Abstract TH919: Associations of total and types of fish intake with cardiometabolic diseases: cross-sectional findings from the South Asia Biobank

Introduction: Epidemiological evidence linking fish intake with cardiometabolic health remains mixed and inconsistent, with a paucity of data from South Asia. Hypothesis: We hypothesized that the association between fish intake and cardiometabolic health outcomes would vary by types of fish and preparation methods. Methods: We evaluated 108, 957 participants (mean age 46. 9y, 63% women) from Bangladesh, India, Pakistan, and Sri Lanka in South Asia Biobank (2018-24). Diet was assessed with interviewer-led digital 24 hour dietary recalls and health outcomes were defined from self-reports and objective measures. Multivariable-adjusted mixed-effect Poisson or linear regression was modelled to examine the cross-sectional associations of fish intake classified by type and preparation methods with prevalent type 2 diabetes (T2D), prevalent hypertension and serum lipid levels. Analyses were conducted by country and pooled using fixed-effect meta-analysis. Results: Proportion of participants reporting fish consumption varied by country: Sri Lanka, 65%; Bangladesh, 51%; India, 11%; and Pakistan, 2%. The overall prevalence of T2D was 26. 1%, hypertension, 35. 5% and dyslipidemia, 87. 9%. In the pooled analysis, higher total fish intake (40 g/day ≈ 2 servings/week) was positively associated with prevalent T2D, hypertension (Figure 1), and cholesterol levels (total cholesterol, LDL-C, and HDL-C) (Figure 2). The results for hypertension prevalence were heterogeneous by country (I² > 75%). Among types of fish, non-oily fish was positively associated with prevalent T2D and levels of total cholesterol, LDL-C and HDL-C, and oily fish was positively associated with total cholesterol and LDL-C. For preparation methods, fried fish was positively associated with prevalent T2D and cholesterol levels, while fish curry was positively associated with prevalent hypertension and cholesterol levels. Fish sourced as raw/frozen fish was positively associated with prevalent T2D and cholesterol levels but inversely associated with prevalent hypertension. Dried fish was positively associated with triglycerides. Conclusions: In four South Asian countries, higher total fish intake was weakly positively associated with prevalent T2D, hypertension and cholesterol levels, but heterogeneous by type of fish and by countries. These cross-sectional findings will guide prospective studies to compare findings, explore causality, and inform country-specific dietary guidelines for South Asian populations.