Consumption of total fish and total cancer.
Total cancer risk: Data about total fish consumption and total cancer risk was provided by 14 cohorts, including 62,967 cases.
A significant protective effect was found among men in one cohort of very large size (Hirayama T [3]), and a significantly increased risk was found
among men in one cohort of small size, but no adjustments were made for any possible confounders (Ikeda M [1]). The average RR could be calculated
from 12 cohorts: RR = 0.94. Excluding the debatable results from Hirayama T [3] eliminated any effect: RR = 1.00.
Advanced stage/metastatic disease risk or disease progression: No data was found.
Total cancer mortality: Data about total fish consumption and total cancer mortality was provided by 12 cohorts, including 24,543 cases.
Significant effects were identical to the ones for the analysis of cancer risk. The average RR could be calculated from 10 cohorts: RR = 0.83.
Again, excluding the debatable results from Hirayama T [3] eliminated any effect: RR = 1.00.
Inclusion of intermediate levels of consumption.
(Non)significant effects at any level of consumption were as follows:
- Hirayama T [3]: Significant protective for men at any level of consumption, and for women at consumption 1-3 times/wk. Nonsignificant for women at other levels of consumption.
- Gillum RF [7]: Significant protective for white man at consumption once/week.
Effect modification: No effect modification was found by omega-6 fay intake (Virtanen JK [14]), BMI, or income (Tomasallo C [16]).
Subjects with prevalant disease: No data was found.
Conclusion: Very few effects were found at any level of consumption, and the average RR's showed zero effect. No evidence was found for an association
between fish consumption and total cancer risk, or total cancer mortality.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 16) Tomasallo C (2010) | No cohort name defined | 77 captains, and 44 referents | Mortality | Captains: HR = 1.02 (0.52-1.02). Women: HR = 0.73 (0.34-1.60). |
| 14) Virtanen JK (2008) | The Health Professionals Follow-up Study | 4,690 | Risk | RR = 0.96 (0.82-1.14; P = 0.99) |
| 13) Couto E (2011) | The EPIC Study | 30,731 | Risk | HR = 1.01 (0.99-1.02) |
| 11) Iso H (2007) | The JACC Study | 3,677 men, and 2,125 women | Mortality | Men: HR = 1.01 (0.93-1.10). Women: HR = 0.97 (0.86-1.09). |
| 10) Khan MM (2004) | No cohort name defined | 155 men, and 89 women | Mortality | Men: RR = 1.0* Women: RR = 1.47* |
| 9) Kelemen LE (2005) | The Iowa Women's Health Study | 4,843 | Risk | RR = 0.98 (0.88-1.09; P = 0.74) |
| 8) Nagata C (2002) | The Takayama Study | 400 men, and 253 women | Mortality | Men: HR = 0.89 (0.66-1.20; P = 0.52). Women: HR = 0.70 (0.47-1.05; P = 0.15) |
| 7) Gillum RF (2000) | The NHANES I Study | 705 (no amount of cases defined for the subcohorts) | Mortality | white men: RR = 0.66 (0.43-1.03). Black men: RR = 2.04 (0.56-7.44). White women: RR = 0.78 (0.46-1.31). Black women: RR = 1.73 (0.49-6.18) |
| 6) Whiteman D (1999) | The OXCHECK Study | 214 | Mortality | RR = 1.04 (0.59-1.82) |
| 5) Kromhout D (1995) | No cohort name defined | 67 | Mortality | RR = 1.30 (0.77-2.20) |
| 4) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial | 132 | Mortality | RR = 0.97 (P = NS) |
| 3) Hirayama T (1990) | No cohort name defined | 8,794 men, and 5,946 women) | Mortality | Men: RR = 1.53 (1.25-1.87) for the lowest vs highest quartile of consumption. Women: RR = 1.22 (1.00-1.49) for the lowest vs highest quartile of consumption. |
| 2) Shekelle RB (1985) | The Western Electric Study | 190 | Mortality | No significant association (P = 0.32) |
| 1) Ikeda M (1983) | The Adult Health Study | 488 | Mortality | RR = 1.33 (P = < 0.05) |
| Total number of cases: 62,967 | Average RR = 0.94 | |||
| Excluding data from Hirayama T [3]: | Total number of cases: 48,227 | Average RR = 1.00 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 16) Tomasallo C (2010) | No cohort name defined | 77 captains, and 44 referents | Captains: HR = 1.02 (0.52-1.02). Women: HR = 0.73 (0.34-1.60). |
| 11) Iso H (2007) | The JACC Study | 3,677 men, and 2,125 women | Men: HR = 1.01 (0.93-1.10). Women: HR = 0.97 (0.86-1.09). |
| 10) Khan MM (2004) | No cohort name defined | 155 men, and 89 women | Men: RR = 1.0* Women: RR = 1.47* |
| 9) Folsom AR (2004) | The Iowa Women's Health Study | 1,840 | RR = 0.91 (0.75-1.11; P = 0.61) |
| 8) Nagata C (2002) | The Takayama Study | 400 men, and 253 women | Men: HR = 0.89 (0.66-1.20; P = 0.52). Women: HR = 0.70 (0.47-1.05; P = 0.15) |
| 7) Gillum RF (2000) | The NHANES I Study | 705 (no amount of cases defined for the subcohorts) | white men: RR = 0.66 (0.43-1.03). Black men: RR = 2.04 (0.56-7.44). White women: RR = 0.78 (0.46-1.31). Black women: RR = 1.73 (0.49-6.18) |
| 6) Whiteman D (1999) | The OXCHECK Study | 214 | RR = 1.04 (0.59-1.82) |
| 5) Kromhout D (1995) | No cohort name defined | 67 | RR = 1.30 (0.77-2.20) |
| 4) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial | 132 | RR = 0.97 (P = NS) |
| 3) Hirayama T (1990) | No cohort name defined | 8,794 men, and 5,946 women) | Men: RR = 1.53 (1.25-1.87) for the lowest vs highest quartile of consumption. Women: RR = 1.22 (1.00-1.49) for the lowest vs highest quartile of consumption. |
| 2) Shekelle RB (1985) | The Western Electric Study | 190 | No significant association (P = 0.32) |
| 1) Ikeda M (1983) | The Adult Health Study | 488 | RR = 1.33 (P = < 0.05) |
| Total number of cases: 24.543 | Average RR = 0.83 | ||
| Excluding data from Hirayama T [3]: | Total number of cases: 9,803 | Average RR = 1.00 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 16) Tomasallo C (2010) | Cohort name not defined | 2 cohorts were formed: -2,123 captains/spouses, and anglers. -1,367 referents. (USA) | 12 (1995-2006) | See variables | Cancer mortality | Total fish (captains were frequent consumers of fish from the Great Lakes, while referents did not consume fish from the Great Lakes, but ate commercial fish) |
No significant interaction was found between fish intake and income, or fish intake and BMI. The size of the fish meal or number of ounces consumed was not obtained. Sex, age, BMI, and income. |
14) Virtanen JK (2008) | The Health Professionals Follow-up Study | 40,230 men aged 40-75 and free of major chronic disease. | (USA) 18 | (1986-2004) 4,690 | Primary cancer incidence (excluding nonmelanoma skin cancer and low-grade organ-confined prostate cancer) | Fish (canned tuna fish, dark meat fish [such as mackerel, salmon, sardines, bluefish, and swordfish], and other fish) |
RR = 0.96 (0.82-1.14; P = 0.99) for the highest vs lowest quintile of consumption. | Amount specific data (servings): < 1/mo: RR = 1. 1-3/mo: RR = 1.01 (0.87-1.16). 1/wk: RR = 0.98 (0.86-1.10). 2-4/wk: RR = 1.02 (0.88-1.17). ≥ 5/wk: RR = 0.96 (0.82-1.14). No significant effect modification by n-6 fatty acid intake was seen (P for interactions > 0.10). Age, BMI, smoking, physical activity, history of diabetes, hypertension or hypercholesterolemia, first-degree family history of MI before age 60, first degree family history of colon cancer, aspirin use, multivitamin use, glycemic load, and intakes of protein, fiber, trans fat, saturated fat, n-6 fatty acids, alpha-linolenic acid, red meat, total calories, and alcohol. |
14) Virtanen JK (2008) | The Health Professionals Follow-up Study | 40,230 men aged 40-75 and free of major chronic disease. | (USA) 18 | (1986-2004) 4,690 | Primary cancer incidence (excluding nonmelanoma skin cancer and low-grade organ-confined prostate cancer) | EPA + DHA (from the consumption of all seafood) |
RR = 1.03 (0.86-1.23; P = 0.83) for the highest vs lowest quintile of consumption. | Amount specific data (g/d): < 0.05: RR = 1. 0.05-< 0.2: RR = 1.03 (0.88-1.19). 0.2-< 0.4: RR = 0.99 (0.85-1.15). 0.4-< 0.6: RR = 0.96 (0.81-1.13). ≥ 0.6: RR = 1.03 (0.86-1.23). Age, BMI, smoking, physical activity, history of diabetes, hypertension or hypercholesterolemia, first-degree family history of MI before age 60, first degree family history of colon cancer, aspirin use, multivitamin use, glycemic load, and intakes of protein, fiber, trans fat, saturated fat, n-6 fatty acids, alpha-linolenic acid, red meat, total calories, and alcohol. |
13) Couto E (2011) | The EPIC Study | 142,604 men, and 335,873 women aged 25-70 | 8.7 | (1992-2000 to 2002-2005) 9,669? men, and | 21,062? women Cancer incidence (excluding non-melanoma skin cancer and second primary cancers) | Fish (not defined) | HR = 1.01 (0.99-1.02) for an increment of 35 g per day. | Stratified by centre and sex. |
Adjusted for smoking status, duration of smoking, education, height, BMI, total energy intake, physical activity, age at menarche, parity, menopausal status, oral contraceptive use, and female hormone therapy use. 13) Benetou V (2008) | The Greek segment of the EPIC Study | 25,623 subjects (10,582 men, and 15,041 women). | (Greece) 7.9 | (1994-99 to 2007) 851 | (421 men, and 430 women) Total cancer risk (excluding nonmelanoma skin cancer) | Fish (not defined) | HR = 1.03 (0.99-1.08; No P-value) for an increment of 15 g/day. | Stratified by sex. Adjusted for age, years of schooling, smoking status, BMI, height, physical activity, ethanol intake, supplement use, and total energy intake. |
11) Iso H (2007) | The JACC Study | 43,918 men, and 59,796 women. | (Japan) Not defined. | 3,677 men, and | 2,125 women. All cancer mortality | Fresh fish (not defined) |
|
Age and study area. |
10) Khan MM (2004) | No cohort name defined | 1,524 men and 1,634 women aged ≥ 40 living in Hokkaido, Japan. | 1984-2002 | 155 men, 89 women? | Total cancer mortality | Fish (not defined) |
|
RRs are for consumption ≥ several times/wk vs ≤ several times/month. Men: age and smoking. Women: age, health status, health education, health screening + smoking. |
9) Kelemen LE (2005) | The Iowa Women's Health study | 29,017 postmenopausal women aged 55-69. | (USA) 15 (1986-2000) | 4,843? (incidence), and | 1,676? (mortality) Cancer incidence and mortality | Fish (fresh fish, canned fish, and seafood) |
|
*Carbohydrate rich foods [defined as: A composite of refined carbohydrates (rice, pasta, potatoes, refined cold breakfast cereal, muffins, snack foods, sweetened sodas, pizza, chocolate, candy, cakes, cookies, donuts, pastries, pies) and whole-grain carbohydrates (dark bread, brown rice, oatmeal, whole-grain breakfast cereal, bran, wheat germ, and other grains such as bulgar, kasha, and couscous)]. Age, total energy, saturated fat, polyunsaturated fat, monounsaturated fat, trans-fat, total fiber, dietary cholesterol, dietary methionine, alcohol, smoking, activity level, BMI, history of hypertension, postmenopausal hormone use, multivitamin use, vitamin E supplement use, education, family history of cancer, servings of fruits and vegetables excluding potatoes, legumes, dairy, eggs, red meats, poultry, and fish. |
9) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | 1,840 | Cancer 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 = 0.91 (0.75-1.11; P = 0.61) for the highest vs lowest quintile of consumption. | Amount specific data (servings/week): < 0.5: RR = 1. 0.5-< 1.0: RR = 0.97 (0.81-1.16). 1.0-1.5: RR = 1.10 (0.93-1.29). > 1.5-< 2.5: RR = 1.03 (0.84-1.27). ≥ 2.5: RR = 0.91 (0.75-1.11). 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. |
9) Folsom AR (2004) | The Iowa Women's Health Study | 41,836 women aged 55-69, and free of heart disease or cancer. | 1986-2000 | 1,840 | Cancer 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. |
8) Nagata C (2002) | The Takayama Study | 13,355 men and 15,724 women aged 35 or older. | (Japan) 7 | (1992-1999) 400 men, and | 253 women Cancer mortality | Fish oil |
|
Age, and total energy. |
Additionally for men: marital status, BMI, smoking status, and alcohol intake. Additionally for women: number of children and history of diabetes mellitus. 7) Gillum RF (2000) | The NHANES I Study | 8,825 white and black men and women aged 24-74. | (USA) 18.8 | (1971-75 to 1992) 705 | Cancer death | Fish or shellfish (not defined) |
|
Age, smoking, history of diabetes, education, high school graduate, systolic blood pressure, serum cholesterol concentration, BMI, alcohol intake, and physical activity. |
6) Whiteman D. (1999) | The OXCHECK Study. | 10,522 men and women aged 35-64 without a previous history of angina. | (UK) 9 | (1989-1997) 214 | Cancer mortality | Fresh or frozen fish (not defined) |
RR = 1.04 (0.59-1.82; No P-value) for the highest vs lowest tertile of consumption. | Amount specific data (days/wk): < 1: RR = 1. 1-3: RR = 0.97 (0.74-1.28). 4-7: RR = 1.04 (0.59-1.82). Gender, smoking and age. |
5) Kromhout D (1995) | Cohort name not defined | 272 subjects (137 men and 135 women) aged 64-87 from a general practice in Rotterdam, and without cancer. | (The Netherlands) 17 | (1971-1987) 67 | Primary & secondary Cancer mortality | Fish (mostly lean fish [e.g., cod and plaice], but also minimal amounts of fatty fish [e.g., herring and mackerel], and canned fish [e.g., sardines]) | RR = 1.30 (0.77-2.20) for fish intake vs no fish intake. | Age, gender, smoking, and alcohol. |
4) Dolecek TA (1992) | The Multiple Risk Factor Intervention Trial (MRFIT) | 6,250 men aged 35-57, and at a high risk of CHD. | (USA) 10.5 | (?-1985) 132? | Cancer mortality | Dietary n-3 fish fatty acids | This was a randomized trial, but only data from the "usual care" group was analyzed. |
Age, race, smoking, baseline diastolic blood pressure, HDL, LDL, and alcohol. |
4) Dolecek TA (1991) | The Multiple Risk Factor Intervention Trial (MRFIT) | 6,258 men aged 35-57, and at a high risk of developing CHD based upon smoking status, diastolic blood pressure, and serum cholesterol levels. | (USA) ?-1985 | 132 | Cancer mortality | Dietary long-chain omega 3 fatty acids from fish [EPA (20:5), DPA (22:5), and DHA (22:6)] | This was a randomized trial, but only data from the "usual care" group was analyzed. | RR = 0.97 (No 95% CI; P = 0.43) for the highest vs lowest quintile of consumption. Amount specific data (g): 0.000: RR = 1 0.009: RR = 1.24 0.046: RR = 1.16 0.153: RR = 0.73 0.664: RR = 0.97 Age, race, baseline smoking, diastolic blood pressure, HDL and LDL levels. |
3) 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) 14,740? (8,794 men, 5,946 women) | Cancer at all sites mortality | Fish & shellfish (not defined) |
|
Not defined (possibly only age). |
2) Shekelle RB (1985) | The Western Electric Study | 1,931 middle-aged men. | (Chicago) 25 | (1957-?) 190 | Death from malignant neoplasms | Fish (not defined) |
No significant association was found for the highest vs lowest quartile of consumption (P = 0.318). | Amount specific data (g/day): 0: % of deaths = 6.3 1-17: % of deaths = 10.5 18-34: % of deaths = 10.0 > 35: % of deaths = 10.3 Unadjusted. |
1) Ikeda M (1983) | The Adult Health Study | 7,553 adults from Hiroshima & Nagasaki. | (Japan) 11 | (1968-1978) 488 | (264 men, and 224 women) Death from cancer at all sites | Broiled fish (not defined) | A significant positive association: RR = 1.33 (P = < 0.05) for consumption ≥ 2 vs < 2 times/week. | This effect remained significant after adjustment for age, sex, radiation dose, smoking, school career, rice, fruit, salted pickle, and milk. The increased risk was significant only among men from Hiroshima (P = < 0.05). Unadjusted. |
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