EAT-Lancet Diet, AHEI Associated With Lower Risk of Stroke, Subtypes of Stroke


According to the study, which assessed the EAT-Lancet diet and Alternate Health Eating Index-2010 in more than 2000 patients, dietary pattern has a distinct association with different stroke subtypes.

Daniel B. Ibsen, PhD, MSc, Department of Public Health, Aarhus University

Daniel B. Ibsen, PhD, MSc

Data from a recent study show that adherence to 2 diets, the primarily plant-based EAT-Lancet diet and the Alternate Health Eating Index-2010 (AHEI), in midlife were associated with lower risk of stroke and subtypes of stroke. 

A total of 55,016 participants were included from the Danish Diet, Cancer, and Health cohort, all of whom were between the age of 50-64 years at baseline (1993-1997). Within the cohort, stroke cases (n = 2253) were identified using a national registry and validated by a medical record review. 

The AHEI was associated with a lower risk of overall stroke (HR, 0.75; 95% CI, 0.64-0.87) and while not statistically significant, the EAT-Lancet diet was also associated with lower risk of stroke (HR, 0.91; 95% CI, 0.76-1.09). When evaluating stroke subtypes, investigators found that EAT-Lancet diet adherence was associated with a lower risk of subarachnoid hemorrhage (HR, 0.30; 95% CI, 0.12-0.73), while the AHEI was associated with a lower risk of ischemic stroke (HR, 0.76; 95% CI, 0.64-0.90) and intracerebral hemorrhage (HR, 0.58; 95% CI, 0.36-0.93). 

Investigators, led by Daniel B. Ibsen, PhD, MSc, Department of Public Health, Aarhus University, in Denmark, found that participants who were younger, women, physically active, had longer education, and had lower BMI and waist circumference had greatest adherence to the EAT-Lancet score (11-14 points), compared with those who had lowest levels of adherence (0-7 points). Those with higher adherence were also more likely to have a history of hypertension or hypercholesterolemia. Greater adherence to the AHEI was also more likely in those with the greatest adherence to the EAT-Lancet diet. Thirteen participants of the 2253 who developed stroke over the follow-up period (median, 15 years) had an unknown cause of stroke that were then not included in analyses. 

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Sensitivity analyses had similar patterns when removing patients with a history of diabetes or myocardial infarction ahead of the study start. The absolute risk difference of total stroke compared greatest and poorest adherence to the EAT-Lancet diet was lower in men than women, among those with a BMI lower than 25 kg/m2 than those with a BMI of 25 kg/m2, and those younger than 57 years at baseline, when compared with those that were 57 years or older. 

The cohort originally included 57,053 participants, with patients excluded in the event of previous cancer diagnosis (n = 585), previous stroke diagnosis (n = 582), or missing information in covariates (n = 870). Participants completed a 192-item food frequency questionnaire (FFQ) designed for the Danish population included in the study, primarily posing questions about intake of grains, potatoes, vegetables, fruits, dairy, meat, and snacks. Questions inquired about eating habits for the past 12 months and were scored based on adherence to both the EAT-Lancet diet and the AHEI. 

After completing the FFQ, patients visited 1 of 2 study centers, then completing a lifestyle questionnaire and underwent a physical examination. In total, only 0.4% of participants (n = 212) were lost to follow-up. 

“One of the strengths of this study is that it used register-identified stroke cases that were subsequently validated and subtyped using medical records,” Ibsen et al wrote. “The distribution of stroke subtypes was representative of typical Western populations with 83% ischemic strokes, 12% intracerebral hemorrhages, and 5% subarachnoid hemorrhages. Only 13 cases were not classified according to the stroke subtype.”

The study was limited as investigators have not updated case ascertainment since 2009 due to its intensive validation process, potentially lacking power to detect weaker associations in certain stroke subtypes. Also noted was the risk for misclassification with the FFQ and the use of only 1 measure of dietary intake, as participants could have changed their diet in the long-term. Future research should evaluate the potential differential role of changes in dietary patterns, as well at the long-term health consequences of moving from a meat-based to a plant-based diet. 

Ibsen DB, Christiansen AH, Olsen A, et al. Adherence to the EAT-Lancet diet and risk of stroke and stroke subtypes: A cohort study. Stroke. 2022;(53):154–163. doi:10.1161/STROKEAHA.121.036738
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