Substitution of Fish for Red Meat or Poultry and Risk of Ischemic Stroke.

Stine Venø,Marianne Jakobsen,Peter Mclennan,Christian Bork,Søren Lundbye-Christensen,Anne Tjønneland,Flemming Bach,Kim Overvad,Erik Schmidt

doi:10.3390/nu10111648

Abstract

We investigated the risk of ischemic stroke and its subtypes when red meat or poultry was substituted with fish. A total of 57,053 participants aged 50–65 years at baseline were included in the Danish Diet, Cancer and Health study. All participants filled in a food-frequency questionnaire at recruitment. Potential ischemic stroke cases were identified by linkage to the Danish National Patient Register, and all cases were validated and subclassified. Substitutions were investigated as 150 g/week of fish for 150 g/week of red meat or of poultry using multivariable Cox proportional hazard regression models. During 13.5 years of follow-up, 1879 participants developed an ischemic stroke. Replacing red meat or poultry with fish was not associated with the rate of total ischemic stroke, but there was a statistically significant lower rate of large artery atherosclerosis when fish replaced processed (hazard ratio (HR): 0.78; 95% confidence interval (CI): 0.67; 0.90) and unprocessed (HR: 0.87; 95% CI: 0.75; 0.99) red meat. A statistically significant higher rate of cardioembolism was found when poultry was replaced by total fish (HR: 1.42; 95% CI: 1.04; 1.93). When fatty fish replaced unprocessed red meat, a statistically significant lower rate of small-vessel occlusion was found (HR: 0.88; 95% CI: 0.77; 0.99). In conclusion, replacing red meat with fish was not associated with risk of total ischemic stroke but was associated with a lower risk of subtypes of ischemic stroke.

Highlights

Ischemic stroke is a leading cause of death and disability worldwide [1]
In this study we aimed to investigate the risk of ischemic stroke and its subtypes when processed or unprocessed red meat or poultry were replaced with fish
By using statistical food substitution models, we investigated the rate of ischemic stroke and its subtypes when intake of 150 g/week of total, lean or fatty fish replaced processed or unprocessed red meat or poultry

Summary

Introduction

Ischemic stroke is a leading cause of death and disability worldwide [1]. Because of the often irreversible and devastating consequences of ischemic stroke, prevention is essential. The health benefits of fish intake have been of interest for several decades and some studies have shown beneficial associations between a high fish consumption and ischemic stroke risk [2,3,4]. Nutrients 2018, 10, 1648 evaluating fish intake in relation to ischemic stroke risk have, assuming energy balance, not taken into consideration that a higher fish intake must necessarily be accompanied by a concomitant lower intake of other foods [5]. Since the food being replaced may attenuate or augment a beneficial effect of fish consumption, the association between fish intake and ischemic stroke risk depends on the replaced foods. Fish contains different important nutrients, and importantly marine n-3 polyunsaturated fatty acids (PUFA), which have shown beneficial effects on risk factors of ischemic stroke including blood pressure, plasma triglycerides, and measures of inflammation [6,7,8]

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