The following are five points to remember about diet and stroke prevention:

1. Stroke is a leading cause of morbidity and mortality, costing an estimated 36.5 billion annually. A Cochrane Review suggests poor diet increases risk for stroke by about 19%. A Mediterranean dietary pattern may reduce risk of stroke. In the PREDIMED study, a secondary analysis noted a significant reduction in relative risk related to a Mediterranean diet (hazard ratio, 0.61; 95% confidence interval [CI], 0.44-0.86).
2. In regards to individual components of a Mediterranean diet, consumption of fruits and vegetables is associated with reduced risk. A recent meta-analysis noted a 21% risk reduction for those in the highest quintile of fruit and vegetable consumption. It appears that the micronutrients and antioxidants when in the diet, as opposed to supplements, are critical to reducing stroke risk. Both olive oil, tree nuts, and peanuts are associated with risk reduction for stroke. A meta-analysis which included over 35,000 participants observed an 18% risk reduction (95% CI, 0.70-0.96) with a 25-gram increase in olive oil consumption. Three or more servings of nuts per week are also associated with approximately a 10% reduction in risk. Last, legumes are also associated with a similar reduction in stroke risk.
3. Regular consumption of fish is also associated with reduction of stroke risk. A meta-analysis of seven trials noted a relative risk of 0.93 (95% CI, 0.87-0.99) for those in the highest tertile of fish consumption. Omega-3 fatty acid content of fatty fish may account for the risk reduction; however, supplementation with omega-3 fatty acids is not strongly associated with risk reduction.
4. Alcohol intake is associated with a J-shaped association with low levels of alcohol consumption associated with the lowest stroke risk, whereas moderate drinking was not associated with stroke and heavy drinking was associated with increased risk. Sweetened beverages are associated with increased risk for ischemic stroke, but not hemorrhagic stroke.
5. In contrast, red meat consumption is associated with increased stroke risk. A meta-analysis of six prospective studies observed one serving per day for processed meat increased risk for stroke by 13% (95% CI, 1.03-1.24). This risk was largely related to ischemic stroke. Association between white meat such as chicken, and stroke risk, is not as clear. In pooled data from the Nurses’ Health Study and the Health Professionals Follow-up Study, replacing a serving of red meat with a serving of poultry reduced risk for stroke by 27%; however, when hemorrhagic and ischemic strokes were examined separately, no association reached statistical significance.

Keywords: Alcohol Drinking, Alcohols, Antioxidants, Diet, Diet, Mediterranean, Dietary Supplements, Epidemiologic Studies, Fatty Acids, Omega-3, Fruit, Hemorrhage, Ischemia, Meat, Micronutrients, Nuts, Plant Oils, Poultry, Primary Prevention, Prospective Studies, Risk, Risk Reduction Behavior, Stroke, Sweetening Agents, Vegetables

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