Author Response: Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults

We are grateful for the comments on our research.1 We investigated the association of fish intake and MRI burden of cerebrovascular disease. We agree with Dr. Brenner that other dietary components, including meat, may affect brain vascular health.2 In our study, we focused on the beneficial effects of fish intake as a primary source of long-chain omega-3 polyunsaturated fatty acids. To account for the potential confounding effect of other dietary components, our models were adjusted for the intake of meat, fruits, vegetables, legumes, and olive oil. For example, higher red meat intake may be associated with lower fish intake, and related to increasing vascular disease. Adjusting for potential confounding factors allows the estimation of the association between the exposure of interest (fish intake) and the outcome (cerebrovascular burden), with all other variables having a constant value. Thus, we believe that it is unlikely that the observed adjusted associations of fish intake to lower cerebrovascular disease burden are confounded by decreased exposure to glycolylneuraminic acid from meat. Investigating the association of glycolylneuraminic acid with brain vascular health would certainly require a dedicated study.

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