Food Addiction: Prevalence, Severity, and Impact on Vascular Stroke Risk Factors in a French Hospital-Based Sample

Stroke ranks as the second leading cause of death and the third leading cause of disability in adults worldwide. While an unhealthy diet is an independent risk factor for stroke, its association with disordered eating behaviours on stroke remains overlooked. This exploratory study aimed to evaluate the prevalence and severity of addictive-like eating behaviours in stroke patients and their association with the main vascular stroke risk factors.

First-ever minor or moderate stroke patients with the ability to complete self-report questionnaires were included. Addictive-like eating was assessed using the Yale Food Addiction Scale 2.0 (YFAS 2.0). The variables of interest were: (i) the proportion of patients meeting the diagnosis of food addiction (FA); (ii) FA symptoms count and severity; (iii) addictive-like eating profile severity. Their association with four main vascular risk factors (obesity, hypertension, dyslipidemia and diabetes) were tested using univariate and multivariate analyses.

Over a 4-month period, 101 patients (mean (standard deviation (SD)), 62.8 (13.7) years; males: 60.4%) were consecutively screened with the YFAS 2.0. Overall, 5% of the sample endorsed an FA diagnosis, and 38.6% screened positive for at least one of the symptom criteria, with the most frequently endorsed symptom being "Inability to cut down". Dyslipidemia was the only vascular risk factor associated with the FA diagnosis (p = 0.043, 95% CI [-0.21; 0.01]). However, the severity of the addictive profile was associated with dyslipidemia (p = 0.016, 95% CI [-2.16; -0.21]) and diabetes (p = 0.038, 95% CI [-1.77; 0.25]), but only independently with dyslipidemia (p = 0.05; OR = 1.25; 95% CI [1.00; 1.56]). There were significant associations between the number of vascular risk factors and the severity of Time spent, Tolerance, and Use despite adverse consequences of FA symptoms, both in univariate and multivariate analyses (all p < 0.05). The number of vascular risk factors and total number of FA symptoms were significantly associated in univariate analyses (p = 0.007) but not after adjusting for age (p = 0.055) or sex (p = 0.083).

This study highlighted the potential importance of addictive-like behaviours in the secondary prevention of stroke. However, larger and longer-term studies investigating addictive-like eating in diverse samples of stroke patients are warranted to achieve precision medicine.