FishConsumptionandtheRiskofChronicDisease: AnUmbrellaReviewofMeta-Analysesof ProspectiveCohortStudies

Abstract

We aimed to present a comprehensive review of published meta-analyses of prospective cohort studies on the association of fish consumption andtheriskofchronicdisease.AsystematicsearchwasundertakeninPubmedandScopustoOctober2019tofindmeta-analysesofobservational studies evaluating the association of fish consumption and the risk of chronic disease. Retrospective and cross-sectional studies and studies with unadjusted risk estimates were excluded. The summary relative risk (SRR) for each meta-analysis was recalculated by using a random-effects model.Themethodologicalqualityofincludedmeta-analysesandthequalityoftheevidencewereassessedbytheAMSTARandNutriGradetools, respectively.Atotalof34meta-analysesofprospectiveobservationalstudies,reportingSRRsfor40differentoutcomesobtainedfrom298primary prospectivecohortstudies,wereincluded.Moderate-qualityevidencesuggestedthateach100-g/dincrementinfishconsumptionwasassociated with a lower risk of all-cause mortality (SRR: 0.92; 95% CI: 0.87, 0.97), cardiovascular mortality (SRR: 0.75; 95% CI: 0.65, 0.87), coronary heart disease (SRR:0.88;95%CI:0.79,0.99),myocardialinfarction(SRR:0.75;95%CI:0.65,0.93),stroke(SRR:0.86;95%CI:0.75,0.99),heartfailure(SRR:0.80;95%CI: 0.67,0.95),depression(SRR:0.88;95%CI:0.79,0.98),andlivercancer(SRR:0.65;95%CI:0.48,0.87).Forcancersofmostsites,therewasnosignificant associationandthequalityoftheevidencewasratedlowandverylow.Inconclusion,evidenceofmoderatequalitysuggeststhatfishconsumption isassociatedwithalowerriskofcardiovasculardisease,depression,andmortalityand,therefore,canbeconsideredasahealthyanimal-baseddietary sourceofprotein.Further researchisneeded foroutcomesforwhichthequality oftheevidencewas rated low and very low, consideringtypes of fishconsumed,differentmethodsofcookingfish,andallpotentialconfoundingvariables.