A higher frequency of intake of lean, fatty, and total fish, and a pattern of consistent frequent fish intake over time, are associated with lower odds of pre-frailty in older community-dwelling Norwegian adults, finds a study published in BMCGeriatr
], one could speculate that fish intakes are over-reported. Another limitation is that the two variables on fish intake that provided the basis for the analyses were too crude to capture the participant’s absolute intake. Moreover, the variables depend on the participants' prior knowledge on what constitutes fatty and lean fish and this may have introduced uncertainty to the study.
Another limitation is the variation within the stable patterns of fish intake, owing to the definition criteria which allows for one differing frequency of intake. Thus, patterns might vary substantially within categories, depending on whether the 'one off' is a higher or lower frequency than the other two, or in what survey the different frequency of intake was reported.
Selection bias is a common limitation in cohort studies, because participants tend to be healthier and have better socioeconomic status than non-attenders []. This is emphasized by the overall good health of the study population and the low prevalence of pre-frailty in Tromsø7.
With these limitations in mind, the study’s results should be interpreted somewhat cautiously and their generalization is limited to relatively healthy, community-dwelling, older Norwegian adults. However, in favour of our findings of an inverse association between increased frequency of fish intake and pre-frailty after 8 years, were the results from the sensitivity analysis performed after exclusion of baseline pre-frail/frail participants and the tracking analysis with MI.
The strengths of the study include its longitudinal study design, the large study sample, and the use of validated instruments for frailty assessment. In addition, the available data were scrutinized to thoroughly assess the fish–pre-frailty association by investigating lean, fatty, and total fish, the impact of different lengths of follow-up and the specific adjustment for use of cod liver oil and LCn-3FA supplements.
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