October 2020 Issue

Meeting Weekly Seafood Recommendations
By Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND
Today’s Dietitian
Vol. 22, No. 8, P. 34

Encourage clients to get creative to achieve their nutrition goals.

On average, consumers eat only one-third of the recommended amount of seafood. The 2015–2020 Dietary Guidelines for Americans recommends adults eat at least two seafood meals or about 8 oz of seafood weekly. Yet the average fish and shellfish intake is about 2.7 oz per week.

Instead of the recommended 20%, seafood accounts for only about 5% of total consumption from the protein foods group, which consists of meat, poultry, seafood, eggs, legumes, nuts, seeds, and soyfoods.1 Shrimp, salmon, canned tuna, tilapia, and Alaskan pollock make up about three-fourths of total seafood consumption in the United States. Dietitians can help clients trade other protein foods for a variety of seafood options to better meet goals and diversify their diets.

“Most people aren’t enjoying the hundreds of other seafood varieties that are available in the US,” says Tim Fitzgerald, senior ocean director at Environmental Defense Fund (edf.org), a leading international nonprofit organization that develops solutions to environmental problems. Part of the reason, Fitzgerald says, is that seafood can be intimidating. “But I’m a firm believer that simple seafood is the best seafood,” he adds.

Familiarity also is a factor, says Rima Kleiner, MS, RDN, LDN, owner of Smart Mouth Nutrition and paid blogger and consultant at Dish on Fish, a blog where people can find seafood recipes and learn health and nutrition information about seafood. Kleiner says people eat a limited variety because they lack awareness and access, and that few Americans consider eating abalone, cockles, squid, and octopus, for example, because it’s not what they see on display.

Who Are the Seafood Eaters?
According to data from the National Health and Nutrition Examination Survey (NHANES) 2013–2016, only 1 in 5 adults aged 20 and older and 1 in 17 youth aged 2 to 19 consumes seafood at least twice weekly. This is a significant downward trend from the previous decade.

Men and women are equally likely to consume seafood. The percentage of adults who consumed the recommended amount of seafood increased with age, with only 17% of adults aged 20 to 39 meeting recommendations; however, 23% of those 60 and older consumed seafood at least twice per week. Non-Hispanic Asian adults were most likely to meet seafood consumption recommendations, with more than 40% reaching goals.2

Recommendations by Stage of Life

In addition to protein and an array of micronutrients, omega-3 fatty acids in fish are critical to children’s health. Specifically, DHA is essential for a child’s developing brain, nervous system, and vision. Research suggests consuming fish early in life may help prevent asthma, eczema, and other allergic diseases.3

The FDA advises parents to offer fish to their children one to two times per week from a variety of low-mercury options. The following is a guide on appropriate portion sizes, which tend to vary, based on age and calorie needs.

• 2 to 3 years: 1 oz
• 4 to 7 years: 2 oz
• 8 to 10 years: 3 oz
• 11-plus years: 4 oz

A 2019 technical report from the American Academy of Pediatrics says that “compared to other animal protein, such as beef, pork or chicken, fish have a favorable nutrient profile and are a good source of lean protein, calcium, vitamin D, and omega-3 fatty acids.”3 However, children eat little fish relative to other protein sources. In fact, fish consumption among children has decreased every year since 2007 to levels not seen since the early 1980s.

Women of Child-Bearing Age
Because of the critical need for omega-3 fatty acids during fetal development and infancy, the American College of Obstetrics and Gynecologists advises women who are pregnant, may become pregnant, or are breast-feeding to eat 8 to 12 oz of low-mercury seafood weekly. The DHA status of the woman has profound and lasting effects on eye and brain development of her fetus and young child.

Yet, again, consumption rates are low. NHANES data from 2003 to 2010 find that 23% of women of child-bearing age and 14% of pregnant women reported eating no fish.4 “Overly cautious, confusing, or just flat out inaccurate advice about how much and what kinds of seafood to eat during pregnancy actually results in decreased consumption of seafood,” Kleiner says.

Dietitians help bolster seafood intakes when they provide positive, uncomplicated information about seafood and pregnancy and when they keep the messages short, such as, “Pregnant women should aim to eat a variety of seafood two to three times each week for optimal baby brain and eye development, as well as for the health of mom’s brain and heart,” Kleiner says. “The numbers show that most pregnant women in the US need to quadruple the amount of seafood they’re eating. As dietitians, we can help expectant and new moms feel confident about eating more seafood.”

The federal guidance for adults to eat 8 oz or more of a variety of seafood each week is based on the total nutrient profile and the amount of omega-3 fatty acids linked to reduced CVD risk. Consuming 8 oz of seafood each week is the approximate average consumption of 250 mg EPA and DHA daily, the amount shown to protect against primary and secondary cardiac deaths.5

The Dietary Guidelines for Americans Committee, which advised the development of the 2015–2020 Dietary Guidelines for Americans, also has found moderate evidence linking seafood consumption to lower risk of obesity. Though not highlighted in federal guidelines, seafood consumption—specifically seafood with high amounts of omega-3 fatty acids—may reduce cognitive decline in the elderly.6 For example, a 2018 study in American Journal of Epidemiology found that older adults who ate fish four or more times per week had memory scores equivalent to being four years younger compared with older adults who rarely ate fish.7

A separate study found that as little as one serving of seafood with long-chain omega-3 fatty acids was linked to less cognitive decline in multiple domains of cognition.7 A small survey conducted by Designsteins found that seafood-eating adults between the ages of 72 and 90 consumed primarily shrimp, tilapia, and flounder, none of which are especially high in omega-3 fatty acids. Among baby boomers, however, the survey found that shrimp and salmon are the most consumed species.

Though experts have advised Americans to consume seafood two or more times per week for years, many consumers are still unaware of this recommendation. According to the Food Marketing Institute, 59% of seafood consumers and 37% of nonconsumers reported knowing the recommendations for consumption.8

Bringing More Seafood to the Table
With seafood intake far below the recommended amounts, dietitians can encourage more frequent consumption of the most preferred species and that of various other species. Different types of seafood offer a wide range of nutrients. Various species provide zinc, iron, choline, iodine, selenium, vitamin D, vitamin B12, and omega-3 fatty acids that together contribute to positive health outcomes, says Valerie Agyeman, RDN, communications manager for Seafood Nutrition Partnership. The greater the variety of seafood eaten, the more diversified and balanced the diet becomes.

In addition to better nutrition, Fitzgerald says individuals who expand their seafood repertoire become better cooks. Also, consuming seafood can be a more responsible way of eating because it allows consumers to focus on items that are more seasonal or abundant, meaning they’re less likely to concentrate on less sustainable choices. While it’s common to think of seafood as one type of food, it’s a highly diverse category with variable environmental impacts and nutritional profiles, Fitzgerald adds.

Agyeman says sustainable seafood is wild-caught from a well-managed fishery or comes from a farm that follows responsible practices. While there are several seafood certification and oversight programs, asking seafood vendors questions about how the seafood was harvested and where it came from is a great step, she says.

Click to enlarge

Source: FDA
For more information, visit fda.gov/food/consumers/advice-about-eating-fish

Since most people choose foods based on familiarity, Kleiner says RDs can teach clients about different species to help change their consumption patterns. Likewise, teaching clients how to prepare seafood and swap one species for another can boost intake.

The following are six ways to help consumers bust out of their seafood rut and expand their meal options.

1. Think beyond dinner. Put a seafood spin on breakfast, suggests John Livera, chef and consultant to the Norwegian Seafood Council. Top pizzas and fill tacos, burritos, and empanadas with any number of seafood types, he says. Combine seafood with eggs or go for a seafood-only version. Other breakfast ideas include a seafood frittata, crab and egg muffins, and a smoked salmon or lobster omelet.

Snack time is another opportunity to seek out the taste and health benefits of seafood. Sushi is a common go-to choice. Other ideas include tuna-filled deviled eggs; fish nachos made with a flaky white fish such as tilapia, pollock, or cod; crab quesadillas; and clam pizza made on a whole wheat English muffin.

2. Look for budget-conscious choices with wide availability. Consumers can find sustainable seafood options in both the canned and frozen aisles. Suggest canned sardines and frozen fish filets, which are readily available throughout the country and at a range of price points. Mussels or clams over pasta is another budget-friendly entrée.

3. Overcome pickiness. Help your clients experiment with flavors that they and their families already like. Create dishes with neutral fish such as cod, shrimp, haddock, or tilapia, Livera suggests. Try shrimp scampi, cod alfredo, mac and cheese with haddock, shrimp tacos, or simple buttered fish filets. When appropriate, serve them over rice or pasta with lots of sauce to encourage trying new foods with familiar flavors. Kleiner recommends clients add seafood to common recipes, such as adding canned anchovies, clams, or sardines to spaghetti sauce. When eating out, she encourages people to select a new fish or shellfish meal for the whole table to taste and share.

4. Relieve seafood intimidation. For clients who feel nervous about cooking seafood, Livera offers these simple seafood combinations.

• Cod or grey sole topped with melted butter or olive oil, bread crumbs, and a squeeze of lemon juice served over rice and steamed vegetables.
• Steelhead trout brushed with jarred BBQ sauce and baked in the oven. Serve with crispy onions and a baked potato.
• Striped bass wrapped in aluminum foil with orange juice, butter or olive oil, and fresh or dried thyme. Bake it or grill it.
• Cod and bacon cooked in the oven on the same tray and served over roasted potatoes and steamed vegetables.

Livera also encourages experienced home cooks to swap other animal proteins for seafood in some of their common recipes to get more comfortable with various species. Some of his examples include the following:

• Pulled pork: hot smoked salmon or steelhead trout (Shred the meat and add the same style sauce as you would for pulled pork.)
• Kung Pao: shrimp, scallops, cod, tilapia (Lightly batter the fish and bake or fry before adding Kung Pao sauce.)
• Française: shrimp, scallops, haddock, fluke (After dredging the seafood in seasoned flour, dip it in egg and cook it in hot oil with white wine and lemon juice.)
• Tandoori: cod, sturgeon, monkfish (Trade the typical chicken in a tandoori chicken masala for seafood and prepare in a traditional tandoori style.)

5. Encourage simple seafood swaps. It shouldn’t be hard for clients to trade one type of seafood for another when they let color and texture guide them, Livera says. Instead of giving up on preparing a seafood recipe when the specified fish isn’t available, find a suitable substitute. Livera groups together the following types of seafood that can serve as substitutes for one another:

• salmon, steelhead trout, Arctic char, Coho salmon, and sockeye salmon; and
• cod, grey sole, flounder, striped bass, haddock, and fluke.

Clients who enjoy canned salmon or tuna also may like exploring cooking with swordfish, monkfish, sturgeon, and Norwegian wolfish or ordering them in restaurants.

6. Clear up confusion about mercury. Reassure clients that advice from the FDA and EPA to choose low mercury seafood options is meant for women who are pregnant, may become pregnant, or are breast-feeding, and for children. The guidance to avoid certain species isn’t directed at populations at lower risk of harm from methylmercury ingestion. In addition, the guidance is based on a cautious approach, so at-risk populations can benefit from seafood while limiting exposure to methylmercury.9

Common choices that are higher in EPA and DHA but lower in methylmercury include salmon, anchovies, herring, shad, sardines, oysters, trout, Atlantic mackerel, and Pacific mackerel (not king mackerel).

Finally, dietitians can educate clients on the benefit of selenium in seafood. Not only is selenium an important mineral for brain and immune health but it also helps counter the potential adverse effects of methylmercury. Methylmercury can be harmful if consumed in excess. It binds with selenium, preventing selenium from performing its role in the brain. Eating fish with a high selenium to methylmercury ratio, however, provides a built-in defense against methylmercury and can offset or even ameliorate potential damage. Fortunately, most types of seafood from the ocean—except large species such as pilot whale—contain significantly higher amounts of selenium than methylmercury.

By sharing the health benefits of eating seafood, emphasizing the importance of variety for nutrition and the environment, and teaching clients about various species and preparation methods, dietitians can help clients consume and enjoy more seafood.

— Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND, is the author of four books, including the best-selling Prediabetes: A Complete Guide, and a freelance writer.

Weisenberger reports the following relevant disclosure: She’s a nutrition and diabetes consultant to the food industry, including the Norwegian Seafood Council.


1. Kantor L. Americans’ seafood consumption below recommendations. Amber Waves. October 3, 2016. https://www.ers.usda.gov/amber-waves/2016/october/americans-seafood-consumption-below-recommendations/. Accessed May 7, 2020.

2. Terry AL, Herrick KA, Afful J, Ahluwalia N. Seafood consumption in the United States, 2013–2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/products/databriefs/db321.htm. Published September 13, 2018. Accessed June 7, 2020.

3. Bernstein, AS, Oken E, de Ferranti S. Fish, shellfish, and children’s health: an assessment of benefits, risks, and sustainability. Pediatrics. 2019;143(6):e20190999.

4. Taylor CM, Emmett PM, Emond AM, Golding J. A review of guidance on fish consumption in pregnancy: is it fit for purpose? Public Health Nutr. 2018;21(11):2149-2159.

5. US Department of Agriculture, US Department of Health and Human Services. Chapter 1 key elements of healthy eating patterns. Dietary Guidelines for Americans 2015-2020: Eighth Edition. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/#callout-seafood. Published January 7, 2016.

6. Rest OVD, Wang Y, Barnes LL, Tangney C, Bennett DA, Morris MC. APOEε4 and the associations of seafood and long-chain omega-3 fatty acids with cognitive decline. Neurology. 2016;86(22):2063-2070.

7. Samieri C, Morris M-C, Bennett DA, et al. Fish intake, genetic predisposition to Alzheimer disease, and decline in global cognition and memory in 5 cohorts of older persons. Am J Epidemiol. 2017;187(5):933-940.

8. FMI. The power of seafood 2019: an in-depth look at seafood through the shoppers’ eyes. https://www.fmi.org/docs/default-source/webinars/pdf-the-power-of-seafood-2019.pdf?sfvrsn=52794a6e_0. Published 2019. Accessed March 12, 2020.

9. Quam J, Casavale K. Five strategies for encouraging seafood consumption: what health professionals need to know. Health.gov website. https://health.gov/news-archive/blog/2017/03/five-strategies-for-encouraging-seafood-consumption-what-health-professionals-need-to-know/index.html. Published March 20, 2017. Accessed May 7, 2020.