Introduction: Subclinical atherosclerosis (SA) is a silent preclinical stage of atherosclerotic cardiovascular disease, particularly in individuals with high-risk metabolic disorders. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have shown cardiovascular benefits in supplementation trials; however, evidence from habitual intake is limited particularly in people with diabetes mellitus (DM). We aimed to assess the association between dietary EPA and DHA and the presence of carotid atherosclerotic plaque(s) (SA) in adults with and without DM.

Methods: A cross-sectional study was conducted in adults with and without DM. EPA and DHA intake were assessed with a validated 101-item Spanish food frequency questionnaire. Ultrasound was used to detect the SA in the common, bulb and internal carotid arteries, by a blinded operator. Statistical analyses included group comparisons and multivariable logistic regression adjusted for age, sex, hypertension, dyslipidemia, smoking, waist circumference, glycemic control, and renal function, conducted in the overall sample and restricted to participants with DM (both type 1 and type 2).

Results: Out of 1,221 participants, 429 (35.1%) had AP (median age: 57 years), while 792 (64.9%) did not (median age: 45 years). DM was more frequent in the group with SA (57.3% vs. 36.4%). EPA intake was slightly higher in individuals with AP (0.14 vs. 0.13 g/day; p = 0.061), while DHA intake showed no difference (0.26 vs. 0.24 g/day; p = 0.202). In adjusted models, higher EPA intake was associated to lower odds of AP in analyses including all subjects (OR: 0.18; p = 0.018) and in those restricted to DM (OR 0.13; p=0.034). DHA intake was inversely associated with AP in all subjects (OR 0.37; p=0.010), with an association even stronger in DM (OR 0.25; p=0.008).

Conclusion: Higher dietary intake of EPA and DHA was associated with a lower likelihood of SA, particularly in subjects with diabetes.