Abstract
Diet is strongly associated with risk for first stroke. In particular, observational and experimental research suggests that a Mediterranean-type diet may reduce risk for first ischemic stroke with an effect size comparable to statin therapy. These data for first ischemic stroke suggest that diet may also be associated with risk for recurrent stroke and that diet modification might represent an effective intervention for secondary prevention. However, research on dietary pattern after stroke is limited and direct experimental evidence for a therapeutic effect in secondary prevention does not exist. The uncertain state of science in this area is reflected in recent guidelines on secondary stroke prevention from the American Heart Association, in which the Mediterranean-type diet is listed with only a class IIa recommendation (level of evidence C). To change guidelines and practice, research is needed, starting with efforts to better define current nutritional practices of stroke patients. Food frequency questionnaires and mobile applications for real-time recording of intake are available for this purpose. Dietary strategies for secondary stroke prevention are low risk, high potential, and warrant further evaluation.
Highlights
Clinical research in nutrition for most of the past century examined the association between health and micronutrients or macronutrients
These data for first ischemic stroke suggest that diet may be associated with risk for recurrent stroke and that diet modification might represent an effective intervention for secondary prevention
Fruits and vegetables are protective against stroke, with one recent meta-analysis demonstrating that persons with the highest fruit and vegetable consumption were 21% less likely to have a stroke compared to those with the lowest consumption [relative risk reduction (RRR), 0.79; 95% confidence interval (CI), 0.71–0.84] [2]
Summary
Clinical research in nutrition for most of the past century examined the association between health and micronutrients (e.g., vitamins) or macronutrients (e.g., fat). One large meta-analysis suggested that saturated fat, previously recommended for lower intake to reduce cardiovascular disease incidence, was not associated with cardiovascular disease or stroke [37] These controversial results [38] have been supported by a large cohort, which showed a reduction in stroke risk with increased consumption of saturated fat in men [39]. Five large observational studies suggest that the Mediterranean-style diet: rich in fruits vegetables, low in red meat, with moderate alcohol, and use of olive oil or non-hydrogenated fats, may have the most potential as a dietary intervention to prevent stroke [5,6,7,8,9,10,11, 42]. Technology, mobile health applications, may play a role in defining the phenotype
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