Conclusions and Research Needs

This issue has outlined an approach to evaluate the potential health benefits of consuming fish against the potential health risks of eating contaminated fish. Some evidence exists for an association between decreased risk of coronary heart disease (CHD) or myocardial infarction (MI), and consumption of small amounts of fish, including mainly lean (nonfatty) fish. Additional studies have seen some association between eating fish and reduced risk of stroke and arthritis and enhanced immunological and nervous system development. These data, along with the superior nutritional value of fish, are strong enough that public health officials routinely encourage the public to eat more fish. Consuming uncontaminated fish (or at least fish that are smaller, younger, or in general less contaminated) may provide health benefits as mentioned, but without the potential health risks associated with contamination. Before eating any contaminated fish, consumers should consider fish supplies from cleaner water bodies, eating smaller, and less contaminated fish, and cooking and cleaning methods that reduce contaminants. The eating of such ‘‘cleaner’’ fish rather than more contaminated fish would maximize the net benefit of fish consumption. This is shown specifically in Figures 6–16 in the framework article for low versus high concentrations of chemicals in fish, for those chemicals that bioaccumulate, or for fish contaminated with more that one chemical. When alternatives to eating contaminated fish are not available or desired, it may be appropriate to weigh the risks of eating less of these contaminated fish with the benefits gained from eating more of these same fish. The framework developed here can crudely compare these risks and benefits.