Consumption of fish and stroke.
Background: In the past, at least 3 systematic reviews were published relating fish consumption to stroke. Results from these systematic reviews are discussed briefly:
- He K. 2004: Examined the relation with stroke risk. 8 cohorts were included with 3,491 stroke events. Three cohorts were not identified/discussed
(Lapidus L [6], Kinjo Y [10], Nagata C [23]).
The authors found a significant protective effect against stroke risk based on the relative risk (RR = 0.69; 95% CI = 0.54-0.88), but not on the P-value (P = 0.06) for consumption ≥ 5 times/week vs < once/month. - Wang C. 2004: Examined the relation with stroke risk. 9 cohorts were included. In one of these cohorts, the association with total omega-3
fatty acids, rather than marine omega-3 fatty acids was examined (Seino F. 1997), so these results were not included in my review. Three cohorts were not
identified/discussed (Lapidus L [6], Nagata C [23], Sauvaget C [27]).
The authors of this review stated that inconsistent findings were done (pages 70-71, 73). - Bouzan C. 2005: This review only included articles identified by Wang C. (2004) in the review mentioned above. And the authors wanted to describe the
dose-response relationship for fish consumption and stroke risk. 4 cohorts, and 1 case-control study were included, and 4 cohorts were excluded
(Keli SO [1], Kinjo Y [10], Morris MC [15], Yuan JM [19]), in addition to the cohort examining total omega-3 fatty acids mentioned above (Seino F. 1997).
Three cohorts were not identified/discussed (Lapidus L [6], Nagata C [23], Sauvaget C [27]).
The authors found that one serving/week of fish decreased stroke risk by 12%. And that any increment of one additional serving/week, decreased risk by an additional 2%.
|Additional references:
Bouzan C. A quantitative analysis of fish consumption and stroke risk. Am J Prev Med. 2005 Nov;29(4):347-52. Abstract
He K. Fish consumption and incidence of stroke: a meta-analysis of cohort studies. Stroke. 2004 Jul;35(7):1538-42. Full text
Seino F. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo). 1997 Feb;43(1):83-99. Abstract
Wang C. Effects of omega-3 fatty acids on cardiovascular disease. Evid Rep Technol Assess (Summ). 2004 Mar;(94):1-8. Full text|
Results:
Total stroke risk. Data about total fish consumption was provided by 22 cohorts, including 21,290 cases.
Significant protective effects were found in 4 cohorts (Kinjo Y [10], Mozaffarian D [24], Sauvaget C [27], Larsson SC [42]), and in two subcohorts among white women,
and black men/women (Gillum RF [17]). These analysis' included 15,156 cases (71% of all cases).
A significantly increased risk was found in two other cohorts (Wennberg M [22] among men only, and Ness AR [31]).
The average RR could be calculated from 21 cohorts: RR = 0.87. One cohort attributed greatly to the total amount of cases (Kinjo Y [10]), but exclusion of
this cohort from the analysis did not change the effect size materially: RR = 0.88.
Ischemic stroke risk. Data about total fish consumption was provided by 10 cohorts, including 8,382 cases.
Significant protective effects were found in 2 US cohorts (He K [14], Mozaffarian D [24]), including 914 cases (11% of all cases). The RR, but
not the trend was significant in one of these cohorts (He K [14]). No (non)significantly increased risks
were found. The average RR = 0.91.
Hemorrhagic stroke risk. Data about total fish consumption was provided by 10 cohorts, including 6,250 cases.
Significant protective effects were found in 2 Asian cohorts (Kinjo Y [10], Sauvaget C [27]), including 5,127 cases (82% of all cases).
No (non)significantly increased risks were found. The average RR = 0.89.
Intermediate levels of consumption: Protective effects seemed get stronger with increasing levels of consumption (RR = 0.98, 0.94, 0.93, and 0.89 for
< 1, 1, 2, and ≥ 3 servings fish/wk, respectively. But these effects depended on data from one single cohorts (Kinjo Y [10]). After exclusion of this cohort,
all effects became stronger (RR = 0.97, 0.89, 0.86, and 0.86 for < 1, 1, 2, and ≥ 3 servings fish/week, respectively. A more detailed analysis can be found
here.
Effect modification: A detailed analysis can be found
here. Briefly, stratified analysis showed the following effects:
- Data about men was available from 11 cohorts (3,929 cases). A significantly increased risk was found in 1 cohort (Wennberg M [22]). No other associations
were found. The average RR = 0.99.
Data about women was available from 9 cohorts (4,309 cases). Significant protective effects were found in 2 cohorts (Gillum RF [17], Larsson SC [42]), including 1,931 cases (45% of all cases). And nonsignificant protective effects were found in another 2 cohorts (Iso H [14], Iso H [36]), including 1,588 cases (37% of all cases). The average RR = 0.80. - Protective effects were found among US cohorts (RR = 0.77) and Asian cohorts (RR = 0.87), but not among European cohorts (RR = 0.96).
- Protective effects among US cohorts were found against ischemic stroke risk, while protective effects among Asian cohorts were found against hemorrhagic stroke risk.
- No consistent effect modification was found by other factors.
Subjects with prevalent disease. In one cohort, a significant protective effect was found against total stroke risk. And this effect was not modified by
diabetes or prevalent CHD (Mozaffarian D [2005]).
Conclusion: Significant protective effects against total stroke risk were found in 6 out of 22 cohorts, 3 of which were of moderate-very large size.
These cohorts included 71% of all cases. High fish consumption possibly protects against total stroke risk (- 13%). Effect sizes were identical for intakes of 2 and
≥ 3 servings/week. Stratified analysis showed that the evidence for a protective effect was restricted to Asian/US cohorts only, and women only.
Stratified analysis shows that the protective effect against total stroke risk among US cohorts is possibly caused by a protective effect against ischemic stroke risk,
while the protective effect against total stroke risk among Asian cohorts is possibly caused by a protective effect against hemorrhagic stroke risk.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 42) Larsson SC (2011) | The Swedish Mammography Cohort | 1,680 | Risk | RR = 0.84 (0.71-0.98; P = 0.049) |
| 38) Kaushik S (2008) | The Blue Mountains Eye Study | 69 | Mortality | HR = 0.62 (0.35-1.10) |
| 36) Yamagishi K (2008) | The JACC Study | 972 | Mortality | HR = 0.91 (0.74-1.13; P = 0.40) |
| 35) Bravata DM (2007) | No cohort name defined | 369 | Risk | HR = 0.89 (0.59-1.36) |
| 34) Myint PK (2006) | The EPIC-Norfolk Study | 217 men, and 204 women | Risk | Men: RR = 1.34 (0.93-2.93; P = 0.26). Women: RR = 0.86 (0.60-1.24; P = 0.29). |
| 32) Nakamura Y (2005) | The NIPPON DATA80 | 288 | Mortality | RR = 1.28 (0.71-2.32; P = 0.50) for the highest vs second quintile of consumption |
| 31) Ness AR (2005) | The Boyd Orr Cohort | 83 | Mortality | RR = 2.01 (1.09-3.69; P = 0.01) |
| 29) Folsom AR (2004) | The Iowa Women's Health Study | 313 | Mortality | RR = 1.06 (0.67-1.67; P = 0.65) |
| 27) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 1,462 | Mortality | HR = 0.85 (0.75-0.98; P = 0.02) |
| 24) Mozaffarian D (2005) | The Cardiovascular Health Study | 626 | Risk | HR = 0.74 (0.54-1.02; P = 0.04) |
| 23) Nagata C (2002) | The Takayama Study | 137 men, and 132 women | Mortality | Men: HR = 1.19 (0.78-1.81; P = 0.37). Women: HR = 0.87 (0.58-1.30; P = 0.49). |
| 22) Wennberg M (2007) | The MONICA Study | 189 men, and 128 women | Risk | Men: OR = 1.24 (1.01-1.51; P = 0.04). Women: OR = 0.90 (0.73-1.12; P = 0.35). |
| 19) Yuan JM (2001) | The Shanghai Cohort Study | 480 | Mortality | RR = 1.05 (0.77-1.43; P = 0.47) |
| 17) Gillum RF (1996) | The NHANES I | 262 white men, 251 white women, 107 black men and women | Risk | White men: RR = 0.85 (0.49-1.46). White women: RR = 0.55 (0.32-0.93; P = 0.05). Black men and women: RR = 0.51 (0.30-0.88; P = < 0.05). |
| 15) Morris MC (1995) | The Physician's Health Study | 173 | Risk | RR = 0.6 (0.3-1.6; P = 0.13) |
| 14) He K (2002) | The Health Professsional's Follow-up Study | 608 | Risk | RR = 0.83 (0.53-1.29; P = 0.81) |
| 14) Iso H (2001) | The Nurses' Health Study | 574 | Risk | RR = 0.48 (0.21-1.06; P = 0.06) |
| 13) Montonen J (2009) | The Finnish Mobile Clinic Health Survey | 659 | Risk | RR = 1.01 (0.81-1.27; P = 0.80) |
| 10) Kinjo Y (1999) | No cohort name defined | 11,030 | Mortality | RR = 0.86 (0.79-0.94) |
| 6) Lapidus L (1986) | No cohort name defined | 13 | Risk | No significant association |
| 2) Orencia AJ (1996) | The Western Electric Study | 222 | Risk | HR = 1.26 (0.74-2.16) |
| 1) Keli SO (1994) | The Zutphen Study | 42 | Risk | HR = 0.71 (0.38-1.33) |
| Total number of cases: 21,290 | Average RR = 0.87 | |||
| Excluding data from Kinjo Y [10]. | Total number of cases: 10,260 | Average RR = 0.88 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 42) Larsson SC (2011) | The Swedish Mammography Cohort | 1,310 | Cerebral infarction risk | RR = 0.87 (0.73-1.04; P = 0.19) |
| 36) Yamagishi K (2008) | The JACC Study | 319 | Ischemic stroke mortality | HR = 0.93 (0.65-1.34; P = 0.78) |
| 32) Nakamura Y (2005) | The NIPPON DATA80 | 165 | Cerebral infarction death | RR = 1.11 (0.50-2.47; P = 0.70) for the highest vs second quintile of consumption |
| 27) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 665 | Cerebral infarction mortality | HR = 0.94 (0.77-1.14; P = 0.50) |
| 24) Mozaffarian D (2005) | The Cardiovascular Health Study | 537 | Ischemic stroke risk | HR = 0.70 (0.50-0.99; P = 0.02) |
| 22) Wennberg M (2007) | The MONICA Study | 147 men, and 111 women | Ischemic stroke risk | Men: OR = 1.25 (1.00-1.56; P = 0.04). Women: OR = 0.93 (0.74-1.17; P = 0.51). |
| 14) He K (2002) | The Health Professsional's Follow-up Study | 377 | Ischemic stroke risk | RR = 0.54 (0.31-0.94; P = 0.28) |
| 14) Iso H (2001) | The Nurses' Health Study | 303 | Ischemic stroke risk | RR = 0.38 (0.12-1.19; P = 0.09) |
| 13) Montonen J (2009) | The Finnish Mobile Clinic Health Survey | 364 | Thrombosis or embolia risk | RR = 0.99 (0.73-1.35; P = 0.96) |
| 10) Kinjo Y (1999) | No cohort name defined | 4,084 | Embolism and thrombosis mortality | RR = 0.99 (0.86-1.14) |
| Total number of cases: 8,382 | Average RR = 0.91 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 42) Larsson S (2011) | The Swedish Mammography Cohort | 233 | Hemorrhagic stroke risk | RR = 0.67 (0.42-1.08; P = 0.08) |
| 36) Yamagishi K (2008) | The JACC Study | 180 intraparenchymal hemorrhage, and 153 subarachnoid hemorrhage | Mortality | Intraparenchymal hemorrhage: HR = 0.95 (0.62-1.47; P = 0.58). Subarachnoid hemorrhage: HR = 0.96 (0.55-1.68; P = 0.84). |
| 32) Nakamura Y (2005) | The NIPPON DATA80 | 63 | Cerebral hemorrhage death | RR = 0.93 (0.20-4.28; P = 0.97) for the highest vs second quintile of consumption |
| 27) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 354 | Intracerebral haemorrhage mortality | HR = 0.70 (0.54-0.92; P = 0.008) |
| 24) Mozaffarian D (2005) | The Cardiovascular Health Study | 73 | Hemorrhagic stroke risk | HR = 0.93 (0.37-2.33; P = 0.66) |
| 22) Wennberg M (2007) | The MONICA Study | 39 men, and 15 women | Hemorrhagic stroke risk | Men: OR = 1.14 (0.69-1.88; P = 0.59). Women: OR = 0.61 (0.23-1.57; P = 0.31). |
| 14) He K (2002) | The Health Professsional's Follow-up Study | 106 | Hemorrhagic stroke risk | RR = 1.55 (0.45-5.35; P = 0.70) |
| 14) Iso H (2001) | The Nurses' Health Study | 181 | Hemorrhagic stroke risk | RR = 1.02 (0.34-3.10; P = 0.33) |
| 13) Montonen J (2009) | The Finnish Mobile Clinic Health Survey | 80 | Intracerebral haemorrhage risk | RR = 1.23 (0.63-2.42; P = 0.41) |
| 10) Kinjo Y (1999) | No cohort name defined | 4,773 | Cerebral haemorrhage mortality | RR = 0.87 (0.76-0.98) |
| Total number of cases: 6,250 | Average RR = 0.89 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 42) Larsson SC (2011) | The Swedish Mammography Cohort | 34,670 women aged 49-83 and free of stroke, ischemic heart disease and cancer. | Mean 10.4 (1998-2008) | See variables | Stroke events (cerebral infarction, hemorrhagic stroke, and unspecified stroke) | Fish (cod, saithe, fish fingers, salmon, whitefish, char, herring, and mackerel) |
Age, smoking history, education, BMI, total physical activity, history of diabetes, history of hypertension, aspirin use, family history of myocardial infarction, and intakes of total energy, alcohol, processed meat, unprocessed red meat, fruit, and vegetables. |
38) Kaushik S (2008) | The Blue Mountains Eye Study (BMES) | 2,683 predominantly Caucasian subjects aged 49+ | 10 | (1992-94 to ?) 69 | Stroke death | Any fish (not defined) |
HR = 0.62 (0.35-1.10) for the highest vs lowest tertile of consumption. | Amount specific data (Frequency of consumption): < 1: HR = 1. 1: HR = 0.51 (0.26-0.99). ≥ 2: HR = 0.62 (0.35-1.10). Age, gender, mean arterial blood pressure, BMI, smoking status, qualification level, self-rated health and past history of MI and stroke. |
36) Yamagishi K (2008) | The JACC Study | 57,972 subjects (22,881 men and 35,091 women) aged 40-79, and without heart disease, stroke, or cancer. | (Japan) 12.7 | (1988-90 to 1999-2003) See variables | Stroke mortality | Fish (fresh fish, kamaboko [steamed fish paste], dried or salted fish, and deep-fried foods or tempura [a common form of deep-fried fish or shellfish]) |
|
No differences were found by gender in any association. Energy, history of hypertension and diabetes mellitus, smoking status, alcohol consumption, BMI, mental stress, walking, sports, education, total energy, dietary intakes of cholesterol, saturated and omega 6 polyunsaturated fatty acids, vegetables, and fruits. |
36) Iso H (2007) | The JACC Study | 43,918 men, and 59,796 women. | (Japan) Not defined. | 1,230 men, and | 1,014 women. Cerebrovascular mortality | Fresh fish (not defined) |
|
Age and study area. |
35) Bravata DM (2007) | No cohort name defined | 5,355 male white twins from the NAS-NRC Twin Registry. | (US) 1972-85 to 1996-98 | 579 | Stroke risk (including transient ischemic attack) | Fish and seafood (not defined) |
|
Unadjusted. |
34) Myint PK (2006) | The EPIC-Norfolk Study | 24,312 subjects (10,972 men and 13,340 women) aged 40-79, and without stroke. | (UK) 8.5 | (1993-97 to 2004) 217 men, and 204 women | Stroke incidence (mortality and hospital episodes) | Total fish (white fish: including cod, haddock, plaice, sole and halibut - either fresh or frozen, fried fish in batter [e.g., fish and chips], fish fingers, and fish cakes. Oily fish: such as mackerel, kippers, tuna, salmon, sardines and herring [either fresh or canned]. Shellfish: such as crab, prawns, mussels. Fish roe and taramasalata) |
|
Age, systolic blood pressure, BMI, smoking, cholesterol, diabetes, fish oil supplements, physical activity, alcohol consumption and total energy intake. |
32) Nakamura Y (2005) | The NIPPON DATA80 | 8,879 subjects (3,945 men, and 4,934 women) aged ≥ 30, and without coronary disease, stroke, cancer, or significant comorbidities such as renal insufficiency. | (Japan) 19 | (1980-1999) See variables | Stroke death | Fish (not defined) |
|
Additional adjustment for serum total cholesterol did not change the association. Age, sex, smoking, alcohol drinking, hypertension, BMI, and diabetes. |
31) Ness AR (2005) | The Boyd Orr Cohort | 4,028 people (1,995 men, and 2,033 women) from England and Scotland. | average 37 | (1948 to 2000) 83 | Stroke mortality | Fish (not defined) |
RR = 2.01 (1.09-3.69; P = 0.01) for the highest vs lowest quartile of consumption. | Amount specific data (g): 0-6.9: RR = 1. 7.0-15.7: RR = 0.79 (0.39-1.60). 15.8-29.2: RR = 1.13 (0.58-2.18). 29.2-148.9: RR = 2.01 (1.09-3.69). Age, energy, sex, childhood family food expenditure, father's social class, district of residence as a child, period of birth, season when studied as a child, and Townsend score for current address or place of death. |
29) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | 313 | Stroke mortality | Total fish and seafood (Dark-meat fish [such as mackerel, salmon, sardines, bluefish, or swordfish]; Canned tuna; Other fish;, and Shrimp, lobster, or callops as a main dish) |
RR = 1.06 (0.67-1.67; P = 0.65) for the highest vs lowest quintile of consumption. | Amount specific data (servings/week): < 0.5: RR = 1. 0.5-< 1.0: RR = 1.30 (0.86-1.96). 1.0-1.5: RR = 0.95 (0.64-1.41). > 1.5-< 2.5: RR = 0.90 (0.53-1.53). ≥ 2.5: RR = 1.06 (0.67-1.67). Age, energy intake, education level, physical activity level, alcohol consumption, smoking status, pack-years of cigarette smoking, age at first livebirth, estrogen use, vitamin use, BMI, waist/hip ratio, diabetes, hypertension, intake of whole grains, fruits and vegetables, red meat, cholesterol, and saturated fat. |
29) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | 313? | Stroke mortality | Omega-3 fatty acids from fish (excluding fish oil supplements) | No association was found (results not shown). | Age, energy intake, education level, physical activity level, alcohol consumption, smoking status, pack-years of cigarette smoking, age at first livebirth, estrogen use, vitamin use, BMI, waist/hip ratio, diabetes, hypertension, intake of whole grains, fruits and vegetables, red meat, cholesterol, and saturated fat. |
27) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 40,349 Japanese atomic bomb surivors (14,350 men, and 24,999 women) aged 34-103. | 16 | (1980-81 to 1996) Non-broiled fish: 1,260. | Broiled fish: 1,068. Fish products: 1,462 (354 intracerebral haemorrhage, and 655 cerebral infarction) Stroke mortality | Fish |
|
Adjustment for each other animal product intake did not alter the risks. Stratified by sex and birth cohort. Adjusted for city, radiation dose, self-reported BMI, smoking status, alcohol habits, education levels, history of diabetes, or hypertension. |
24) Mozaffarian D (2005) | The Cardiovascular Health Study | 4,775 men and women aged 65-98, and free of cerebrovascular disease. | (US) 12 | (1989-90 to 2001) See variables | Stroke risk | Tuna/other fish (tuna fish or other broiled/baked fish) |
|
*Potential mediators include systolic blood pressure and low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and C-reactive protein levels. Tuna and other fish consumption were correlated, and associations of each with risk were similar to associations of tuna/other fish intake combined. Effect modification: There was little evidence that findings varied by age, sex, education, diabetes, prevalent coronary heart disease, treated hypertension, systolic blood pressure, smoking, or aspirin use (P >.05 for each interaction). Age, sex, education, diabetes, prevalant CHD, smoking status, pack-years of smoking, aspirin use, BMI, leisure-time physical activity, alcohol use, total and caloric intake. |
Race, income, enrollment site, hypertension, frequent falls, exercise intensity, diastolic blood pressure, carotid intimal medial thickness, and atrial fibrillation; use of ß-blockers, lipidlowering medication, fish oil, and estrogen; fasting glucose, insulin, fibrinogen, factor VII, and factor VIII; and estimated intake of total fat, saturated fat, linolenic acid, carbohydrates, protein, fiber, wine, thiamine, vitamin A, and vitamin C did not appreciably alter the relations. 23) Nagata C (2002) | The Takayama Study | 13,355 men and 15,724 women aged 35 or older. | (Japan) 7 | (1992-1999) 137 men, and | 132 women. Cerebrovascular disease mortality | Fish oil |
|
Age, total energy, marital status, BMI, smoking status, exercise, and history of hypertension. |
Additionally for men: alcohol intake, coffee intake, and history of diabetes mellitus. Additionally for women: age at menarche, and history of hysterectomy. Ischemic heart disease and cerebrovascular disease were adjusted for total energy and nondietary covariates. 22) Wennberg M (2007) | The Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Study | Approximately 74,000 Swedish subjects. | (Nested case-control) 1985-2000 | See variables | Stroke incidence (excluding transient ischaemic attacks, subdural haemorrhages and acute strokes with concomitant brain tumor or severe blood disease) | Total fish (for example herring, lavaret, salmon, perch, cod) |
|
Mercury: No association was found between total stroke risk and mercury in erythrocytes - from blood samples obtained before the event - among men (OR = 0.99; 95% CI = 0.93-1.06) and women (OR = 1.00; 95% CI = 0.94-1.08). Controls matched for sex, age, date of health survey and residential area. |
Adjusted for diabetes, hypertension, BMI, and smoking. 19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) 480 | Stroke mortality | Seafood (fresh fish [e.g., carp, beam, pomfret]; salted fish [e.g., yellow croaker and hairtail]; and shellfish [e.g., shrimp and crab]) |
RR = 1.11 (0.83-1.47; P = 0.42) for the highest vs lowest quintile of consumption. | Amount specific data (g/week): < 50: RR = 1. 50-< 100: RR = 0.93 (0.72-1.21). 100-< 150: RR = 0.79 (0.58-1.07). 150-< 200: RR = 1.01 (0.74-1.37). ≥ 200: RR = 1.11 (0.83-1.47). One serving = 50 g. Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) 480 | Stroke mortality | Fresh and salted fish (fresh fish [e.g., carp, beam, pomfret]; salted fish [e.g., yellow croaker and hairtail]) |
RR = 1.05 (0.77-1.43; P = 0.47) for the highest vs lowest quintile of consumption. | Amount specific data (g/week): < 30: RR = 1. 30-< 60: RR = 0.84 (0.64-1.09). 60-< 100: RR = 0.87 (0.65-1.15). 100-< 150: RR = 0.95 (0.69-1.31). ≥ 150: RR = 1.05 (0.77-1.43). Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
19) Yuan JM (2001) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai (China), and without a history of cancer. | 12 | (1986-89 to 1998) 480 | Stroke mortality | N-3 fatty acids from seafood |
RR = 1.00 (0.75-1.33; P = 0.36) for the highest vs lowest quintile of consumption. | Amount specific data (g/week): < 0.27: RR = 1. 0.27-0.43: RR = 0.76 (0.57-1.03). 0.44-0.72: RR = 0.76 (0.58-0.98). 0.73-1.09: RR = 0.93 (0.69-1.24). ≥ 1.10: RR = 1.00 (0.75-1.33). Age, total energy intake, level of education, BMI, current smoking, cigarettes smoked, alcohol, history of diabetes, and history of hypertension. |
19) Ross RK (1997) | No cohort name defined | 18,244 men aged 45-64 from Shanghai, and without cancer. | (China) 1986-89 to 1994 | 245? | Stroke/cerebrovascular accident death | Fresh fish of any kind | No significant association was found when evaluated either as median levels of daily intake or as tertiles of intake frequencies (No data shown). | Education, marital status, BMI, lifetime cigarette smoking, lifetime ethanol intake, and history of hypertension. |
17) Gillum RF (1996) | The NHANES I | 5,192 White (4,410) and black (782) men and women aged 45-74, and without a history of stroke. | (USA) 12 | (1971-75 to 1986-87) See variables | Stroke incidence (hospital admission or death) | Fish or shellfish (not defined) |
|
Since portion sizes were not recorded on the frequency history, no attempt was made to convert consumption to grams per day. Age, smoking, history of diabetes, history of heart disease, education, systolic blood pressure, serum albumin concentration, serum cholesterol concentration, BMI, alcohol intake, and non-recreational physical activity. |
The model for black men and women additionaly adjusted for gender. 15) Morris MC (1995) | The Physician's Health Study | 21,185 men aged 40-84, and without a history of MI, stroke, transient ischemic attacks, cancer, liver/renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or NSAID's. | (USA) 4 | (1983-1988) 173 | Fatal and nonfatal stroke (infarcts caused by thrombotic or embolic occlusion of cerebral arteries [ischemic stroke], and intracerebal hemorrhage due to rupture of a vessel) | Fish (canned tuna fish; dark meat fish [e.g., mackerel, salmon, sardines, bluefish, swordfish]; other fish. | Excluding shrimp, lobster, or scallops as a main dish)
RR = 0.6 (0.3-1.6; P = 0.13) for the highest vs lowest quartile of consumption. | Amount specific data (meals/week): < 1: RR = 1. 1: RR = 0.9 (0.6-1.3). 2-4: RR = 0.8 (0.3-1.6). ≥ 5: RR = 0.6 (0.3-1.6). Age, aspirin and beta-carotene assignment, smoking, alcohol consumption, obesity, diabetes mellitus, vigorous exercise, parental history of MI, history of hypertension, history of hypercholesterolemia, vitamin supplement use, and saturated fat intake. |
15) Morris MC (1995) | The Physician's Health Study | 21,185 men aged 40-84, and without a history of MI, stroke, transient ischemic attacks, cancer, liver/renal disease, peptic ulcer, gout, current use of aspirin, other platelet-active drugs, or NSAID's. | (USA) 4 | (1983-1988) 173 | Fatal and nonfatal stroke (infarcts caused by thrombotic or embolic occlusion of cerebral arteries [ischemic stroke], and intracerebal hemorrhage due to rupture of a vessel) | Long-chain omega 3 fatty acids from seafood (EPA & DHA from canned tuna fish; dark meat fish [e.g., mackerel, salmon, sardines, bluefish, swordfish]; other fish; and shrimp, lobster, or scallops as a main dish. | Excluding alpha-linolenic acid, and fish oil supplements)
RR = 1.0 (0.6-1.6; P = 0.49) for the highest vs lowest quintile of consumption. | Amount specific data (g/week): < 0.5: RR = 1. 0.5-< 1.0: RR = 0.9 (0.6-1.6). 1.0-< 1.7: RR = 1.1 (0.7-1.8). 1.7-< 2.3: RR = 0.7 (0.4-1.2). ≥ 2.3: RR = 1.0 (0.6-1.6). Age, aspirin and beta-carotene assignment, smoking, alcohol consumption, obesity, diabetes mellitus, vigorous exercise, parental history of MI, history of hypertension, history of hypercholesterolemia, vitamin supplement use, and saturated fat intake. |
14) He K (2002) | The Health Professional's Follow-up Study | 43,671 men aged 40-75, and free of diabetes mellitues and CVD. | 12 | (1986-1998) See variables | Stroke incidence (fatal and nonfatal) | Fish (canned fish tuna [3-4 oz/84-112 g]; dark meat fish such as mackerel, salmon, sardines, bluefish, and swordfish [3-5 oz/84-140 g]; other fish [3-5 oz/84-140 g]; and shrimp, lobster, or scallops as a main dish [3.5 oz/98 g]) |
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Age, smoking, BMI, physical activity, history of hypertension, use of aspirin, fish oil, multivitamins, intake of total calories, total fat, saturated fat, trans-unsaturated fat, alcohol, potassium, magnesium, total servings of fruits and vegetables, and hypercholesterolemia. |
14) He K (2002) | The Health Professional's Follow-up Study | 43,671 men aged 40-75, and free of diabetes mellitues and CVD. | 12 | (1986-1998) See variables | Stroke incidence (fatal and nonfatal) | Omega-3 polyunsaturated fatty acids (EPA and DHA from fish and seafood) |
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Age, smoking, BMI, physical activity, history of hypertension, use of aspirin, fish oil, multivitamins, intake of total calories, total fat, saturated fat, trans-unsaturated fat, alcohol, potassium, magnesium, total servings of fruits and vegetables, and hypercholesterolemia. |
14) Iso H (2001) | The Nurses' Health Study | 85,764 women aged 34-59, and without cancer, angina, MI, coronary revascularization, stroke, or other CVD. | (USA) 14 | (1980-1994) 74? | Intraparenchymal hemmorhage risk | Fish | A significant inverse association (No data shown). | Age, smoking status, time interval, BMI, alcohol intake, menopausal status and postmenopausal hormone use, vigorous exercise, usual aspirin use, multivitamin use, vitamin E use, n3 fatty acid intake, calcium intake, and histories of hypertension, diabetes, and high cholesterol levels, and total energy. |
14) Iso H (2001) | The Nurses' Health Study | 79,839 women aged 34-59, and without a history of cancer, angina, myocardial infarction, coronary revascularization, stroke, or other cardiovascular diseases, high serum cholesterol levels, or diabetes. | (USA) 14 | (1980-1994) See variables | Stroke risk | Fish (dark-meat fish such as mackerel, salmon, sardines, bluefish, or swordfish; canned tuna; other fish; and shrimp, lobster, or scallops as main dish) |
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One portion = 6-8 oz (168-224 g). Joules, body mass index, alcohol intake, menopausal status and postmenopausal hormone use, vigorous exercise, usual aspirin use, multivitamin use, history of hypertension, and frequency of total fruit and vegetable servings and for nutrient intake of saturated fat, trans-unsaturated fat, linoleic acid, animal protein, and calcium. |
13) Montonen J (2009) | The Finnish Mobile Clinic Health Examination Survey | 3,958 men and women aged 40-79 and free of heart disease. | 28 | (1967-1994) See variables | CVA incidence | Total fish (not defined) |
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Age, sex, energy intake, smoking, BMI, physical activity, geographic area, occupation, diabetes, use of postmenopausal hormones, hypertension, serum cholesterol, and consumptions of butter, vegetables, fruits, and berries. |
13) Montonen J (2009) | The Finnish Mobile Clinic Health Examination Survey | 3,958 men and women aged 40-79 and free of heart disease. | 28 | (1967-1994) See variables | CVA incidence | Marine long-chain n-3 fatty acids (not defined) |
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Age, sex, energy intake, smoking, BMI, physical activity, geographic area, occupation, diabetes, use of postmenopausal hormones, hypertension, serum cholesterol, and consumptions of butter, vegetables, fruits, and berries. |
10) Kinjo Y (1999) | No cohort name defined | 223,170 men and women aged 40-69, and without a history of diseases other than stomach disease. | (Japan) 1966-1981 | See variables | Cerebrovascular disease mortality (Cerebral haemorrhage, cerebral embolism and thrombosis, subarachnoid haemorrhage, and other cerebrovascular disease) | Fish (not defined) |
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Effect modification: The results from separate analyses for men and women, non-smokers and smokers, and rural and urban areas were similar (data not shown). Sex, attained age, follow-up interval, prefecture, alcohol drinking, smoking and occupation. |
10) Hirayama T (1990) | No cohort name defined | 265,118 adults (122,261 men, 142,857 women) aged ≥ 40 from 6 prefectures in Japan. | 17 | (1966-1982)
Cerebrovascular disease mortality: (Number of cases not clearly defined). | Subarachnoid haemorrhage mortality: (211? men, and 277? women). Cerebral haemorrhage mortality: (3,556? men, and 2,811? women). Cerebral embolism mortality: (3,380? men, and 2,497? women). Cerebrovascular disease mortality | Fish & shellfish (not defined) |
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Not defined (possibly only age). |
Age and sex-adjusted for the associations with men & women combined. 6) Lapidus L (1986) | Cohort name not defined. | 1,462 women in Gothenburg. | (Sweden) 12 | (1968-69 to 1980-81) 13? | Stroke risk | Fish (not defined) | No significant correlation was found (no data shown) | Age. |
2) Orencia AJ (1996) | The Chicago Western Electric Study | 1,847 men aged 40-55, and free of CHD and stroke. | 30 | (1957-59 to ?) See variables | Stroke incidence (excluding transient ischemic attacks) | Fish (not defined) |
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Age, systolic blood pressure, cigarette smoking, serum cholesterol, diabetes, ECG abnormalities, tabe salt use, alcohol intake, iron, thiamine, riboflavin, niacin, vitamin C, beta-carotene, and retinol, and total energy, polyunsaturated fatty acids, carbohydrates, and total protein. |
1) Keli SO (1994) | The Zutphen Study | (The Dutch contribution to The Seven Countries Study) 552 men aged 50-69. | (The Netherlands) 1970-1985 | 42 | First stroke incidence (a sudden onset of neurological paralysis of > 24-hour duration or leading to death) | Fish (not defined) | HR = 0.49 (0.24-1.01; P = 0.52) for > 20 vs ≤ 20 g/d. | Results were unaffected by BMI and history of MI and diabetes mellitus. Long-term consumption: HR = 0.71 (0.38-1.33) for fish consumption at all 3 surveys (in 1960, 1965, and 1970) vs consumption at 0-2 surveys. Age, average systolic blood pressure 1960-70, average serum cholesterol 1960-70, cigarette smoking, and intake of energy, vegetable protein, and alcohol. |
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