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

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^*

^*Corresponding author for this work

Department of Public Health - Department of Epidemiology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: We previously reported habitual consumption of dietary flavanol oligomers + polymers and anthocyanins are associated with a lower risk of ischemic stroke. No studies, however, have investigated their relationship with ischemic stroke subtypes.

OBJECTIVES: In this follow-up analysis, we examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes including 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 for up to 16 years 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 Phenol-Explorer 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 vs. quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with lower risk of specific ischemic stroke subtypes including large-artery atherosclerosis [flavanol oligomers + polymers, HR (95%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 lower risk of ischemic stroke from atherosclerosis and/or cardioembolism, but not with other subtypes.

Original language	English
Journal	The Journal of Nutrition
Volume	153
Issue	11
Pages (from-to)	3280-3286
Number of pages	7
ISSN	0022-3166
DOIs	https://doi.org/10.1016/j.tjnut.2023.09.011
Publication status	Published - Nov 2023

Keywords

flavonoids
TOAST
anthocyanins
flavanols
ischemic stroke

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10.1016/j.tjnut.2023.09.011

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Parmenter, B. H., Pokharel, P., Dalgaard, F., Murray, K., Cassidy, A., Bondonno, C. P., Lewis, J. R., Kyrø, C., Tjønneland, A., Overvad, K., Hodgson, J. M., & Bondonno, N. P. (2023). Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes: A follow-up analysis. The Journal of Nutrition, 153(11), 3280-3286. https://doi.org/10.1016/j.tjnut.2023.09.011

@article{6be4d777c1b541c5bd516d0c4a80befc,

title = "Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes: A follow-up analysis",

abstract = "BACKGROUND: We previously reported habitual consumption of dietary flavanol oligomers + polymers and anthocyanins are associated with a lower risk of ischemic stroke. No studies, however, have investigated their relationship with ischemic stroke subtypes.OBJECTIVES: In this follow-up analysis, we examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes including 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 for up to 16 years 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 Phenol-Explorer 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 vs. quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with lower risk of specific ischemic stroke subtypes including large-artery atherosclerosis [flavanol oligomers + polymers, HR (95%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 lower risk of ischemic stroke from atherosclerosis and/or cardioembolism, but not with other subtypes.",

keywords = "flavonoids, TOAST, anthocyanins, flavanols, ischemic stroke",

author = "Parmenter, {Benjamin H} and Pratik Pokharel and Frederik Dalgaard and Kevin Murray and Aed{\'i}n Cassidy and Bondonno, {Catherine P} and Lewis, {Joshua R} and Cecilie Kyr{\o} and Anne Tj{\o}nneland and Kim Overvad and Hodgson, {Jonathan M} and Bondonno, {Nicola P}",

year = "2023",

month = nov,

doi = "10.1016/j.tjnut.2023.09.011",

language = "English",

volume = "153",

pages = "3280--3286",

journal = "The Journal of Nutrition",

issn = "0022-3166",

publisher = "Elsevier B.V.",

number = "11",

}

Parmenter, BH, Pokharel, P, Dalgaard, F, Murray, K, Cassidy, A, Bondonno, CP, Lewis, JR, Kyrø, C, Tjønneland, A, Overvad, K, Hodgson, JM & Bondonno, NP 2023, 'Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes: A follow-up analysis', The Journal of Nutrition, vol. 153, no. 11, pp. 3280-3286. https://doi.org/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. / Parmenter, Benjamin H; Pokharel, Pratik; Dalgaard, Frederik et al.
In: The Journal of Nutrition, Vol. 153, No. 11, 11.2023, p. 3280-3286.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes

T2 - A follow-up analysis

AU - Parmenter, Benjamin H

AU - Pokharel, Pratik

AU - Dalgaard, Frederik

AU - Murray, Kevin

AU - Cassidy, Aedín

AU - Bondonno, Catherine P

AU - Lewis, Joshua R

AU - Kyrø, Cecilie

AU - Tjønneland, Anne

AU - Overvad, Kim

AU - Hodgson, Jonathan M

AU - Bondonno, Nicola P

PY - 2023/11

Y1 - 2023/11

N2 - BACKGROUND: We previously reported habitual consumption of dietary flavanol oligomers + polymers and anthocyanins are associated with a lower risk of ischemic stroke. No studies, however, have investigated their relationship with ischemic stroke subtypes.OBJECTIVES: In this follow-up analysis, we examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes including 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 for up to 16 years 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 Phenol-Explorer 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 vs. quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with lower risk of specific ischemic stroke subtypes including large-artery atherosclerosis [flavanol oligomers + polymers, HR (95%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 lower risk of ischemic stroke from atherosclerosis and/or cardioembolism, but not with other subtypes.

AB - BACKGROUND: We previously reported habitual consumption of dietary flavanol oligomers + polymers and anthocyanins are associated with a lower risk of ischemic stroke. No studies, however, have investigated their relationship with ischemic stroke subtypes.OBJECTIVES: In this follow-up analysis, we examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes including 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 for up to 16 years 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 Phenol-Explorer 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 vs. quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with lower risk of specific ischemic stroke subtypes including large-artery atherosclerosis [flavanol oligomers + polymers, HR (95%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 lower risk of ischemic stroke from atherosclerosis and/or cardioembolism, but not with other subtypes.

KW - flavonoids

KW - TOAST

KW - anthocyanins

KW - flavanols

KW - ischemic stroke

UR - http://www.scopus.com/inward/record.url?scp=85173214138&partnerID=8YFLogxK

U2 - 10.1016/j.tjnut.2023.09.011

DO - 10.1016/j.tjnut.2023.09.011

M3 - Journal article

C2 - 37716608

SN - 0022-3166

VL - 153

SP - 3280

EP - 3286

JO - The Journal of Nutrition

JF - The Journal of Nutrition

IS - 11

ER -

Higher habitual dietary intakes of flavanols and anthocyanins differentially associate with lower incidence of ischemic stroke subtypes: A follow-up analysis

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