Dietary phytochemical index in relation to risk of stroke: a case-control study.

BACKGROUND & AIM: No study explores the association of dietary phytochemical index (DPI) with stroke. This study was undertaken to obtain the required insight in this regard in Iranian adults. METHODS: This hospital-based case-control study was carried out on 195 stroke patients (diagnosed based on clinical and brained CT findings) and 195 control subjects with no history of cerebrovascular diseases or neurologic disorders). Data collection on dietary intakes was done using a 168-item validated FFQ. DPI was calculated using the McCarty equation. Logistic regression model in different models was used to evaluate the association between DPI and stroke. RESULTS: Mean age of study participants was 64.8 years, and 53.4% of them were male. Individuals in the highest tertile of DPI were younger (63 ± 11 vs. 67.4 ± 13 y, P = 0.01) and less likely to be physically active (2804 ± 5714 vs. 4772 ± 11912 M, P = 0.03). After adjustment for potential confounders, no significant relationship was observed between DPI and stroke risk (OR: 0.76; 95% CI: 0.39-1.49). However, when we considered the effect of dietary intakes, subjects in the top tertile of DPI were 61% less likely to have a stroke than those in the bottom tertile (OR: 0.39; 95% CI: 0.16-0.95). When BMI was controlled, the association between DPI and stroke became strengthened (OR: 0.32; 95% CI: 0.12-0.86). CONCLUSION: We found evidence indicating a significant inverse association between DPI and odds of stroke in adults. Further prospective studies are warranted to confirm this association.

The association between adherence to the MIND diet and stroke: a case-control study.

OBJECTIVES: Although some components of MIND diet were associated with stroke, no information is available on the association between adherence to the MIND diet and odds of stroke. This study was conducted to investigate the association between adherence to the MIND diet and odds of stroke among Iranian adults. METHODS: This case-control study was done on 193 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary intakes of study participants were assessed using a validated 168-item food frequency questionnaire (FFQ). The MIND diet score was computed based on participants' dietary intakes obtained from FFQ. Stroke was confirmed by a trained neurologist using standard imaging methods. RESULTS: After controlling for age, sex, energy intake, physical activity, smoking, hypertension, diabetes, dyslipidemia, and heart disease, there was no significant association between adherence to the MIND diet and stroke (OR: 0.54; 95% CI: 0.26, 1.12). However, after further adjustment for BMI, we found that those with the greatest adherence to the MIND diet were less likely to have stroke compared with those with the lowest adherence; such that greater adherence to the MIND diet was associated with a 59% reduced odds of stroke (OR: 0.41; 95% CI: 0.18-0.94). CONCLUSION: In conclusion, we found that adherence to the MIND diet was inversely associated with odds of stroke in a case-control study. Further studies are required to confirm these findings.

Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study.

Background: Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. Methods: In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Results: Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). Conclusion: We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.

Dietary total antioxidant capacity in relation to stroke among Iranian adults.

Objective: This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults.Methods: This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods.Results: Mean dietary TAC was not significantly different comparing cases and controls (10.2 ± 6.0 vs. 10.4 ± 4.8, P = 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found an almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, P = 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have a stroke than those in the bottom tertile (0.49; 0.23-1.00).Discussion: We found an almost significant inverse association between dietary TAC and odds of stroke.

Dietary patterns in relation to stroke among Iranians: a case-control study.

BACKGROUND: Although several studies have linked dietary patterns to the risk of stroke in Western countries, we are aware of no report in Middle Eastern populations with regard to this association. OBJECTIVE: The aim of this study was to examine the association between major dietary patterns and risk of stroke among a group of Iranian population. METHODS: In a hospital-based case-control study, 195 stroke patients, hospitalized in Alzahra University Hospital in 2008, were selected as cases and 195 control subjects from patients hospitalized in orthopedic or surgical wards with no history of cerebrovascular diseases or neurologic disorders were recruited. Usual dietary intakes of participants were assessed by means of a validated 168-item semiquantitative food frequency questionnaire. To identify major dietary patterns, principal component analysis was used and each participant received a factor score for each identified pattern. RESULTS: We identified 3 major dietary patterns: high carbohydrate-low fat dietary pattern, sweet-fatty dietary pattern, and traditional dietary pattern. Those in the highest quartile of traditional dietary pattern were 4.48 times more likely to have stroke compared to those in the lowest quartile. After adjustment for confounders, the association was attenuated. A significant association between high carbohydrate-low fat dietary pattern and stroke was also observed after controlling for potential confounding factors (odds ratio = 2.19, 95% confidence interval, 1.08-4.44). Consumption in the sweet-fatty food pattern was not associated with the risk of stroke either in crude or in adjusted models. CONCLUSION: Major dietary patterns identified by principal components analysis are significantly associated with stroke in a Middle Eastern population.

Adherence to a DASH-Style Diet in Relation to Stroke: A Case-Control Study.

BACKGROUND: Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries. OBJECTIVE: This study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of stroke among the Iranian population. METHODS: This hospital-based case-control study included 194 stroke patients and 194 controls and was conducted at the Alzahra University Hospital, Isfahan, Iran. The cases were stroke patients who were hospitalized in the neurology ward of the Alzahra University Hospital. Controls were randomly selected from among hospitalized patients in the orthopedic or surgical wards of this center. A validated food frequency questionnaire (FFQ) was used to assess the patients' usual dietary intake. We constructed the DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. RESULTS: The prevalence of stroke among those in the top quartile of the DASH diet score was 40%, which was 15% lower than among those in the bottom quartile; this difference was marginally significant (p = 0.10). After controlling for age, sex, and total energy intake, adherence to the DASH diet was inversely associated with the risk of stroke (OR: 0.52; 95% CI: 0.28; 0.98). These associations remained significant even after additionally controlling for physical activity, smoking, hypertension, and diabetes, such that individuals in the highest quartile of the DASH diet score had a 58% lower risk of stroke than those in the lowest category (OR: 0.48; 95% CI: 0.24, 0.96). However, after further adjustment for body mass index (BMI), the association disappeared (OR: 0.62; 95% CI: 0.29, 1.31), indicating an obesity-dependent association. CONCLUSION: We found an inverse relationship between the DASH-style diet and prevalence of stroke. Prospective studies are needed to confirm this association.

A case-control study on red meat consumption and risk of stroke among a group of Iranian adults.

OBJECTIVE: We aimed to examine the association between red meat consumption and stroke in a group of Iranian adults. DESIGN: A hospital-based case-control study. SETTING: The study included stroke patients and hospital-based controls. Usual dietary intakes of participants were assessed by means of a validated 168-item semi-quantitative FFQ. Total red meat consumption was calculated by summing up the consumption of red, processed and visceral meats. SUBJECTS: One hundred and ninety-five cases were stroke patients hospitalized in the neurology ward and 195 controls were recruited from patients hospitalized in other wards with no history of cerebrovascular diseases or neurological disorders. RESULTS: Participants with stroke were older, more likely to be male and less likely to be obese. Individuals in the highest tertile of red meat intake were 119 % more likely to have stroke (OR=2·19; 95% CI 1·33, 3·60) compared with those in the lowest tertile. After controlling for age, sex and total energy intake, the association between red meat consumption and stroke was strengthened (OR=2·72; 95% CI 1·53, 4·83). This association remained significant even after further controlling for physical activity and smoking as well as dietary intakes. Additional adjustments for BMI, diabetes, hypertension and hyperlipidaemia did not influence the association significantly (OR=2·51; 95 % CI 1·19, 5·09). CONCLUSIONS: Consumption of red meat was associated with greater odds of having stroke in a group of Iranian adults.

Consumption of sugar-sweetened beverages in relation to stroke: a case-control study.

Sugar-sweetened beverages (SSBs) have recently received great attention in the field of diet-disease relations. Limited data are available linking SSBs intake to the risk of stroke. This study was conducted to examine the association between habitual intake of SSBs and risk of stroke among Iranian population. This hospital-based case-control study was conducted in Alzahra University Hospital, Iran. Cases were stroke patients and controls were selected among hospitalized patients without prior history of stroke. A semi-quantitative food frequency questionnaire was used to assess the usual intakes of SSBs. Total intake of SSBs was not significantly different between cases and controls (48.2 ± 6.2 vs. 47.2 ± 6.2 g/day, p = 0.90). After adjustment for potential confounders, the odds ratios for stroke across increasing tertiles of SSB consumption were 1.00, 0.84 (95% CI: 0.46-1.54) and 0.85 (0.43-1.66) (p(trend) = 0.12). No statistically significant association was found between habitual intakes of SSBs and stroke.

A Hospital-Based Case-Control Study on Whole- and Refined-Grain Intake and Risk of Stroke.

INTRODUCTION: The aim of the present study was to ascertain the correlation between the intake of whole and refined grains and the risk of stroke in the Iranian adult population. METHOD: This hospital-based case-control study was conducted at Alzahra University Hospital, Isfahan, Iran, in 2008. The cases (n=195) were stroke patients admitted to the neurology ward, and the controls (n=195) were patients admitted to other wards in this center, with no prior history of cerebrovascular accident or any neurological disorders. The usual dietary intakes of the study participants during the previous year were assessed using a validated semi-quantitative food frequency questionnaire. Whole and refined grains were defined according to the definition of the American Association of Cereal Chemists International; foods that contained at least 8 g per 30 g of their weight were considered as whole grains. RESULTS: The mean age of the case and control groups was 68.0 (±13.5) and 61.5 (±10.5) years, respectively; 40% of the cases and 53.3% of the controls were female. The total intake of whole grains (27.8±4.3 vs. 29.4±3.6 g/d, P=0.77) and refined grains (264±11 vs. 296±13 g/d, P=0.07) was not significantly different between the cases and controls. After adjusting for potential confounders, individuals in the second tertile of refined grain intake had a two-fold higher odds of stroke (OR: 2.02; 95% CI: 1.08-3.71), compared to those in the first tertile. Furthermore, no significant relationships were observed between the consumption of whole grains and the risk of stroke, before or after adjustment for confounding variables. No significant trend was found between the tertiles of refined or whole grain intake and the risk of stroke. CONCLUSION: The authors did not find a statistically significant association between the intake of whole and refined grains and the risk of stroke. Further prospective studies on the relationship between both whole and refined grains and stroke are warranted.

A case-control study on egg consumption and risk of stroke among Iranian population.

BACKGROUND: Most available data that linked intake of egg to risk of stroke came from western countries, with conflicting findings. We aimed to examine the association between egg consumption and risk of stroke among Iranian adults. METHODS: In a hospital-based case-control study, 195 stroke patients, hospitalized in Alzahra University Hospital, were selected as cases and 195 control subjects, from patients hospitalized in other wards with no history of cerebrovascular diseases or neurologic disorders, were recruited. A validated 168-item food frequency questionnaire (FFQ) was used to assess participants' usual dietary intake, including egg consumption, over the previous year. Other required information was gathered by the use of questionnaires. RESULTS: Consumption of eggs was associated with lower odds of stroke, such that after adjustment for potential confounders, those in the highest category of egg intake (>2 eggs/week) were 77% lower odds to have stroke, compared with those with the lowest category of egg intake (<1 egg/week) (OR 0.23; 95% CI 0.11-0.45). Further controlling for body mass index strengthened the association (OR 0.20; 95% CI 0.09-0.41). CONCLUSIONS: We found evidence indicating that high intake of eggs (>2 eggs/week) during the past 1 year was associated with a lower risk of stroke. Further prospective studies are required to confirm these findings.

Dairy Consumption and Risk of Stroke: A Case-control Study.

BACKGROUND: It remains controversial if dairy product intake is associated with risk of stroke. Limited information is available from Middle East countries in this regard. This case-control study was conducted to assess the relationship between dairy consumption and risk of stroke in Iranian adults. METHODS: In this study, 195 stroke patients (recognized based on clinical findings and computed tomography scan) hospitalized in neurology ward of Alzahra University Hospital were enrolled. Controls (n = 195) were selected with convenience nonrandom sampling procedure from other wards of this hospital. A validated food frequency questionnaire was used to assess participants' usual dietary intakes. Data on other variables were collected by the use of questionnaires. RESULTS: Patients with stroke were older (P < 0.001), had lower weight and body mass index (P < 0.05) and were more likely to be male (P < 0.05) and less likely to be obese (P < 0.001). After adjustment for age, sex and total energy intake, Individuals with the highest consumption of low-fat dairy had a significantly decreased risk of stroke (odds ratio [OR]: 0.58; 95% of confidence interval [CI]: 0.34-0.99), while those with the highest intake of high-fat dairy had a 2-fold increased risk of stroke. The association between high-fat dairy consumption and stroke even persisted after additional adjustments for physical activity, smoking and dietary variables (OR: 2.02; 95% CI: 1.02-4.02); but the association between low-fat dairy intake and stroke disappeared after these adjustments (OR: 0.84; 95% CI: 0.44-1.58). CONCLUSIONS: We found a significant positive association between high-fat dairy consumption and risk of stroke. Further prospective studies are required to confirm this finding.

A case-control study on potato consumption and risk of stroke in central Iran.

UNLABELLED:   BACKGROUND: Potato, a high- glycemic index (GI) food, is one of the most widely used starchy foods worldwide. Previous studies on the association of dietary intakes with stroke have mostly focused on the dietary GI and there is no information regarding the association between potato consumption and risk of stroke. This case-control study was conducted to evaluate the association between potato consumption and risk of stroke in an Iranian adult population. METHODS: In this case-control study, 195 patients with stroke, hospitalized in the Neurology Ward of Alzahra University Hospital and 195 controls from other wards of the hospital with convenience non-random sampling method were enrolled. To assess participants' dietary intakes, a validated food frequency questionnaire was used. Information on socioeconomic and demographic variables, physical activity pattern, and smoking were collected by the use of questionnaires. Logistic regression method in different models was applied to explore the associations between potato intake and stroke. First quartile of potato intake was used as a reference in all models. Mantel-Haenszel extension chi-square test was used to assess the overall trend across quartiles of potato consumption. RESULTS: Individuals with stroke were more likely to be male (60% vs. 46%, P < 0.05) and older (68.0 ± 1.0 vs. 61.5 ± 0.8 y, P < 0.001) as compared with controls. They had lower body mass index (BMI) (25.2 ± 0.3 vs. 28.5 ± 1.0 kg/m2, P < 0.05), and were less likely to be obese (11.3% vs. 29.2%, P < 0.001) compared with controls. The mean potato consumption was 31.1 ± 3.4 and 23.4 ± 1.3 g/d for cases and controls, respectively. Participants with the highest potato consumption were younger and more likely to be physically active. High potato consumption was associated with higher intakes of energy, fruits, vegetables, pulses, and grains. After adjustment for age, sex, and total energy intake, we found that individuals with the highest potato consumption were more likely to have stroke as compared with those with the lowest consumption (OR: 1.9; 95%CI: 1.0 - 3.6). The correlation between physical activity and potato consumption was 0.03, P = 0.54 and that of smoking and potato intake was -0.004, P = 0.94. Even after additional control for smoking and physical activity, the association remained significant (OR: 1.9; 95% CI: 1.0 - 3.6). Further adjustment for dietary intakes made the associations non significant (OR: 1.1; 95%CI: 0.5 - 2.5). However, when BMI was taken into account in the final model, we found that individuals in the third quartile of potato consumption were significantly more likely to have stroke (OR: 2.2; 95%CI: 1.0 - 4.7). CONCLUSION: We found evidence indicating that there is a marginally significant independent association between potato consumption and risk of stroke. Prospective studies are required to confirm this finding.