title: Total antioxidant capacity of the diet is associated with lower risk of ischemic stroke in a large Italian cohort.
abstract: Experimental studies suggest that oxidative stress and systemic inflammation are involved in the pathogenesis of ischemic stroke. Consuming a diet with a high total antioxidant capacity (TAC) has been related to reduced inflammation and increased circulating antioxidants in cross-sectional and randomized intervention studies. This study investigates the relation between dietary TAC and risk of ischemic and hemorrhagic stroke in 41,620 men and women not previously diagnosed with stroke or myocardial infarction, representing the Italian segment of the European Prospective Investigation into Cancer and Nutrition. Controlling for potential confounders, a diet rich in TAC was associated with a reduction in HR for all types of stroke, but this association was only marginally significant (P-trend = 0.054). When only ischemic stroke cases were considered, data suggest a stronger inverse association with dietary TAC, with HR = 0.41 (95% CI = 0.23-0.74). Regarding single antioxidants, data from subanalyses on stroke types suggest that vitamin C is significantly associated with a decreased risk of ischemic stroke [HR = 0.58 (95% CI = 0.34-0.99)], whereas vitamin E was associated with increased HR of hemorrhagic stroke in the highest tertile of intake [HR = 2.94 (95% CI = 1.13-7.62)]. In conclusion, our findings suggest that antioxidants may play a role in reducing the risk of cerebral infarction but not hemorrhagic stroke. However, a high intake of vitamin E could be positively associated to the risk of brain hemorrhagic events; therefore, more focused investigations about this observation are needed.
authors.affiliation: Department of Public Health, University of Parma, Parma 43125, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Rio
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pellegrini
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Furio
authors.initials: F
authors.lastname: Brighenti
authors.forename: Teresa
authors.initials: T
authors.lastname: Mazzeo
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bendinelli
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Patrizia Concetta
authors.initials: PC
authors.lastname: Rollo
authors.forename: Valentina
authors.initials: V
authors.lastname: Gallo
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000517:prevention & control*; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000975:Antioxidants