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Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants

MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus Cambridge, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Inserm U 1198, Montpellier University, F-34000 Montpellier, France
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
Postgraduate Program in Epidemiology Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90040-060, Brazil
Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain
CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
Navarra’s Health Research Institute (IdiSNA), 31008 Pamplona, Spain
Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam UMC—Amsterdam VUMC, 1081 HV Amsterdam, The Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland
Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran 1411713135, Iran
Biology Department, School of Arts and Sciences, Utica College, Utica, NY 13502, USA
Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
Institute of Public Health and Nutrition, University of Eastern Finland, FI-70211 Kuopio, Finland
CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai, Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
Department of Community Medicine, Pb. 5060, UiT The Arctic University of Norway, 9037 Tromsø, Norway
The Cancer Registry of Norway, 0379 Oslo, Norway
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, DO4 Dublin, Ireland
School of Health & Human Performance, National Institute for Cellular Biotechnology, Dublin City University, Whitehall, DO9 Dublin, Ireland
Center of Research on Psychological and Somatic Disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, UK
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN 37203, USA
Department of Surgical Sciences, Orthopaedics, Uppsala University, 75185 Uppsala, Sweden
Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
Authors to whom correspondence should be addressed.
Academic Editor: Ahmad Al-Mrabeh
Nutrients 2021, 13(4), 1223;
Received: 25 February 2021 / Revised: 5 April 2021 / Accepted: 5 April 2021 / Published: 7 April 2021
(This article belongs to the Special Issue Nutrition and Lipid Metabolism in Type 2 Diabetes)
The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01–1.03, I2 = 61%) for total fish, 1.04 (1.01–1.07, I2 = 46%) for fatty fish, and 1.02 (1.00–1.04, I2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02–1.04, I2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns. View Full-Text
Keywords: type 2 diabetes; fish; federated meta-analysis; prospective studies type 2 diabetes; fish; federated meta-analysis; prospective studies
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MDPI and ACS Style

Pastorino, S.; Bishop, T.; Sharp, S.J.; Pearce, M.; Akbaraly, T.; Barbieri, N.B.; Bes-Rastrollo, M.; Beulens, J.W.J.; Chen, Z.; Du, H.; Duncan, B.B.; Goto, A.; Härkänen, T.; Hashemian, M.; Kromhout, D.; Järvinen, R.; Kivimaki, M.; Knekt, P.; Lin, X.; Lund, E.; Magliano, D.J.; Malekzadeh, R.; Martínez-González, M.Á.; O’Donoghue, G.; O’Gorman, D.; Poustchi, H.; Rylander, C.; Sawada, N.; Shaw, J.E.; Schmidt, M.; Soedamah-Muthu, S.S.; Sun, L.; Wen, W.; Wolk, A.; Shu, X.-O.; Zheng, W.; Wareham, N.J.; Forouhi, N.G. Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants. Nutrients 2021, 13, 1223.

AMA Style

Pastorino S, Bishop T, Sharp SJ, Pearce M, Akbaraly T, Barbieri NB, Bes-Rastrollo M, Beulens JWJ, Chen Z, Du H, Duncan BB, Goto A, Härkänen T, Hashemian M, Kromhout D, Järvinen R, Kivimaki M, Knekt P, Lin X, Lund E, Magliano DJ, Malekzadeh R, Martínez-González MÁ, O’Donoghue G, O’Gorman D, Poustchi H, Rylander C, Sawada N, Shaw JE, Schmidt M, Soedamah-Muthu SS, Sun L, Wen W, Wolk A, Shu X-O, Zheng W, Wareham NJ, Forouhi NG. Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants. Nutrients. 2021; 13(4):1223.

Chicago/Turabian Style

Pastorino, Silvia, Tom Bishop, Stephen J. Sharp, Matthew Pearce, Tasnime Akbaraly, Natalia B. Barbieri, Maira Bes-Rastrollo, Joline W. J. Beulens, Zhengming Chen, Huaidong Du, Bruce B. Duncan, Atsushi Goto, Tommi Härkänen, Maryam Hashemian, Daan Kromhout, Ritva Järvinen, Mika Kivimaki, Paul Knekt, Xu Lin, Eiliv Lund, Dianna J. Magliano, Reza Malekzadeh, Miguel Ángel Martínez-González, Gráinne O’Donoghue, Donal O’Gorman, Hossein Poustchi, Charlotta Rylander, Norie Sawada, Jonathan E. Shaw, Maria Schmidt, Sabita S. Soedamah-Muthu, Liang Sun, Wanqing Wen, Alicja Wolk, Xiao-Ou Shu, Wei Zheng, Nicholas J. Wareham, and Nita G. Forouhi. 2021. "Heterogeneity of Associations between Total and Types of Fish Intake and the Incidence of Type 2 Diabetes: Federated Meta-Analysis of 28 Prospective Studies Including 956,122 Participants" Nutrients 13, no. 4: 1223.

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