Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies

OBJECTIVE: Results of studies on fish consumption and CHD mortality are inconsistent. The present updated meta-analysis was conducted to investigate the up-to-date pooling effects. DESIGN: A random-effects model was used to pool the risk estimates. Generalized least-squares regression and restricted cubic splines were used to assess the possible dose-response relationship. Subgroup analyses were conducted to examine the sources of heterogeneity. SETTING: PubMed and ISI Web of Science databases up to September 2010 were searched and secondary referencing qualified for inclusion in the study. SUBJECTS: Seventeen cohorts with 315,812 participants and average follow-up period of 15·9 years were identified. RESULTS: Compared with the lowest fish intake (5 servings/week). The dose-response analysis indicated that every 15 g/d increment of fish intake decreased the risk of CHD mortality by 6% (RR = 0·94; 95% CI 0·90, 0·98). The method of dietary assessment, gender and energy adjustment affected the results remarkably. CONCLUSIONS: Our results indicate that either low (1 serving/week) or moderate fish consumption (2-4 servings/week) has a significantly beneficial effect on the prevention of CHD mortality. High fish consumption (>5 servings/week) possesses only a marginally protective effect on CHD mortality, possibly due to the limited studies included in this group.