Dietary Habits in Patients with Ischemic Stroke: A Case-Control Study

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Abstract

Background and Aims

Diet appears to have some role in stroke development. The objective of our study was to describe the dietary habits in patients admitted with acute ischemic stroke and compare selected dietary components with healthy controls. Adherence to healthy diet behaviors was also assessed.

Methods

A case-control study of consecutive patients with acute ischemic stroke admitted to the Neurology Department of Hospital del Mar from 2007 to 2010. Patients were matched by age and sex with control subjects. A previously validated nutritional survey was administered to patients and controls. Demographic data, vascular risk factors, caloric intake and dietary nutrients were evaluated. Intention to follow a healthy diet was also assessed in both groups.

Results

A total of 300 acute ischemic stroke patients and 300 controls with evaluation of dietary habits. No differences were observed in vascular risk factors, except smoking habit, diabetes and ischemic heart disease. Stroke patients reported a higher caloric intake: 2444.8(1736.8–3244.5) vs 2208.7(1753.1–2860.7) Kcal, p = 0.001. After adjusting for energy intake, patients had higher intake of proteins (p<0.001; OR 1.02), total cholesterol (p = 0.001; OR 1.04), and breaded foods (p = 0.001; OR 1.94) and lower consumption of probiotic yogurt (p = 0.002; OR 0.88). Compared to patients, control participants indicated greater intention to eat vegetables (p = 0.002; OR 1.5) and whole foods (p = 0.000; OR 2.4) and reduce their intake of salt (p = 0.002; OR 1.7), fat (p = 0.000; OR 3.7) and sweets (p = 0.004; OR 1.7) than patients.

Conclusion

We observed different dietary patterns between stroke patients and controls. Stroke patients have a higher caloric intake and are less concerned about maintaining healthy nutritional habits.

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Most cited references 20

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Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee (2008)

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

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Fruit and vegetable intake in relation to risk of ischemic stroke.

Kaumudi Joshipura (1999)

Few studies have evaluated the relationship between fruit and vegetable intake and cardiovascular disease. To examine the associations between fruit and vegetable intake and ischemic stroke. Prospective cohort studies, including 75 596 women aged 34 to 59 years in the Nurses' Health Study with 14 years of follow-up (1980-1994), and 38683 men aged 40 to 75 years in the Health Professionals' Follow-up Study with 8 years of follow-up (1986-1994). All individuals were free of cardiovascular disease, cancer, and diabetes at baseline. Incidence of ischemic stroke by quintile of fruit and vegetable intake. A total of 366 women and 204 men had an ischemic stroke. After controlling for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake (median of 5.1 servings per day among men and 5.8 servings per day among women) had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.52-0.92) compared with those in the lowest quintile. An increment of 1 serving per day of fruits or vegetables was associated with a 6% lower risk of ischemic stroke (RR, 0.94; 95 % CI, 0.90-0.99; P =.01, test for trend). Cruciferous vegetables (RR, 0.68 for an increment of 1 serving per day; 95% CI, 0.49-0.94), green leafy vegetables (RR, 0.79; 95% CI, 0.62-0.99), citrus fruit including juice (RR, 0.81; 95% CI, 0.68-0.96), and citrus fruit juice (RR, 0.75; 95% CI, 0.61-0.93) contributed most to the apparent protective effect of total fruits and vegetables. Legumes or potatoes were not associated with lower ischemic stroke risk. The multivariate pooled RR for total stroke was 0.96 (95% CI, 0.93-1.00) for each increment of 2 servings per day. These data support a protective relationship between consumption of fruit and vegetables-particularly cruciferous and green leafy vegetables and citrus fruit and juice-and ischemic stroke risk.

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Dietary protein sources and the risk of stroke in men and women.

Hsu-An Pan, Daniel M. Bernstein, Walter C. Willett … (2012)

Few dietary protein sources have been studied prospectively in relation to stroke. We examined the relation between foods that are major protein sources and risk of stroke. We prospectively followed 84 010 women aged 30 to 55 years at baseline and 43 150 men aged 40 to 75 years at baseline without diagnosed cancer, diabetes, or cardiovascular disease. Diet was assessed repeatedly by a standardized and validated questionnaire. We examined the association between protein sources and incidence of stroke using a proportional hazard model adjusted for stroke risk factors. During 26 and 22 years of follow-up in women and men, respectively, we documented 2633 and 1397 strokes, respectively. In multivariable analyses, higher intake of red meat was associated with an elevated risk of stroke, whereas a higher intake of poultry was associated with a lower risk. In models estimating the effects of exchanging different protein sources, compared with 1 serving/day of red meat, 1 serving/day of poultry was associated with a 27% (95% CI, 12%-39%) lower risk of stroke, nuts with a 17% (95% CI. 4%-27%) lower risk, fish with a 17% (95% CI, 0%-30%) lower risk, low-fat dairy with an 11% (95% CI, 5%-17%) lower risk, and whole-fat dairy with a 10% (95% CI, 4%-16%) lower risk. We did not see significant associations with exchanging legumes or eggs for red meat. These data suggest that stroke risk may be reduced by replacing red meat with other dietary sources of protein.

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Author and article information

Contributors

Thiruma V. Arumugam: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 15 December 2014

Volume: 9

Issue: 12

Electronic Location Identifier: e114716

Affiliations

[1 ]Stroke Unit, Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain

[2 ]Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

[3 ]DCEXS, Universitat Pompeu Fabra, Barcelona, Spain

[4 ]Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Program of Research in Inflammatory and Cardiovascular Disorders (RICAD), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain, CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

National University of Singapore, Singapore

Author notes

* E-mail: 92269@ 123456hospitaldelmar.cat

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: ARC JJC HS. Performed the experiments: ARC GR MLL MGA. Analyzed the data: ARC JJC HS AO EGS ECG CST JR. Contributed reagents/materials/analysis tools: CST MLL GR MGA. Wrote the paper: ARC JJC AO EGS ECG JR.

Article

Publisher ID: PONE-D-14-24941

DOI: 10.1371/journal.pone.0114716

PMC ID: 4266513

PubMed ID: 25506934

SO-VID: f9987dbc-f818-4601-807c-0db378f029b2

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 4 June 2014

Date accepted : 12 November 2014

Page count

Pages: 14

Funding

This study was partly funded in part by Spain's Ministry of Health (Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, FEDER, RD12/0042/0020). Additional support provided by Recercaixa'13 (JJ086116). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

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Dietary Habits in Patients with Ischemic Stroke: A Case-Control Study

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Abstract

Background and Aims

Methods

Results

Conclusion

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PLOS Climate

Most cited references 20

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

Fruit and vegetable intake in relation to risk of ischemic stroke.

Dietary protein sources and the risk of stroke in men and women.

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Cited by 11