Higher Habitual Dietary Intakes of Flavanols and Anthocyanins Differentially Associate with Lower Incidence of Ischemic Stroke Subtypes-A Follow-Up Analysis

Benjamin H Parmenter; Pratik Pokharel; Frederik Dalgaard; Kevin Murray; Aedín Cassidy; Catherine P Bondonno; Joshua R Lewis; Cecilie Kyrø; Anne Tjønneland; Kim Overvad; Jonathan M Hodgson; Nicola P Bondonno

doi:10.1016/j.tjnut.2023.09.011

Higher Habitual Dietary Intakes of Flavanols and Anthocyanins Differentially Associate with Lower Incidence of Ischemic Stroke Subtypes-A Follow-Up Analysis

J Nutr. 2023 Nov;153(11):3280-3286. doi: 10.1016/j.tjnut.2023.09.011. Epub 2023 Sep 15.

Authors

Affiliations

¹ School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Australia; Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia.
² Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; The Danish Cancer Society Research Centre, Copenhagen, Denmark.
³ Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark; Department of Medicine, Nykøbing Falster Sygehus, Nykøbing Falster, Denmark.
⁴ School of Population and Global Health, University of Western Australia, Australia.
⁵ Institute for Global Food Security, Queen's University, Belfast, Northern Ireland.
⁶ Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia.
⁷ Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia; Centre for Kidney Research, School of Public Health, The University of Sydney, Sydney, Australia.
⁸ The Danish Cancer Society Research Centre, Copenhagen, Denmark.
⁹ The Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Department of Public Health, Aarhus University, Aarhus, Denmark.
¹¹ Nutrition & Health Innovation Research Institute, Edith Cowan University, Perth, Australia; The Danish Cancer Society Research Centre, Copenhagen, Denmark. Electronic address: n.bondonno@ecu.edu.au.

PMID: 37716608
DOI: 10.1016/j.tjnut.2023.09.011

Abstract

Background: We previously reported that habitual consumption of dietary flavanol oligomers + polymers and anthocyanins is associated with a lower risk of ischemic stroke. However, no studies have investigated their relationship with ischemic stroke subtypes.

Objectives: In this follow-up analysis, we aimed to examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes, including the following: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) other determined etiology, and 5) undetermined etiology.

Methods: Participants (n = 55,094) from the Danish Diet, Cancer, and Health Study were followed up for <16 y for first-time ischemic stroke events, which were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Intakes of flavanol oligomers + polymers and anthocyanins were calculated from food frequency questionnaires using the Phenol-Explorer database, and their relationships with ischemic stroke subtypes were investigated using restricted cubic splines within Cox proportional hazards models. After multivariable adjustment, higher habitual intakes (quintile 5 compared with quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with a lower risk of specific ischemic stroke subtypes, including large-artery atherosclerosis [flavanol oligomers + polymers, hazard ratio {HR} (95% confidence interval {CI}): 0.64 (0.47, 0.87)], cardioembolism [anthocyanins, HR (95% CI): 0.45 (0.25, 0.82)], and small-vessel occlusion [flavanol oligomers + polymers, HR (95% CI): 0.65 (0.54, 0.80); anthocyanins, HR (95% CI): 0.79 (0.64, 0.97)], but not stroke of other determined or undetermined etiology.

Conclusions: Higher habitual intakes of flavanols and anthocyanins are differentially associated with a lower risk of ischemic stroke from atherosclerosis and/or cardioembolism but not with other subtypes.

Keywords: TOAST; anthocyanins; flavanols; flavonoids; ischemic stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anthocyanins
Atherosclerosis* / epidemiology
Atherosclerosis* / prevention & control
Brain Ischemia* / epidemiology
Brain Ischemia* / etiology
Brain Ischemia* / prevention & control
Eating
Follow-Up Studies
Humans
Incidence
Ischemic Stroke* / complications
Polymers
Polyphenols
Risk Factors
Stroke* / epidemiology
Stroke* / prevention & control

Substances

Anthocyanins
Polyphenols
Polymers