Association of five dietary indices with all-cause mortality in stroke survivors: A national cohort study

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.

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.

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).

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.