Fish consumption and risk of stroke and its subtypes: accumulative evidence from a meta-analysis of prospective cohort studies - PubMed (original) (raw)

Meta-Analysis

. 2012 Nov;66(11):1199-207.

doi: 10.1038/ejcn.2012.133. Epub 2012 Oct 3.

Affiliations

Meta-Analysis

Fish consumption and risk of stroke and its subtypes: accumulative evidence from a meta-analysis of prospective cohort studies

P Xun et al. Eur J Clin Nutr. 2012 Nov.

Abstract

Background/objectives: To provide a reliable assessment of the hypothesized association of fish consumption with stroke risk accumulatively, an updated meta-analysis of published prospective cohort studies was conducted.

Subjects/methods: Prospective cohort studies through April 2012 in peer-reviewed journals indexed in MEDLINE and EMBASE were selected. Additional information was retrieved through Google or a search of the reference list in relevant articles. The main outcome measure was the weighted hazards ratio (HR) and corresponding 95% confidence interval (CI) for incident stroke according to fish consumption using a random-effects model.

Results: A database was derived from 16 eligible studies (19 cohorts), including 402,127 individuals (10,568 incident cases) with an average 12.8 years of follow-up. Compared with those who never consumed fish or ate fish <1/month, the pooled adjusted HRs of total stroke risk were 0.97 (95% CI, 0.87-1.08), 0.86 (0.80-0.93), 0.91 (0.85-0.98) and 0.87 (0.79-0.96) for those who consumed fish 1-3/month, 1/week, 2-4/week and ~5/week, respectively (P(linear trend) = 0.09; P(nonlinear trend) = 0.02). Study location was a modifier. An inverse association between fish intake and stroke incidence was only found by studies conducted in North America. The modest inverse associations were more pronounced with ischemic stroke and were attenuated with hemorrhagic stroke.

Conclusions: Accumulated evidence generated from this meta-analysis suggests that fish intake may have a protective effect against the risk of stroke, particularly ischemic stroke.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr Xun and Dr Nakamura declare no conflict of interest. Mrs Qin received Sanofi-Aventis/UNC Global Nutrition Scholarship. Dr Song received research funding from the National Institutes of Health. Dr Kurth has received within the past 2 years investigator-initiated research funding from the French National Research Agency, the US National Institutes of Health, Merck, the Migraine Research Foundation, and the Parkinson’s Research Foundation. Furthermore, he is a consultant to World Health Information Science Consultants, LLC; he has received honoraria from the American Academy of Neurology and Merck for educational lectures and from MAP Pharmaceutical for contributing to a scientific advisory panel. Mrs Yaemsiri received American Heart Association’s pre-doctoral fellowship.

Figures

Figure 1

Figure 1

Multivariable adjusted HRs and 95% CIs of incidence of total stroke according to fish consumption in 19 cohorts from 16 prospective cohort studies. The summary estimates were obtained by using a random-effects model. The dots indicate the adjusted HRs by comparing fish consumption 2–4 times per week (only 17 cohorts had data in this category) to less than once per month. The horizontal lines represent 95% CIs. The diamond markers indicate the pooled estimate.

Figure 2

Figure 2

Influence of removing studies one by one on multivariable adjusted HRs of incident stroke comparing fish consumption 2–4 times per week to less than once per month. Circles are HRs and horizontal dotted lines 95% CIs for meta-analysis of the studies listed excluding the study listed in the left. The dash vertical line in the center is the summary estimate of the HR including all included studies.

Figure 3

Figure 3

Funnel plot with pseudo 95% CIs for HR of incident stroke comparing fish consumption 2–4 times per week to less than once per month in 17 cohorts from 15 prospective cohort studies. The funnel plot shows s.e. of ln(HR) against ln(HR) for the 17 separated cohorts included in the meta-analysis. The vertical line indicates the fixed-effects summary estimate of the HR with sloping lines representing the expected 95% CIs for a given s.e., assuming no heterogeneity between studies.

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