Cited by 379Fatty Acid Research and HealthNutritional Studies and DietAquaculture Nutrition and Growth

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

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Chowdhury, R., Stevens, S., Gorman, D., Pan, A., Warnakula, S., Chowdhury, S., Ward, H., Johnson, L. +3 more·2012·BMJ

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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  • An analysis of 26 prospective cohort studies and 12 RCTs (794,000 people, 34,817 cerebrovascular outcomes) found dietary fish intake protective against stroke.

    “In an analysis of 26 prospective cohort studies and 12 randomized controlled trials with aggregate data on 794,000 nonoverlapping people and 34,817 cerebrovascular outcomes, dietary fish intake was protective against stroke (30).”

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  1. [8]NICE: Secondary prevention in primary and secondary care for patients following a myocardial infarction. May 2007. 2012. www.nice.org.uk/nicemedia/pdf/CG48NICEGuidance.pdf. 21290635
  2. [25]Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-12. 10789670

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Authors
Chowdhury, R., Stevens, S., Gorman, D., Pan, A., Warnakula, S., Chowdhury, S., Ward, H., Johnson, L., Crowe, F., Hu, F. B., & Franco, O. H.
Affiliations
  • University of Cambridge (GB)
  • Harvard University (US)
  • Imperial College London (GB)
  • University of Oxford (GB)
Corresponding author
Franco, O. H.
Venue
BMJ
Publisher
BMJ
Published
2012-10-30
Volume
345
Issue
oct30 3
Pages
e6698-e6698
ISSN
1756-1833 (ISSN-L)
OpenAlex
W2117551083
Cited by
379
References
54
Citations by year
2026: 4 · 2025: 9 · 2024: 15 · 2023: 16 · 2022: 24 · 2021: 14 · 2020: 28 · 2019: 22 · 2018: 32 · 2017: 38 · 2016: 37 · 2015: 40 · 2014: 53 · 2013: 32 · 2012: 12
FWCI
5.31
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, cc-by-nc)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Agricultural and Biological Sciences › Aquatic Science › Aquaculture Nutrition and Growth
Keywords
fish consumption, n-3 long-chain polyunsaturated fatty acids, cerebrovascular disease, ischemic stroke, hemorrhagic stroke, omega-3 supplementation, primary prevention, secondary prevention, dietary intake, circulating biomarkers, cardiovascular risk, transient ischemic attack, stroke
MeSH terms
Animals, Cerebrovascular Disorders, Diet, Fishes, Humans, Prospective Studies, Risk Factors, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Dietary Supplements

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