Cohort study2020Open access

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

Tong TYN, Appleby PN, Key TJ, Dahm CC, Overvad K, Olsen A, Tjønneland A, Katzke V, Kühn T, Boeing H, Karakatsani A, Peppa E, Trichopoulou A, Weiderpass E, Masala G, Grioni S, Panico S, Tumino R, Boer JMA, Verschuren WMM, Quirós JR, Agudo A, Rodríguez-Barranco M, Imaz L, Chirlaque MD, Moreno-Iribas C, Engström G, Sonestedt E, Lind M, Otten J, Khaw KT, Aune D, Riboli E, Wareham NJ, Imamura F, Forouhi NG, di Angelantonio E, Wood AM, Butterworth AS, Perez-Cornago A

European heart journal · 72 citations

Review labels

Food frequency questionnaireNo stated lifestyle adjustment

Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.

How it was studied

Design: Cohort study (indexed by PubMed)
Studied in: People
Main outcome: Clinical events such as disease or death
Intake measured by: Food frequency questionnaire

Who paid for it

Funding: Independent funding
Government: World Health Organization
Government: National Institute on Handicapped Research
Nonprofit: Kræftens Bekæmpelse
University or hospital: Deutsches Krebsforschungszentrum
University or hospital: Centre International de Recherche sur le Cancer
Government: National Research Council Sri Lanka
Nonprofit: Wellcome Trust
Government: Centres de Recerca de Catalunya
Nonprofit: Cancer Research UK
Government: National Institute for Health and Care Research
Nonprofit: British Heart Foundation
Government: European Commission
Government: Institut National de la Santé et de la Recherche Médicale
Government: Bundesministerium für Bildung und Forschung
Nonprofit: Cancerfonden
Government: Generalitat de Catalunya
Nonprofit: Ligue Contre le Cancer
Government: Vetenskapsrådet
Nonprofit: Associazione Italiana per la Ricerca sul Cancro
Nonprofit: Deutsche Krebshilfe
University or hospital: Institut Gustave-Roussy
Nonprofit: Hellenic Health Foundation
Government: Sixth Framework Programme
Government: Medical Research Council
Nonprofit: World Cancer Research Fund
Government: H2020 European Research Council
Government: EU Sixth Framework Programme
Government: Dutch Ministry of Public Health, Welfare and Sports
Nonprofit: German Cancer Aid, German Cancer Research Center
Government: MRC Epidemiology Unit Cambridge
Nonprofit: Mutuelle Générale de l’Education Nationale
Nonprofit: Our Planet Our Health, Livestock Environment and People
University or hospital: EPIC-Oxford
Government: Medical Research Council Epidemiology Unit
Nonprofit: Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy
Government: International Agency for Research on Cancer
Government: European Research Council
Government: European Union Framework 7
Government: Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research
Nonprofit: Ligue Contre le Cancer, Institut Gustave Roussy
Government: National Institute for Health Research (NIHR)
Nonprofit: Danish Cancer Society
Government: National Research Council
University or hospital: Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme
Government: Federal Ministry of Education and Research
Grants: Vetenskapsrådet (14136); Hellenic Health Foundation (C8221/A19170); Medical Research Council (IS-BRC-1215-20014); Medical Research Council (MC_UU_12015/1); Medical Research Council (MC_UU_12015/5); Medical Research Council (M012190/1); Institut Gustave-Roussy (C570/A16491); Medical Research Council (1000143 (to EPIC‐Norfolk)); Cancerfonden (C8221/A19170); Deutsche Krebshilfe (14136); Cancer Research UK (C570/ A16491); National Institute for Health and Care Research (C8221/A19170); World Cancer Research Fund (14136); Cancer Research UK (14136 to EPIC-Norfolk); Ligue Contre le Cancer (MR/M012190/1); Medical Research Council (C570/A16491); Institut National de la Santé et de la Recherche Médicale (C570/A16491); Bundesministerium für Bildung und Forschung (1000143); Ligue Contre le Cancer (C570/A16491); World Cancer Research Fund (MR/M012190/1); Bundesministerium für Bildung und Forschung (14136); Institut Gustave-Roussy (MR/M012190/1); Ligue Contre le Cancer (C8221/A19170); Deutsche Krebshilfe (MR/M012190/1); Medical Research Council (MC_UU_12015/5); Deutsches Krebsforschungszentrum (C8221/A19170); World Cancer Research Fund (C8221/A19170); Medical Research Council (MC_UU_12015); Ligue Contre le Cancer (14136); National Institute for Health and Care Research ([IS-BRC-1215-20014); Cancer Research UK (C8221/A19170 to EPIC‐Oxford); Bundesministerium für Bildung und Forschung (C8221/A19170); Institut Gustave-Roussy (C8221/A19170); Medical Research Council (14136); Centre International de Recherche sur le Cancer (14136); Cancerfonden (14136); Medical Research Council (MR/M012190); Cancer Research UK (14136 (to EPIC‐Norfolk), C570/A16491 and C8221/A19170 (to EPIC‐Oxford)); World Cancer Research Fund (C570/A16491); Institut Gustave-Roussy (14136); Hellenic Health Foundation (C570/A16491); National Institute for Health and Care Research (BRC1215-20014); Institut Gustave-Roussy (1000143); World Cancer Research Fund (1000143); National Institute for Health and Care Research (C570/A16491); Bundesministerium für Bildung und Forschung (MR/M012190/1); British Heart Foundation (G0800270); Hellenic Health Foundation (14136); Medical Research Council (C8221/A19170); European Commission (C570/A16491); European Commission (C8221/A19170); Associazione Italiana per la Ricerca sul Cancro (1000143); Medical Research Council (MR/L003120/1); Medical Research Council (1000143); Institut National de la Santé et de la Recherche Médicale (MR/M012190/1); European Commission (14136); Institut National de la Santé et de la Recherche Médicale (C8221/A19170); Medical Research Council (MR/M012190/1); British Heart Foundation (SP/09/002); Institut National de la Santé et de la Recherche Médicale (1000143); Deutsche Krebshilfe (C570/A16491); British Heart Foundation (RG/08/014); Centre International de Recherche sur le Cancer (MR/M012190/1); European Commission (1000143); Associazione Italiana per la Ricerca sul Cancro (MR/M012190/1); Centre International de Recherche sur le Cancer (1000143); Wellcome Trust (205212); Associazione Italiana per la Ricerca sul Cancro (14136); Cancer Research UK (BRC-1215-20014); European Commission (MR/M012190/1); H2020 European Research Council (268834); Institut National de la Santé et de la Recherche Médicale (14136); Medical Research Council (G0800270); Deutsche Krebshilfe (C8221/A19170); National Institute for Health and Care Research (MC_UU_12015/1); Cancer Research UK (14136); Cancer Research UK (1000143); Medical Research Council (MR/M012190/1); National Institute for Health and Care Research (NF-SI-0512-10114); National Institute for Health and Care Research (IS-BRC-1215); Cancer Research UK (MR/M012190/1); European Commission (279233); Medical Research Council (MR/N003284/1); Medical Research Council (BRC-1215-20014); National Institute for Health and Care Research (1000143); Centre International de Recherche sur le Cancer (C570/A16491); Cancer Research UK (C8221/A19170); Medical Research Council (MC_UU_12015/1); Wellcome Trust (People 205212/Z/16/Z); Associazione Italiana per la Ricerca sul Cancro (C570/A16491); Cancer Research UK (570/A16491); Deutsches Krebsforschungszentrum (C570/A16491); Ligue Contre le Cancer (1000143); Deutsches Krebsforschungszentrum (14136); British Heart Foundation (RG/13/13/30194); Hellenic Health Foundation (1000143); Cancerfonden (C570/A16491); Deutsche Krebshilfe (1000143); Wellcome Trust (BRC-1215-20014); Wellcome Trust (205212/Z/16/Z); Medical Research Council (MR/L003120); Vetenskapsrådet (1000143); Associazione Italiana per la Ricerca sul Cancro (C8221/A19170); Deutsches Krebsforschungszentrum (MR/M012190/1); Bundesministerium für Bildung und Forschung (C570/A16491); Centre International de Recherche sur le Cancer (C8221/A19170); Vetenskapsrådet (C8221/A19170); Hellenic Health Foundation (MR/M012190/1); National Institute for Health and Care Research (NF-SI-0617-10149); National Institute for Health and Care Research (MR/M012190/1); Vetenskapsrådet (C570/A16491); Sixth Framework Programme (LSHM_CT_2006_037197); British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194); Vetenskapsrådet (MR/M012190/1); Deutsches Krebsforschungszentrum (1000143); Cancer Research UK (MC-UU_12015/1); National Institute for Health and Care Research (14136); Medical Research Council (MR/M012190/1 to EPIC-Oxford); Medical Research Council (MR/L003120/1)

Based on 45 listed funder(s) and full-text disclosure statement.

Publication

Published: 2020-01-10 · Eur Heart J · vol. 41 · issue 28 · pp. 2632–2640
Publisher: Oxford University Press
Cited: 92 citations · more than 99% of similar papers · 11.0× the field average
Impact: Top 10% most cited in its field
References: 85 works
Access: Open access (hybrid journal) · CC-BY
Research areas: Nutritional Studies and Diet · Dysphagia Assessment and Management · Nutrition and Health in Aging
Keywords: Medicine, Prospective cohort study, EPIC, Cohort, Stroke (engine), European Prospective Investigation into Cancer and Nutrition, Cohort study, Ischaemic stroke, Environmental health, Surgery, Internal medicine, Ischemia
MeSH: animals, humans, brain ischemia, diet, risk factors, prospective studies, dietary fiber, europe, female, male, stroke, hemorrhagic stroke

DOI ↗PubMed Central ↗OpenAlex ↗

40 authors

From GB, DK, DE, GR, FR, US, IT, NL, ES, SE, NO

Tammy Y. N. Tong · correspondingUniversity of Oxford
Paul N. ApplebyUniversity of Oxford
Timothy J. KeyUniversity of Oxford
Christina Catherine DahmAarhus University
Kim OvervadAarhus University; Aalborg University Hospital
Anja OlsenDanish Cancer Society

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.

Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).

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