The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: A prospective study of 418 329 participants in the EPIC cohort across nine European countries

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Aim: To investigate the associations between major foods and dietary fibre with subtypes of stroke in a large prospective cohort. Methods and results: We analysed data on 418 329 men and women from nine European countries, with an average of 12.7 years of follow-up. Diet was assessed using validated country-specific questionnaires which asked about habitual intake over the past year, calibrated using 24-h recalls. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HRs) for ischaemic and haemorrhagic stroke associated with consumption of red and processed meat, poultry, fish, dairy foods, eggs, cereals, fruit and vegetables, legumes, nuts and seeds, and dietary fibre. For ischaemic stroke (4281 cases), lower risks were observed with higher consumption of fruit and vegetables combined (HR; 95% CI per 200 g/day higher intake, 0.87; 0.82-0.93, P-trend < 0.001), dietary fibre (per 10 g/day, 0.77; 0.69-0.86, P-trend < 0.001), milk (per 200 g/day, 0.95; 0.91-0.99, P-trend = 0.02), yogurt (per 100 g/day, 0.91; 0.85-0.97, P-trend = 0.004), and cheese (per 30 g/day, 0.88; 0.81-0.97, P-trend = 0.008), while higher risk was observed with higher red meat consumption which attenuated when adjusted for the other statistically significant foods (per 50 g/day, 1.07; 0.96-1.20, P-trend = 0.20). For haemorrhagic stroke (1430 cases), higher risk was associated with higher egg consumption (per 20 g/day, 1.25; 1.09-1.43, P-trend = 0.002). Conclusion: Risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre, and dairy foods, while risk of haemorrhagic stroke was positively associated with egg consumption. The apparent differences in the associations highlight the importance of examining ischaemic and haemorrhagic stroke subtypes separately.


  • Tammy Y.N. Tong
  • Paul N. Appleby
  • Timothy J. Key
  • Christina C. Dahm
  • Kim Overvad
  • Anja Olsen
  • Anne Tjønneland
  • Verena Katzke
  • Tilman Kühn
  • Heiner Boeing
  • Anna Karakatsani
  • Eleni Peppa
  • Antonia Trichopoulou
  • Elisabete Weiderpass
  • Giovanna Masala
  • Sara Grioni
  • Salvatore Panico
  • Rosario Tumino
  • Jolanda M.A. Boer
  • W. M.Monique Verschuren
  • J. Ramón Quirós
  • Antonio Agudo
  • Miguel Rodríguez-Barranco
  • Liher Imaz
  • Mariá Dolores Chirlaque
  • Conchi Moreno-Iribas
  • Marcus Lind
  • Julia Otten
  • Kay Tee Khaw
  • Dagfinn Aune
  • Elio Riboli
  • Nicholas J. Wareham
  • Fumiaki Imamura
  • Nita G. Forouhi
  • Emanuele Di Angelantonio
  • Angela M. Wood
  • Adam S. Butterworth
  • Aurora Perez-Cornago
External organisations
  • University of Oxford
  • Aarhus University
  • Aalborg University Hospital
  • Danish Cancer Society Research Center
  • University of Copenhagen
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • International Agency for Research on Cancer, World Health Organization
  • Istituto Nazionale dei Tumori
  • University of Naples Federico II
  • Civic and M.P Arezzo Hospital
  • National Institute for Public Health and the Environment (RIVM)
  • University Medical Center Utrecht
  • Public Health Directorate
  • Catalan Institute of Oncology
  • University of Granada
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Biodonostia Health Research Institute
  • University of Murcia
  • Health Research Institute of Navarra (IDISNA)
  • Umeå University
  • Strangeways Research Laboratory
  • Imperial College London
  • Oslo university hospital
  • University of Cambridge
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics
  • Cancer and Oncology


  • Diet, Fibre, Fruit, Haemorrhagic stroke, Ischaemic stroke, Vegetables
Original languageEnglish
Pages (from-to)2632-2640
Number of pages9
JournalEuropean Heart Journal
Issue number28
Publication statusPublished - 2020
Publication categoryResearch