title: 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.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Studies published before September 2012 identified through electronic searches using Medline, Embase, BIOSIS, and Science Citation Index databases.
  
  
  METHODS
  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.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Sarah
authors.initials: S
authors.lastname: Stevens
authors.forename: Donal
authors.initials: D
authors.lastname: Gorman
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.forename: Samantha
authors.initials: S
authors.lastname: Warnakula
authors.forename: Susmita
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Heather
authors.initials: H
authors.lastname: Ward
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.forename: Francesca
authors.initials: F
authors.lastname: Crowe
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D000818:Animals; D002561:Cerebrovascular Disorders / Q000178:diet therapy / Q000517:prevention & control*; D004032:Diet; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005399:Fishes; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D015525:Fatty Acids, Omega-3