Thomas Aline, Crivello Fabrice, Mazoyer Bernard, Debette Stephanie, Tzourio Christophe, Samieri Cecilia
From the University of Bordeaux (A.T., S.D., C.T., C.S.), INSERM, BPH, U1219; and University of Bordeaux (F.C., B.M.), CNRS, CEA, Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, France.
Neurology. 2021 Nov 30;97(22):e2213-e2222. doi: 10.1212/WNL.0000000000012916. Epub 2021 Nov 3.
Fish intake may prevent cerebrovascular disease (CVD), yet the mechanisms are unclear, especially regarding its impact on subclinical damage. Assuming that fish may have pleiotropic effect on cerebrovascular health, we investigated the association of fish intake with global CVD burden based on brain MRI markers.
This cross-sectional analysis included participants from the Three-City Dijon population-based cohort (age ≥65 years) without dementia, stroke, or history of hospitalized cardiovascular disease who underwent brain MRI with automated assessment of white matter hyperintensities, visual detection of covert infarcts, and grading of dilated perivascular spaces. Fish intake was assessed through a frequency questionnaire, and the primary outcome measure was defined as the first component of a factor analysis of mixed data applied to MRI markers. The association of fish intake with the CVD burden indicator was studied with linear regressions.
In total, 1,623 participants (mean age 72.3 years, 63% women) were included. The first component of factor analysis (32.4% of explained variance) was associated with higher levels of all 3 MRI markers. Higher fish intake was associated with lower CVD burden. In a model adjusted for total intracranial volume, compared to participants consuming fish <1 time per week, those consuming fish 2 to 3 and ≥4 times per week had a β = -0.19 (95% confidence interval -0.37 to -0.01) and β = -0.30 (-0.57 to -0.03) lower indicator of CVD burden, respectively ( trend < 0.001). We found evidence of effect modification by age such that the association of fish to CVD was stronger in younger participants (65-69 years) and not significant in participants ≥75 years of age. For comparison, in the younger age group, consuming fish 2 to 3 times a week was roughly equivalent (in the opposite direction) to the effect of hypertension.
In this large population-based study, higher frequency of fish intake was associated with lower CVD burden, especially among participants <75 years of age, suggesting a beneficial effect on brain vascular health before manifestation of overt brain disease.
This study provides Class II evidence that in individuals without stroke or dementia, higher fish intake is associated with lower subclinical CVD on MRI.
摄入鱼类可能预防脑血管疾病（CVD），但其机制尚不清楚，尤其是对亚临床损伤的影响。假设鱼类可能对脑血管健康具有多效性作用，我们基于脑部MRI标记物研究了鱼类摄入量与全球CVD负担之间的关联。
这项横断面分析纳入了来自第戎三城市基于人群队列研究的参与者（年龄≥65岁），这些参与者无痴呆、中风或住院心血管疾病史，且接受了脑部MRI检查，并对脑白质高信号进行自动评估、对隐匿性梗死灶进行视觉检测以及对血管周围间隙扩张进行分级。通过频率问卷评估鱼类摄入量，主要结局指标定义为应用于MRI标记物的混合数据因子分析的第一个成分。采用线性回归研究鱼类摄入量与CVD负担指标之间的关联。
总共纳入了1623名参与者（平均年龄72.3岁，63%为女性）。因子分析的第一个成分（解释方差的32.4%）与所有3种MRI标记物的较高水平相关。较高的鱼类摄入量与较低的CVD负担相关。在根据总颅内体积进行调整的模型中，与每周食用鱼类<1次的参与者相比，每周食用鱼类2至3次和≥4次的参与者的CVD负担指标分别低β = -0.19（95%置信区间-0.37至-0.01）和β = -0.30（-0.57至-0.03）（趋势<0.001）。我们发现年龄存在效应修正的证据，即鱼类与CVD的关联在较年轻的参与者（65 - 69岁）中更强，而在≥75岁的参与者中不显著。作为比较，在较年轻的年龄组中，每周食用鱼类2至3次的效果大致相当于（方向相反）高血压的影响。
在这项基于大规模人群的研究中，较高频率的鱼类摄入量与较低的CVD负担相关，尤其是在<75岁的参与者中，这表明在明显脑部疾病出现之前对脑血管健康具有有益作用。
本研究提供了II类证据，即在无中风或痴呆的个体中，较高的鱼类摄入量与MRI上较低的亚临床CVD相关。
