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Aim: To investigate the associations between major foods and dietary fibre with subtypes of stroke in a large prospective cohort.
Methods and results: We analysed data on 418 329 men and women from nine European countries, with an average of 12.7 years of follow-up. Diet was assessed using validated country-specific questionnaires which asked about habitual intake over the past year, calibrated using 24-h recalls. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HRs) for ischaemic and haemorrhagic stroke associated with consumption of red and processed meat, poultry, fish, dairy foods, eggs, cereals, fruit and vegetables, legumes, nuts and seeds, and dietary fibre. For ischaemic stroke (4281 cases), lower risks were observed with higher consumption of fruit and vegetables combined (HR; 95% CI per 200 g/day higher intake, 0.87; 0.82–0.93, P-trend < 0.001), dietary fibre (per 10 g/day, 0.77; 0.69–0.86, P-trend < 0.001), milk (per 200 g/day, 0.95; 0.91–0.99, P-trend = 0.02), yogurt (per 100 g/day, 0.91; 0.85–0.97, P-trend = 0.004), and cheese (per 30 g/day, 0.88; 0.81–0.97, P-trend = 0.008), while higher risk was observed with higher red meat consumption which attenuated when adjusted for the other statistically significant foods (per 50 g/day, 1.07; 0.96–1.20, P-trend = 0.20). For haemorrhagic stroke (1430 cases), higher risk was associated with higher egg consumption (per 20 g/day, 1.25; 1.09–1.43, P-trend = 0.002).
Conclusion: Risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre, and dairy foods, while risk of haemorrhagic stroke was positively associated with egg consumption. The apparent differences in the associations highlight the importance of examining ischaemic and haemorrhagic stroke subtypes separately.
Tammy Y N Tong
Tammy Y N Tong
Tammy Y N Tong,Paul N Appleby,Timothy J Key,Christina C Dahm,Kim Overvad,Anja Olsen,Anne Tjønneland,Verena Katzke,Tilman Kühn,Heiner Boeing,Anna Karakatsani,Eleni Peppa,Antonia Trichopoulou,Elisabete Weiderpass,Giovanna Masala,Sara Grioni,Salvatore Panico,Rosario Tumino,Jolanda M A Boer,W M Monique Verschuren,J Ramón Quirós,Antonio Agudo,Miguel Rodríguez-Barranco,Liher Imaz,María Dolores Chirlaque,Conchi Moreno-Iribas,Gunnar Engström,Emily Sonestedt,Marcus Lind,Julia Otten,Kay-Tee Khaw,Dagfinn Aune,Elio Riboli,Nicholas J Wareham,Fumiaki Imamura,Nita G Forouhi,Emanuele Di Angelantonio,Angela M Wood,Adam S Butterworth,Aurora Perez-Cornago