Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose–response meta-analysis of observational and experimental studies

Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose–response meta-analysis of observational and experimental studies

Abstract Context Randomized controlled trials (RCTs) testing supplementation with eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids have failed to provide evidence supporting a suggested inverse association between fish intake and dementia risk. Objective Dose–response analyses were condu...

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Bibliographic Details
Published in:Nutrition reviews Vol. 80; no. 6; pp. 1445 - 1458
Main Authors: Kosti, Rena I, Kasdagli, Maria I, Kyrozis, Andreas, Orsini, Nicola, Lagiou, Pagona, Taiganidou, Fani, Naska, Androniki
Format: Journal Article
Language:English
Published: United States Oxford University Press 09-05-2022
Subjects:
Alzheimer Disease - epidemiology
Alzheimer Disease - prevention & control
Alzheimer's disease
Animals
Bias
Blood levels
Cognition
Cognitive ability
Cognitive Dysfunction - epidemiology
Cognitive Dysfunction - prevention & control
Cognitive tasks
Data analysis
Dementia
Dementia disorders
Dietary Supplements
Docosahexaenoic Acids
Eicosapentaenoic Acid
Executive function
Fatty acids
Fatty Acids, Omega-3
Fish
Humans
Long-term effects
Medicin och hälsovetenskap
Meta-analysis
Neurodegenerative diseases
Observational studies
Performance evaluation
Supplements
Systematic review
omega-3 index
dose–response
dementia
Alzheimer’s disease
cognitive decline
fish
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Summary:Abstract Context Randomized controlled trials (RCTs) testing supplementation with eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids have failed to provide evidence supporting a suggested inverse association between fish intake and dementia risk. Objective Dose–response analyses were conducted to evaluate associations between fish intake, all-cause dementia or Alzheimer’s Disease (AD), and the effect of EPA/DHA supplementation on cognitive performance. Data Sources PubMed, Scopus and Web of Science databases were searched for original research evaluating either associations between fish intake and dementia or AD, or the impact of EPA and/or DHA supplementation on the risk of cognitive decline. Data Extraction Data were collected on study characteristics and methods; number of cases/deaths (for observational studies); categories of exposure; model covariates; risk estimates from the most-adjusted model; type and dosage of supplementation (from RCTs); fatty acid levels in blood; and differences in cognition test results before and after supplementation. Risk of bias was assessed through the ROBINS-E and RoB2.0 tools for observational and experimental studies, respectively. Data Analysis Weighted mixed-effects models were applied, allowing for the inclusion of studies with 2 levels of exposure. Based on findings with low/moderate risk of bias, fish intake of up to 2 portions (250 g) per week was associated with a 10% reduction (95% confidence interval [CI]: 0.79, 1.02, Ν = 5) in all-cause dementia and a 30% reduction (95% CI: 0.54, 0.89, Ν = 3) in AD risk. Changes in EPA and DHA body status had a positive impact on participants’ executive functions, but not on their overall cognitive performance. Conclusion The protection offered by fish intake against cognitive decline levels off at intakes higher than 2 portions/week and likely relates to the impact of EPA and DHA on the individual’s executive functions, although there remain questions about the mechanisms linking the short- and long-term effects. Systematic Review Registration PROSPERO registration no. CRD42019139528.
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ISSN:0029-6643
1753-4887
1753-4887
DOI:10.1093/nutrit/nuab078