title: Adherence to a DASH-Style Diet in Relation to Stroke: A Case-Control Study.
abstract: BACKGROUND
  Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries.
  
  
  OBJECTIVE
  This study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of stroke among the Iranian population.
  
  
  METHODS
  This hospital-based case-control study included 194 stroke patients and 194 controls and was conducted at the Alzahra University Hospital, Isfahan, Iran. The cases were stroke patients who were hospitalized in the neurology ward of the Alzahra University Hospital. Controls were randomly selected from among hospitalized patients in the orthopedic or surgical wards of this center. A validated food frequency questionnaire (FFQ) was used to assess the patients' usual dietary intake. We constructed the DASH diet score based on food and nutrients emphasized or minimized in the DASH diet.
  
  
  RESULTS
  The prevalence of stroke among those in the top quartile of the DASH diet score was 40%, which was 15% lower than among those in the bottom quartile; this difference was marginally significant (p = 0.10). After controlling for age, sex, and total energy intake, adherence to the DASH diet was inversely associated with the risk of stroke (OR: 0.52; 95% CI: 0.28; 0.98). These associations remained significant even after additionally controlling for physical activity, smoking, hypertension, and diabetes, such that individuals in the highest quartile of the DASH diet score had a 58% lower risk of stroke than those in the lowest category (OR: 0.48; 95% CI: 0.24, 0.96). However, after further adjustment for body mass index (BMI), the association disappeared (OR: 0.62; 95% CI: 0.29, 1.31), indicating an obesity-dependent association.
  
  
  CONCLUSIONS
  We found an inverse relationship between the DASH-style diet and prevalence of stroke. Prospective studies are needed to confirm this association.
authors.affiliation: a Food Security Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.
authors.forename: Mahdieh
authors.initials: M
authors.lastname: Niknam
authors.affiliation: b Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Saadatnia
authors.affiliation: c Students' Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.
authors.forename: Forough
authors.initials: F
authors.lastname: Shakeri
authors.affiliation: e Department of Medicine , University of Alberta , Edmonton , Alberta , CANADA.
authors.forename: Ammar Hassanzadeh
authors.initials: AH
authors.lastname: Keshteli
authors.affiliation: a Food Security Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.|c Students' Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.|d Department of Community Nutrition , Isfahan University of Medical Sciences , Isfahan , IRAN.
authors.forename: Parvane
authors.initials: P
authors.lastname: Saneei
authors.affiliation: a Food Security Research Center, Isfahan University of Medical Sciences , Isfahan , IRAN.|d Department of Community Nutrition , Isfahan University of Medical Sciences , Isfahan , IRAN.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Esmaillzadeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D004032:Diet; D002149:Energy Intake; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D010349:Patient Compliance; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: DASH diet; case-control study; stroke