title: A priori-defined dietary patterns are associated with reduced risk of stroke in a large Italian cohort.
abstract: Stroke is a major cause of death. Several foods and nutrients have been linked to stroke, but their effects may be best investigated considering the entire diet. In the present EPICOR study, we investigated the association between stroke and adherence to 4 a priori-defined dietary patterns: Healthy Eating Index 2005 (HEI-2005), Dietary Approaches to Stop Hypertension (DASH), Greek Mediterranean Index, and Italian Mediterranean Index. We followed 40,681 volunteers and estimated the HR and 95%CI for stroke according to dietary pattern by using multivariate Cox models with adjustment for risk factors. During a mean follow-up of 7.9 y, 178 stroke cases were diagnosed (100 ischemic, 47 hemorrhagic). Scores of 3 dietary patterns (not HEI) were inversely associated with risk of all types of stroke, with the strongest association for the Italian Index [HR = 0.47 (95%CI = 0.30-0.75); third vs. first tertile]. All patterns were significantly inversely associated with ischemic stroke except the Greek Index, with the strongest association for the Italian Index [HR = 0.37 (95%CI = 0.19-0.70); third vs. first tertile]. Only the Italian Index tended to be inversely associated with hemorrhagic stroke [HR = 0.51 (95%CI = 0.22-1.20); P = 0.07)]. These epidemiological findings suggest that adherence to any one dietary pattern investigated would protect against at least one type of stroke. For our Italian population, a diet with a high score on the Italian Index was associated with the greatest risk reduction, probably because it was conceived to capture healthy eating in the context of foods typically available in Italy.
authors.affiliation: Nutritional Epidemiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan 20133, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Graziella
authors.initials: G
authors.lastname: Frasca
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*