Drs Max, Murad, and Limburg nicely summarized the results of our meta-analysis and raised some issues concerning search and selection strategy and the use of quality scores. Our meta-analysis was a small part of the major WCRF/AICR systematic literature review project. Therefore, the search strategy and the first 3 selection steps have been performed to identify all human studies on the association between food, nutrition, and physical activity and CRC. The total number of potentially eligible studies was 43,191. Of these, 3193 references were selected based on title and keywords and subsequently 1703 based on the abstract. After reading the full papers, we ended up with 715 papers concerning 164 exposures. Of these exposures, fish consumption and/or n-3 polyunsaturated fatty acids (PUFAs) were evaluated in 24 publications involving 20 independent cohort studies on CRC incidence or mortality. As mentioned by Max et al, the use of quality scores is controversial. They have been poor predictors of study results, are hard to extract from published information, and using them as weighting factor might produce biased effect estimates (Biostatistics 2001;2:463–471). We performed our meta-analysis according to the WCRF/AICR methodology, advised by a methodology taskforce of experts (J Nutr 2003;133:3837S–3842S), which states that studies should not be excluded on the basis of perceived quality but study characteristics that may influence results should be defined. We did not provide quality scores because a score assumes that the relative importance of the separate characteristics of the study is known. In an analysis, it is more informative if the separate study characteristics can be studied, to explore quality differences as an explanation for heterogeneity in study results. Therefore, we reviewed qualitative characteristics of each study, such as aspects of study design, methods of exposure assessment, adjustment for potential confounding variables, and so on. However, contrary to the STROBE guidelines for reporting observational studies, most publications did not provide reasons for inclusion or exclusion of potential confounding variables in multivariate analyses (Lancet 2007;370:1453–1457). More standardized information in papers on observational studies would be very helpful. Our meta-analysis on observational studies suggests that there may be a “catch,” but to be sure randomized controlled trials are essential. We are currently involved in a trial on the effects of fatty and lean fish on markers of CRC, which will make it possible to answer the question whether n-3 PUFA and/or other nutrients like selenium or vitamin D are responsible for the chemopreventive action of fish. This study is part of the integrated, EU-funded research project SEAFOODplus (www.seafoodplus.org). Results are expected in 2008; let’s hope we will catch something. Fish Consumption and Colorectal Cancer Prevention: Is There a Catch?GastroenterologyVol. 134Issue 2PreviewGeelen A, Schouten JM, Kamphuis C, et al. (Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.) Fish consumption, n-3 fatty acids, and colorectal cancer: a meta-analysis of prospective cohort studies. Am J Epidemiol 2007;166:1116–1125. Full-Text PDF