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Prospective Study of 418329 Subjects for Dietary Risk Assessment of Ischaemic in Nine European Countries

By 3rd March 2020No Comments

The following study was conducted by Scientists from Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Public Health, Aarhus University, Aarhus, Demark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden, Copenhagen, Denmark; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany; Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, Athens, Greece; 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens , “ATTIKON” University Hospital, Haidari, Athens, Greece; Hellenic Health Foundation, Kaisareias  & Alexandroupoleos, Athens, Greece; International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon CEDEX, France; Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network – ISPRO , Via Cosimo Il Vecchio; Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Dipartimento Di Medicina Clinica E Chirurgia Federico II University, Naples, Italy; Cancer Registry and Histopathology Department, “M.P.Arezzo” Hospital , ASP Contrada Rito, Ragusa, Italy; Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada , Granada, Spain; CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, Madrid, Spain; Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain; Biodonostia Health Research Institute, Paseo Doctor Begiristain, Donostia-San Sebastian, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain; Instituto de Salud Pública de Navarra, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Recinto Hospitalario de Navarra , Pamplona, Spain; Department of Clinical Science in Malmö, Lund University , Malmö, Sweden; Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London , South Kensington Campus, London, UK; Department of Nutrition, Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge , Strangeways Research Laboratory, Wort’s Causeway, Cambridge, UK; Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Study is published in European Heart Journal as detailed below.

European Heart Journal, (2020); ehaa007,

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



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).


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.


European Heart Journal



Tong, T. Y. N., P. N. Appleby, et al. (2020). “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.” European Heart Journal, ehaa007,