Fish Consumption Frequency in the Adult Population in Poland

Abstract

Fish provide energy, protein, and other important nutrients, including n-3 fatty acids, vitamin D, and iodine. However, some species of fish could contain contaminants such as mercury and dioxins. The aim of the study was to assess the frequency of fish consumption in Poland, including of sea and freshwater fish species, referring to some socio-economic determinants. The frequency of consumption was assessed using Food Propensity Questionnaire data from 1489 adults (722 males, 767 females) in 2019–2020. The fish consumption frequency in Polish adults was lower than the recommendation (at least twice a week). About 80% of respondents consumed fish less frequently than recommended. Sea fish were mostly consumed less than once a month (31.8%) or 1–3 times a month (30.9%). Most subjects (44.8%) consumed freshwater fish less than once a month. Consumption also depended educational level, economic status, place of residence, declared health status, and BMI value or BMI status. However, taking into account sex, the occurrence of these relationships was different between men and women. It seems that educational activities and dissemination of proper nutrition principles is necessary in order to increase the consumption of fish in Poland. It is important to emphasize the health benefits of fish consumption in relation to the possible adverse effects of their contamination.

1. Introduction

Fish are an important source of energy, protein, and a range of other important nutrients for maintaining health, including long-chain omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), iodine, selenium, vitamin D, taurine, and carnitine, which have metabolic and hormonal importance [1,2]. The richest source of long-chain omega-3 fatty acids is oily sea fish, such as herring, salmon, pilchards, mackerel, sardines, sprats, and trout. These fish are also a valuable source of vitamin D. Oily sea fish that are eaten with bones, such as canned sardines, also provide calcium and phosphorus. White fish (cod, haddock, plaice, pollock, dabba, flounder, mullet, gurnard, and tilapia) are low-fat (lean fish). Some species (e.g., sea bass, bream, turbot, and halibut) can be a source of omega-3 fatty acids, but contain smaller amounts of these acids than oily fish (UK).

Eating fish at least twice a week is recommended by nutritionists around the world. It is assumed that the consumption of two servings of sea fish corresponds to an intake of DHA + EPA at the level of 250 mg/day [3,4,5].

However, some species of fish could contain contaminants such as mercury and dioxins. It is important to emphasize the benefits of fish consumption for multiple health outcomes throughout the life course, including during pregnancy, childhood, and adulthood [1].

According to an EUMOFA report, the total production of EU fisheries and aquaculture in 2023 was 3.6 million tonnes, representing more than a quarter of European production. In Europe as a whole, a share of more than 50% is related to five fish species, namely, herring (with 1.8 million tonnes produced in 2021), Alaska pollock (with 1.7 million tonnes), cod (with 1.3 million tonnes) and blue whiting and mackerel (together, more than 1.2 million tonnes) [6].

In Poland, processed fish products (including canned fish) account for the largest share (45.2%) of total fish industry production. The highest share of such products was observed in Germany, of 81%. In Poland, processed herring products have the largest market share (43% in 2022). It should be added that Poland is the most important producer of salted fish products (29.3% of total EU production in 2022) [7].

According to the results of the Household Budget Survey provided by Statistics Poland, in 2012 the average consumption of fish and fish products in all households was 0.42 kg/person/month, of which sea and freshwater fish (fresh, chilled or frozen) was 0.26 kg/person/month [8]. In 2022, the consumption of fish and seafood and their products was 0.24 kg/person/month. Dried, smoked, or salted fish and seafood accounted for 37.5% of this food group [9]. These differences may be due to a change in the classification of fish products in the Household Budget Survey. Currently, consumption data do not include tinned and pickled fish. These data are only included in expenditure.

According to the Food Balance Sheet, the consumption of fish and seafood in 2022 was 13.68 kg/person/year in live fish equivalents [10]. Using conversion factors developed on the basis of Polish Food Composition Tables [11], the consumption of fish edible parts in 2022 was 7.43 kg/person/year. Most of the fish consumed in Poland was frozen fish, with a share of 79.5%. Compared to the previous year, this consumption was about 5% lower. The share of freshwater fish was 16.9% [10].

According to FAOSTAT data, fish consumption in Poland in 2021 was lower than in the European Union as a whole. For sea fish it was 9.75 kg/person/year in Poland com-pared to 13.97 kg/person/year in the European Union. For freshwater fish it was 0.92 vs. 3.78 kg/person/year [12].

Polish market analysis has shown that Poles mainly consume sea fish, such as pollock, herring, mackerel, cod, and, less frequently, tuna and salmon; consumption of freshwater fish is mainly of panga [13]. The results of a nationwide cross-sectional study conducted in 2021 among Polish youth aged 14–22 years shows that the species of fish most frequently consumed by respondents were salmon, cod, mackerel, herring, tuna, and pollock [14].

In addition to providing valuable nutrients, fish is also a source of contaminants, particularly heavy metals. A problem of fish contamination has been observed, particularly with dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) and methylmercury [1,15,16,17].

According to a study carried out by the National Marine Fisheries Research Institute in cooperation with the National Research Institute of Animal Production, the National Veterinary Institute—National Research Institute and Eurofins Steins Laboratory, the average content of toxic metals (mercury, lead, and cadmium) in Baltic fish (cod, herring, and salmon) is low in comparison with the maximum acceptable levels for fish. It should be added that Baltic fish are more contaminated with mercury than other fish species, but the levels are very low compared to the maximum permissible limit [18].

The aim of the study was to assess the frequency of fish consumption in Poland, including sea and freshwater fish species, in relation to some socio-economic determinants.

2. Materials and Methods

2.1. Study Population

This study was a part of the Nationwide Dietary Cross-Sectional Survey in Poland, conducted from July 2019 to February 2020 in a representative nationwide sample of adolescents (aged 10–17 years) and adults (aged ≥ 18 years) according to the European Food Safety Authority (EFSA) guidance on the EU Menu methodology [19,20]. It included assessment of dietary habits, nutritional status, and physical activity level. The study protocol was approved by the Bioethics Committee at the Institute of Food and Nutrition in Warsaw, Poland (approval dated 4 June 2018). Participation in the study was voluntary. Written informed consent to participate in the study was obtained from each respondent.

The sample selection procedure consisted of the stratification of the Polish population and the random selection of individuals. Subjects were randomly selected from the PESEL register (the national register of inhabitants in Poland) [21]. The stratified sampling method was used taking into account such demographic details as gender (male, female), age (7 age cohorts), the size of the place of residence, and the territorial distribution within voivodships (16 voivodships, 9 subdivisions of localities). All the steps taken to conduct the study were described in the report published by EFSA [22].

Individuals that were hospitalized and/or were following enteral and parenteral nutrition because of their health conditions, and individuals whose mental condition made it impossible to obtain reliable information (neurodegenerative diseases, drunkenness, or state after taking drugs and other stimulating substances) were excluded from the study.

To avoid unforeseen circumstances or refusals, and to ensure that the planned number of people was reached, 10 times more people were randomly selected than the planned number of respondents. If a participant refused to participate in the study, withdrew from the study, or met the exclusion criteria, the next person in the group was selected. Interviewers contacted 4249 persons and the response rate was 57%. Data were collected from 2432 adolescents and adults, but only adults (persons ≥ 18 years old) were included in the analysis of the fish consumption frequency. Complete data on fish consumption frequency were collected from 1489 adults (722 males, 767 females).

2.2. Data Collection

Data were collected by interviewers in the respondents’ homes. The CAPI (Computer Assisted Personal Interview) technique was used. Each interviewer was previously trained but also had experience in collecting data in similar studies.

The sociodemographic data were collected using a questionnaire containing questions about, among other factors, sex (male or female), age (in years), educational level, economic status, and place of residence (rural or urban). Educational level was classified as follows: primary education/lower secondary education, vocational education, upper secondary education, post-secondary education, and higher education. Economic status was assessed on a 5-point scale: very good, good, fair, poor, very poor. Participants were also asked about their self-reported health status (covering both physical and mental health).

Based on the questionnaire used by Statistics Poland in the European Health Interview Survey (EHIS) [23], the following question was used: “How is your health in general?” with five possible answers: “very good”, “good”, “neither good nor bad”, “bad”, or “very bad”.

Physical activity was assessed using the Polish version of the International Physical Activity Questionnaire (IPAQ) [24].

Food consumption frequency data, including fish consumption, were collected using the Food Propensity Questionnaire (FPQ). This questionnaire was based on a food frequency questionnaire developed by the Polish Academy of Sciences [25] and on the information from the project “Pilot study in the view of a Pan-European dietary survey-adolescents, adults and elderly (PANEU)” [26]. Respondents were asked about their frequency of fish consumption during the 12 months prior to the study. They could choose from the following answers: “never”, “less than once a month”, “1–3 times a month”, “once a week”, “2–3 times a week”, “4–5 times a week”, “once a day”, or “several times a day”. It was also possible to choose the answer “I don’t know”. During the data collection, the interviewer asked the respondent about the consumption of fish, giving the example of sea fish (such as salmon, hake, cod, pollack, herring, mackerel, and sardines) and freshwater fish (such as carp, trout, pikeperch, pike, bream, tench fish, roach, and perch).

Anthropometric measurements including height and body weight were taken on the respondents. Height measurements were made using a portable stadiometer, ensuring accuracy of 0.1 cm. Body weight was measured using electronic scales with accuracy of 0.1 kg. The results of height and weight measurements were used to calculate the Body Mass Index (BMI) as weight divided by height square (kg/m²). The BMI categories were identified according to WHO criteria [27].

2.3. Statistical Analysis

Data were analyzed using the computer software PQStat 1.8.2. In the case of continuous data (age, BMI values), normality of distribution was verified using the Shapiro–Wilk test. The data distribution was not normal, so the significance of difference was assessed using the Mann–Whitney U test for non-parametric data. The chi-square test was used for qualitative data. Relationships between sociodemographic factors, BMI, health status, physical activity level, and fish consumption frequency were examined using Spearman’s correlation. A significance level of α = 0.05 was used for all analyses.

3. Results

3.1. Characteristic of Subjects

Of the 1489 subjects, 48.5% were men and 51.5% were women. The average age of subjects was 51.6 ± 19.6 (18–96) and was similar in men and women (51.6 ± 19.6 and 51.5 ± 19.7, respectively, p = 0.8689). Most respondents had an upper secondary education (42.7%), followed by vocational education (31.8%). More women than men had a higher education level (16.3% vs 8.7%) and more men than women had a vocational education (37.8% vs 26.1%) (p < 0.0001). Most subjects described their economic status as “moderate” (52.7%) or “good” (37.6%). More respondents lived in an urban setting than a rural setting (58% vs. 42%). In the case of health status, respondents most often chose the answer “good” (45.1%), followed by “moderate” (31.6%). Most respondents had moderate physical activity level (44.3%), but one-third of the participants were characterized by a high level of physical activity. The average BMI value of subjects was 26.0 ± 4.0 (16.1–41.5). Only 41.6% had a normal weight. Overweight or obesity was observed in 57.1% persons. The mean BMI value was lower in women than men (25.2 ± 4.3 vs. 26.7 ± 3.5, p < 0.0001). More women than men had a normal weight (51.9% vs. 30.7%), whereas more men than women were overweight (53.3% vs. 31.4%, p < 0.0001) (

Table 1. Sociodemographic characteristic, health status, physical activity level, and BMI status of subjects.

Parameter	Total n = 1489		Men n = 722		Women n = 767		M vs. W
	n	%	n	%	n	%	p *
Educational level:
Primary education/lower secondary education	142	9.5	65	9.0	77	10.0	<0.0001
Vocational education	473	31.8	273	37.8	200	26.1
Upper secondary education	636	42.7	305	42.2	331	43.2
Post-secondary education	50	3.4	16	2.2	34	4.4
Higher education	188	12.6	63	8.7	125	16.3
Economic status:
Very bad	8	0.5	4	0.6	4	0.5	0.2711
Bad	74	5.0	27	3.7	47	6.1
Moderate	784	52.7	384	53.2	400	52.2
Good	560	37.6	279	38.6	281	36.6
Very good	63	4.2	28	3.9	35	4.6
Place of residence:
Rural	624	42.0	304	42.3	320	41.7	0.8270
Urban	862	58.0	415	57.7	447	58.3
Health status:
Very bad	6	0.4	3	0.4	3	0.4	0.6300
Bad	43	2.9	26	3.6	17	2.2
Moderate	471	31.6	226	31.3	245	31.9
Good	672	45.1	325	45.0	347	45.2
Very good	297	19.9	142	19.7	155	20.2
Physical activity level:
Low	335	22.5	148	20.5	187	24.4	0.1857
Moderate	660	44.3	325	45.0	335	43.7
High	494	33.2	249	34.5	245	31.9
BMI status:
Underweight	18	1.2	2	0.3	16	2.1	<0.0001
Normal weight	620	41.6	222	30.7	398	51.9
Overweight	626	42.0	385	53.3	241	31.4
Obese	225	15.1	113	15.7	112	14.6

M vs. W—men versus women, * chi-square test.

).

3.2. Fish Consumption Frequency during the 12 Months Prior to the Study

The assessment of fish consumption frequency in the adult population in Poland indicated that their consumption was lower than the recommendations (at least 2 times a week) (

Table 2. Fish consumption frequency in the Polish adults.

Consumption Frequency	Total		Men		Women		M vs. W
	n	%	n	%	n	%	p *
Sea fish
I don’t know	28	1.9	11	1.5	17	2.2	0.3412
Never	76	5.1	39	5.4	37	4.8
Less than once a month	474	31.8	225	31.2	249	32.5
1–3 times a month	460	30.9	238	33.0	222	28.9
Once a week	375	25.2	177	24.5	198	25.8
2–3 times a week	66	4.4	29	4.0	37	4.8
4–5 times a week	6	0.4	3	0.4	3	0.4
Once a day	4	0.3	0	0	4	0.5
Several times a day	0	0	0	0	0	0
Freshwater fish
I don’t know	33	2.2	16	2,2	17	2.2	0.2173
Never	169	11.4	80	11.1	89	11.6
less than once a month	667	44.8	317	43.9	350	45.6
1–3 times a month	443	29.8	235	32.5	208	27.1
once a week	141	9.5	59	8.2	82	10.7
2–3 times a week	27	1.8	12	1.7	15	2.0
4–5 times a week	8	0.5	2	0.3	6	0.8
once a day	1	0.1	1	0.1	0	0
several times a day	0	0	0	0	0	0
Total fish
I don’t know	22	1.5	10	1.4	12	1.6	0.2428
Never	22	1.5	14	1.9	8	1.0
Less than once a month	413	27.7	198	27.4	215	28.0
1–3 times a month	319	21.4	157	21.7	162	21.1
Once a week	405	27.2	194	26.9	211	27.5
2–3 times a week	257	17.3	131	18.1	126	16.4
4–5 times a week	37	2.5	13	1.8	24	3.1
Once a day	12	0.8	3	0.4	9	1.2
Several times a day	2	0.1	2	0.3	0	0.0

Men vs. Women—men versus women, * chi-square test.

). Only 20.7% of respondents (20.6% of men, 20.7% of women) consumed fish twice a week or more often. Respondents most often declared that they consumed fish less than once a month (27.7%) or once a week (27.2%). There were no significant differences in the consumption frequency of total fish between men and women.

Sea fish were most often consumed less than once a month (31.8% of subjects) or 1–3 times a month (30.9% of subjects). Most males (33%) consumed sea fish 1–3 times a month and most females (32.5%) consumed sea fish less than once a month. One-quarter of respondents, including both men and women, ate sea fish once a week. Only 5.1% of respondents (4.4% of men, 5.7% of women) declared more frequent consumption of sea fish.

Freshwater fish were eaten even less frequently by both men and women. Most subjects (44.8%) consumed them less than once a month. Many respondents (29.8%) ate freshwater fish 1–3 times a month. Only 11.9% of subjects ate these fish once a week or more often.

3.3. Relationships between Sociodemographic Factors, BMI, Health Status, Physical Activity Level, and Fish Consumption Frequency

For the whole group of respondents, a significant positive relationship was observed between the consumption frequency of total fish, sea fish, and freshwater fish, and educational level, economic status, place of residence, and health status. A negative relationship was noted in the case of the consumption frequency of freshwater fish and BMI value, and the consumption frequency of sea fish and BMI status.

In men, the consumption frequency of total fish, sea fish, and freshwater fish was positively related to educational level and economic status, and negatively related to BMI value. Additionally, the consumption frequency of total fish and sea fish was positively related to health status and negatively to BMI status.

In women, a positive relationship was observed between the consumption of total fish and sea fish and the place of residence; between the consumption of total fish and freshwater fish and economic status; and between the consumption of freshwater fish and educational level and health status (

Table 3. Relationships between sociodemographic factors, BMI, health status, physical activity level, and fish consumption frequency in the Polish adults.

Type of Fish		Total Fish			Sea Fish			Freswater Fish
Parameter		Total	Men	Women	Total	Men	Women	Total	Men	Women
Sex *	rs	0.0111			0.0149			−0.0062
	p	0.6715			0.5692			0.8126
Age	rs	−0.0112	-0.0095	−0.0121	−0.0129	−0.0084	−0.0165	−0.0391	−0.0517	−0.0267
	p	0.6672	0.801	0.739	0.623	0.8214	0.6526	0.1358	0.1704	0.4661
Educational level	rs	0.0822	0.0968	0.0659	0.0564	0.0806	0.0322	0.0877	0.0774	0.0976
	p	0.0016	0.0097	0.0703	0.0312	0.0315	0.3778	0.0008	0.0397	0.0075
Economic status	rs	0.1709	0.2352	0.1129	0.126	0.1963	0.0646	0.1245	0.143	0.1077
	p	<0.0001	<0.0001	0.0019	0.0001	<0.0001	0.0768	<0.0001	0.0001	0.0032
Place of residence **	rs	0.0779	0.0438	0.1095	0.0657	0.035	0.0937	0.0576	0.035	0.069
	p	0.0029	0.2438	0.0026	0.0121	0.3523	0.0103	0.0281	0.3523	0.0589
Health status	rs	0.0763	0.1089	0.0453	0.0656	0.101	0.0323	0.0779	0.0655	0.0894
	p	0.0034	0.0036	0.2135	0.0121	0.007	0.376	0.0029	0.0822	0.0143
BMI value	rs	−0.0403	−0.122	0.0172	−0.0459	−0.121	0.0064	−0.0565	−0.0911	−0.0398
	p	0.1227	0.0011	0.6365	0.0796	0.0012	0.8600	0.0311	0.0154	0.2761
BMI status	rs	−0.0461	−0.1005	−0.003	−0.0549	−0.1078	−0.0133	−0.0482	−0.0624	−0.0436
	p	0.0774	0.0073	0.934	0.0358	0.004	0.7163	0.0659	0.0976	0.2331
Physical activity level	rs	0.0262	0.0655	−0.0095	0.0409	0.0583	0.0262	−0.0214	0.0179	−0.0574
	p	0.3167	0.0809	0.7941	0.1183	0.1205	0.4741	0.4155	0.6343	0.1164

* range of men: 1, range of women: 2, ** range of rural: 1, range of urban: 2, rs—Spearman’s rho correlation coefficient.

).

4. Discussion

Food-based dietary guidelines in Poland emphasize the importance of eating fish, especially oily fish, such as salmon, herring, hake, and mackerel [4]. They were developed in the form of three steps. Step 1 concerns the initial stage of implementing the guidelines and indicates eating fish once a week, preferably oily fish. Step 2 concerns the recommended level and indicates eating fish at least twice a week, including oily fish at least once a week. Step 3 concerns achieving further health benefits and indicates eating a variety of oily fish twice a week. Most of the studied population did not follow these guidelines at the recommended level; 77.8% of subjects declared that they eat fish less than twice a week and 1.5% could not specify how often. Moreover, half of respondents (50.6%) did not eat fish even once a week.

The frequency of fish consumption was part of a study conducted in Poland in 2021–2022 among young adults aged 19–30 years. The majority of that population reported a consumption frequency of from one to three times a month: 42% of men and 36% of women. Respectively, 17% and 15% of respondents consumed fish once a week, while 14% and 10% consumed fish less than once a month [28]. Although these percentages differed from those obtained in our study, the cited study [28] confirms the low fish consumption in the Polish population. Consumption according to the recommendations of at least twice a week was reported by only 15% of men and 19% of women. In our study, this percentage was slightly higher in men and similar in women.

Too-low fish consumption, as well as eating fish in too-small quantities compared to the recommendations, was also observed in the nationwide cross-sectional study conducted in 2021 among Polish youth aged 14–22 years. Only 13% of the survey participants consumed fish 1–2 times a week or more often. Consumption of fish products with this frequency was declared by only 5.6% of the respondents. The majority of the survey participants consumed fish (70.5%) and fish products (53.7%) 1–3 times a month or less often. Fish were not consumed at all by 16.5% of the respondents, and fish products were not consumed at all by 40.8%. The average amount of fish and fish products consumed by the surveyed young people was 78.7 g/week (girls: 65.8 g/week, boys: 103.6 g/week), and among their parents/guardians it was 107.2 g/week (women) and 165.7 g/week (men) [14].

A study conducted in 2019 among subjects aged 50 or over also confirmed the low consumption of fish in Poland [29]. Fish was usually eaten once a week or less; the percentage of subjects consuming fish several times a week was 15.26%, and the percentage of subjects consuming fish daily was 1.56%. A similar study was carried out in Greece, where these percentages were higher: 23.4% consumed fish twice a week, and 4.17% consumed fish daily [29].

Countries with low fish consumption also include Bulgaria. According to a study conducted in 2018, the largest percentage of respondents (45.8%) consumed fish 1–2 times a month, 25% 1–2 times a week, and 5% more than twice a week [30].

In the US, a low percentage (14%) of adults aged between 20–65 years consumed seafood (fish and shellfish) more than eight times a month between 2011 and 2016 [31].

In contrast, countries with a high frequency of fish consumption include Portugal. A 2012 study estimated that 77% of respondents ate fish at least twice a week, and 13.2% once a week [32]. The same group of researchers conducted a parallel study in Brazil. In this country, the frequency of fish consumption was lower: 12% ate it at least twice a week, and 28.7% once a week [32].

Our study reported a higher consumption of sea fish than freshwater fish. Polish food-based dietary guidelines at the recommended level indicate eating oily sea fish (salmon, herring, hake, mackerel, sardine, or cod) at least once a week [4]. However, the majority of respondents (67.8%) consumed sea fish less than once a week, and 1.9% could not determine the frequency of consumption of these fish. It would be very difficult to achieve step 3 of guidelines, which suggests eating these fish twice a week, because as many as 93.0% of respondents reported less frequent consumption of sea fish.

Consumption of sea fish was also examined in a nationwide study carried out by the National Institute of Public Health NIH—National Research Institute in 2018 (before the COVID-19 pandemic) and 2022 (post-pandemic) among subjects aged 20 or older [33]. That kind of fish was most often eaten less than once a week: by 47.1% in 2018 and by 49.4% in 2022. Only 7.8% of respondents in 2018, and 8.1% in 2022, ate sea fish at least twice a week. In our study, sea fish was also more frequently consumed once a week and was very rarely consumed more frequently, but these percentages were lower than in the cited 2018 and 2022 studies. Similarly, in a Cyprus study, a decrease in fish consumption frequency after the COVID-19 pandemic was observed: for 1–2 portions/week, the share fell from 45.2% (before pandemic) to 36.1% in normal-weight persons aged 18 years old and over [34].

In our study, there was no difference in fish consumption between men and women. Similarly, in a study by Frąckiewicz et al. [28], gender was not a differentiating factor in the case of the frequency of fish consumption. A study conducted in Spain in 2009–2013 among respondents aged 9–75 also showed no differences in the consumption of fish and seafood depending on gender [35]. In our study, the frequency of consumption of sea and freshwater fish did not differ significantly between men and women. In another Polish study, there were also no differences in the frequency of sea fish consumption between 2018 (before the COVID-19 pandemic) and 2022 (after the pandemic) among men or women. [33]

We found that the frequency of fish consumption was also influenced by educational level and economic status. A higher educational level and economic status were associated with more frequent fish consumption. Fish prices in Poland are generally higher than meat prices. According to Statistics Poland, in 2019–2020, the price of frequently consumed fish (frozen fillets of hake) was 33–38% higher than the price of frequently consumed pork (loin), and 3.4–3.6 times higher than the price of poultry (disemboweled chicken) [36].

A similar relationship related to educational level and economic status and fish consumption was found in a study conducted in the Netherlands in 2007–2013 [37]. With the increase in education or income level, fish consumption also significantly increased. Educational level also had an influence on fish consumption in a study conducted among 25–65-year-old residents of the Subcarpathian voivodeship in Poland [38]. Higher-education respondents were much more likely to choose fish than those with lower levels of education.

Our study showed fish consumption was influenced by the place of residence; urban dwellers consumed it more often. Such a relationship was not observed in the above-mentioned study from the Subcarpathian voivodeship [38].

In our study, a higher frequency of fish consumption was associated with better health. In addition, among men, a higher frequency of fish consumption was observed among respondents with a lower BMI. Similar relationships were reported in the NHANES 2011–2016 in the USA [31]. A greater seafood intake frequency was associated with healthier body measurements and blood pressure and dietary intake.

Frequent consumption of fish is associated with many health benefits. Beneficial effects of fish consumption are observed in cardiovascular diseases. A meta-analysis by Ricci et al. [39] confirmed that two servings of fish per week could reduce the cardiovascular risk by approximately 10%. In a cohort study conducted in Japan, it was shown that a higher frequency of fish intake was associated with a lower neutrophil/lymphocyte ratio (NLR), a marker of systemic inflammation, which may be associated with the development of coronary artery disease events [40]. A study in China found that higher fish consumption (300–450 g/week) reduced the risk of total stroke and ischemic stroke compared to consuming less fish [41]. In a Dutch cohort, consumption of at least 1 portion/week of fatty or lean fish reduced the incidence of ischemic stroke [42].

Frequent fish consumption may be particularly important for people suffering from diseases. In an analysis of four cohort studies, a lower risk of cardiovascular disease and total mortality was found with higher fish consumption (at least 175 g/week) among high-risk subjects or those with vascular disease. No such relationship was observed in the general population without vascular disease [43].

However, the way fish is prepared is important. Studies indicate that non-fried fish consumption may be associated with a reduced risk of overall cardiovascular disease and myocardial infarction; however, fried fish consumption may increase the risk of overall cardiovascular disease and myocardial infarction [44].

High consumption of fish may reduce the risk of depression [45,46]. The anti-inflammatory properties of long-chain omega-3 polyunsaturated fatty acids contained in fish may be important in preventing depression [47]. The PREDIMED-Plus trial showed that even a moderate intake of fatty fish (about 20–30 g/day) was inversely associated with depression prevalence [48].

The effect of fish consumption on reducing the risk of depression may vary depending on gender. a longitudinal study from Australia reported that women who ate fish 2 times/week or more had significantly lower depression than those who ate fish less frequently, while for men, depression was not associated with fish consumption [49].

Fish consumption may also be beneficial for dementia. A meta-analysis of seven prospective cohort studies found that subjects with the highest category of fish consumption had a 17% reduced risk of dementia compared with those with the lowest category of fish consumption [50].

Data on the impact of fish consumption on the risk of cancer are not clear. According to the WCRF/AICR, limited evidence shows that fish consumption reduces the risk of colorectal and liver cancers [51]. On the other hand, it is not beneficial to eat salted fish, which can increase the risk of nasopharyngeal cancer. According to an umbrella review of meta-analyses from 2020, in most of the analyzed studies the relationship between fish and omega-3 fatty acid intake and cancer risk was insignificant or weak [52].

The literature also reports the problem of fish contamination, especially with dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) and methylmercury [1,15,16,17].

It is demonstrated in studies that the overall health benefits of a high consumption of fish high in omega-3 fatty acids may outweigh the adverse effects of contaminants [1,53,54]. However, special consideration should be taken to avoid potential risks due to contaminant exposure for selected groups, such as children, women of childbearing age, pregnant women, and breastfeeding mothers [55,56].

Infrequent fish consumption may contribute to deficiencies in omega-3 acids, especially docosahexaenoic acid (DHA). People who do not eat fish or eat them in small amounts should consider supplementing omega-3 acids. In particular, in the preconception period, supplementation with this nutrient is recommended for pregnant women and women who do not eat fish or eat it in small amounts due to the influence of DHA on the proper course of pregnancy and ensuring the proper development of the child [57].

There is a need to educate and promote dietary recommendations to increase awareness of the beneficial health effects of fish consumption and to increase the availability of fish for the average consumer. It is important to involve government administration in such activities. In 2008–2009, the Ministry of Agriculture and Rural Development conducted a nationwide educational campaign in Poland on the benefits of eating fish under the slogan “Fish Affects Everything”, the aim of which was to increase fish consumption among Poles. The campaign included television and radio spots aimed at people at different stages of life and different social groups, to make consumers aware of the benefits of a fish diet from early childhood to old age. As reported by the Ministry, as a result of this campaign, there was an increase in average fish consumption (in 2007 the average was 12.91 kg/person, in 2008 the average was 13.67 kg/person, and in 2009 the average was 13.94 kg/person) [58].

Nationwide studies carried out in Poland in 2018 and 2022 showed that the Internet was a very important source of nutritional knowledge, in particular among women. Poles also often used knowledge obtained from family or friends. Unfortunately, information from a doctor or nurse was used less in 2022 than 4 years earlier [33]. Therefore, it is essential to use the Internet as a pathway to disseminate knowledge about the health benefits of eating fish.

The relationship between fish consumption and health benefits and possible risk requires further research. In particular, it is important to conduct in-depth analyses of the consumption of individual species.

4.1. Strengths of the Study

This study examined the fish consumption frequency in a representative group of Polish adults.

The study of the frequency of consumption covered the whole year. The results were not disturbed by seasonal variation. The method used made it possible to study consumption in people who rarely eat fish.

This study may have practical implications for policymakers and public health authorities.

This study underlines the need to provide a nationwide campaign on increasing fish consumption.

The sociodemographic factors associated with fish consumption that were identified in this study may allow personalizing educational campaigns in that area.

4.2. Limitations of the Study

This study has several limitations.

This study was based on the Food Propensity Questionnaire method, and focused not only on fish consumption habits, but also covered other food groups. The selected fish species were not included in the questionnaire.

The study was conducted just before the COVID-19 pandemic. During the pandemic, other research on changes in consumption during this period was conducted in Poland. The nationwide survey, conducted in April and May 2020 among people aged 18 or over, showed that the quarantine had some impact on the frequency of fish consumption: 17.0% of respondents reported a decrease, 76.2% reported no change, and 6.8% reported an increase [59]. The above-mentioned study by the National Institute of Public Health NIH—National Research Institute examined sea fish consumption in 2018 and 2022, and found that consumption did not differ between before and after the pandemic [33]. However, it is not known whether this is also true for freshwater fish.

5. Conclusions

The fish consumption frequency in Polish adults was lower than the recommendations (at least 2 times a week). About 80% of respondents consumed fish less frequently than recommended.

The frequency of consumption of total fish, as well as of sea fish and freshwater fish, was similar in men and women, and depended on sociodemographic factors, such as educational level, economic status, place of residence; on reported health status; and additionally, in the case of freshwater fish and sea fish, on BMI value or BMI status. However, taking into account sex, the occurrence of these relationships was different between men and women.

It seems that educational activities and dissemination of proper nutrition principles are necessary in order to increase the consumption of fish in Poland. It is important to emphasize the health benefits of fish consumption in relation to the possible adverse effects of its contamination.

There is a need for policies to create possible strategies such as tax incentives and guidelines for catering in educational institutions, hospitals, nursing homes, etc. Specific educational programs should be developed to promote dietary recommendations to increase awareness of the beneficial health effects of fish consumption, especially among people of low socioeconomic status, and to increase the availability of fish for the average consumer. The Internet should be used as an appropriate pathway to disseminate the knowledge on the health benefits of fish, in particular, oily sea fish.