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Epidemiology

Low diet quality and the risk of stroke mortality: the multiethnic cohort study

European Journal of Clinical Nutrition volume 72, pages 1035–1045 (2018)Cite this article

Subjects

Abstract

Background/objectives

Several diets, e.g., those low in fruits/vegetables, high in sodium, and red/processed meat, have been related to a higher stroke risk. We investigated stroke mortality associated with a priori diet-quality indices in the Multiethnic Cohort study.

Subjects/methods

Based on 172,043 observations including 3548 stroke deaths, we investigated the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010, the alternate Mediterranean diet score, and the Dietary Approaches to Stop Hypertension index in relation to stroke mortality. Using Cox regression, we estimated adjusted population attributable risks (PAR) and hazard ratios (HR) for tertiles of the indices while adjusting for relevant confounders.

Results

The associations between all diet-quality indices and stroke mortality were consistent in direction; a low-quality diet was associated with a greater risk of stroke death, but the HEI-2010 was the strongest predictor. The PAR for stroke death based on HEI-2010 was 7.9% (95%-CI: 3.7–12.2%), indicating the preventable percentage of deaths if the total population had the same diet quality as those in the highest tertile for this diet-quality index. The lowest as compared to the highest tertile of the HEI-2010 was associated with a 1.23-fold (95%-CI: 1.13–1.34) risk. The PARs for low and medium adherence to the indices were similar by sex and follow-up time, but varied by ethnicity, with the highest PAR in Whites (15.4%) and no association in Latinos.

Conclusions

Findings for four diet-quality indices, in particular the HEI-2010, indicated that diet quality acts as an independent risk factor for stroke mortality. Promotion of a high diet quality could have a substantial impact on the prevention of stroke deaths.

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Funding

The Multiethnic Cohort has been supported by NCI grant U01 CA164973 (PI: Drs. L. Le Marchand/C.A. Haiman/L.W. Wilkens). SJ was supported by a postdoctoral fellowship from the German Research Foundation (DFG, JA 2564/1-1). AA received funding from the German Exchange Service (DAAD) for her research stay at the University of Hawaii Cancer Center.

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Authors and Affiliations

  1. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Annette Aigner & Heiko Becher

  2. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Simone Jacobs

  3. Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA

    Simone Jacobs, Lynne R. Wilkens, Carol J. Boushey, Loic Le Marchand & Gertraud Maskarinec

  4. Department of Preventive Medicine, Norris Cancer Center, University of Southern California, Los Angeles, CA, USA

    Christopher A. Haiman

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  1. Annette Aigner
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Correspondence to Annette Aigner.

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Aigner, A., Becher, H., Jacobs, S. et al. Low diet quality and the risk of stroke mortality: the multiethnic cohort study. Eur J Clin Nutr 72, 1035–1045 (2018). https://doi.org/10.1038/s41430-018-0103-4

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