The Role of Nutrition in the Risk and Burden of Stroke
An Update of the Evidence
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Since last reviewed,1 several epidemiological studies have reported the substantial role of suboptimal nutrition in the risk and burden of stroke and illustrated the potential for dietary modification to reduce the global burden of stroke.
I searched the Cochrane Library, PubMed, and MEDLINE using the search term stroke in combinations with the terms nutrition, diet, nutrients, foods, dietary patterns, risk, burden, epidemiology, randomised trial, systematic review, and meta-analysis for articles published between January 1, 2012, and June 1, 2017. I also searched the reference lists of articles identified by the search. I selected mainly articles published in the past 5 years but included older key publications.
The Role of Nutrition in the Risk of Stroke
Diet quality was 1 of 10 potentially modifiable risk factors for stroke in the prospective INTERSTROKE study of 13 447 cases of acute first stroke and 13 472 age- and sex-matched controls with no history of stroke in 32 countries.2 Diet quality was derived from the modified Alternative Healthy Eating Index, which was based on daily servings of fruits, vegetables, nuts and soy protein, fish, meat, eggs, whole grain, and fried foods. Higher modified Alternative Healthy Eating Index scores have been associated with lower risk of cardiovascular disease in previous studies.3 In INTERSTROKE, individuals in the highest tertile for the modified Alternative Healthy Eating Index had a 40% lower odds of stroke (odds ratio, 0.60; 99% confidence interval [CI], 0.53–0.67), and individuals in the second tertile had a 23% lower odds of stroke (odds ratio, 0.77; 99% CI, 0.69–0.86), compared with those in the lowest tertile.2 Individuals in the lowest 2 tertiles contributed substantially to the population attributable risk of stroke (population attributable risk, 23.2%; CI, 18.2–28.9) compared with the highest tertile of modified Alternative Healthy Eating Index.2
Diet had a stronger association with stroke in individuals older than 55 years …