Fish Consumption and Colorectal Cancer Risk in Humans: A Systematic Review and Meta-analysis Shengjun Wu, MD, PhD, Bin Feng, MD, Kai Li, MD, Xia Zhu,

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Fish Consumption and Colorectal Cancer Risk in Humans: A Systematic Review and Meta-analysis Shengjun Wu, MD, PhD, Bin Feng, MD, Kai Li, MD, Xia Zhu, PhD, Shuhui Liang, MD, PhD, Xufeng Liu, MD, PhD, Shuang Han, MD, PhD, Biaoluo Wang, MD, PhD, Kaichun Wu, MD, PhD, Danmin Miao, MD, PhD, Jie Liang, MD, PhD, Daiming Fan, MD, PhD The American Journal of Medicine Volume 125, Issue 6, Pages 551-559.e5 (June 2012) DOI: 10.1016/j.amjmed.2012.01.022 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 Selection of studies for inclusion in meta-analysis. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 Consumption of fish in association with colorectal cancer risk. Each study specific point estimate is plotted as a square box. The size of the box is proportional to the precision of the estimate, and its 95% CI is denoted by a horizontal line through the box. The vertical dashed line and the lower vertex of the diamond indicate the combined risk estimate of the analysis, and the left and right vertices of the diamond represent its 95% confidence limits. Results of the analysis using the random-effects model yielded a combined risk estimate of 0.88 (95% CI, 0.80-0.95; Q=131.97, P<.001, I2 = 56.80%). CI=confidence interval; OR=odds ratio. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Forest plot of the RRs of colorectal cancer incidence or mortality and fish consumption (highest compared with the lowest category) in population-based case-control studies. As depicted in a symmetric Begg's funnel plot with intercept=0.37 and P=.45, no evidence of bias was detected in this meta-analysis by Egger's test. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Supplemental Figure 1 Consumption of fish in association with colorectal cancer in case-control and prospective cohort studies. A, Consumption of fish in association with colorectal cancer risk in case-control studies, with a combined risk estimate of 0.83 (95% CI, 0.72-0.95; Q=89.69, P<.001, I2 = 68.8%). B, Consumption of fish in association with colorectal cancer risk in prospective cohort studies, with a combined risk estimate of 0.93 (95% CI, 0.86-1.01; Q=33.49, P=.22, I2 = 16.4%). Both analyses were conducted using the random-effects model. CI=confidence interval; OR=odds ratio. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Supplemental Figure 2 Consumption of fish in association with colorectal cancer in hospital-based and population-based case-control studies. A, Consumption of fish in association with colorectal cancer risk in hospital-based case-control studies, with a combined risk estimate of 0.70 (95% CI, 0.59-0.84; Q=33.91, P=.001, I2 = 61.70%). B, Consumption of fish in association with colorectal cancer risk in population-based case-control studies, with a combined risk estimate of 0.96 (95% CI, 0.81-1.13; Q=31.65, P=.004, I2 = 55.8%). Both analyses were conducted using the random-effects model. CI=confidence interval; OR=odds ratio. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Supplemental Figure 3 Consumption of fish in association with colon or rectal cancer, respectively. A, Consumption of fish in association with colon cancer risk, with a combined risk estimate of 0.96 (95% CI, 0.81-1.14; Q=53.53, P<.001, I2 = 68.20%). B, Consumption of fish in association with rectal cancer risk, with a combined risk estimate of 0.79 (95% CI, 0.65-0.97; Q=18.89, P=.03, I2 = 52.30%). Both analyses were conducted using the random-effects model. CI=confidence interval; OR=odds ratio. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions

Supplemental Figure 4 Consumption of fish in association with colorectal cancer incidence and mortality. A, Consumption of fish in association with colorectal cancer incidence, with a combined risk estimate of 0.86 (95% CI, 0.79-0.95; Q=125.03, P<.001, I2 = 59.20%). B, Consumption of fish not significantly in association with colorectal cancer mortality, with a combined risk estimate of 1.01 (95% CI, 0.82-1.26); Q=33.49, P=.22, I2 = 16.4%). Both analyses were conducted using the random-effects model. CI=confidence interval; OR=odds ratio. The American Journal of Medicine 2012 125, 551-559.e5DOI: (10.1016/j.amjmed.2012.01.022) Copyright © 2012 Elsevier Inc. Terms and Conditions