Fish Consumption and Stroke Risk: A Meta-Analysis of Prospective Cohort Studies

Background: Inconsistent results of the association between fish consumption and stroke risk have been indicated in previous epidemiological studies. Therefore, we performed a meta-analysis of prospective cohort studies to estimate the impact of fish consumption on stroke risk. Methods: The PubMed and EMBASE databases were searched through a computer search. Prospective cohort studies satisfying predetermined inclusion criterion were included. Random-effect model was adopted in this meta-analysis. Analysis of subgroup, sensitivity, publication bias, dose-response, power, and quality of evidence was also conducted. Results: Thirty one publications including 33 independent prospective cohort studies were identified in this meta-analysis. In the primary analysis of the highest versus lowest categories of fish consumption, pooled results indicated that a significant trend toward an inverse association between fish intake and stroke risk (HR = .90, 95% confidence interval [CU .85-.96). Further subgroup analyses indicated an inverse association was more pronounced in the group of hemorrhagic stroke (HR=.88, 95% CI .80-.96), female (HR =.83, 95% CI .75-.92), and Asia-Pacific (HR = .87, 95% CI .80-.95). Both the funnel plot and Egger tests suggested no evidence of publication bias. Dose-response analysis showed a linear relationship between fish intake and stroke and the risk of stroke decreased by 2%-12% with increasing intake of fish up to 100-700 g/week. According to the NutriGrade scoring system, the level of metaevidence quality was moderate. Conclusions: Based on current evidence from prospective cohort studies, we concluded that fish consumption was associated with a decreased risk of stroke.