Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies

Keum Hwa Lee¹, Hyo Jin Seong², Gaeun Kim³, Gwang Hun Jeong⁴, Jong Yeob Kim², Hyunbong Park⁵, Eunyoung Jung⁵, Andreas Kronbichler⁶, Michael Eisenhut⁷, Brendon Stubbs^{8

9

10}, Marco Solmi¹¹, Ai Koyanagi^{12

13}, Sung Hwi Hong^{2

14}, Elena Dragioti¹⁵, Leandro Fórnias Machado de Rezende¹⁶, Louis Jacob^{12

17}, NaNa Keum^{18

19}, Hans J van der Vliet²⁰, Eunyoung Cho^{21

22}, Nicola Veronese²³, Giuseppe Grosso²⁴, Shuji Ogino^{25

26

27

28}, Mingyang Song^{18

26

29

30}, Joaquim Radua^{31

32

33

34}, Sun Jae Jung^{26

35}, Trevor Thompson³⁶, Sarah E Jackson³⁷, Lee Smith³⁸, Lin Yang^{39

40}, Hans Oh⁴¹, Eun Kyoung Choi⁴², Jae Il Shin¹, Edward L Giovannucci^{18

22}, Gabriele Gamerith⁴³

Affiliations

¹ Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Keimyung University College of Nursing, Daegu, Republic of Korea.
⁴ College of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
⁵ Yonsei University Graduate School, Department of Nursing, Seoul, Republic of Korea.
⁶ Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
⁷ Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom.
⁸ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁹ South London and Maudsley NHS Foundation Trust, London, United Kingdom.
¹⁰ Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
¹¹ Department of Neuroscience, University of Padova, Padova, Italy.
¹² Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
¹³ ICREA, Barcelona, Spain.
¹⁴ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁵ Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
¹⁶ Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, São Paulo, Brazil.
¹⁷ Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea.
²⁰ Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, Amsterdam, The Netherlands.
²¹ Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
²² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²³ National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
²⁴ Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
²⁵ Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.
²⁶ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
²⁷ Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²⁸ Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
²⁹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³⁰ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³¹ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
³² Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain.
³³ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
³⁴ Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
³⁶ Department of Psychology, University of Greenwich, London, United Kingdom.
³⁷ Department of Behavioral Science and Health, University College London, London, United Kingdom.
³⁸ The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, United Kingdom.
³⁹ Department of Cancer Epidemiology and Cancer Prevention, Alberta Health Services, Calgary, Canada.
⁴⁰ Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁴¹ School of Social Work, University of Southern California, CA, USA.
⁴² Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
⁴³ Internal Medicine V, Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.

PMID: 32488249
PMCID: PMC7490175
DOI: 10.1093/advances/nmaa055

Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies

Keum Hwa Lee et al. Adv Nutr. 2020.

. 2020 Sep 1;11(5):1134-1149.

doi: 10.1093/advances/nmaa055.

Authors

Affiliations

¹ Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Keimyung University College of Nursing, Daegu, Republic of Korea.
⁴ College of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
⁵ Yonsei University Graduate School, Department of Nursing, Seoul, Republic of Korea.
⁶ Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
⁷ Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom.
⁸ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁹ South London and Maudsley NHS Foundation Trust, London, United Kingdom.
¹⁰ Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
¹¹ Department of Neuroscience, University of Padova, Padova, Italy.
¹² Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
¹³ ICREA, Barcelona, Spain.
¹⁴ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁵ Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
¹⁶ Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, São Paulo, Brazil.
¹⁷ Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea.
²⁰ Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, Amsterdam, The Netherlands.
²¹ Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
²² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²³ National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
²⁴ Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
²⁵ Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.
²⁶ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
²⁷ Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²⁸ Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
²⁹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³⁰ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³¹ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
³² Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain.
³³ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
³⁴ Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
³⁶ Department of Psychology, University of Greenwich, London, United Kingdom.
³⁷ Department of Behavioral Science and Health, University College London, London, United Kingdom.
³⁸ The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, United Kingdom.
³⁹ Department of Cancer Epidemiology and Cancer Prevention, Alberta Health Services, Calgary, Canada.
⁴⁰ Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁴¹ School of Social Work, University of Southern California, CA, USA.
⁴² Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
⁴³ Internal Medicine V, Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.

PMID: 32488249
PMCID: PMC7490175
DOI: 10.1093/advances/nmaa055

Abstract

Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks.

Keywords: cancer; fish; meta-analysis; umbrella review; ω-3 fatty acid.

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Figures

**FIGURE 1**
Flow chart of the literature search.

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References

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Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies

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Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies

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