?588?7 Dab 9?427?450?00?018?514?543?393?80?022?123?561?4100?00?028?512?745?293?80?017?4 Eel 6?732?525?00?015?22?411?517?50?08?33?010?525?00?010?62?511?817?50?08?1 Emperor 3?722?518?80?08?23?817?125?00?09?44?114?125?00?013?01?26?20?00?04?4 Goatfish 9?222?450?00?023?09?633?245?00?026?820?343?5112?50?034?16?617?337?50?021?5 Grenadier 8?829?450?00?018?114?835?193?80?027?120?060?893?80?030?113?335?393?80?023?5 , subject totheCambridge Coreterms ofuse. Grouper 0?74?50?00?02?51?810?60?00?04?10?64?10?00?02?41?27?70?00?03?5 Gurnard 4?127?622?50?08?24?730?718?10?06?810?641?647?50?015?43?633?20?00?04?4 Haddock 7?540?825?00?011?14?919?937?50?09?715?755?4100?00?020?33?517?618?80?06?4 Hake 25?756?5 125?00?033?324?554?2 137?50?031?931?749?2137?50?045?521?448?8 118?80?031?1 Halibut 7?323?737?50?018?512?648?562?50?023?012?748?650?00?020?310?234?750?00?020?1 Herring 7?722?456?30?018?58?934?345?00?018?432?2 191?0100?00?017?97?530?637?50?016?0 John dory 3?616?318?80?010?34?413?925?00?014?48?026?350?00?017?92?39?718?80?08?1 Ling 20?061?2 100?00?030?918?237?4 100?00?033?228?647?9125?00?044?713?228?462?50?029?7 Mackerel 26?762?9 109?40?041?224?965?8 112?50?039?728?456?8150?00?045?524?475?9 112?50?033?7 Mullet 2?813?118?80?06?64?729?618?80?05?71?05?50?00?03?33?725?10?00?04?9 Plaice 8?237?650?00?012?311?545?775?00?016?522?170?3100?00?020?38?148?037?50?011?3 Pollack 12?042?955?00?020?214?141?993?80?021?718?936?9118?80?033?310?733?650?00?018?6 Pout 2?210?913?00?06?22?212?66?50?05?62?39?125?00?06?51?310?30?00?04?4 Ray 25?246?5 125?00?043?625?648?1 118?80?046?342?362?6125?018?856?122?648?0 100?00?040?7 Redfish, rockfish 0?56?50?00?00?80?99?60?00?01?42?011?70?00?03?30?55?80?00?01?2 Saithe/coalfish 53?876?6 200?025?062?658?578?9 200?035?067?949?676?9200?018?852?064?177?1 200?037?576?7 Salmon 55?690?7 190?627?560?567?394?4 220?035?071?156?574?1220?036?360?270?590?9 220?045?074?7 Sardine 24?737?8 109?412?554?719?639?193?80?044?126?740?4109?412?556?914?433?193?80?034?9 Scorpionfish 3?313?325?00?08?63?211?622?50?011?05?723?625?00?012?22?38?918?80?09?3 Seabass 29?748?9 109?412?553?923?358?4 100?00?044?626?254?5125?00?045?516?630?565?60?041?9 Sea bream 26?558?1 118?80?037?923?458?7 112?90?037?330?375?7150?00?039?816?353?870?00?030?2 Smelt 2?75 13?118?80?07?02?111?117?50?07?01?67?16?30?06?52?311?618?80?07?6 Sole 49?576?7 250?018?858?035?164?9 171?90?048?762?893?8275?034?460?235?970?5 171?90?047?1 Sprat 0?46?10?00?00?80?32?60?00?01?40?74?40?00?03?30?22?40?00?01?2 Swordfish 7?925?948?80?016?05?724?027?50?011?68?343?427?50?017?94?822?827?50?09?9 Tuna 32?654?5 190?60?045?328?053?8 137?50?043?229?343?5137?50?048?824?144?5 112?50?038?1 Turbot 3?920?723?80?06?22?38?418?80?08?34?116?125?00?010?62?07?918?80?07?0 Whiting 25?251?1 125?00?037?026?150?4 125?00?043?327?555?5125?00?043?123?946?2 100?00?041?3 Bemrah N Total 633?0a 497?0 1491?0 500?099?6 636?5a 460?01521?9 510?0 100?0 787?8b 539?0 1783?1 630?0 100?0569?4 438?0 1286?9462?8100?0

Values in the same line with different superscript letters are signiﬁcantly different, P , 0?05 (Tukey’s test). *Consumer rate. tal. et Fish and seafood consumption and omega 3 intake in French coastal populations: CALIPSO survey 603

found to be 633 (SD 497) g/week in men aged 18–64 years consumption by women is significantly higher than the (P95 1491 g/week), 636?5(SD 460) g/week for women in the consumption by the elderly. Tuna is the most consumed same age group (P95 1521?9 g/week) and 787?8(SD 539) canned product in all the groups, and salmon is the most g/week for subjects over 65 years of age (P95 1783?1 g/week), consumed smoked product. Paella and fish soup are which is significantly higher than the mean consumption widely consumed in all the population groups, though of adult men and women (P , 0?05). Moreover, the con- with a marked preference for soup among elderly people. sumption of lean fish (,5 g lipid/100 g) is significantly For total products, significant differences between the higher in older subjects than in adult men or women average consumption levels are observed between the (P , 0?05). There is no significant difference concerning study zones for all the groups studied. In particular, oily fish (.5 g lipid/100 g). consumption levels in Toulon are higher than in the other For all population groups, cod is the most consumed regions (P , 0?05, not presented). fish, not only in terms of quantity but also in terms of consumer rate, which is between 81 % and 88 %. Women Fatty acid intake of childbearing age conform to the same trend as female Fatty acid intakes through fish and seafood consumption adults, but with an even higher consumer rate of cod. for the four study zones and for each group are presented Salmon, saithe and sole are also among the most con- in Table 4. One should bear in mind that they do not sumed fishes by each group even if the difference is not correspond to fatty acid intakes through the total diet; significant for all the species. however, marine products are the main source of n-3 The distribution of the consumed species is slightly LC PUFA as explained in the introduction section. Aver- different between groups. For example, elderly people age EPA intakes are 419–517 mg/d for adult males and consume much more herring than the other groups 403–509 mg/d for adult females; DHA intakes are (32?2 v.7?7 and 8?9 g/week for male and female adults, 739–960 mg/d for men and 713–885 mg/d for women. respectively). Elderly people also consume more ray Table 5 shows that the main contributors to n-3 PUFA (42?3 v.25?2 and 25?6 g/week, respectively). exposure are salmon (26?6 %), mackerel (11?5 %), sardine Some regional differences have also been determined (9?53 %), and anchovy and herring (about 5 %). Salmon (not presented). Generally, people in Le Havre consume consumption contributes on average to 66?2 % of the RDI of significantly less fish than those in Lorient (P , 0?01) and EPA and DHA (500 mg/d), mackerel to 28?0 % and sardine La Rochelle (P , 0?05). to 23?8 %. Indeed mackerel, sardine and salmon are major Concerning molluscs and crustaceans, weekly average contributors (.5 %) in all four study zones, providing consumption is 270?3(SD 225) g for men aged 18–64 7–16 %, 6–17 % and 24–31 %, respectively, of the intake years, with a 95th percentile of 703?4 g; 259?9(SD 258) g (details per area not presented). Herring, another oily fish, for women in the same age group, with a 95th percentile accounts for at least 5 % of the intake only in Le Havre and of 665?3 g; and 279?3(SD 253) g for people over 65 years, La Rochelle, while anchovies contribute to more than 5 % of with a 95th percentile of 648?8 g (Table 2). There is no n-3 LC PUFA intake in Lorient and Toulon. significant difference of intake between these groups. In each group, average consumption is the highest for oysters, shrimps, mussels and great scallops. Discussion Concerning geographical differences, people in Lorient and La Rochelle consume significantly more molluscs The amounts of consumed fish and seafood in the and crustaceans than people in Le Havre and Toulon CALIPSO study were compared with those of INCA (P , 0?05, not presented). (French national dietary survey in 1999). The consump- Consumption of canned and smoked fish and other tion levels in the CALIPSO study are about 2?5 times seafood-based products must be interpreted with care higher than for the average consumers of the INCA survey since the recipes of products such as fish soup and paella for fish, mollusc and crustacean consumption, and about vary highly between individuals and commercial brands; 1?5 times higher for the other products. For the total their fish or crustacean content can differ. Table 3 consumption of these products, a factor of about 3?5is includes the consumption of a few complete dishes observed between the two studies, which demonstrates without taking into account the recipe or the proportion that our study’s objective of targeting high fish and of seafood they contain. Consequently, these data might seafood consumers was effectively reached. overestimate the intake. Concerning total LC PUFA and DHA, the French RDI The weekly consumption of canned and smoked fish are well covered in the studied population, regardless of and seafood-based dishes is 312?3(SD 237) g for men aged age and gender (P , 0?0001 for all groups for DHA and 18–64 years, which is significantly higher than the mean LC PUFA). For example, for women of childbearing age, consumption of 272?2(SD 220) g for women of the same the average intake of DHA is 757 (SD 633) mg/d. Regard- age and is also significantly higher than the average 187?7 ing this particular group of women, in the four study (SD 151) g for elderly people (P , 0?05). Moreover, the zones fish and seafood consumption alone provide

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. Downloaded from 604 https://www.cambridge.org/core

Table 2 Consumption of molluscs and crustaceans by high seafood consumers (g/week)

Adult men (18–64 years) Adult women (18–64 years) Older subjects (65 years and over) Women of childbearing age (18–44 years)

. (n 243) (n 630) (n 123) (n 344) 28 Sep 2021at16:41:41

Mollusk, crustacean Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR*

Abalone 0?66?30?00?01?20?30?30?00?01?11?716?10?00?01?60?44?00?00?01?2 Calico scallop 14?6 103?046?90?021?411?548?845?00?026?522?555?0 112?50?033?313?963?245?00?024?7 Carpet shell 3?610?220?00?026?32?26?810?00?021?42?95?712?00?033?31?96?610?00?018?3 Clam 0?31?60?00?04?50?21?10?00?04?00?21?40?00?01?60?10?90?00?04?1 Cockle 2?46?512?50?023?53?29?017?50?026?23?07?617?50?022?02?57?212?50?023?3 , subject totheCambridge Coreterms ofuse. Common periwinkle 3?87?515?00?047?74?28?925?00?047?65?110?225?00?044?73?69?212?50?043?0 Crab 8?814?940?05?061?78?313?540?05?058?78?117?725?02?551?27?511?925?05?057?8 Cuttle ﬁsh 9?926?250?00?027?26?720?232?50?019?85?913?332?50?017?96?318?532?50?020?1 Donax clam 0?10?60?00?00?80?43?50?00?01?90?21?30?00?01?60?22?30?00?00?9 Great scallop 34?046?7 125?025?069?539?862?7 156?325?073?242?6 104?0 156?318?867?534?057?1 125?018?870?1 Grooved sea squirt 1?310?00?00?02?50?96?40?00?03?20?75?80?00?01?60?75?00?00?02?6 Hard clam 1?43?99?40?016?91?14?46?30?014?42?67?912?50?020?30?72?86?30?09?9 Limpet 0?10?80?00?00?40?33?30?00?01?40?44?50?00?00?80?33?10?00?01?2 Lobster 4?112?422?50?013?65?515?245?00?018?43?29?622?50?012?26?317?845?00?019?5 Mussel 23?121?970?017?588?121?623?670?012?585?624?120?470?017?587?821?121?670?012?584?0 Octopus 7?123?832?50?018?54?113?726?30?013?71?66?616?30?07?33?611?026?30?013?4 Oyster 40?960?3 144?018?067?127?948?490?012?061?451?3 102?0 144?018?071?523?743?190?09?055?5 Queen scallop 1?211?90?00?02?50?00?20?00?00?20?21?90?00?01?60?00?20?00?00?3 Razor clam 0?85?00?00?03?30?34?00?00?01?10?00?00?00?00?00?65?40?00?01?7 Scampi 19?431?190?07?554?317?434?675?04?552?725?940?8 112?512?058?514?328?160?00?049?4 Sea urchin 8?328?252?50?011?913?094?552?50?010?88?342?643?80?010?67?634?652?50?010?2 Shrimp 36?033?2 100?025?091?841?549?7 125?025?091?737?141?6 100?021?384?643?051?1 140?025?092?7 Slipper lobster 0?00?10?00?02?10?00?10?00?00?60?00?10?00?00?80?00?10?00?00?6 Spider crab 4?510?220?00?029?24?311?320?00?029?04?08?525?00?031?72?76?810?00?024?4 Spiny lobster 0?00?012?50?013?60?00?16?30?017?00?00?06?30?017?90?00?112?50?017?4 Squid 20?935?3 103?110?052?716?126?780?010?051?610?921?550?00?035?815?128?681?30?047?4 Swimcrab 7?825?750?00?015?68?334?250?00?016?08?229?550?00?015?44?217?125?00?010?8 Whelk 12?630?662?50?035?417?352?093?80?033?36?717?637?50?019?516?749?193?80?033?4 Total 270?3a 225?0 703?4 222?598?4 259?9a 258?0 665?3192?999?7 279?3a 253?0 648?8 217?5100?0235?1 214?0 607?4 170?099?4

Values in the same line with different superscript letters are signiﬁcantly different, P , 0?05 (Tukey’s test). *Consumer rate. Bemrah N tal. et Downloaded from ihadsaodcnupinadoea3itk nFec osa ouain:CLPOsre 605 survey CALIPSO populations: coastal French in intake 3 omega and consumption seafood and Fish https://www.cambridge.org/core .

28 Sep 2021at16:41:41 Table 3 Consumption of canned food, smoked ﬁsh and other seafood by high seafood consumers (g/week)

Adult men (18–64 years) Adult women (18–64 years) Older subjects (65 years and over) Women of childbearing age (18–44 years) (n 243) (n 630) (n 123) (n 344)

Other seafood Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR* Mean SD P95 Median CR*

Canned food

, subject totheCambridge Coreterms ofuse. Anchovy 31?763?2180?00?039?122?859?9 120?00?036?219?553?293?80?035?816?957?875?00?028?8 Crab 4?716?722?50?025?56?423?622?50?033?22?55?415?00?027?68?60?937?50?032?0 Mackerel 17?626?465?67?559?314?129?860?04?754?910?015?237?53?854?516?335?660?05?655?8 Pilchard 2?810?815?00?010?31?46?07?50?010?21?04?27?50?07?31?36?77?50?07?8 Sardine 15?721?260?07?568?712?018?140?05?065?217?517?460?010?081?311?418?540?05?059?9 Tuna 52?384?6180?022?591?845?064?1 120?030?091?621?828?190?011?378?955?377?6 180?030?093?6 Total canned food 124?8 130?0381?081?398?8101?8 125?0 302?565?697?972?371?7 182?551?393?5 109?8 144?0 360?067?598?8 Smoked ﬁsh Haddock 1?03?47?50?010?31?88?47?50?012?50?52?43?80?05?71?35?77?50?011?0 Herring 7?915?146?90?037?94?610?522?50?030?04?59?122?50?032?54?410?122?50?027?9 Mackerel 3?110?215?00?016?02?19?811?30?012?90?94?45?00?08?12?812?515?00?015?7 Salmon 10?111?537?55?078?610?314?837?55?081?37?117?825?02?563?410?315?840?00?081?1 Total smoked ﬁsh 22?124?975?015?086?818?825?370?010?085?713?016?940?010?079?718?826?566?310?085?8 Seafood-based dish Fish soup 65?296?4250?037?557?656?998?8 250?025?051?161?187?0 250?037?566?762?2 113?0 250?00?048?3 Paella 68?9 103?0175?062?570?452?370?6 200?040?062?127?056?6 125?00?035?860?581?1 200?040?066?6 Surimi 26?344?370?015?070?835?754?2 140?017?577?011?629?143?80?046?340?959?9 140?025?081?4 Tarama 5?010?631?30?035?86?822?431?30?040?52?69?612?50?017?18?728?431?30?041?3 Total seafood-based dish 165?4 154?0450?0 127?592?2151?7 146?0 472?5 112?595?1 102?0122?0 256?365?085?4 172?0 162?0 522?5126?695?3 Total 312?3a 237?0798?8 251?999?6272?2b 220?0 742?5 205?099?5 187?7c 151?0 472?5 147?599?2 300?8 250?0 795?0207?599?1

Values in the same line with different superscript letters are signiﬁcantly different, P , 0?05 (Tukey’s test). *Consumer rate. 606 N Bemrah et al.

Table 4 Mean dietary intake of fatty acids from ﬁsh and other seafood (mg/d)

Le Havre Lorient La Rochelle Toulon Total

Mean SD Mean SD Mean SD Mean SD Mean SD

C20 : 5 n-3 (EPA) AM (18–64) 442 275 517 247 419 317 467 354 456 377 AW (18–64) 509 413 403 303 438 289 433 326 448 343 OS (.64) 693 812 406 226 416 395 388 194 467 468 WCA (18–44) 472 415 389 347 452 303 407 327 432 354 C22 : 5 n-3 (DPA) AM (18–64) 126 105 148 53 109 91 145 104 129 108 AW (18–64) 137 134 114 173 117 155 136 102 127 142 OS (.64) 190 226 104 60 95 70 135 86 125 125 WCA (18–44) 128 120 122 237 128 186 127 104 126 165 C22 : 6 n-3 (DHA) AM (18–64) 782 537 960 421 739 563 750 514 797 567 AW (18–64) 885 751 733 559 757 505 713 517 776 603 OS (.64) 1164 1317 770 458 709 491 686 336 819 737 WCA (18–44) 837 762 724 637 783 544 678 541 757 633 Total n-3 AM (18–64) 1569 1045 1975 822 1510 1138 1659 1184 1657 1186 AW (18–64) 1802 1528 1502 1164 1556 1053 1588 1166 1621 1262 OS (.64) 2307 2535 1506 872 1439 1155 1449 689 1644 1468 WCA (18–44) 1692 1498 1488 1372 1616 1134 1517 1196 1583 1312

DPA, docosopentaenoic acid; AM, adult men; AW, adult women; OS, older subjects; WCA, women of childbearing age.

Table 5 Contributors to the average intake of n-3 PUFA (ALA, especially EPA and DHA are also much higher than that of C18 : 4 n-3, EPA, DPA and DHA) in % of contribution – mean the American population, which do not exceed 200 or values for all subjects and all areas 300 mg EPA and DHA per day(28–30). Species % of contribution Species % of contribution Compared with other high seafood consumers, for the Salmon* 26?6 Ray 0?52 four study zones, n-3 LC PUFA intakes are lower than the Mackerel* 11?5 Squid 0?5 estimated intakes of the Inuit, and of the same order of Sardine 9?53 Pilchard 0?44 magnitude as the Japanese population(30–32). The varia- Anchovy* 4?85 Calico scallop 0?43 Herring* 4?66 Dab 0?38 bility between individuals is also consistent with the Tuna* 4?35 Hake 0?38 results found in the literature. Seabream 3?45 Whelk 0?37 Generally speaking, in all zones, and irrespective of the Halibut 3?37 Seabass 0?33 Scorpion fish 2?72 Scampi 0?3 age group and gender considered, the average EPA 1 Paella 2?55 Whiting 0?28 DHA intake remains below the upper limit of EPA 1 DHA Surimi 2?29 Catshark 0?27 intake of 2 g/d (P , 0?0001 for all groups) proposed by Crab* 1?9 Cuttle fish 0?24 Fish soup 1?9 Ling 0?24 the Agence Française de Sećurite´ Sanitaire des Aliments in Swordfish 1?83 Grenadier/hoki 0?23 2003(2). Fourteen per cent of the subjects exceed this Saithe 1?76 Periwinkle 0?23 recommendation, through fish and seafood consumption Tarama 1?4 Lobster 0?16 Cod 1?38 Pollack 0?15 alone. However, given the rarity of available data, this Great scallop 1?1 Sea urchin 0?15 limit is not considered to be an intake beyond which a Goatfish 1?08 Angler fish 0?11 health risk might appear, but rather an intake beyond Mussel 0?98 Plaice 0?11 Swimcrab 0?78 John dory 0?09 which there is no proven nutritional benefit. Moreover, Emperor 0?69 Haddock* 0?07 some studies have shown the beneficial effect of EPA 1 Shrimp 0?69 Octopus 0?05 DHA intake exceeding 3 or 4 g/d(4,30). Oyster 0?68 Cockle 0?04 Eel 0?66 Gurnard 0?02 Results show that the average EPA 1 DHA intake Sole 0?59 Pout 0?02 exceeds the 1 g/d recommended for patients with docu- Spider crab 0?59 Total 100 mented CHD by the American Heart Association ALA, a-linolenic acid; DPA, docosopentaenoic acid. (P , 0?0001) and, in fact, this intake significantly exceeds *For these species the different packaging forms are taken into account: her- the ISSFAL recommendation of 500 mg/d for each sub- ring: fresh and canned, mackerel: fresh, canned and smoked, sardine: fresh and canned, salmon: fresh and smoked, tuna: fresh and canned, anchovy: group of population, including women of childbearing fresh and canned, crab: fresh and canned, haddock: fresh and smoked. age (P , 0?0001 for each group). Actually, 84 % of individuals have EPA 1 DHA intakes exceeding this recom- average intakes largely exceeding the RDI of DHA and mendation of 500 mg/d. The people with an EPA 1 DHA LC PUFA for adult females (400 mg LC PUFA of which intake lower than 500 mg/d consume fish and seafood 100 mg is DHA) and pregnant women (1000 mg LC PUFA at least twice weekly, which therefore qualifies them as of which 250 mg is DHA). The intakes of n-3 LC PUFA and high consumers. Their low intake of n-3 LC PUFA is

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. Fish and seafood consumption and omega 3 intake in French coastal populations: CALIPSO survey 607 explained by the fact that they consume products con- since the participants consume fish or seafood at least taining small amounts of these fatty acids, on average twice weekly. The results showed that this quantity (i.e. at 596 g of fish and seafood products per week including least twice weekly) allowed them to reach the recom- 52 g of oily fish (8?7 % of total fish and seafood), v. 1277 g mended intakes of n-3 LC PUFA with some variations of fish and seafood including 277 g of oily fish (21?7 %) for between regions or subgroups of the population and people whose intake exceeds the recommendations. demonstrated the validity of the French National Nutri- Considering the average value of EPA 1 DHA in oily fish, tional-Health Programme recommendations concerning which corresponds to 22?5 mg/g, an individual has to fish consumption. consume 150 g of oily fish per week to reach the international recommendation of 500 mg/d. Therefore, the Acknowledgements consumption of fish twice weekly including one serving of oily fish complies with the French National Nutritional- Funding source: The authors would like to thank the Health Programme recommendations. General Directorate for Foods of the French Ministry of The results provided in Table 5 are important to be Agriculture and Fisheries for its financial support. taken into account by national agencies when they pro- Conflict of interest: No conflicts of interest. pose recommendations. For instance, on the one hand, in Author contributions: N.B. was responsible for the France pregnant women are recommended to eat fish fish and seafood consumption survey in the CALIPSO twice weekly without excluding oily fish. On the other study, V.S. was responsible for the survey on lipid and hand, they are recommended not to eat some predator fatty acid composition and their intake, J.C.L. was the fish such as swordfish, marlin and siki because of their coordinator of the whole study and J.L.V. the supervisor. high methylmercury levels. The scientific assessment Acknowledgements: The authors would like to thank bodies have to be coherent in their recommendations; the National Institute for Agricultural Research for its they must not recommend some species for their nutri- administrative support. The authors also express their tional benefits and to advise against the same products particular gratitude to all the participants in the CALIPSO because of the risk. That is the reason why it is important survey without whose support this study would not have to have a better knowledge about the fish species: on been possible. the one hand, knowledge on the beneficial nutritional contributors, and on the other hand, on the major contributors to contaminant exposure. References At this stage, only a descriptive analysis of the benefits of daily n-3 PUFA consumption regarding health could be 1. Ministe`re Français de l’Emploi et de la Solidarite´, Ministe`re de´le´gue´ a` la Sante´ (French Ministry of Employment and performed, based on existing recommendations and pub- Solidarity and the Secretary of State for Health and Social lished epidemiological data, but without correlating the Action) (2001) National Nutritional-Health Programme impact on the health of our population. Nevertheless, the 2001–2005. http://www.sante.gouv.fr/htm/pointsur/nutrition/ recommendation on fish consumption should be integrated 1nbis.htm 2. Agence Française de Sećurite´ Sanitaire des Aliments (2003) into a larger discussion on the validity or the re-assessment The omega 3 fatty acids and the cardiovascular system: of the nutritional recommendation concerning n-3 PUFA. nutritional benefits and claims. http://www.afssa.fr/ftp/ A working group of the French Food Safety Agency initiated afssa/39490-39491.pdf an update of the French nutritional recommendations on 3. Bucher HC, Hengstler P, Schindler C & Meier G (2002) N-3 polyunsaturated fatty acids in coronary heart disease: a fatty acids published in 2001. Our data on fish, as a source of meta-analysis of randomized controlled trials. Am J Med n-3 LC PUFA, should be taken into account when conse- 112, 298–304. quently translating these future updated fatty acid recom- 4. Breslow JL (2006) N-3 fatty acids and cardiovascular disease. Am J Clin Nutr 83, 1477S–1482S. mendations into food consumption frequency and into food- 5. FSA Scientific Advisory Committee on Nutrition (2004) based dietary recommendations. Such a discussion should Advice on fish consumption: benefits and risk. http:// then integrate some points such as the link between health www.food.gov.uk/multimedia/pdfs/fishreport2004full.pdf and physiological status of n-3 LC PUFA, and then the link (accessed April 2007). 6. Arterburn LM, Hall HB & Oken H (2006) Distribution, between PUFA intake and biology, i.e. biomarkers of intake interconversion, and dose response of n-3 fatty acids in (33) such as EPA and DHA in blood , which need further human. Am J Clin Nutr 83, 1467S–1476S. investigation and will be the topic of another paper. 7. Akabas RS & Deckelbaum RJ (2006) Preface. Am J Clin Nutr 83, Suppl., 1451S. 8. Martin A (2001) Apports nutritionnels conseille´s pour la population française, 3rd ed. Paris: Tec&Doc. Conclusion 9. International Society for the Study of Fatty Acids and Lipids (2004) Report of the Sub-Committee on commendations for The CALIPSO survey is the first one in France that focused intake of PUFA in healthy adults. Issfal Newsletter. 10. Kris-Etherton PM, Harris WS & Appel LJ (2002) Fish on French high seafood consumers. The main inclusion consumption, fish oil (n-3) fatty acids, and cardiovascular criteria allowed us to reach the expected target population, disease. Circulation 106, 2747–2754.

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use. 608 N Bemrah et al.

11. Australian Health and Medical Research Council (2005) Diet Studies, Brisbane, Australia, 4–15 February 2002. Nutrient reference values for Australia and New Zealand. http://www.who.int/foodsafety/publications/chem/tds_feb http://www.nhmrc.gov.au/publications/synopses/_files/n35. 2002/en/index.html pdf (accessed April 2007). 23. World Health Organization/National Agricultural Research 12. Pawlosky RJ, Hibbeln JR, Novotny JA & Salem N Jr (2001) Institute/Food and Agriculture Organization of the United Physiological compartmental analysis of alpha-linolenic Nations (2004) Third International Workshop on Total Diet acid metabolism in adult humans. J Lipid Res 42, Studies, Paris, France, 14–21 May 2004. http://www.who. 1257–1265. int/foodsafety/publications/chem/tds_paris04/en/index.html 13. Goyens PLL, Spilker ME, Zock PL, Katan MB & Mensink RP 24. World Health Organization/US Food and Drug Administra- (2005) Compartmental modeling to quantify alpha-linole- tion (1999) GEMS/Food total diet studies – joint USFDA/ nic acid conversion after longer term intake of multiple WHO international workshop in cooperation with the Pan tracer boluses. J Lipid Res 46, 1474–1483. American Health Organization. http://www.who.int/food 14. Burdge GC & Wootton SA (2002) Conversion of alpha- safety/publications/chem/tds_aug1999/en/index.html linolenic acid to eicosapentaenoic, docosapentaenoic and 25. Sirot V, Oseredczuk M, Bemrah-Aouachria N, Volatier JL & docosahexaenoic acids in young women. Br J Nutr 88, Leblanc JC (2008) Lipid and fatty acid composition of fish and 411–420. seafood consumed in France. J Food Compos Anal 21, 8–16. 15. Burdge GC & Calder PC (2005) Conversion of alpha- 26. Agence Française de Sećurite´ Sanitaire des Aliments (2005) linolenic acid to longer-chain polyunsaturated fatty acids in Data from the French database REGAL of the Informatics human adults. Reprod Nutr Dev 45, 581–597. Centre for Food Quality of the French Food Safety Agency. 16. CREDOC-AFSSA-DGAL ( JL Volatier, coordinator) (2000) Retrieved September 2005 (not published). Enqueˆte nationale sur les consommations alimentaires. 27. Souci SW, Fachmann W & Kraut H (2000) Food Composition Paris: Tec&Doc. and Nutrition Tables, 6th ed., revised and completed. Boca 17. Dufour A & Volatier JL (1998) Enqueˆte sur la consommation Raton, FL: Medpharm Scientific Publishers, CRC Press. alimentaire dans le Nord Cotentin pour la Cogema. Internal 28. Jonnalagadda SS, Egan SK, Heimbach JT, Harris SS & Technical Report. Paris: French Research Center for the Kris-Etherton PM (1995) Fatty acid consumption pattern of Study and Monitoring of Living Standards. Americans: 1987–1988 USDA nationwide food consump- 18. Institut National de la Statistique et des Etudes Economi- tion survey. Nutr Res 15, 1767–1781. ques (National Institute for Statistics and Economic Studies) 29. Allison DB, Egan SK, Barraj LM, Caughman C, Infante M & (1999) Population Census March 1999. http://www. Eimbach JT (1999) Estimated intakes of trans fatty and recensement.insee.fr/RP99/rp99/page_accueil.paccueil?nivgeo5 other fatty acids in the US population. J Am Diet Assoc 99, F&theme5ALL&typeprod5ALLamp;lang5EN&lang5EN 166–174. 19. Leblanc JC (coordinator) (2006) CALIPSO, Fish and seafood 30. Hibbeln JR, Nieminen LRG, Blasbalg TL, Riggs JA & Lands consumption study and biomarker of exposure to trace WEM (2006) Healthy intakes of n-3 and n-6 fatty acids: elements, pollutants and omega 3. http://www.afssa.fr/ftp/ estimations considering worldwide diversity. Am J Clin afssa/38719-38720.pdf Nutr 83, 1483S–1493S. 20. Le Moullec N, Deheeger M, Preziosi P, Montero P, Valeix P, 31. Yamada T, Strong JP, Ishii T, Ueno T, Koyama M, Rolland-Cachera ME, Potier de Courcy G, Christides JP, Wagayama H, Shimizu A, Sakai T, Malcom GT & Guzman Galan P & Hercberg S (1996) Validation du manuel-photos MA (2000) Atherosclerosis and omega-3 fatty acids in the utilise´ pour l’enqueˆte alimentaire de l’e´tude SUVIMAX. populations of a fishing village and a farming village in Cah Nutrt Diet 31, 158–164. Japan. Atherosclerosis 153, 469–481. 21. Leblanc JC, Tard A, Volatier JL & Verger P (2005) Estimated 32. Dewailly E, Blanchet C, Lemieux S, Sauve´ L, Gringas S, dietary exposure to principal food mycotoxins from Ayotte P & Holub BJ (2001) N-3 fatty acids and the French Total Diet Study. Food Addit Contam 22, cardiovascular disease risk factors among the Inuit of 652–672. Nunavik. Am J Clin Nutr 74, 464–473. 22. World Health Organization/Australia New Zealand Food 33. Harris WS (2007) Omega-3 fatty acids and cardiovascular Authority/Food and Agriculture Organization of the United disease: A case for omega-3 index as a new risk factor. Nations (2002) Second International Workshop on Total Pharmacol Res 55, 217–223.

Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 16:41:41, subject to the Cambridge Core terms of use.