Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes—a follow-up analysis
Document Type
Journal Article
Publication Title
Journal of Nutrition
Volume
153
Issue
11
First Page
3280
Last Page
3286
PubMed ID
37716608
Publisher
Elsevier
School
Nutrition and Health Innovation Research Institute
RAS ID
60688
Funders
Danish Cancer Society, Denmark / Australian Government Research Training Program Scholarship / University of Western Australia Postgraduate Research Travel Award / Convocation Postgraduate Research Travel Award / National Heart Foundation Future Leader Fellowship / Royal Perth Hospital Foundation 'Lawrie Beilin' Career Advancement Fellowship
Abstract
Background: We previously reported that habitual consumption of dietary flavanol oligomers + polymers and anthocyanins is associated with a lower risk of ischemic stroke. However, no studies have investigated their relationship with ischemic stroke subtypes. Objectives: In this follow-up analysis, we aimed to examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes, including the following: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) other determined etiology, and 5) undetermined etiology. Methods: Participants (n = 55,094) from the Danish Diet, Cancer, and Health Study were followed up for <16 y for first-time ischemic stroke events, which were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Intakes of flavanol oligomers + polymers and anthocyanins were calculated from food frequency questionnaires using the Phenol-Explorer database, and their relationships with ischemic stroke subtypes were investigated using restricted cubic splines within Cox proportional hazards models. After multivariable adjustment, higher habitual intakes (quintile 5 compared with quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with a lower risk of specific ischemic stroke subtypes, including large-artery atherosclerosis [flavanol oligomers + polymers, hazard ratio {HR} (95% confidence interval {CI}): 0.64 (0.47, 0.87)], cardioembolism [anthocyanins, HR (95% CI): 0.45 (0.25, 0.82)], and small-vessel occlusion [flavanol oligomers + polymers, HR (95% CI): 0.65 (0.54, 0.80); anthocyanins, HR (95% CI): 0.79 (0.64, 0.97)], but not stroke of other determined or undetermined etiology. Conclusions: Higher habitual intakes of flavanols and anthocyanins are differentially associated with a lower risk of ischemic stroke from atherosclerosis and/or cardioembolism but not with other subtypes.
DOI
10.1016/j.tjnut.2023.09.011
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Parmenter, B. H., Pokharel, P., Dalgaard, F., Murray, K., Cassidy, A., Bondonno, C. P., . . . Bondonno, N. P. (2023). Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes—a follow-up analysis. The Journal of Nutrition, 153(11), 3280-3286. https://doi.org/10.1016/j.tjnut.2023.09.011