Dietary pattern, nutritional density, and dietary quality were low in patients with cerebral infarction in Korea

Dietary Intake and Quality among Stroke Survivors: NHANES 1999-2018

BACKGROUND

Nutrition is an important modifiable risk factor for prevention and treatment of stroke. However, examination of nutrient intake and diet quality in stroke survivors is limited.

OBJECTIVES

The aim of the study was to estimate usual nutrient intake and diet quality in US adults with and without a history of self-reported stroke.

METHODS

Using US National Health and Nutrition Examination Survey (NHANES) 1999-2018, we analyzed demographics, health history, and dietary intake data in 1626 individuals with a history of stroke matched for age, gender, and survey cycle to respective controls (n=1621) with no history of stroke. A minimum of one 24-h dietary recall was used to assess dietary intake. Diet quality was determined using Healthy Eating Index 2015 (HEI-2015) scores. Adult food security was assessed based on responses to the US Department of Agriculture Household Food Security Survey Module. Physical and mental limitations were assessed from responses to the NHANES Physical Functioning Questionnaire. Estimates were reported as mean (standard error).

RESULTS

In comparison to controls, stroke survivors were more likely to be food insecure, experience poverty, and report physical and mental limitations (P < .001, all comparisons). Stroke survivors were more likely to report excessive (% > acceptable macronutrient distribution range) intake for total fat (50.9 [2.7]% vs. 40.4 [2.2]%, P < .001) and inadequate intake (% < estimated average requirement) for calcium (54.6 [1.8]% vs. 43.5 [2.4]%, P = .001) and magnesium (66 [1.8] vs. 53.6 [1.8]%, P < .001). In addition, stroke survivors reported lower HEI-2015 total scores than controls (49.8 vs. 51.9, P < .001). Finally, HEI-2015 total scores were lower in stroke survivors who were food insecure and those with a lower income-to-poverty ratio (< 185%) (P = .001).

CONCLUSIONS

Dietary intake in stroke survivors was nutritionally poor, with suboptimal nutrient intake and lower overall diet quality compared with age- and gender-matched controls. Furthermore, poverty and food insecurity were more prevalent in stroke survivors and associated with worse diet quality.

Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people: A national health examination survey from Thailand

Background

Cardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people.

Methods

This cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included.Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0-32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models.

Results

In the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted β (95% CI) values of -0.01 (-0.01, -0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted β (95% CI) values of -0.002 (-0.004, -0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted β (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level.

Conclusion

Higher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.

Modifiable Risk Factors for Cardiovascular Disease in Korea and Japan

Cardiovascular disease (CVD) is the leading cause of death and a major contributor to disability worldwide. Since the majority of cardiovascular events are preventable, identification of modifiable CVD risk factors and implementation of primordial prevention strategies should be a public health priority. In this aspect, the American Heart Association declared a strategic goal to reduce total CVD mortality in the US by 20% within 10 years via eliminating 7 major CVD risk factors (hypertension, diabetes, dyslipidemia, cigarette smoking, physical inactivity, obesity, and poor-quality diet) in 2010, and their strategy has been achieving. However, the applicability of similar metrics to prevent CVD among East Asians requires an in-depth investigation of the modifiable CVD risk factors based on national and regional evidence-based findings. Herein, this review article aims to discuss several modifiable risk factors for CVDs, using epidemiological evidence from cohort studies and nationally representative data of 2 East Asian countries: Korea and Japan.

Diet quality in patients with stroke

Objective

A healthy diet is associated with reduced risk for stroke, myocardial infarction, cancer and death. We examined the prevalence of a healthy diet in patients with a recent stroke or transient ischaemic attack (TIA).

Methods

We recruited a convenience sample of 95 patients with a recent ischaemic stroke or TIA. Using information from a 125-item Food Frequency Questionnaire, we calculated dietary quality and the percentage of patients meeting recommended daily intake (RDI) for common macronutrients and elements.

Results

The mean age of patients was 66 years (SD: 16) and 46% were women. 39 patients (41%) were classified as having a healthy diet (35% of men and 48% of women). The majority of patients were within the RDI for carbohydrates (56.8%), total fat (61.1%), long-chain n-3 fats (68.4%), polyunsaturated fats (79.0%) and protein (96.8%). Very few patients consumed the recommended intake for sodium (25.3%), and even fewer consumed the RDI for potassium (4.2%), with the majority of patients consuming too much sodium and too little potassium.

Conclusion

We found that most patients with recent stroke or TIA were not following a healthy diet before their stroke event. For most patients, sodium intake was much above and potassium intake was much below RDI.

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis

BACKGROUND/OBJECTIVES

This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes.

SUBJECTS/METHODS

A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed.

RESULTS

When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B₆, β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B₆, B₁₂, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B₁₂ intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test.

CONCLUSIONS

When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

Association between previously diagnosed circulatory conditions and a dietary inflammatory index

Inflammation is a key contributor to the development or recurrence of circulatory disorders. Diet is a strong modifier of inflammation. It was hypothesized that more pro-inflammatory diets, as indicated by higher Dietary Inflammatory Index (DII) scores, would be associated with self-reported previously diagnosed circulatory disorders using National Health and Nutrition Examination Survey (NHANES) data. This analysis included NHANES respondents from 2005-2010 (n = 15,693). The DII was calculated from micro and macronutrients derived from a single 24-hour recall. Logistic regression, stratified by sex and adjusted for important covariates, was used to determine the odds of previous circulatory disorder diagnoses by quartile of DII scores. Excluding hypertension, which had a prevalence of 30%, the prevalence of any circulatory disorder was 8%. Those in DII quartile 4 were 1.30 (95%CI = 1.06-1.58) times more likely to have a previous circulatory disorder (excluding hypertension) compared to those in DII quartile 1. Similar findings were observed for specific CVDs including congestive heart failure, stroke, and heart attack. Participants in DII quartile 4 were more likely to have a diagnosis of hypertension compared to those in DII quartile 1 (prevalence odds ratio = 1.19, 95%CI = 1.05-1.34). Results tended to be stronger among females. Individuals with a previous circulatory disorder diagnosis from NHANES appear to have more pro-inflammatory diets compared to those without a previous diagnosis. Because inflammation is an important factor related to recurrence of circulatory disorders, the DII could be used in treatment programs to monitor dietary modulators of inflammation among individuals with these conditions.

Association between oral health and the risk of lacunar infarction in Japanese adults

BACKGROUND

Poor oral health is associated with an increased risk of dementia in the elderly. One possible pathway linking these two phenomena is lacunar infarction, a potential cause of dementia. An association between poor oral health and an increased risk of ischaemic stroke has been recognised through the oral infection-inflammation pathway. However, little is known about whether poor oral health is associated with the progression of lacunar infarction.

OBJECTIVE

We examined the association between variables related to oral health and lacunar infarction, as detected by magnetic resonance imaging (MRI).

METHODS

A total of 110 subjects (52 men, 58 women), aged 27-76 years, who visited our periodontology clinic participated in this study. The subjects underwent dental radiography, periodontal examinations and brain MRI. One experienced specialist in cardiovascular disease and one experienced neurosurgeon determined the number of lacunar infarctions on brain MRI. Periodontologists performed clinical periodontal examinations. Variables related to oral health were determined from the radiographs by an oral radiologist. Information on the subjects' lifestyles and disease histories were obtained using a structured questionnaire and confirmed by clinical records. Adjacent categories logit regression analysis with backward elimination was used to determine variables associated with three groups based on the number of lacunar infarctions.

RESULTS

Of the 110 subjects, 61 had lacunar infarctions. Nineteen had multiple (≥7) lesions. Aging (p = 0.0004), increased time spent in physical activity per day (p = 0.042), the presence of hypertension (p = 0.006), the absence of hyperlipidaemia (p = 0.045), the presence of diabetes mellitus (p = 0.025) and low alveolar bone height (p = 0.026) were significantly associated with an increased number of lacunar infarctions in the final regression model. The significance of hyperlipidaemia and alveolar bone height disappeared in an unadjusted model. An increased pocket depth, which indicates current periodontal disease progression, tended to be associated with an increased number of lacunar infarctions (p = 0.058). This tendency did not disappear in an unadjusted model.

CONCLUSION

Our results suggest that lacunar infarction may be associated with current periodontal disease in Japanese adults.

Impact of nutritional status and dietary quality on stroke: do we need specific recommendations?

Stroke, one of the most prevalent geriatric diseases, is a leading cause of death worldwide that often results in permanent physical disability and decreased quality of life, and can have a negative impact on families both financially and emotionally. Although many previous studies have shown relationships between the risk of stroke and nutritional factors, clear dietary recommendations for the prevention and reduction of stroke recurrence have not been established. Several factors should be considered to control and manage stroke. For example, a considerable number of patients with stroke are poorly nourished, have several comorbidities and undesirable health-related behaviors may be present. Stroke patients are less likely to consume beneficial foods, have poorer eating habits and have impoverished dietary quality. In addition, psychological factors such as depression must also be considered in stroke management. Given these factors, dietary recommendations for stroke patients should be established. In this article, we summarized the nutritional status and dietary quality of stroke patients. We also suggested some nutritional guidelines for stroke patients and for those who are at risk for stroke.