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Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis.

Abstract

OBJECTIVE

To clarify associations of fish consumption and long chain omega 3 fatty acids with risk of cerebrovascular disease for primary and secondary prevention.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Studies published before September 2012 identified through electronic searches using Medline, Embase, BIOSIS, and Science Citation Index databases.

ELIGIBILITY CRITERIA

Prospective cohort studies and randomised controlled trials reporting on associations of fish consumption and long chain omega 3 fatty acids (based on dietary self report), omega 3 fatty acids biomarkers, or supplementations with cerebrovascular disease (defined as any fatal or non-fatal ischaemic stroke, haemorrhagic stroke, cerebrovascular accident, or transient ischaemic attack). Both primary and secondary prevention studies (comprising participants with or without cardiovascular disease at baseline) were eligible.

RESULTS

26 prospective cohort studies and 12 randomised controlled trials with aggregate data on 794,000 non-overlapping people and 34,817 cerebrovascular outcomes were included. In cohort studies comparing categories of fish intake the pooled relative risk for cerebrovascular disease for 2-4 servings a week versus ≤ 1 servings a week was 0.94 (95% confidence intervals 0.90 to 0.98) and for ≥ 5 servings a week versus 1 serving a week was 0.88 (0.81 to 0.96). The relative risk for cerebrovascular disease comparing the top thirds of baseline long chain omega 3 fatty acids with the bottom thirds for circulating biomarkers was 1.04 (0.90 to 1.20) and for dietary exposures was 0.90 (0.80 to 1.01). In the randomised controlled trials the relative risk for cerebrovascular disease in the long chain omega 3 supplement compared with the control group in primary prevention trials was 0.98 (0.89 to 1.08) and in secondary prevention trials was 1.17 (0.99 to 1.38). For fish or omega 3 fatty acids the estimates for ischaemic and haemorrhagic cerebrovascular events were broadly similar. Evidence was lacking of heterogeneity and publication bias across studies or within subgroups.

CONCLUSIONS

Available observational data indicate moderate, inverse associations of fish consumption and long chain omega 3 fatty acids with cerebrovascular risk. Long chain omega 3 fatty acids measured as circulating biomarkers in observational studies or supplements in primary and secondary prevention trials were not associated with cerebrovascular disease. The beneficial effect of fish intake on cerebrovascular risk is likely to be mediated through the interplay of a wide range of nutrients abundant in fish.

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  • Authors+Show Affiliations

    ,

    Department of Public Health and Primary Care, University of Cambridge, UK.

    , , , , , , , , ,

    Source

    BMJ (Clinical research ed.) 345: 2012 Oct 30 pg e6698

    MeSH

    Animals
    Cerebrovascular Disorders
    Diet
    Dietary Supplements
    Fatty Acids, Omega-3
    Fishes
    Humans
    Prospective Studies
    Randomized Controlled Trials as Topic
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23112118

    Citation

    Chowdhury, Rajiv, et al. "Association Between Fish Consumption, Long Chain Omega 3 Fatty Acids, and Risk of Cerebrovascular Disease: Systematic Review and Meta-analysis." BMJ (Clinical Research Ed.), vol. 345, 2012, pp. e6698.
    Chowdhury R, Stevens S, Gorman D, et al. Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis. BMJ. 2012;345:e6698.
    Chowdhury, R., Stevens, S., Gorman, D., Pan, A., Warnakula, S., Chowdhury, S., ... Franco, O. H. (2012). Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis. BMJ (Clinical Research Ed.), 345, pp. e6698. doi:10.1136/bmj.e6698.
    Chowdhury R, et al. Association Between Fish Consumption, Long Chain Omega 3 Fatty Acids, and Risk of Cerebrovascular Disease: Systematic Review and Meta-analysis. BMJ. 2012 Oct 30;345:e6698. PubMed PMID: 23112118.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis. AU - Chowdhury,Rajiv, AU - Stevens,Sarah, AU - Gorman,Donal, AU - Pan,An, AU - Warnakula,Samantha, AU - Chowdhury,Susmita, AU - Ward,Heather, AU - Johnson,Laura, AU - Crowe,Francesca, AU - Hu,Frank B, AU - Franco,Oscar H, Y1 - 2012/10/30/ PY - 2012/11/1/entrez PY - 2012/11/1/pubmed PY - 2013/1/9/medline SP - e6698 EP - e6698 JF - BMJ (Clinical research ed.) JO - BMJ VL - 345 N2 - OBJECTIVE: To clarify associations of fish consumption and long chain omega 3 fatty acids with risk of cerebrovascular disease for primary and secondary prevention. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Studies published before September 2012 identified through electronic searches using Medline, Embase, BIOSIS, and Science Citation Index databases. ELIGIBILITY CRITERIA: Prospective cohort studies and randomised controlled trials reporting on associations of fish consumption and long chain omega 3 fatty acids (based on dietary self report), omega 3 fatty acids biomarkers, or supplementations with cerebrovascular disease (defined as any fatal or non-fatal ischaemic stroke, haemorrhagic stroke, cerebrovascular accident, or transient ischaemic attack). Both primary and secondary prevention studies (comprising participants with or without cardiovascular disease at baseline) were eligible. RESULTS: 26 prospective cohort studies and 12 randomised controlled trials with aggregate data on 794,000 non-overlapping people and 34,817 cerebrovascular outcomes were included. In cohort studies comparing categories of fish intake the pooled relative risk for cerebrovascular disease for 2-4 servings a week versus ≤ 1 servings a week was 0.94 (95% confidence intervals 0.90 to 0.98) and for ≥ 5 servings a week versus 1 serving a week was 0.88 (0.81 to 0.96). The relative risk for cerebrovascular disease comparing the top thirds of baseline long chain omega 3 fatty acids with the bottom thirds for circulating biomarkers was 1.04 (0.90 to 1.20) and for dietary exposures was 0.90 (0.80 to 1.01). In the randomised controlled trials the relative risk for cerebrovascular disease in the long chain omega 3 supplement compared with the control group in primary prevention trials was 0.98 (0.89 to 1.08) and in secondary prevention trials was 1.17 (0.99 to 1.38). For fish or omega 3 fatty acids the estimates for ischaemic and haemorrhagic cerebrovascular events were broadly similar. Evidence was lacking of heterogeneity and publication bias across studies or within subgroups. CONCLUSIONS: Available observational data indicate moderate, inverse associations of fish consumption and long chain omega 3 fatty acids with cerebrovascular risk. Long chain omega 3 fatty acids measured as circulating biomarkers in observational studies or supplements in primary and secondary prevention trials were not associated with cerebrovascular disease. The beneficial effect of fish intake on cerebrovascular risk is likely to be mediated through the interplay of a wide range of nutrients abundant in fish. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23112118/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=23112118 DB - PRIME DP - Unbound Medicine ER -