The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries-Reference-Cited by-同舟云学术

The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries

Published:2020-02-24 Issue:28 Volume:41 Page:2632-2640
ISSN:0195-668X
Container-title:European Heart Journal
language:en
Short-container-title:

Author:

Tong Tammy Y N¹^ORCID,Appleby Paul N¹,Key Timothy J¹^ORCID,Dahm Christina C²^ORCID,Overvad Kim²³,Olsen Anja⁴^ORCID,Tjønneland Anne⁴⁵,Katzke Verena⁶^ORCID,Kühn Tilman⁶,Boeing Heiner⁷^ORCID,Karakatsani Anna⁸⁹^ORCID,Peppa Eleni⁸,Trichopoulou Antonia⁸^ORCID,Weiderpass Elisabete¹⁰^ORCID,Masala Giovanna¹¹^ORCID,Grioni Sara¹²^ORCID,Panico Salvatore¹³^ORCID,Tumino Rosario¹⁴^ORCID,Boer Jolanda M A¹⁵^ORCID,Verschuren W M Monique¹⁵¹⁶,Quirós J Ramón¹⁷,Agudo Antonio¹⁸,Rodríguez-Barranco Miguel¹⁹²⁰,Imaz Liher²¹²²,Chirlaque María-Dolores²⁰²³,Moreno-Iribas Conchi²⁴²⁵,Engström Gunnar²⁶,Sonestedt Emily²⁷^ORCID,Lind Marcus²⁸^ORCID,Otten Julia²⁸^ORCID,Khaw Kay-Tee²⁹^ORCID,Aune Dagfinn³⁰³¹³²^ORCID,Riboli Elio³⁰^ORCID,Wareham Nicholas J³³^ORCID,Imamura Fumiaki³³^ORCID,Forouhi Nita G³³^ORCID,di Angelantonio Emanuele³⁴,Wood Angela M³⁴,Butterworth Adam S³⁴^ORCID,Perez-Cornago Aurora¹^ORCID

Affiliation:

1. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK

2. Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Demark

3. Department of Cardiology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark

4. Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark

5. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden 49, 2100 Copenhagen, Denmark

6. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg Germany

7. Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Arthur-Scheunert-Allee 114, 14558 Nuthetal, Germany

8. Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece

9. 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, 1, Rimini Str, Haidari, 12462 Athens, Greece

10. International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France

11. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Via Cosimo Il Vecchio

12. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milan, Italy

13. Dipartimento Di Medicina Clinica E Chirurgia Federico II University, Corso Umberto I, 40, 80138 Naples, Italy

14. Cancer Registry and Histopathology Department, “M.P.Arezzo” Hospital, ASP Contrada Rito, 97100 Ragusa, Italy

15. National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands

16. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 Utrecht, the Netherlands

17. Public Health Directorate, General Elorza 32, 33001 Oviedo, Asturias, Spain

18. Unit of Nutrition and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL. Avinguda de la Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain

19. Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada, Cuesta del Observatorio, 4, 18011 Granada, Spain

20. CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain

21. Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Andia 13, 20004 Donostia-San Sebastian, Spain

22. Biodonostia Health Research Institute, Paseo Doctor Begiristain, s/n, 20014 Donostia-San Sebastian, Spain

23. Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Ronda de Levante, 11, 30008 Murcia, Spain

24. Instituto de Salud Pública de Navarra, IdiSNA, Navarre Institute for Health Research, Calle de Irunlarrea 3, 31008 Pamplona, Spain

25. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Recinto Hospitalario de Navarra, Calle de Irunlarrea s/n, 31621 Pamplona, Spain

26. Department of Clinical Science in Malmö, Lund University, Bergsgatan 31 B, 21445 Malmö, Sweden

27. Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, CRC, hus 60 plan 13 205 02 Malmö, Sweden

28. Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden

29. Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK

30. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK

31. Department of Nutrition, Bjørknes University College, Lovisenberggata 13, N- 0456 Oslo, Norway

32. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, OUS HF Aker sykehus, Postboks 4959 Nydalen, 0424 Oslo, Norway

33. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK

34. MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK

Abstract

Abstract Aim To investigate the associations between major foods and dietary fibre with subtypes of stroke in a large prospective cohort. Methods and results We analysed data on 418 329 men and women from nine European countries, with an average of 12.7 years of follow-up. Diet was assessed using validated country-specific questionnaires which asked about habitual intake over the past year, calibrated using 24-h recalls. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HRs) for ischaemic and haemorrhagic stroke associated with consumption of red and processed meat, poultry, fish, dairy foods, eggs, cereals, fruit and vegetables, legumes, nuts and seeds, and dietary fibre. For ischaemic stroke (4281 cases), lower risks were observed with higher consumption of fruit and vegetables combined (HR; 95% CI per 200 g/day higher intake, 0.87; 0.82–0.93, P-trend < 0.001), dietary fibre (per 10 g/day, 0.77; 0.69–0.86, P-trend < 0.001), milk (per 200 g/day, 0.95; 0.91–0.99, P-trend = 0.02), yogurt (per 100 g/day, 0.91; 0.85–0.97, P-trend = 0.004), and cheese (per 30 g/day, 0.88; 0.81–0.97, P-trend = 0.008), while higher risk was observed with higher red meat consumption which attenuated when adjusted for the other statistically significant foods (per 50 g/day, 1.07; 0.96–1.20, P-trend = 0.20). For haemorrhagic stroke (1430 cases), higher risk was associated with higher egg consumption (per 20 g/day, 1.25; 1.09–1.43, P-trend = 0.002). Conclusion Risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre, and dairy foods, while risk of haemorrhagic stroke was positively associated with egg consumption. The apparent differences in the associations highlight the importance of examining ischaemic and haemorrhagic stroke subtypes separately.

Funder

Medical Research Council

Cancer Research UK

Wellcome Trust

Our Planet Our Health, Livestock Environment and People

European Union Framework 7

European Research Council

British Heart Foundation

National Institute of Health Research

EU Sixth Framework Programme

Medical Research Council Epidemiology Unit

European Commission