Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies
Identifieur interne : 000D80 ( Istex/Corpus ); précédent : 000D79; suivant : 000D81Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies
Auteurs : Ju-Sheng Zheng ; Xiao-Jie Hu ; Yi-Min Zhao ; Jing Yang ; Duo LiSource :
- BMJ : British Medical Journal [ 1756-1833 ] ; 2013.
Abstract
Objectives To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. Design Meta-analysis and systematic review of prospective cohort studies. Data sources PubMed and Embase up to December 2012 and references of retrieved relevant articles. Eligibility criteria for selecting studies Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. Results Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I2=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I2=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I2=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I2=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I2=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I2=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I2=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. Conclusions Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.
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DOI: 10.1136/bmj.f3706
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</title><author><name sortKey="Zheng, Ju Sheng" sort="Zheng, Ju Sheng" uniqKey="Zheng J" first="Ju-Sheng" last="Zheng">Ju-Sheng Zheng</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Hu, Xiao Jie" sort="Hu, Xiao Jie" uniqKey="Hu X" first="Xiao-Jie" last="Hu">Xiao-Jie Hu</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Zhao, Yi Min" sort="Zhao, Yi Min" uniqKey="Zhao Y" first="Yi-Min" last="Zhao">Yi-Min Zhao</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Yang, Jing" sort="Yang, Jing" uniqKey="Yang J" first="Jing" last="Yang">Jing Yang</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Li, Duo" sort="Li, Duo" uniqKey="Li D" first="Duo" last="Li">Duo Li</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:41688A96F53A85DFD263DE1F78511F130FBF9C81</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/bmj.f3706</idno><idno type="url">https://api.istex.fr/document/41688A96F53A85DFD263DE1F78511F130FBF9C81/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000D80</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</title><author><name sortKey="Zheng, Ju Sheng" sort="Zheng, Ju Sheng" uniqKey="Zheng J" first="Ju-Sheng" last="Zheng">Ju-Sheng Zheng</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Hu, Xiao Jie" sort="Hu, Xiao Jie" uniqKey="Hu X" first="Xiao-Jie" last="Hu">Xiao-Jie Hu</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Zhao, Yi Min" sort="Zhao, Yi Min" uniqKey="Zhao Y" first="Yi-Min" last="Zhao">Yi-Min Zhao</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Yang, Jing" sort="Yang, Jing" uniqKey="Yang J" first="Jing" last="Yang">Jing Yang</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author><author><name sortKey="Li, Duo" sort="Li, Duo" uniqKey="Li D" first="Duo" last="Li">Duo Li</name><affiliation><mods:affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: duoli@zju.edu.cn</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013">2013</date><biblScope unit="volume">346</biblScope></imprint></series><idno type="istex">41688A96F53A85DFD263DE1F78511F130FBF9C81</idno><idno type="DOI">10.1136/bmj.f3706</idno><idno type="href">bmj-346-bmj-f3706.pdf</idno><idno type="ArticleID">zhej010754</idno><idno type="local">bmj;346/jun27_5/f3706</idno></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objectives To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. Design Meta-analysis and systematic review of prospective cohort studies. Data sources PubMed and Embase up to December 2012 and references of retrieved relevant articles. Eligibility criteria for selecting studies Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. Results Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I2=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I2=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I2=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I2=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I2=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I2=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I2=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. Conclusions Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Ju-Sheng Zheng</name><affiliations><json:string>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</json:string><json:string>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string></affiliations></json:item><json:item><name>Xiao-Jie Hu</name><affiliations><json:string>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</json:string><json:string>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string></affiliations></json:item><json:item><name>Yi-Min Zhao</name><affiliations><json:string>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</json:string><json:string>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string></affiliations></json:item><json:item><name>Jing Yang</name><affiliations><json:string>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</json:string><json:string>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string></affiliations></json:item><json:item><name>Duo Li</name><affiliations><json:string>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</json:string><json:string>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string><json:string>E-mail: duoli@zju.edu.cn</json:string></affiliations></json:item></author><articleId><json:string>zhej010754</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objectives To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. Design Meta-analysis and systematic review of prospective cohort studies. Data sources PubMed and Embase up to December 2012 and references of retrieved relevant articles. Eligibility criteria for selecting studies Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. Results Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I2=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I2=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I2=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I2=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I2=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I2=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I2=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. Conclusions Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 841.89 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2328</abstractCharCount><pdfWordCount>6480</pdfWordCount><pdfCharCount>41145</pdfCharCount><pdfPageCount>10</pdfPageCount><abstractWordCount>346</abstractWordCount></qualityIndicators><title>Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort 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bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>British Medical Journal Publishing Group</publisher><availability status="free"><p>Open Access</p></availability><date>2013</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</title><author xml:id="author-1"><persName><forename type="first">Ju-Sheng</forename><surname>Zheng</surname></persName><email>duoli@zju.edu.cn</email><note type="biography">PhD student</note><note type="correspondence"><p>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</p></note><affiliation>PhD student</affiliation><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation></author><author xml:id="author-2"><persName><forename type="first">Xiao-Jie</forename><surname>Hu</surname></persName><email>duoli@zju.edu.cn</email><note type="biography">PhD student</note><note type="correspondence"><p>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</p></note><affiliation>PhD student</affiliation><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation></author><author xml:id="author-3"><persName><forename type="first">Yi-Min</forename><surname>Zhao</surname></persName><email>duoli@zju.edu.cn</email><note type="biography">masters student</note><note type="correspondence"><p>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</p></note><affiliation>masters student</affiliation><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation></author><author xml:id="author-4"><persName><forename type="first">Jing</forename><surname>Yang</surname></persName><email>duoli@zju.edu.cn</email><note type="biography">PhD student</note><note type="correspondence"><p>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</p></note><affiliation>PhD student</affiliation><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation></author><author xml:id="author-5" corresp="yes"><persName><forename type="first">Duo</forename><surname>Li</surname></persName><email>duoli@zju.edu.cn</email><email>duoli@zju.edu.cn</email><note type="biography">professor</note><note type="correspondence"><p>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</p></note><affiliation>professor</affiliation><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation></author></analytic><monogr><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013"></date><biblScope unit="volume">346</biblScope></imprint></monogr><idno type="istex">41688A96F53A85DFD263DE1F78511F130FBF9C81</idno><idno type="DOI">10.1136/bmj.f3706</idno><idno type="href">bmj-346-bmj-f3706.pdf</idno><idno type="ArticleID">zhej010754</idno><idno type="local">bmj;346/jun27_5/f3706</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objectives To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. Design Meta-analysis and systematic review of prospective cohort studies. Data sources PubMed and Embase up to December 2012 and references of retrieved relevant articles. Eligibility criteria for selecting studies Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. Results Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I2=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I2=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I2=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I2=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I2=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I2=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I2=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. Conclusions Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.</p></abstract></profileDesc><revisionDesc><change when="2013">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-4">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/41688A96F53A85DFD263DE1F78511F130FBF9C81/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">zhej010754</article-id><article-id pub-id-type="doi">10.1136/bmj.f3706</article-id><article-id pub-id-type="other">bmj;346/jun27_5/f3706</article-id><article-id pub-id-type="other">bmj;bmj.f3706</article-id><article-id pub-id-type="other">jun27_5</article-id><article-id pub-id-type="other">bmj.f3706</article-id><article-id pub-id-type="other">bmj.f3706</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="no"><name><surname>Zheng</surname><given-names>Ju-Sheng</given-names></name><role>PhD student</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Hu</surname><given-names>Xiao-Jie</given-names></name><role>PhD student</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Zhao</surname><given-names>Yi-Min</given-names></name><role>masters student</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Yang</surname><given-names>Jing</given-names></name><role>PhD student</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Li</surname><given-names>Duo</given-names></name><role>professor</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><aff id="aff1"><label>1</label>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</aff><aff id="aff2"><label>2</label>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</aff></contrib-group><author-notes><corresp>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China <email>duoli@zju.edu.cn</email></corresp></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub-original"><year>2013</year></pub-date><volume>346</volume><volume-id pub-id-type="other">346</volume-id><volume-id pub-id-type="other">346</volume-id><elocation-id>f3706</elocation-id><history><date date-type="accepted"><day>31</day><month>May</month><year>2013</year></date></history><permissions><copyright-statement>© Zheng et al 2013</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Zheng et al</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/3.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-346-bmj-f3706.pdf"></self-uri><abstract><p><bold>Objectives</bold> To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation.</p><p><bold>Design</bold> Meta-analysis and systematic review of prospective cohort studies.</p><p><bold>Data sources</bold> PubMed and Embase up to December 2012 and references of retrieved relevant articles.</p><p><bold>Eligibility criteria for selecting studies</bold> Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers.</p><p><bold>Results</bold> Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest <italic>v</italic> lowest category 0.86 (95% confidence interval 0.78 to 0.94), I<sup>2</sup>=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I<sup>2</sup>=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I<sup>2</sup>=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I<sup>2</sup>=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I<sup>2</sup>=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I<sup>2</sup>=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I<sup>2</sup>=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid.</p><p><bold>Conclusions</bold> Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies</title></titleInfo><name type="personal"><namePart type="given">Ju-Sheng</namePart><namePart type="family">Zheng</namePart><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><description>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</description><description>PhD student</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Xiao-Jie</namePart><namePart type="family">Hu</namePart><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><description>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</description><description>PhD student</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yi-Min</namePart><namePart type="family">Zhao</namePart><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><description>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</description><description>masters student</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jing</namePart><namePart type="family">Yang</namePart><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><description>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</description><description>PhD student</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Duo</namePart><namePart type="family">Li</namePart><affiliation>Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China</affiliation><affiliation>APCNS Center of Nutrition and Food Safety, Hangzhou 310058, China</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><affiliation>E-mail: duoli@zju.edu.cn</affiliation><description>Correspondence to: D Li, Department of Food Science and Nutrition, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China</description><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2013</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objectives To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. Design Meta-analysis and systematic review of prospective cohort studies. Data sources PubMed and Embase up to December 2012 and references of retrieved relevant articles. Eligibility criteria for selecting studies Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. Results Twenty six publications, including 20 905 cases of breast cancer and 883 585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13 323 breast cancer events and 687 770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16 178 breast cancer events and 527 392 participants), and 12 articles investigated alpha linolenic acid (14 284 breast cancer events and 405 592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I2=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I2=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I2=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I2=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I2=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I2=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I2=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. Conclusions Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.</abstract><relatedItem type="host"><titleInfo><title>BMJ : British Medical Journal</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal">journal</genre><identifier type="eISSN">1756-1833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>346</number></detail></part></relatedItem><identifier type="istex">41688A96F53A85DFD263DE1F78511F130FBF9C81</identifier><identifier type="DOI">10.1136/bmj.f3706</identifier><identifier type="href">bmj-346-bmj-f3706.pdf</identifier><identifier type="ArticleID">zhej010754</identifier><identifier type="local">bmj;346/jun27_5/f3706</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. 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