Abstract
BackgroundHigh adherence to a Mediterranean Diet is associated with reduced incidence and mortality of acute ischemic stroke (AIS) but may also be associated with severity. Our purpose was to investigate the association of adherence to a Mediterranean diet and severity in a prospective hospital register of AIS patients.MethodsWe included AIS patients admitted from February 2017 to July 2019. All were assessed by a neurologist with a standard stroke protocol, including NIHSS. Adherence to Mediterranean diet was prospectively measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and defined as low (0–6 points) or high (7–14 points). Demographic and clinical characteristics were compared by group with univariate analysis. A Generalized Linear Model (GLM) was used to investigate the association of admission NIHSS as a continuous ordinal variable and an ordinal logistic regression (OLR) analysis to determine the independent association of the NIHSS quartiles with adherence to Mediterranean diet.ResultsThree hundred sixty-eight patients were included, mean age 68.3 (17.7), 158 (42.9%) females. The median NIHSS score was 3 (IQR 1–9) and the median MEDAS score was 6 (IQR 4.5–8). Patients with high MEDAS scores had significantly lower; admission NIHSS scores, sedentary lifestyle, body mass index, total and LDL cholesterol levels, but higher alcohol consumption. After adjustments, high adherence to Mediterranean diet remained independently associated with lower stroke severity both in the GLM (β coefficient = − 0.19, p = 0.01) and in the OLR model (OR for lower NIHSS quartiles 0.6 (95% CI 0.37–0.98, p = 0.04).ConclusionsHigher pre-stroke adherence to a Mediterranean diet is independently associated with lower AIS severity.
Highlights
High adherence to a Mediterranean Diet is associated with reduced incidence and mortality of acute ischemic stroke (AIS) but may be associated with severity
We investigated the association of adherence to Mediterranean diet and National Institutes of Health Stroke Scale (NIHSS) scores computed as an ordinal variable using a Generalized Linear Model (GLM) with gamma distribution and link function identity adjusting for the following explanatory variables: Diabetes Mellitus, sedentary lifestyle, alcohol consumption, Body Mass Index (BMI), total and Low-Density Lipoprotein (LDL) cholesterol
A high adherence to Mediterranean diet was protective of stroke severity resulting in an Odds Ratio for higher quartiles of NIHSS of 0.6
Summary
High adherence to a Mediterranean Diet is associated with reduced incidence and mortality of acute ischemic stroke (AIS) but may be associated with severity. Our purpose was to investigate the association of adherence to a Mediterranean diet and severity in a prospective hospital register of AIS patients. Eating patterns and their components may be predictive of health status and disease risk factors. High adherence to a Mediterranean Diet pattern is associated with reduced incidence of acute ischemic stroke (AIS) and mortality both in observational as well as in a large primary prevention clinical trial [5, 6]. The beneficial role of this diet could be through modifying classical cardiovascular risk factor such as high blood pressure, diabetes, obesity and the metabolic syndrome [7,8,9]
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