Adherence to the Mediterranean diet decreases the risk of stroke in the Lebanese population: a case-control study
Objective: The objective of this study was to assess adherence to the Mediterranean diet (MeD) and the risk of stroke in the Lebanese population.
Methods: A hospital based case-control study was conducted in Lebanon between January 1st, 2015 and December 31st, 2016. Data were collected prospectively using a standardized questionnaire. Adherence to the MeD was assessed based on the total number of points a patient can have on the MeD scale. Data were analysed using SPSS version 24. The strength of association between the risk of stroke and adherence to MeD was expressed in odds ratio (OR) through 95% confidence interval. P-value <0.05 determined statistical significance.
Results: Around 205 stroke cases and 445 hospitalized stroke-free patients were included in this study. In the total study sample, the MeD had a minimum of 2 and a maximum of 11 points with a median of 7 points. Stroke patients had a lower MeD median compared to controls (6 vs 8 points). Around 29.5% of the total sample had a MeD score within the first quartile (52.3% of them had a stroke) and 24% of all included subjects scored within the last quartile (7% of them hospitalized for stroke) (p<0.001). The higher the adherence to MeD the lower the risk of stroke. High adherence to MeD was associated with a decreased risk of stroke, OR 0.1 (95%CI, 0.04-0.24; p<0.001).
Conclusions: Higher adherence to MeD significantly decreases the risk of stroke in the Lebanese population. Good lifestyle choices are encouraged in order to prevent many vascular diseases including stroke.
Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(2):517-584. https://doi.org/10.1161/str.0b013e3181fcb238
El-Hajj M, Salameh P, Rachidi S, Al-Hajje A, Lahoud N, Hosseini H. Stroke risk factors: a hospital-based case-control study in Lebanon. J Roy Soc Med. 2017;8(6):1-10.
Lahoud N, Salameh P, Saleh N, Hosseini H. Prevalence of Lebanese stroke survivors: A comparative pilot study. J Epidemiol Glob Health. 2016;6(3):169-176. https://doi.org/10.1016/j.jegh.2015.10.001
World Health Organization. World Health Rankings: Live Longer Live Better. http://www.worldlifeexpectancy.com/cause-of-death/stroke/by-country/ (accessed Sep 8, 2020).
Farah R, Zeidan RK, Chahine MN, et al. Prevalence of stroke symptoms among stroke-free residents: first national data from Lebanon. Int J Stroke. 2015;10(Suppl A100):83-88. https://doi.org/10.1111/ijs.12563
Medeiros F, Casanova Mde A, Fraulob JC, Trindade M. How can diet influence the risk of stroke?. Int J Hypertens. 2012;2012:763507. https://doi.org/10.1155/2012/763507
Saulle R, Semyonov L, La Torre G. Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients. 2013;5(11):4566-4586. https://doi.org/10.3390/nu5114566
Babio N, Bulló M, Basora J, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardiovasc Dis. 2009;19(8):563-570. https://doi.org/10.1016/j.numecd.2008.10.007
Rosato V, Temple NJ, La Vecchia C, Castellan G, Tavani A, Guercio V. Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Nutr. 2019;58(1):173-191. https://doi.org/10.1007/s00394-017-1582-0
Saulle R, Lia L, De Giusti M, La Torre G. A systematic overview of the scientific literature on the association between Mediterranean Diet and the Stroke prevention. Clin Ter. 2019;170(5):e396-e408. https://doi.org/10.7417/ct.2019.2166
Hwalla N, El Khoury D. Lebanese Traditional Diets and Health Effects. In: De Meester F, Watson RR eds. Wild-Type Food in Health Promotion and Disease Prevention. Totowa, NJ: Humana Press; 2008. ISBN: 978-1-59745-330-1.
Lakkis NA, Adib SM, Osman MH, Musharafieh UM, Hamadeh GN. Breast cancer in Lebanon: incidence and comparison to regional and Western countries. Cancer Epidemiol. 2010;34(3):221-225. https://doi.org/10.1016/j.canep.2010.02.013
Chamieh MC, Moore HJ, Summerbell C, Tamim H, Sibai AM, Hwalla N. Diet, physical activity and socio-economic disparities of obesity in Lebanese adults: findings from a national study. BMC Public Health. 2015;15:279. https://doi.org/10.1186/s12889-015-1605-9
Issa C, Darmon N, Salameh P, Maillot M, Batal M, Lairon D. A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon. Int J Obes (Lond). 2011;35(2):251-258. https://doi.org/10.1038/ijo.2010.130
Cordahi C. Adherence to the Mediterranean diet and risk of metabolic syndrome in Lebanese urban adults. American University of Beirut; 2015.
Martínez-González MA, Sanchez-Villegas A, De Irala J, Marti A, Martínez JA. Mediterranean diet and stroke: objectives and design of the SUN project. Seguimiento Universidad de Navarra. Nutr Neurosci. 2002;5(1):65-73. https://doi.org/10.1080/10284150290007047
Naja F, Itani L, Hamade R, Chamieh MC, Hwalla N. Mediterranean diet and its environmental footprints amid nutrition transition: the case of Lebanon. Sustainability. 2019;11(23):6690.
The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105-114. https://doi.org/10.1016/0895-4356(88)90084-4
Moser M. World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension-Do These Differ From the U.S. Recommendations? Which Guidelines Should the Practicing Physician Follow?. J Clin Hypertens (Greenwich). 1999;1(1):48-54.
Kontogianni MD, Panagiotakos DB. Dietary patterns and stroke: a systematic review and re-meta-analysis. Maturitas. 2014;79(1):41-47. https://doi.org/10.1016/j.maturitas.2014.06.014
Spence JD. Diet for stroke prevention. Stroke Vasc Neurol. 2018;3(2):44-50. https://doi.org/10.1136/svn-2017-000130
Demarin V, Lisak M, Morović S. Mediterranean diet in healthy lifestyle and prevention of stroke. Acta Clin Croat. 2011;50(1):67-77.
Gardener H, Wright CB, Gu Y, et al. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study. Am J Clin Nutr. 2011;94(6):1458-1464. https://doi.org/10.3945/ajcn.111.012799
Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229-241. https://doi.org/10.1056/nejmoa0708681
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