Original Article | Published:

Food and health

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

European Journal of Clinical Nutrition volume 66, pages 11991207 (2012) | Download Citation

Contributors: PX reviewed all relevant papers, identified eligible studies, extracted the data, analyzed data, drafted the manuscript and contributed to the critical revision of the manuscript; BQ reviewed all relevant papers, identified eligible studies, extracted the data, drafted the manuscript and contributed to the critical revision of the manuscript; YS contributed to the critical revision of the manuscript; YN contributed to de novo data analysis of NIPPON DATA80 study and the critical revision of the manuscript; TK contributed to de novo data analysis of Physicians’ Health Study and the critical revision of the manuscript; SY contributed to the critical revision of the manuscript; LD contributed to the critical revision of the manuscript; KH made study concept and design, drafted the manuscript and contributed to the critical revision of the manuscript; PX and BQ had the primary responsibility for final content. All authors have read and approved the final manuscript.

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 (Plinear trend=0.09; Pnonlinear 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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Acknowledgements

This study was partially supported by Grants R21DK073812 and R21NS056445 from the National Institutes of Health. Dr Djousse received research funding from the National Institutes of Health. Dr He received research funding from the National Institutes of Health and the American Cancer Society.

Author information

Author notes

    • P Xun
    •  & B Qin

    These authors contributed equally to this work.

Affiliations

  1. Department of Nutrition, Gillings Schools of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    • P Xun
    • , B Qin
    •  & K He
  2. Department of Epidemiology, Gillings Schools of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    • P Xun
    • , S Yaemsiri
    •  & K He
  3. Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • Y Song
    •  & T Kurth
  4. Department of Health Science, Shiga University of Medical Science, Otsu, Japan

    • Y Nakamura
  5. Department of Cardiovascular Epidemiology, Kyoto Women’s University, Kyoto, Japan

    • Y Nakamura
  6. Inserm Unit 708—Neuroepidemiology, Bordeaux, France

    • T Kurth
  7. University of Bordeaux, Unit 708, Bordeaux, France

    • T Kurth
  8. Division of Aging, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • L Djousse

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Competing interests

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.

Corresponding author

Correspondence to K He.

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DOI

https://doi.org/10.1038/ejcn.2012.133

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