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The associations were J-shaped with the strongest reduced risk for an intermediate intake of fish or PUFA.
Among women, the highest versus lowest intake of punch/lemonade/non-carbonated fruit drinks was associated with a borderline statistically significant doubling in risk, but intermediate intake categories were inversely associated with risk.
For fatty fish (herring/mackerel, salmon-type fish), the strongest inverse association was found for an intermediate intake (RR: 0.81, 95% CI, 0.66-0.98), whereas a high intake of fatty fish was associated with an increased risk of psychotic-like symptoms (RR: 1.90, 95% CI, 1.34-2.70).
We found support for a protective effect regarding the risk of positive psychotic-like symptoms with high dietary intake of fish, omega-3 and omega-6 PUFA, as well as of vitamin D. The associations were J-shaped with the strongest reduced risk for an intermediate intake of fish or PUFA.
Reviews or meta-analytic techniques that summarize categorical data from primary investigations comparing highest to lowest intakes have several limitations, including a loss of data when intermediate intake categories are excluded, which may introduce reporting bias, a problem termed "publication bias in situ" [ 40].
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The associations for fatty fish or shellfish were J-shaped, with the strongest inverse association for an intermediate dietary intake, whereas a high intake was associated with a higher rate of high level psychotic-like symptoms.
However, there was a J-shaped association between psychotic-like symptoms and fatty fish (herring/mackerel and salmon-type fish) with the strongest inverse association for intermediate dietary intake (RR: 0.81, 95% CI, 0.66-0.98), whereas a high intake (RR: 1.90, 95% CI, 1.34-2.70) ofattyty fish was associated with an increased risk of high level psychotic-like symptoms.
Thus under intermediate calorie intakes, intermediate senemorphs are to be expected.
The results for omega-3 fatty acid and marine fatty acids (EPA, DHA) had a similar pattern, indicating a reduced risk of psychotic-like symptoms among women with intermediate levels of intake.
Wormuth et al. (2006) conducted a similar analysis, and their "intermediate" estimate of intake characterized as specific to Europe was 2.1 µg/kg-day (although like Clark, they used concentration data from around the world).
Overall, our results are consistent with other studies that pointed out that life satisfaction is positively associated with most of the prudent health behaviours across culturally diverse countries, with effects strong for psychical exercise, intermediate for fruit intake and lower but significant for cigarette smoking and dietary fat avoidance [ 16].
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