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Eur J Epidemiol. 2019 Mar 2. doi: 10.1007/s10654-019-00504-7. [Epub ahead of print]

Adherence to the Mediterranean diet and risk of stroke and stroke subtypes.

Author information

1
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. guochong.chen@einstein.yu.edu.
2
Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China. guochong.chen@einstein.yu.edu.
3
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA. guochong.chen@einstein.yu.edu.
4
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
5
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain.
6
IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
7
CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain.
8
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
9
Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
10
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
11
Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.
12
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
13
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
14
Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.
15
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. rob.van.dam@nus.edu.sg.
16
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. rob.van.dam@nus.edu.sg.
17
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 12 Science Drive 2, Tahir Foundation Building (Block MD1) #10-01U, Singapore, 117549, Singapore. rob.van.dam@nus.edu.sg.

Abstract

Several meta-analyses including a small number of cohorts showed inverse associations between the Mediterranean Diet (MedDiet) and risk of stroke. However, it remains unclear whether such a relation varies by region of the study population or by major subtypes of stroke. We searched PubMed and EMBASE databases for relevant studies and we further included unpublished results from the Singapore Chinese Health Study (N = 57,078) and the Seguimiento Universidad de Navarra (SUN) study (N = 12,670). We used a random-effects model to calculate summary relative risk (RR) with 95% confidence intervals (CI) of stroke for each 4-point increment of the MedDiet score, roughly corresponding to the difference between extreme quintiles of the MedDiet score among participants of the included studies. The final analyses included 20 prospective cohort studies involving 682,149 participants and 16,739 stroke cases. The summary RRs for each 4-point increment of the MedDiet score were 0.84 (95% CI 0.81-0.88; I2 = 11.5%) for all combined, 0.76 (95% CI 0.65-0.89) for studies in Mediterranean populations and 0.86 (95% CI 0.83-0.89) for those in non-Mediterranean populations. Lower risk of stroke associated with higher MedDiet score also was observed in the analyses stratified by study population and methodological characteristics including study risk of bias, version of the MedDiet index, and definition of moderate alcohol consumption. The MedDiet was similarly associated with lower risk of ischemic stroke (RR 0.86, 95% CI 0.81-0.91; nine studies) and hemorrhagic stroke (RR 0.83, 95% CI 0.74-0.93; eight studies). Our meta-analysis suggests that adhering to the Mediterranean diet was associated with lower risk of stroke in both Mediterranean and non-Mediterranean populations, and for both ischemic stroke and hemorrhagic stroke risk.

KEYWORDS:

Cohort studies; Hemorrhagic stroke; Ischemic stroke; Mediterranean diet; Meta-analysis

PMID:
30826941
DOI:
10.1007/s10654-019-00504-7

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