Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis

  • Choe, Hansaem (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Hwang, Ji-Yun (Department of Foodservice Management and Nutrition, Sangmyung University) ;
  • Yun, Jin A (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Kim, Ji-Myung (Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University) ;
  • Song, Tae-Jin (Department of Neurology, Ewha Womans University, School of Medicine) ;
  • Chang, Namsoo (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Kim, Yong-Jae (Department of Neurology, Ewha Womans University, School of Medicine) ;
  • Kim, Yuri (Department of Nutritional Science and Food Management, Ewha Womans University)
  • Received : 2015.06.25
  • Accepted : 2016.05.17
  • Published : 2016.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND/OBJECTIVES: This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS: A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS: When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits ($73.1{\pm}83.2g$ vs. $230.9{\pm}202.1g$, P < 0.001), vegetables ($221.1{\pm}209.0g$ vs. $561.7{\pm}306.6g$, P < 0.001), and antioxidants, including vitamins C, E, $B_6$, ${\beta}$-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, $B_6$, $B_{12}$, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin $B_{12}$ intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS: When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

Keywords

References

  1. World Health Organization. The top ten cause of death [Internet]. Geneva: World Health Organization; 2014 [cited 2014 May]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/index.html.
  2. Statistics Korea. Death Rates for the 10 Leading Causes of Death. Seoul: Statistics Korea; 2012.
  3. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention; 2010.
  4. Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke. Eur J Clin Nutr 2005;59:1367-73. https://doi.org/10.1038/sj.ejcn.1602248
  5. Murat Sumer M, Erturk O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurol Sci 2002;22:449-54. https://doi.org/10.1007/s100720200004
  6. Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 2013;12:1106-14. https://doi.org/10.1016/S1474-4422(13)70195-9
  7. Tholstrup T. Dairy products and cardiovascular disease. Curr Opin Lipidol 2006;17:1-10.
  8. Keli SO, Hertog MG, Feskens EJ, Kromhout D. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med 1996;156:637-42. https://doi.org/10.1001/archinte.1996.00440060059007
  9. Hirvonen T, Virtamo J, Korhonen P, Albanes D, Pietinen P. Intake of flavonoids, carotenoids, vitamins C and E, and risk of stroke in male smokers. Stroke 2000;31:2301-6. https://doi.org/10.1161/01.STR.31.10.2301
  10. Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282:1233-9. https://doi.org/10.1001/jama.282.13.1233
  11. Witztum JL. The oxidation hypothesis of atherosclerosis. Lancet 1994;344:793-5. https://doi.org/10.1016/S0140-6736(94)92346-9
  12. Navab M, Ananthramaiah GM, Reddy ST, Van Lenten BJ, Ansell BJ, Fonarow GC, Vahabzadeh K, Hama S, Hough G, Kamranpour N, Berliner JA, Lusis AJ, Fogelman AM. The oxidation hypothesis of atherogenesis: the role of oxidized phospholipids and HDL. J Lipid Res 2004;45:993-1007. https://doi.org/10.1194/jlr.R400001-JLR200
  13. Sarkar PK, Lambert LA. Aetiology and treatment of hyperhomocysteinaemia causing ischaemic stroke. Int J Clin Pract 2001;55:262-8.
  14. Sanchez-Moreno C, Jimenez-Escrig A, Martin A. Stroke: roles of B vitamins, homocysteine and antioxidants. Nutr Res Rev 2009;22:49-67.
  15. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53. https://doi.org/10.1056/NEJM199108153250701
  16. Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators. Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology 2003;22:106-17. https://doi.org/10.1159/000068744
  17. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41. https://doi.org/10.1161/01.STR.24.1.35
  18. Oh SY, Kim EM, Shin MH, Lee SH, Kim JE, Lee HS. Development and validation of food frequency questionnaire for adults. The Korean Society of Health Promotion Annual Spring Conference; 2007 May 19. Seoul: The Korean Society of Health Promotion; 2007. p.67-72.
  19. The Korean Nutrition Society. Dietary Reference Intakes for Koreans. 1st rev. ed. Seoul: The Korean Nutrition Society; 2010.
  20. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997;65:1220S-1228S. https://doi.org/10.1093/ajcn/65.4.1220S
  21. Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke 1999;30:2535-40. https://doi.org/10.1161/01.STR.30.12.2535
  22. Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, Kikuchi S, Koizumi A, Kondo T, Inaba Y, Tanabe N, Tamakoshi A. Dietary intake of calcium in relation to mortality from cardiovascular disease: the JACC Study. Stroke 2006;37:20-6. https://doi.org/10.1161/01.STR.0000195155.21143.38
  23. Liu S, Manson JE, Stampfer MJ, Rexrode KM, Hu FB, Rimm EB, Willett WC. Whole grain consumption and risk of ischemic stroke in women: a prospective study. JAMA 2000;284:1534-40. https://doi.org/10.1001/jama.284.12.1534
  24. Steffen LM, Jacobs DR Jr, Stevens J, Shahar E, Carithers T, Folsom AR. Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003;78:383-90. https://doi.org/10.1093/ajcn/78.3.383
  25. Lim H, Choue R. Dietary pattern, nutritional density, and dietary quality were low in patients with cerebral infarction in Korea. Nutr Res 2011;31:601-7. https://doi.org/10.1016/j.nutres.2011.08.004
  26. Carden DL, Granger DN. Pathophysiology of ischaemia-reperfusion injury. J Pathol 2000;190:255-66. https://doi.org/10.1002/(SICI)1096-9896(200002)190:3<255::AID-PATH526>3.0.CO;2-6
  27. Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Colditz G, Ascherio A, Rosner B, Spiegelman D, Willett WC. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001;134:1106-14. https://doi.org/10.7326/0003-4819-134-12-200106190-00010
  28. Johnsen SP, Overvad K, Stripp C, Tjonneland A, Husted SE, Sorensen HT. Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of Danish men and women. Am J Clin Nutr 2003;78:57-64. https://doi.org/10.1093/ajcn/78.1.57
  29. Massey LK. Dairy food consumption, blood pressure and stroke. J Nutr 2001;131:1875-8. https://doi.org/10.1093/jn/131.7.1875
  30. Hak AE, Ma J, Powell CB, Campos H, Gaziano JM, Willett WC, Stampfer MJ. Prospective study of plasma carotenoids and tocopherols in relation to risk of ischemic stroke. Stroke 2004;35:1584-8. https://doi.org/10.1161/01.STR.0000132197.67350.bd
  31. Voko Z, Hollander M, Hofman A, Koudstaal PJ, Breteler MM. Dietary antioxidants and the risk of ischemic stroke: the Rotterdam Study. Neurology 2003;61:1273-5. https://doi.org/10.1212/01.WNL.0000090458.67821.A3
  32. Van Guelpen B, Hultdin J, Johansson I, Stegmayr B, Hallmans G, Nilsson TK, Weinehall L, Witthoft C, Palmqvist R, Winkvist A. Folate, vitamin B12, and risk of ischemic and hemorrhagic stroke: a prospective, nested case-referent study of plasma concentrations and dietary intake. Stroke 2005;36:1426-31. https://doi.org/10.1161/01.STR.0000169934.96354.3a
  33. Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J. Folate, vitamin B6, vitamin B12, and methionine intakes and risk of stroke subtypes in male smokers. Am J Epidemiol 2008;167:954-61. https://doi.org/10.1093/aje/kwm395
  34. Gale CR, Martyn CN, Winter PD, Cooper C. Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people. BMJ 1995;310:1563-6. https://doi.org/10.1136/bmj.310.6994.1563
  35. Gonzalez-Gross M, Marcos A, Pietrzik K. Nutrition and cognitive impairment in the elderly. Br J Nutr 2001;86:313-21. https://doi.org/10.1079/BJN2001388
  36. Weng LC, Yeh WT, Bai CH, Chen HJ, Chuang SY, Chang HY, Lin BF, Chen KJ, Pan WH. Is ischemic stroke risk related to folate status or other nutrients correlated with folate intake? Stroke 2008;39:3152-8. https://doi.org/10.1161/STROKEAHA.108.524934
  37. Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. Lancet 1999;354:407-13. https://doi.org/10.1016/S0140-6736(98)11058-9
  38. Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2006;30:108-14. https://doi.org/10.1177/0148607106030002108
  39. Choi-Kwon S, Yang YH, Kim EK, Jeon MY, Kim JS. Nutritional status in acute stroke: undernutrition versus overnutrition in different stroke subtypes. Acta Neurol Scand 1998;98:187-92.
  40. Neaton JD, Wentworth DN, Cutler J, Stamler J, Kuller L; Multiple Risk Factor Intervention Trial Research Group. Risk factors for death from different types of stroke. Ann Epidemiol 1993;3:493-9. https://doi.org/10.1016/1047-2797(93)90103-B
  41. WHO publishes definitive atlas on global heart disease and stroke epidemic. Indian J Med Sci 2004;58:405-6.
  42. Mahe G, Ronziere T, Laviolle B, Golfier V, Cochery T, De Bray JM, Paillard F. An unfavorable dietary pattern is associated with symptomatic ischemic stroke and carotid atherosclerosis. J Vasc Surg 2010;52:62-8. https://doi.org/10.1016/j.jvs.2010.02.258
  43. Fujishima M. Cerebrovascular disorders among Japanese. Nihon Naika Gakkai zasshi 1996;85:1407-18. https://doi.org/10.2169/naika.85.1407
  44. Evers S, Koch HG, Grotemeyer KH, Lange B, Deufel T, Ringelstein EB. Features, symptoms, and neurophysiological findings in stroke associated with hyperhomocysteinemia. Arch Neurol 1997;54:1276-82. https://doi.org/10.1001/archneur.1997.00550220074017
  45. Eikelboom JW, Hankey GJ, Anand SS, Lofthouse E, Staples N, Baker RI. Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke. Stroke 2000;31:1069-75. https://doi.org/10.1161/01.STR.31.5.1069
  46. Chambers JC, Ueland PM, Obeid OA, Wrigley J, Refsum H, Kooner JS. Improved vascular endothelial function after oral B vitamins: an effect mediated through reduced concentrations of free plasma homocysteine. Circulation 2000;102:2479-83. https://doi.org/10.1161/01.CIR.102.20.2479

Cited by

  1. Relationship between atherosclerosis and occlusal support of natural teeth with mediating effect of atheroprotective nutrients: From the SONIC study vol.12, pp.8, 2017, https://doi.org/10.1371/journal.pone.0182563
  2. High Dietary Glycemic Load is Associated with Poor Functional Outcome in Patients with Acute Cerebral Infarction vol.14, pp.2, 2018, https://doi.org/10.3988/jcn.2018.14.2.165
  3. Plasma retinol and the risk of first stroke in hypertensive adults: a nested case-control study vol.109, pp.2, 2019, https://doi.org/10.1093/ajcn/nqy320
  4. A Critical Review of Bioactive Food Components, and of their Functional Mechanisms, Biological Effects and Health Outcomes vol.23, pp.19, 2016, https://doi.org/10.2174/1381612823666170317122913
  5. Dietary Vitamin B6 Intake Associated with a Decreased Risk of Cardiovascular Disease: A Prospective Cohort Study vol.11, pp.7, 2016, https://doi.org/10.3390/nu11071484