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

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.

Keywords: TOAST classification; cohort studies; diet; fish; ischemic stroke; meat; poultry; substitution models.

Figure 1

Hazard ratios and 95% confidence intervals for total ischemic stroke, large artery atherosclerosis, cardioembolism, and small-vessel occlusion when substituting total, lean, or fatty fish for processed and unprocessed red meat or poultry. Adjusted for age, sex, energy intake, length of schooling, physical activity, waist circumference adjusted for body mass index, alcohol intake, alcohol abstinence, and smoking status.

Figure 2

Radar charts illustrating the difference in intake of food groups and beverages according to lowest and highest intakes of (A) fish, (B) processed red meat, (C) unprocessed red meat, and (D) poultry. Highest intake is illustrated with a black line and lowest intake is illustrated with a grey line.