Jul 2026· Journal of Stroke & Cerebrovascular Diseases· Vol 35, pp.
108699
· 0 citations· 43 references
Medicine
TL;DR
AHEI and DII were significantly associated with all-cause mortality among stroke survivors, highlighting the potential clinical relevance of dietary quality in long-term prognosis, although prospective studies are needed to confirm these associations.
Abstract
Background
Stroke, as the fourth leading cause of disability worldwide, poses significant long-term health challenges for survivors. Dietary interventions, being among the most modifiable risk factors, hold great potential in secondary prevention and long-term care for stroke survivors. However, there is insufficient evidence focusing on this topic.
Methods
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 survey, including 1212 participants with complete dietary data. Cox proportional hazards models, adjusted for various covariates, were used to examine the association between five dietary indices and all-cause mortality in stroke survivors.
Results
The Alternative Healthy Eating Index (AHEI) was found to be inversely associated with all-cause mortality in stroke survivors, while the Dietary Inflammatory Index (DII) showed a positive association. No significant associations were observed for The Healthy Eating Index-2020 (HEI-2020), Alternate Mediterranean Diet Score (aMED), or Dietary Approaches to Stop Hypertension score (DASH). Compared to the lowest quartile, the highest quartile of AHEI was associated with a 64.8% reduction in all-cause mortality risk (HR = 0.352, 95% CI 0.153, 0.809, p = 0.014). Conversely, the highest quartile of DII was associated with a 47.1% increase in mortality risk (HR = 1.471, 95% CI 1.028, 2.104, p = 0.035).
Conclusion
AHEI and DII were significantly associated with all-cause mortality among stroke survivors. These findings highlight the potential clinical relevance of dietary quality in long-term prognosis, although prospective studies are needed to confirm these associations.
This study examines the association between the Dietary Inflammatory Index (DII) and all-cause mortality in older adults and investigates the mediating role of estimated glomerular filtration rate (eGFR) using National Health and Nutrition Examination Survey data. We included 6300 participants aged ≥ 60 years from 9 National Health and Nutrition Examination Survey cycles (2001–2018). All-cause mortality (ascertained via linkage to the National Center for Health Statistics) was the primary endpoint. Cox proportional hazards models evaluated the association. Mediation analysis (mediation package, R 4.4.0) quantified eGFR’s contribution. The average DII of the enrolled subjects was 0.73 (0.04), and the average age was 68.84 (0.13) years. Over 116.4 months of follow-up, 1746 all-cause deaths occurred. Each 1-unit DII increase increased all-cause mortality risk by 5.6% (adjusted hazard ratio = 1.056, 95% confidence interval [CI]:1.020–1.094; P = .002). The highest DII tertile had 26% higher all-cause mortality vs the lowest (hazard ratio = 1.26, 95% CI:1.08–1.48). eGFR mediated 9.67% (95% CI:3.65–25.7%) of the DII-all-cause mortality association. Pro-inflammatory diets independently increase all-cause mortality in older adults, partially mediated through eGFR. Dietary interventions and renal monitoring may reduce this risk.
It is shown that a combination of appropriate PA and higher DQ is associated with reduced odds of stroke and mortality among stroke survivors, and this findings support lifestyle modification as a strategy for stroke prevention and survivor care.
Mu-Lei Yang, Shuangfang Fang, Gareth Ambler et al.· British Journal of Nutrition· 0 citations
Background: Current dietary guidelines are largely based on evidence from the general population, and data on dietary patterns and survival after myocardial infarction (MI) remain limited. We evaluated post-MI adherence to multiple healthy dietary patterns, as well as changes in adherence from before to after MI diagnosis, in relation to mortality among MI survivors. Methods: We included 3,277 women from the Nurses’ Health Study and 2,618 men from the Health Professionals Follow-up Study who survived a non-fatal MI. The mean age at MI diagnosis was 68.2 (standard deviation, 10.2) years. Diet was assessed using validated food frequency questionnaires and updated every two to four years. We calculated post-MI adherence scores for eight healthy patterns: the Alternate Healthy Eating Index (AHEI), the Healthy Eating Index-2015 (HEI-2015), the Alternate Mediterranean Diet Score (AMED), the Dietary Approaches to Stop Hypertension (DASH), the healthful Plant-Based Diet Index (hPDI), the reversed empirical dietary inflammatory pattern (rEDIP), the reversed empirical dietary index for hyperinsulinemia (rEDIH), and the reversed empirical dietary index for insulin resistance (rEDIR). The main outcome was total mortality, with cardiovascular disease (CVD) mortality and recurrent non-fatal MI as secondary outcomes. Results: During 15.7 years of follow-up after MI, 3,858 deaths (65.4%) were documented, including 1,639 CVD deaths (42.5% of deaths). Comparing the highest with the lowest quintile, higher post-MI dietary scores were consistently associated with lower total mortality, with the hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.60–0.74) for AHEI, 0.73 (0.65–0.81) for HEI-2015, 0.66 (0.59–0.75) for AMED, 0.77 (0.69–0.86) for DASH, 0.74 (0.66–0.83) for hPDI, 0.77 (0.68–0.86) for rEDIP, 0.73 (0.65–0.83) for rEDIR, and 0.71 (0.64–0.80) for rEDIH. Similar inverse associations were observed for CVD mortality and recurrent non-fatal MI. Improved AHEI adherence from before to after MI was associated with lower mortality (HR: 0.86; 95% CI: 0.76–0.97), whereas decreased adherence to most patterns was associated with higher mortality. Conclusions: Among individuals who survived MI, adherence to post-MI dietary patterns emphasizing higher diet quality was associated with better long-term survival. These findings support dietary guidance focusing on overall diet quality for the secondary prevention of deaths among MI survivors.
L. Ma, Yang Hu, Gang Liu et al.· Circulation· 0 citations
HEI-2020 was inversely associated with PSD, with nonlinear and race-specific patterns and DI-GM showed a significant but inconsistent indirect association, suggesting a suppressive rather than mediating role.
Can Xing, Zhenhui Lu, Xiaoming Guo et al.· BMC Psychiatry· 0 citations
BACKGROUND
Type 2 diabetes (T2D) is associated with an increased risk of premature death. Diet may influence long-term health outcomes among individuals with T2D, but prospective evidence on dietary patterns and mortality remains limited.
OBJECTIVES
To prospectively examine associations of eleven pre-defined or empirically-developed dietary patterns with all-cause and cause-specific mortality (e.g., cardiovascular disease [CVD] and cancer) among U.S. individuals with T2D.
METHODS
We included 7,795 participants with incident T2D in the Nurses' Health Study (1984-2016) and Health Professionals Follow-Up Study (1986-2020), who were free of CVD and cancer at diagnosis. Diet was assessed using a validated food frequency questionnaire and updated every four years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs.
RESULTS
Over 24 years of follow-up, 3,509 deaths were confirmed, including 1,079 from CVD and 649 from cancer. Adherence to healthy dietary patterns after diagnosis (comparing the 90th with the 10th percentile of dietary pattern scores) was consistently associated with lower all-cause mortality, with multivariable-adjusted HRs ranging from 0.78 (95% CI: 0.71, 0.85) for the Planetary Health Diet to 0.92 (95% CI: 0.84, 1.01) for the Dietary Approaches to Stop Hypertension. Furthermore, greater improvements in dietary pattern adherence from pre- to post-diagnosis (comparing the 90th with the 10th percentile of change scores) were also associated with lower all-cause mortality, with HRs (95% CI) ranging from 0.63 (0.58, 0.70) to 0.92 (0.85, 1.01). A similar pattern of inverse associations with CVD mortality was also observed for these dietary scores. Additionally, the reversed Empirical Dietary Index for Hyperinsulinemia was specifically associated with lower cancer mortality.
CONCLUSIONS
Adherence to healthy dietary patterns is universally associated with better survival in individuals with T2D. These findings suggest the importance of consuming high-quality diets in the prevention of premature deaths among individuals with T2D.
Zixin Qiu, Gang Liu, Binkai Liu et al.· American Journal of Clinical...· 0 citations
Abstract This study aimed to determine if habitual intake of key dietary antioxidants, both individually and collectively, is associated with all-cause and cause-specific mortality among U.S. adults, given that oxidative stress heightens cardiovascular and cancer mortality risk. This prospective cohort study analysed 34,955 participants from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Intakes of vitamins A, C, E, zinc, selenium, and carotenoids were assessed, and a composite dietary antioxidant index (CDAI) was calculated. The principal results, from 347,580 person-years of follow-up where 4,456 deaths occurred (1,368 CVD; 1,038 cancer), showed significant associations. Compared with the lowest intake quintile, the highest quintile of vitamin E was associated with lower all-cause mortality (HR: 0.69, 95% CI: 0.58–0.83) and CVD mortality (HR: 0.67, 0.48–0.92). High carotenoid intake was inversely associated with all-cause mortality (HR: 0.77, 0.67–0.88). Participants in the highest CDAI quintile experienced an 18% lower risk of all-cause mortality (HR: 0.82, 0.70–0.97) and a 39% lower risk of cancer mortality (HR: 0.61, 0.45–0.84). Dose–response relationships for vitamins A, C, selenium, and zinc were U-or L-shaped, and WQS analyses assigned the greatest weights to vitamin A or C. In conclusion, while individual antioxidants like vitamin E show strong protective associations, the evidence collectively suggests that greater overall antioxidant exposure from a varied diet is linked to materially lower risks of death. This reinforces that focusing on diets rich in diverse antioxidant sources is superior to single-nutrient strategies.
