A systematic review of the determinants of seafood consumption

Abstract

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood.

Fish and seafood are widely consumed throughout the world⁽¹⁾ and are an important source of vitamins A, D and E, as well as essential n-3 fatty acids which contribute to healthy eye, brain and neurological development in babies and children⁽²⁾. Seafood is also a major source of lean protein worldwide, and according to a report conducted by the FAO of the United Nations, approximately 6 % of dietary protein comes from seafood globally⁽¹⁾. Seafood is also generally rich in iodine, important in proper thyroid function, and its consumption can contribute towards meeting the daily requirement of 150 μg/d for adults⁽³⁾. Whilst there are a number of positive reasons to consume seafood from a nutritional point of view, it is important to consider both sustainability of the type of seafood that is consumed^(4,5) , as well as biotoxicity risk^(6,7) . The European Commission⁽⁸⁾ recommends 1–4 servings of fish a week to maximise the health benefits as well as minimise biotoxicity risks associated with seafood consumption. From a sustainability aspect, the 2019 EAT-Lancet report recommends consumption of 28 g/d (up to 100 g) of fish to keep within planetary bounds and prevent depletion of fish stocks⁽⁴⁾. In Ireland and the UK, healthy eating guidelines currently recommend the consumption of two servings of about 140 g of fish/week, one to be oily fish. According to the Irish National Adult Nutrition Survey (2010) data, fish was consumed by half of 18–64-year-olds and two-thirds of those aged 65 years and over in the Republic of Ireland. However, the average daily intake of fish in National Adult Nutrition Survey consumers was approximately 50 g, which is below the recommended amounts⁽⁹⁾.

Furthermore, intakes across European countries vary greatly⁽¹⁰⁾ and national consumption surveys often lack information about less commonly consumed foods as data collection focuses on a snapshot of habitual diet⁽⁹⁾. For example, in the last Irish national food consumption survey, from 133 050 rows of data generated, only twelve of these related to shellfish which is not sufficient data to assess contribution to nutrient intake or undertake risk exposure assessment in this food group.

This review aims to examine published literature from Western countries (Europe, Australia, New Zealand, USA and Canada) and investigate, at a time when consumers are moving to diversify their diet from animal-based protein⁽¹¹⁾, the characteristics of seafood consumers, as well as the barriers and influences on seafood consumption. Seafood is defined as ‘animals from the sea that can be eaten, especially fish or sea creatures with shells’; thus, this paper will focus on the consumption of both fish and shellfish.

Materials and methods

To our knowledge, this is the first review to examine the determinants of seafood consumption across multiple countries. Our primary objective was to characterise seafood consumers residing in Western countries (Europe, Australia, New Zealand, USA and Canada). The primary review question was ‘What are the characteristics of seafood consumers in developed countries?’. Secondary considerations included ‘What are the associations (positive and negative) on seafood consumption in these countries?’. A comprehensive search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in Embase, MEDLINE and Web of Science of papers published between 1 October 2008 and 31 December 2018. Two additional searches for papers published between 1 January 2019 and 27 August 2019 were performed on 27 August 2019 and 29 August 2020, in order to identify any papers that were missed in the original search, using identical terms and databases as the initial search. The search strategy included a combination of the following search terms: ((factors OR influences OR determinants OR indicators) AND (fish OR seafood OR shellfish OR marine products) AND (diet OR dietary intake OR intake OR consumption)). When performing the search on the Web of Science database, categories were refined to ‘Nutrition and Dietetics’, ‘Behavioural Sciences’, ‘Public Environmental Occupational Health’ and ‘Environment Sciences’. For each concept, the database-specific indexing terms (MeSH or Web of Science terms) were searched in addition to terms in the title or abstract. Studies were only considered if meeting the following criteria – full-text articles on human studies conducted between 1 January 2008 and 31 December 2018 among adults (18+ years) in Europe, USA, Canada, Australia and New Zealand, published in English. The search was limited to adults (>18 years); studies involving children were excluded. Studies which did not statistically analyse associations between seafood consumption and the following factors were excluded: age, sex, education, affluence, BMI, physical activity and smoking. Included studies explored participants’ intakes of fish, seafood and/or proxy measures of same, such as marine PUFA or perceived barriers to or drivers of seafood/fish consumption.

In the final selected papers, the following key characteristics were captured: (a) study methodologies: the country and year of the study, the number of subjects and their sex, age (age range), intake of specific foods, food groups and/or nutrients being investigated, dietary assessment method and dietary analysis; (b) the characteristics of seafood consumers described in the study, findings of stratified analysis by sex, age, education, income, smoking, BMI or physical activity and (c) barriers to and drivers of seafood consumption that exist in these populations, which were consequently categorised under the following broader terms: personal preference, availability/convenience, cost, cooking skills, environment, health and nutritional beliefs and psychological traits.

Results

Combined, the three literature searches yielded 1961 titles of potentially relevant articles in PubMed, 1828 titles in Embase and 2460 titles in Web of Science. A total of 4406 unique articles were found, after duplicates were removed. Following this, a further 3899 articles were excluded following consideration of title and abstract. The remaining articles (n 506) were screened based on inclusion/exclusion criteria. Two authors independently assessed abstracts of potentially eligible papers that examined fish and seafood intake and decided on inclusion of full-text articles, resolving any differences by discussion and, when necessary, in consultation with the review team. Of the remaining 121 articles, eighty-two articles explored the characteristics of seafood consumers and thirty-seven articles explored the barriers and/or influences on seafood consumption (Fig. 1). These papers and their findings are described below.

Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of the searching and selection process.

Details of each study included in this review are summarised in Table 1 and online Supplementary Table S1. Online Supplementary Table S1 lists the papers that analysed the characteristics of seafood consumers. Studies were conducted in the USA (n 27), Europe (n 49), Australia (n 2), New Zealand (n 1) and Canada (n 3). Sixty-seven percentage of all papers exploring the characteristics of seafood consumers collected dietary intake data using only a FFQ, 7 % used 24-h recalls, 5 % used a food record, 10 % used interviews and 9 % used a combination of these methods. Fifty-two studies had a cross-sectional design, and thirty were prospective observational studies. This review focuses on the following characteristics: age, sex, affluence, education, BMI, physical activity and smoking.

Table 1. Descriptions of studies that explored the barriers and drivers to seafood consumption

SES, socio-economic status; LCPUFA, long-chain PUFA.

Characteristics of seafood consumers

Age

Fifty-four papers explored the association between seafood consumption and age. There was a positive association between older age and seafood consumption in forty-three of these papers^(12–53). The largest study to find this was Patel et al.⁽³⁹⁾ which analysed 21 984 participants’ seafood intake. A smaller number of studies (n 5) noted a positive association between seafood consumption and younger age group^(54–58); however, these studies all had a sample population of over 50 years of age, their interpretation of young age was relative only to their specific study cohort.

Sex

Thirty-one papers explored the association between seafood consumption and sex. Overall, there was not a strong directional association between sex and seafood consumption observed. Seafood consumption was higher in men than in women in thirteen papers^{(13,16,18,22,29,31,52–54,59–62)} as opposed to eleven papers^{(13,24,32,34,37,40,51,54–56,63)} finding that women were more likely to consume seafood. Two of these studies found that men are more likely to consume fried fish^(13,54) , and according to three studies, women were more likely to consume non-fried fish^(13,54,63) . For a number of papers, no association between fish consumption and sex was identified^{(14,19,47,58,64–68)} . When considering intakes by sex, it is important to consider adjustments for energy intake in the analysis. The following papers adjusted for energy intake^{(23,27,28,30,36,38,43,52–56,67)} , with the remaining studies not adjusting for energy intake, or not reporting adjustment.

Affluence

The majority of papers (twenty-one out of twenty-nine) that explored correlations between affluence and seafood intake found that seafood consumption had a positive association with higher socio-economic status, higher income or higher employment level. One paper saw a positive association between seafood consumption and lower socio-economic status status, income or employment level; however, this was associated with fried fish intake specifically⁽⁶⁹⁾. There was no association between these variables according to seven papers^{(12,24,31,32,44,59,70)} . The most common association found was between higher income and seafood consumption^{(14,18,26,37,63–65,71–75)} . Significant associations were also seen between seafood consumption and higher socio-economic status^(56,76–79) as well as higher grade employment^{(13,27,29,41)} .

Education

Thirty-six papers found a significant association between education and seafood consumption. Most of these studies highlighted a positive association between education level and seafood consumption^{(14–16,18,23,26–30,36–39,41,42,45,46,51–55,57–59,63,64,71,73,80–84)} . An association between higher education and non-fried fish consumption, as well as an association between lower education level and fried fish consumption, was reported in two papers^(54,57) . Whilst the majority of papers did find a positive association, Karlsson et al.⁽⁴³⁾ and Hansen-Krone et al.⁽³³⁾ both found that a higher percentage of people with lower fish intake had higher education or a university degree compared with those in the highest quintile of fish intake. However, despite statistical significance, in Hansen-Krone et al.’s⁽³³⁾ study, the second highest percentage of people in higher education was seen in those who consumed fish 2–2·9 times/week. There was no significant association found between seafood intake and education in thirteen studies^{(12,19,21,22,24,31,34,44,56,65,68,70,85)} .

BMI

There was no clear association between BMI and seafood consumption with results varying greatly between studies. While thirty-four papers explored the association between BMI range and seafood intake, there was a correlation between higher fish intake and lower BMI in six of these papers^{(14,23,40,51,57,63)} . Two papers found an association between higher BMI and lower seafood intake^(27,31) . An association was seen between higher fish intake and higher BMI in eleven papers^{(20–22,34,36,43,54,57,68,86,87)} . Three of these papers^(14,54,86) stated that this association was with fried fish intake specifically. Fifteen papers found no association^{(15,19,28,33,37,44,52,55,56,58,66,70,85,88,89)} .

Smoking

Seafood consumption was positively associated with smoking in five papers^{(34,36,56,57,86)} . Belin et al. ⁽⁵⁷⁾ specified that this association was with fried fish intake. Strøm et al. ⁽²⁷⁾ found that women who consumed less fish were more likely to be smokers. High fish intake was associated with former or non-smoking in twenty-seven studies^{(14,15,21,22,34,37–42,51,52,54,55,58,63,67,73,83,84,88–93)} . Eleven papers did not find an association between fish intake and smoking^{(12,19,20,23,28,33,43,64,68,70,87)} .

Physical activity

Twenty-nine studies included in this review explored associations between seafood consumption and physical activity level. Most studies (n 22) found that higher seafood intake was associated with higher engagement in physical activity^{(16,20,22,27,33,36–39,51,52,56,57,63,64,67,84–86,88–90)} . Three of these studies found a significant association between physical activity level and non-fried fish consumption specifically^(57,63,64) . Belin et al.⁽⁵⁷⁾ also found a correlation between fried fish consumption and lower physical activity levels in adults. A correlation between higher non-fried fish intake and low physical activity was observed in one paper⁽¹⁴⁾.

Influences on seafood consumption

Thirty-seven studies examined participant reported influences on seafood consumption (Table 1). Twenty of these reported on barriers to the consumption of seafood and twenty reported on drivers of consumption of seafood, with ten papers reporting on both. Studies were conducted in the USA (n 5), Europe (n 22), Canada (n 3) and Australia (n 7). All studies had a cross-sectional design. The selected studies identified some major influences on seafood consumption, most of which have both positive and negative aspects and can thus function as both drivers and barriers (Fig. 2).

Fig. 2. Number of papers examining the association between the demographic and social characteristics of seafood consumption.

Sensory and taste preferences

Sensory and taste preferences were named as barriers to seafood consumption in fourteen studies. Seven of these papers specified that the barriers to fish consumption were to do with fish characteristics such as taste, smell or presence of bones^(94–103). Within elderly, problems with dentition were highlighted as a barrier to consumption, as it was reported to impact on one’s ability to chew and bite⁽⁹⁴⁾. Gastro-intestinal issues following consumption of seafood also presented a barrier for some^(104,105) . Unsurprisingly, a greater liking of the taste of fish was reported to drive consumption of fish^{(100,106,107)} .

Cost, convenience and availability

According to three studies^{(100,108,109)} , residing in locations with poor availability of seafood or fish presented a barrier to its consumption. For example, Hilger et al. ⁽¹⁰⁸⁾ explored barriers to healthy eating specifically in college students and found that lack of availability or lack of choice of fish and seafood in the canteen was a barrier to consumption of these products for students. Santos et al. ⁽¹⁰⁹⁾ also looked at eating habits of university students; however, this sample size only focused on Portuguese students post-migration to the UK. This paper noted that migration to a country with lower reported fish consumption caused a significant decrease in these student’s fish consumption. Lack of access and availability were also noted in elderly cohort, where the impact of physical impairments such as reduced mobility or disability was highlighted as a barrier to the consumption for elderly people⁽⁹⁴⁾. Convenience in relation to preparing and consuming seafood was also highlighted as a barrier in five studies^{(94,101,103,110,111)} .

In addition, a lack of ‘good quality’ seafood was also reported as a barrier to its purchase and consumption^{(100,101,112)} . Living in a location where fresh and ‘good quality’ seafood was available positively influenced people to consume it, which was reported in two papers^(94,100) . Cost of seafood was a commonly reported barrier to consumption and was mentioned in nineteen studies^{(65,95–102,104,107,108,111–117)} . Sotos-Prieto et al. ⁽¹¹⁶⁾ specified that those with low income were less likely to consume fish regularly. However, three papers found that providing good value for money (i.e. special offers in stores) had a positive influence on seafood consumption^{(100,110,112)} .

Knowledge of storage, handling and cooking

Three studies highlighted that lack of skills, particularly cooking skills, can be barriers to seafood consumption^(99,104,111) . Bishop & Leblanc⁽¹⁰⁴⁾ and Rahmawaty et al. ⁽⁹⁹⁾ reported that people who lacked cooking knowledge and inspiration found it difficult to find the motivation to cook seafood for themselves and their household. Dijkstra et al. ⁽⁶⁵⁾ also found that holding the belief that fish spoils easily is a barrier to its consumption. Believing that fish is a convenient food and is easy to prepare was highlighted as a positive influence on its consumption in two studies^(97,106) .

Familial, lifestyle and cultural environment

Six studies^{(65,97,99,107,115,116)} found that the dietary preferences of household members were an influence to seafood consumption. Low- or non-fish consumers were more likely to view the taste preferences of household members as a negative influence on frequency of seafood consumption⁽⁹⁹⁾. A busy lifestyle was also noted as a barrier by Pinho et al.⁽¹¹⁵⁾. Four papers found various environmental influences can drive seafood consumption. Neale et al. ⁽⁹⁷⁾ stated that religious and cultural traditions, as well as parental attitudes, can be positive influences on seafood consumption if they encourage the same. Participants in Rahmawaty’s et al.⁽⁹⁹⁾ study mentioned that professionals, media, household and society can be positive influences on their seafood consumption. Parental dietary habits strongly influence seafood consumption in their children⁽¹¹⁶⁾. Subjective norm and feelings of moral obligation can also positively influence seafood consumption; therefore, this can act as both a barrier and a driver of seafood consumption depending on the situation⁽¹¹⁸⁾.

Health and nutritional beliefs

Holding certain health and nutritional beliefs about seafood can influence whether or not the person chooses to consume seafood. For example, the perception that fish and seafood may contain harmful contaminants was seen as a barrier in five papers^{(65,97,104,119,120)} . Three papers^(96,121,122) found avoidance of fish, due to the belief that it is harmful, was a common barrier during pregnancy. Perceiving seafood to have a high ‘health’ value, or believing it contains certain nutrients needed for good health, is a commonly reported positive driver of its consumption^{(94–99,101,107,110,111,117–120,123–129)} .

Psychological traits

A small number of papers (n 3) found that having certain psychological traits may present barriers to consuming seafood. Having high levels of distress⁽¹¹⁴⁾ and neuroticism⁽¹³⁰⁾, and low willpower⁽¹¹⁵⁾ were highlighted as possible barriers to seafood consumption. Four papers explored the influence of various psychological states and personality traits on seafood consumption and noted that having high levels of self-efficacy, optimism, life satisfaction, resilience and a general healthy psychological well-being positively influenced seafood consumption^{(124,130–132)} .

Discussion

The results of this systematic review highlight that seafood consumers were more likely to be older, more affluent (in terms of income, employment level and/or socio-economic status), educated and physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a clear influence on seafood consumption. The findings also suggest that the most commonly reported influences on seafood consumption relate to personal preference, availability, cost, cooking skills and knowledge, environment, health and nutritional beliefs and psychological traits. The most commonly reported barrier to seafood consumption was price. Other barriers included the sensory or physical characteristics of seafood, household preferences, health and nutritional beliefs (e.g. that fish contains harmful contaminants), environmental barriers, lack of cooking skills and negative psychological states/personality traits. The most commonly reported drivers of seafood consumption were perceived health benefits of seafood, environmental influences (e.g. family, friends and social norm), availability of fresh seafood, positive psychological states or personality traits and personal preferences. These barriers and drivers agree with certain common characteristics that seafood consumers seem to share.

Cost was the most commonly reported barrier to seafood consumption^{(95–100,104,108,115,133)} . This is a particularly important barrier for people who have a lower income level^(114,116) . Food prices play a major role in diet quality and food choice⁽⁷⁷⁾. Although seafood has become more widely available, depending on the country, the fish species, and the presentation or format of sale, it can be a costly item compared with other high protein foods^(134,135) . This is in line with our findings, as those who consumed the highest amounts of seafood tended to have higher incomes, as well as be of older age, which agrees with the general trend of income increasing with age as a person gain experience over time⁽¹³⁶⁾. In addition, as individuals age, increased risk of health issues such as cognitive decline and CVD can influence food choice, including that of seafood, known to be rich in nutrients beneficial to health^(137,138) , with the perceived cost benefit changing as one ages. Unsurprisingly, cost was also highlighted as a barrier to healthy eating for university students⁽¹⁰⁸⁾. Interventions carried out in the UK⁽¹³⁹⁾ and the USA⁽¹⁴⁰⁾ which trialled providing vouchers for the purchase of healthy foods, such as fruits and vegetables or seafood, have been found to be a simple and effective way of encouraging people to purchase these products. Interestingly, the provision of these vouchers was more effective than dietary advice alone. Other reviews found that pricing interventions generally increased the consumption and purchase of promoted foods^(141–143).

Our findings suggest that those who achieve a higher level of education are more likely to be seafood consumers. Having a higher degree of education may result in better knowledge and understanding of current healthy eating recommendations for fish^(77,144) . Education may also be associated with increased nutritional knowledge in general and the ability to translate this knowledge into healthy dietary practice⁽¹⁴⁵⁾. However, education level does not directly determine level of seafood consumption as evidenced by population groups that eat fish traditionally, but have generally low rates of formal education⁽¹⁴⁶⁾. Belief that fish is healthy and contains important nutrients for health is often reported as a major influence on seafood consumption, regardless of education level^{(94–99,110,118,119,123–125)} . The most commonly reported barrier was the belief that fish or seafood may contain harmful contaminants^{(97,99,104,119,133)} or that fish/seafood is harmful during pregnancy, with particular concern about its mercury content^(96,121,122) . Education regarding true contamination levels in various fish and seafood species, as well as guidelines for fish consumption during pregnancy, may be paramount to overcoming these barriers, and information received from healthcare professionals need to be clear⁽¹³³⁾. Those who are in greater agreement that fish should be fresh, that it is easy to prepare, is convenient and disagreement that fish spoils easily are more likely to consume it^(97,106) . However, interventions aiming to improve diet quality or intakes of certain food groups through nutrition education alone have had mixed results, suggesting a combination of methods including education may be needed to improve diets^{(123,147–152)} .

Gaining knowledge about the health benefits of seafood may help overcome barriers such as nutritional and health beliefs, or habits arising from an individual’s Familial, Lifestyle and Cultural Environment. However, it is also important to know that may be less effective in overcoming barriers such as taste. Having a dislike of the taste and/or smell of fish^{(94–100,104)} , as well as a dislike of its texture, is a commonly reported barrier to seafood consumption in general^(97,98) . In particular, pregnant women seem to have a high level of food disgust or gastrointestinal issues related to seafood consumption^(104,105) . Changes that come with old age, such as chemosensory loss, can lead to reduced enjoyment of the taste of seafood⁽⁹⁴⁾. Physical impairments that reduce the convenience of cooking or purchasing foods present an important barrier to seafood consumption in the elderly^(94,99) . Some of these barriers are personal preferences and therefore are difficult to overcome; however, in regards to taste changes, adding natural food flavours has been used in an attempt to increase food and nutrient intakes in the elderly with some success⁽¹⁵³⁾. Previous research has also shown that participants who disliked the taste of fish or seafood, but who were aware of its health benefits, attempted to overcome this taste preference barriers by experimenting with various cooking methods and seafood products⁽⁹⁶⁾. However, knowing the benefits of seafood alone may not be enough to initiate its purchase and consumption due to time constraints for cooking as well as affordability⁽⁷⁷⁾. Physical impairments to cooking and food shopping may be overcome by organising meal delivery to the persons home, which have been shown to increase diet quality and nutrient intakes among the elderly^(154,155) . However, this may not be appropriate for everyone, such as patients with behavioural and cognitive impairments⁽¹⁵⁶⁾.

Good local availability of fresh, or what consumers deem good quality seafood, or lack thereof, seems to influence intent to purchase what actually is on offer^{(94,100,108,109)} . Availability of seafood in an individual’s living location, or where they tend to purchase their meals, influences whether or not they consume it^{(100,108,109)} . The purchasing behaviour can concern overall availability of seafood in general but may also be influenced by the type of seafood available. According to Bord Bia⁽¹³⁵⁾, fish represented 2 % of the Irish grocery spent in 2018 and the large majority of this was fresh fish. Frozen fish sales decreased compared with previous years, partially due to a decrease in shoppers’ willingness to buy frozen fish. This seems to highlight a preference for fresh fish over frozen. Therefore, if fresh fish is not available, the consumption of seafood may decrease due to the consumer’s unwillingness to purchase frozen alternatives that are available. Food availability is also related to affluence⁽⁷⁷⁾. Analyses show that supermarkets tend to cluster in more affluent areas and that ‘food deserts’ are common within lower socio-economic status neighbourhoods⁽⁷⁷⁾. Studies have also shown that residing in lower-income neighbourhoods has been associated with lower consumption of fish⁽¹⁵⁷⁾ and that a person’s level of income and occupation is a significant determinant of fish consumption⁽¹⁵⁸⁾.

This study has identified multiple barriers to seafood consumption which need to be overcome in order to increase seafood intake. Methods to help people overcome these barriers include pricing interventions, such as the provision of food vouchers or in-store discounts or value offers^(139–143). In addition to this, interventions may need to focus on increasing nutritional knowledge and awareness through school-based⁽¹⁵¹⁾ and adult⁽¹⁵⁹⁾ educational programmes as well as environmental sustainability education⁽¹²³⁾. However, the most promising results are seen when interventions tackle multiple or most of the aforementioned barriers to consumption^(150,159) . This means combining individual education (which should combine nutrition theory and practice, i.e. cooking skills) from school level through to senior years with structural environmental changes, such as improving access to supermarkets⁽⁷⁷⁾ and making healthy foods such as seafood more affordable⁽¹³⁹⁾, particularly for people on lower incomes. Future interventions aiming to increase seafood consumption, or diet quality overall, should therefore take on a multi-faceted approach, as seen in the Community Intervention to Increase Seafood Consumption Project carried out in Australia⁽¹⁶⁰⁾. Any interventions seeking to promote seafood consumption should be carried out with consideration of biotoxicity risk^(6,7) . In addition, recommendations should also take into account sustainability targets, such as those set out in the EAT-Lancet report which recommend a maximum of about 100 g of fish/d⁽⁵⁾.

Limitations

It is important to note that, in cross-sectional studies, any solitary associations are not evidence of causality. The determinants of food choice are complex and cannot be attributed to only one single reason. Overall, conclusions should be drawn with caution owing to the small number of studies for each specific influence–intake association. Limitations of this study include that the findings of this review are limited to published papers only (unpublished results or additional reports were not included), in English, between 2008 and 2019. This is also one of the first systematic reviews published on the determinants of seafood consumption. Although it is a systematic review, meta-analysis was not carried out; therefore, sample size was not considered. Additionally, categorisation of findings was subjective however was decided on once consensus that was reached among authors following discussion.

Conclusions

This review has highlighted two key aspects of importance for the development of effective public health campaigns aiming to increase consumption of seafood. It firstly determined demographic factors influencing consumption of seafood, thus outlining which population groups could be targeted. It then secondly outlined evidence of the reported reasons influencing seafood consumption, outlining areas for potential intervention including nutritional education, development of cooking skills, pricing and availability amongst others. The evidence presented demonstrates that specific population groups such as those of a younger age and those less educated would benefit most from interventions, information which would allow the development of targeted and appropriately designed interventions, which could focus on aspects specifically influencing intakes in each of these population groups. More research is needed to explore the effectiveness of specific interventions in increasing the consumption of seafood.