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

Research output: Contribution to journalJournal articleResearchpeer-review

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

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.

Original languageEnglish
JournalJournal of Nutrition
Volume153
Issue number11
Pages (from-to)3280-3286
Number of pages7
ISSN0022-3166
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 American Society for Nutrition

    Research areas

  • anthocyanins, flavanols, flavonoids, ischemic stroke, TOAST

ID: 375498311