1Department of Community Nutrition,School of Nutritional Sciences and Dietetics,Tehran University of Medical Sciences,Tehran,Islamic Republic of Iran.
2Department of Clinical Nutrition,School of Nutritional Sciences and Dietetics,Tehran University of Medical Sciences,44 Hojat Dost Street,Naderi Street,Enghelab Avenue,Tehran,Islamic Republic of Iran.
Public Health Nutr. 2018 May;21(7):1297-1306. doi: 10.1017/S1368980017003834. Epub 2018 Jan 10.
There are some indications of regional differences in the association between fish consumption and clinical outcomes. We aimed to test the linear and potential non-linear dose-response relationships between fish consumption and risk of all-cause and cardiovascular (CVD) mortality, and possible confounding by region.
Systematic review and dose-response meta-analysis.
Systematic search using PubMed and Scopus, from inception up to September 2016.
Prospective observational studies reporting the estimates of all-cause and CVD mortality in relation to three or more categories of fish intake were included. Random-effects dose-response meta-analysis was conducted.
Fourteen prospective cohort studies (ten publications) with 911 348 participants and 75 451 incident deaths were included. A 20 g/d increment in fish consumption was significantly and inversely associated with the risk of CVD mortality (relative risk=0·96; 95 % CI 0·94, 0·98; I 2=0 %, n 8) and marginally and inversely associated with the risk of all-cause mortality (relative risk=0·98; 95 % CI 0·97, 1·00; I 2=81·9 %, n 14). Subgroup analysis resulted in a significant association only in the subgroup of Asian studies, compared with Western studies, in both analyses. Analysis of Western studies suggested a nearly U-shaped association, with a nadir at fish consumption of ~20 g/d in analysis of both outcomes. Meanwhile, the associations appeared to be linear in Asian studies.
There was potential evidence of regional differences in the association between fish consumption and mortality. It may be helpful to examine the associations by considering types of fish consumed and methods of fish preparation.
鱼类摄入量与临床结局之间的关联存在一些地域差异的迹象。我们旨在检验鱼类摄入量与全因和心血管（CVD）死亡率风险之间的线性和潜在非线性剂量反应关系，并检验地域差异是否存在混杂作用。
系统综述和剂量反应荟萃分析。
系统检索 PubMed 和 Scopus，检索时间截至 2016 年 9 月。
纳入报告了三种或更多类别鱼类摄入量与全因和 CVD 死亡率之间关系的前瞻性观察性研究。采用随机效应剂量反应荟萃分析。
纳入了 14 项前瞻性队列研究（10 项研究），共 911348 名参与者和 75451 例心血管死亡事件。与鱼类摄入量增加 20 g/d 相比，鱼类摄入量与 CVD 死亡率风险呈显著负相关（相对风险=0.96；95%置信区间 0.94，0.98；I 2=0%，n=8），与全因死亡率风险呈弱负相关（相对风险=0.98；95%置信区间 0.97，1.00；I 2=81.9%，n=14）。亚组分析结果显示，仅在亚洲研究亚组中，鱼类摄入量与死亡率之间的关联具有统计学意义，而在西方研究亚组中则无统计学意义。对西方研究的分析表明，在分析这两种结局时，鱼类摄入量约为 20 g/d 时存在近似 U 形关联。而在亚洲研究中，这种关联似乎呈线性。
鱼类摄入量与死亡率之间的关联存在潜在的地域差异证据。考虑到所食用鱼类的种类和鱼类的烹饪方法，对这些关联进行检验可能会有所帮助。
