Mediterranean Diet and Stroke Prediction | Journal Scan

Study Questions:

Does adherence to a Mediterranean diet reduce the risk of stroke?


Data from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study were used for the present analysis. Participants with a prior history of stroke or missing data were excluded. Average food consumption information at baseline was obtained using the self-administered Block 98 Food Frequency Questionnaire. The Mediterranean diet score was computed as the sum of scores in the 9 food categories (range, 0–9), with a higher score indicating a higher adherence to the Mediterranean diet. Adherence to the Mediterranean diet was categorized as high, moderate, and low using Mediterranean diet score tertiles (Mediterranean diet score, 6–9, 4–5, and 0–3, respectively). The diet score was also analyzed in a median split (low adherence range, 0–4; high adherence range, 5–9). Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.


A total of 20,197 adults were included. Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke and hemorrhagic stroke, respectively). High adherence to the Mediterranean diet (score, 5–9) was associated with lower risk of incident ischemic stroke in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70–1.00; p = 0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65–0.96; p = 0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When the Mediterranean diet was evaluated as a continuous variable, a 1-point increase in Mediterranean diet score was independently associated with a 5% reduction in the risk of incident ischemic stroke (95% confidence interval, 0–11%). No association of adherence to the Mediterranean diet with incident hemorrhagic stroke was observed. There was no interaction of race (p = 0.37) on the association of adherence to the Mediterranean diet with incident ischemic stroke.


The authors concluded that high adherence to the Mediterranean diet seems to be associated with a lower risk of incident ischemic stroke independent of potential confounders. Adherence to the Mediterranean diet is not related to the risk of incident hemorrhagic stroke.


These data support recommendations for long-term adherence to a healthy diet, in particular, a Mediterranean dietary pattern that is high in plant-based foods and monounsaturated fats (from sources such as olive oil),and low in saturated fats from meat and dairy.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Diet, Mediterranean, Diet, Plant Oils, Risk, Risk Factors, Stroke

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