Chicken or salmon: the two salmon trials we have came out flat

Neither randomised trial we have of salmon found anything on the outcome it was built for, and only one of them put salmon against meat. Feeding 205 children aged four to six salmon three times a week for 16 weeks in place of meat raised their EPA and DHA and left every scale score of the WPPSI-III unchanged. Two of eight raw subtest scores favoured salmon, uncorrected for running eight comparisons. Giving 123 pregnant women who rarely ate oily fish two 150 g portions of farmed salmon a week from week 20 to delivery, against women who kept their habitual diet, changed neither the gut bacteria of the mothers nor the gut immune markers of their babies. Everything that separates these two foods comes from watching what people eat rather than assigning it. Across 14 prospective cohorts covering 911 348 adults and 75 451 deaths, each extra 20 g of fish a day went with 4 percent lower cardiovascular mortality, a relative risk of 0.96 with an interval of 0.94 to 0.98. People who ate more fish differed in other ways too. In the Western cohorts the curve was U-shaped with its low point near 20 g a day, about one salmon portion a week.

What your body absorbs

• Cooked salmon delivering 1.2 g of EPA plus DHA a day raised serum EPA by 129% over 8 weeks, more than cod liver oil delivering 3.0 g a day, which raised it by 106%. — 71 volunteers in five groups, 15 on cod liver oil and 15 on cooked salmon 400 g a week for 8 weeks (n = 71) Evidence C source
  Serum EPA +129% and DHA +45% on cooked salmon against +106% and +25% on cod liver oil, at a 2.5-fold lower dose

What it does to your health

• Each extra 20 g of fish a day was associated with 4% lower cardiovascular mortality (RR 0.96, 95% CI 0.94 to 0.98) across 14 prospective cohorts of 911 348 people. — 911 348 adults in 14 prospective cohort studies with 75 451 deaths (n = 911348) Evidence C source
  Cardiovascular mortality RR 0.96, 95% CI 0.94 to 0.98 per 20 g/d; all-cause mortality RR 0.98, 95% CI 0.97 to 1.00
• White meat such as poultry was associated with 13% lower stroke incidence (RR 0.87, 95% CI 0.78 to 0.97), while total and processed meat went the other way, in cohorts covering 254 742 people. — 254 742 adults in 7 prospective cohort studies of stroke incidence, 9 522 strokes (n = 254742) Evidence C source
  Stroke incidence RR 0.87, 95% CI 0.78 to 0.97 for white meat, against RR 1.17, 95% CI 1.08 to 1.25 for processed meat
• Feeding 205 preschool children salmon three times a week for 16 weeks instead of meat raised their EPA and DHA but left every WPPSI-III scale score unchanged. — 205 children aged 4 to 6 years randomised to salmon meals or meat meals three times weekly for 16 weeks (n = 205) Evidence B source
  No difference in WPPSI-III scale scores or the Nine Hole Peg Test; 2 of 8 raw subtest scores favoured salmon, symbol search p = 0.038 and picture concepts p = 0.047

Safety, limits and interactions

• FDA and EPA advise people who are pregnant or breastfeeding to eat 8 to 12 ounces of lower-mercury seafood a week, and salmon sits in the Best Choices group they name. — people who are pregnant or breastfeeding, and children aged 1 to 11 years Evidence E source
  8 to 12 ounces per week from lower-mercury choices; children 2 servings a week from the Best Choices list
• Atlantic salmon carried Anisakidae larvae in 5% of fish pooled across 83 surveys, against 33% for cod, and farmed fish were the least infected at 2%. — commercial fish sampled in 83 studies from 13 countries exporting to Belgium (n = 83 studies) Evidence C source
  Mean prevalence 5% in Atlantic salmon, 33% in cod, 2% in farmed fish, 68% in the Northeast Atlantic fishing zone
• Fish allergy in Europe was reported by 1.4% of people over a lifetime, but only 0.02% were confirmed by food challenge, pooled from 93 studies. — all age groups in 93 European prevalence studies published up to 2021 (n = 93 studies) Evidence C source
  Self-reported lifetime fish allergy 1.4%, 95% CI 0.8 to 2.0; challenge-verified point prevalence 0.02%, 95% CI 0.0 to 0.1
• Giving 123 pregnant women two 150 g portions of farmed salmon a week from week 20 to delivery changed neither maternal gut microbiota nor infant gut immune markers. — 123 women who rarely ate oily fish, randomised from 20 weeks of pregnancy to delivery, with 38 infants followed to day 84 (n = 123) Evidence B source
  No effect on maternal faecal microbiota, secretory IgA or calprotectin; Atopobium cluster counts lower in formula-fed infants of the salmon group, P below 0.05

What people believe that the data does not support

• Swapping red meat for poultry was associated with 12% lower coronary heart disease risk (RR 0.88, 95% CI 0.82 to 0.96), while the same swap for fish showed no association with coronary disease (RR 0.91, 95% CI 0.79 to 1.04), across 13 prospective studies. — adults in 13 prospective observational studies reporting substitution analyses (n = 13 studies) Evidence C source
  Coronary heart disease RR 0.88, 95% CI 0.82 to 0.96 for poultry replacement against RR 0.91, 95% CI 0.79 to 1.04 for fish replacement; all-cause mortality RR 0.92 for both
• The EU register authorises one heart claim for the EPA and DHA that salmon carries, and holds no authorised claim for chicken or any poultry substance. — food labelling in the European Union Evidence E source
  1 authorised claim for EPA and DHA on heart function, 9 authorised DHA claims in total, 0 for poultry

Who this works differently for

• Higher fish intake during pregnancy was associated with 25% lower food allergy in the child (pooled effect 0.75, 95% CI 0.64 to 0.88) across 31 observational studies. — mother and child pairs in 31 cross-sectional, case-control and cohort studies (n = 31 studies) Evidence C source
  Food allergy pooled effect 0.75, 95% CI 0.64 to 0.88; wheeze 0.97, 95% CI 0.96 to 0.99; asthma, rhinitis and eczema not associated

The bottom line

Chicken holds up well in the same kind of data. White meat, which in these analyses means poultry and explicitly excludes fish, went with 13 percent lower stroke incidence across seven cohorts covering 254 742 adults. That is a relative risk of 0.87 with an interval of 0.78 to 0.97, against 1.17 for processed meat in the same analysis. Replacing red meat with poultry went with 12 percent lower coronary heart disease risk in 13 prospective studies, 0.88 with an interval of 0.82 to 0.96. The same replacement with fish and seafood showed no association, 0.91 with an interval of 0.79 to 1.04. Heterogeneity of 69.5 percent makes that flat number weakly held rather than a finding that fish does nothing, and for all-cause mortality the two swaps land on the same value. What salmon carries and chicken does not is the omega-3 pair. In a non-randomised trial with five parallel groups of about 15 people, eight weeks of cooked salmon at 400 g a week supplied 1.2 g of EPA plus DHA a day. That raised serum EPA by 129 percent, against 106 percent on cod liver oil supplying 3.0 g a day. Groups that small and unrandomised make the size of the gap soft. The EU register authorises one heart claim for EPA and DHA and none for chicken or any poultry substance, which means nobody applied rather than that poultry was refused. The caution runs the other way. FDA and EPA advise people who are pregnant or breastfeeding to eat 8 to 12 ounces of lower-mercury seafood a week, roughly 225 to 340 g, with salmon on their Best Choices list. Poultry carries no advice of that kind. Anisakidae larvae turned up in 5 percent of Atlantic salmon pooled across 83 surveys of fish as caught, against 33 percent of cod, with farmed fish lowest at 2 percent. That is prevalence in fish rather than illness in people, and it is why raw salmon is subject to a freezing rule. We hold no card on the microbiology of raw poultry, so nothing on this page says anything about eating chicken raw. Fish is a named allergen and poultry is not. In 93 European studies, 1.4 percent of people reported fish allergy over a lifetime, interval 0.8 to 2.0, and 0.02 percent were confirmed by a food challenge. In pregnancy, higher fish intake went with 25 percent lower food allergy in the child across 31 observational studies, a pooled effect of 0.75 with an interval of 0.64 to 0.88. Nobody has studied poultry that way.

Sources

1. chsal-r2-04 · controlled clinical trial
   The serum content of EPA and DHA before and after intervention revealed a higher rise in EPA and DHA in the cooked salmon group (129% rise in EPA and 45% rise in DHA) as compared with CLO (106 and 25%, respectively) despite an intake of EPA and DHA in the CLO group of 3.0 g/d compared with 1.2 g/d in the cooked salmon group.
   Lipids, 2006 · checked 2026-09-24
2. chsal-r2-01 · meta-analysis of observational studies
   Fourteen prospective cohort studies (ten publications) with 911 348 participants and 75 451 incident deaths were included. ... A 20 g/d increment in fish consumption was significantly and inversely associated with the risk of CVD mortality
   Public Health Nutr, 2018 · checked 2026-09-24
3. chsal-r2-02 · meta-analysis of observational studies
   Previous meta-analyses on meat intake and risk of stroke did not report the effect of white meat (poultry meat, excluding fish) and did not examine stroke incidence and mortality separately. ... The pooled relative risks (95% confidence intervals) for total, red, processed and white meat consumption and total stroke incidence were 1.18 (1.09-1.28), 1.11 (1.03-1.20), 1.17 (1.08-1.25), and 0.87 (0.78-0.97), respectively.
   J Am Heart Assoc, 2017 · checked 2026-09-24
4. chsal-r2-05 · randomised controlled trial
   Children (n = 205, age 4-6 years) in this trial were individually randomized to eating meals containing farmed Atlantic salmon or meat three times weekly for 16 weeks. ... In general linear models no significant differences between the intervention groups were found in the scale scores of the WPPSI-III tests and the 9-HPT.
   Clin Nutr, 2019 · checked 2026-09-24
5. chsal-r2-06 · agency advice
   Those who are pregnant or breastfeeding consume between 8 and 12 ounces per week of a variety of seafood from choices that are lower in mercury.
   U.S. Food and Drug Administration and U.S. Environmental Protection Agency, Advice about Eating Fish · checked 2026-09-24
6. chsal-r2-07 · meta-analysis of prevalence studies
   Cod (Gadus morhua) and Atlantic salmon (Salmo salar), the most consumed fish species in Belgium, have a mean prevalence of 33% and 5% respectively. ... Farmed fish were found to be the least infected (2%) but were still not Anisakidae free.
   Int J Food Microbiol, 2020 · checked 2026-09-24
7. chsal-r2-08 · meta-analysis of prevalence studies
   The overall pooled estimates for all age groups of self-reported lifetime prevalence were as follows: cow's milk (5.7%, 95% confidence interval 4.4-6.9), egg (2.4%, 1.8-3.0), wheat (1.6%, 0.9-2.3), soy (0.5%, 0.3-0.7), peanut (1.5%, 1.0-2.1), tree nuts (0.9%, 0.6-1.2), fish (1.4%, 0.8-2.0) and shellfish (0.4%, 0.3-0.6).
   Allergy, 2023 · checked 2026-09-24
8. chsal-r2-10 · randomised controlled trial
   Women (n 123) who rarely ate oily fish were randomly assigned to continue consuming their habitual diet or to consume two 150 g portions of farmed salmon per week from 20 weeks of pregnancy to delivery. ... There was no effect of salmon consumption on maternal faecal microbiota or on maternal or infant faecal sIgA and calprotectin concentrations.
   Br J Nutr, 2014 · checked 2026-09-24
9. chsal-r2-03 · meta-analysis of observational studies
   Replacing total red meat with poultry (RR, 0.88, 95%CI, 0.82-0.96; I2 = 0%), dairy (RR, 0.90, 95%CI, 0.88-0.92; I2 = 0%), eggs (RR, 0.86, 95%CI, 0.79-0.94; I2 = 7.1%), nuts (RR, 0.84, 95%CI, 0.74-0.95; I2 = 66.8%), or legumes (RR, 0.84, 95%CI, 0.74-0.95; I2 = 7.3%) was associated with a lower risk of CHD, whereas substituting fish/seafood (RR, 0.91, 95%CI, 0.79-1.04; I2 = 69.5%) for total red meat was not associated with the risk of CHD.
   Nutr Rev, 2022 · checked 2026-09-24
10. chsal-r2-11 · claims register
    POL-HC-6368 Eicosapentaenoic acid and docosahexaenoic acid (EPA/DHA) EPA and DHA contribute to the normal function of the heart Authorised
    EU Register on nutrition and health claims, claim POL-HC-6368, snapshot 2026-09-21 · checked 2026-09-24
11. chsal-r2-09 · meta-analysis of observational studies
    Greater maternal fish intake was associated with a reduced risk of wheeze (Pooled effect size: 0.97; 95% CI: 0.96-0.99) and food allergy (0.75; 95% CI: 0.64-0.88).
    Crit Rev Food Sci Nutr, 2022 · checked 2026-09-24