Christina C. Dahm

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Tammy Y N Tong, University of Oxford, United Kingdom
  • Paul N Appleby, University of Oxford, United Kingdom
  • Timothy J Key, University of Oxford, United Kingdom
  • Christina C Dahm
  • Kim Overvad
  • Anja Olsen
  • Anne Tjønneland, Danish Cancer Society, University of Copenhagen, Denmark
  • Verena Katzke, German Cancer Research Center (DKFZ), Germany
  • Tilman Kühn, German Cancer Research Center (DKFZ), Germany
  • Heiner Boeing, German Institute of Human Nutrition (DIfE) , Germany
  • Anna Karakatsani, Hellenic Health Foundation, Athens, Greece., “ATTIKON” University Hospital, Greece
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Greece
  • Elisabete Weiderpass, World Health Organization, Lyon, France
  • Giovanna Masala, Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO., Italy
  • Sara Grioni, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Italy
  • Salvatore Panico, Federico II University of Naples, Italy
  • Rosario Tumino, "M.P.Arezzo" Hospital, Italy
  • Jolanda M A Boer, National Institute for Public Health and the Environment, Netherlands
  • W M Monique Verschuren, National Institute for Public Health and the Environment, Utrecht University, Netherlands
  • J Ramón Quirós, Public Health Directorate, Spain
  • Antonio Agudo, L'Hospitalet de Llobregat, Barcelona, Spain
  • Miguel Rodríguez-Barranco, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Spain., Spain
  • Liher Imaz, Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Spain
  • María-Dolores Chirlaque, CIBER of Epidemiology and Public Health (CIBERESP), Spain., University Murcia, Spain
  • Conchi Moreno-Iribas, Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain., Recinto Hospitalario de Navarra, Spain
  • Gunnar Engström, Lund University, Sweden
  • Emily Sonestedt, Lund University, Sweden
  • Marcus Lind, Umeå University, Sweden
  • Julia Otten, Umeå University, Sweden
  • Kay-Tee Khaw, University of Cambridge, United Kingdom
  • Dagfinn Aune, Imperial College London, Bjørknes University College, Ullevaal University Hospital, Oslo, Norway., Norway
  • Elio Riboli, Imperial College London, United Kingdom
  • Nicholas J Wareham, University of Cambridge School of Clinical Medicine, United Kingdom
  • Fumiaki Imamura, University of Cambridge School of Clinical Medicine, United Kingdom
  • Nita G Forouhi, University of Cambridge School of Clinical Medicine, United Kingdom
  • Emanuele di Angelantonio, University of Cambridge, United Kingdom
  • Angela M Wood, University of Cambridge, United Kingdom
  • Adam S Butterworth, University of Cambridge, United Kingdom
  • Aurora Perez-Cornago, University of Oxford, United Kingdom

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.

Original languageEnglish
Article numberehaa007
JournalEuropean Heart Journal
Volume41
Issue28
Pages (from-to)2632-2640
Number of pages9
ISSN0195-668X
DOIs
Publication statusPublished - Jul 2020

    Research areas

  • diet, fibre, fruit, haemorrhagic stroke, ischaemic stroke, vegetables

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