Caffeic acid, a hydroxycinnamic acid common in different vegetable sources, has been employed as a natural antioxidant for inhibiting oxidation of fish lipids present in different food matrices. The aim of this review is to discuss the mechanisms involved in the antioxidative and prooxidative effects of caffeic acid found in different model systems containing fish lipids. These model systems include bulk fish oils, liposomes from cod roe phospholipids, fish oil emulsions, washed cod mince, regular horse mackerel mince and a fish oil fortified fitness bar. The data reported show that the antioxidant activity depends on the physical state of the lipids and the composition of the intrinsic matrix in which they are situated. Caffeic acid significantly prevented rancidity in both unwashed and washed fish mince, the latter which was fortified with haemoglobin. In the unwashed mince, the activity was however clearly dependent on the lipid to antioxidant ratio. In these systems, an important redox cycle between caffeic acid and the endogenous reducing agents ascorbic acid and tocopherol were further thought to play an important role for the protective effects. The effect of caffeic acid was also highly dependent on the storage temperature, showing higher effectiveness above than below 0°C. Caffeic acid was not able to inhibit oxidation of bulk fish oils, fish oil in water emulsions and the fish-oil enriched fitness bar. In the liposome system, caffeic acid inhibited haemoglobin (Hb)-promoted oxidation but strongly mediated Fe2+ mediated oxidation. In conclusion, caffeic acid can significantly prevent Hb-mediated oxidation in fish muscle foods but its activity in food emulsions and liposomes is highly dependent on the pH, the emulsifier used and the prooxidants present.