Ungvari Zoltan, Fekete Mónika, Varga Péter, Fekete János Tibor, Buda Annamaria, Szappanos Ágnes, Lehoczki Andrea, Mózes Noémi, Grosso Giuseppe, Menyhart Otilia, Munkácsy Gyöngyi, Tarantini Stefano, Yabluchanskiy Andriy, Ungvari Anna, Győrffy Balázs
Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
Geroscience. 2025 Jan 7. doi: 10.1007/s11357-024-01491-8.
Stroke is a leading cause of morbidity and mortality worldwide, and dietary patterns have emerged as a significant modifiable factor in stroke prevention. The Mediterranean diet, characterized by high intake of fruits, vegetables, whole grains, nuts, olive oil, and fish, has been widely recognized for its cardiovascular benefits. However, its specific impact on stroke risk requires further elucidation. We conducted a comprehensive meta-analysis of 30 studies, including both cohort and case-control designs, to evaluate the relationship between adherence to the Mediterranean diet and the risk of stroke. A systematic search was performed across multiple databases, and a random-effects model was used to estimate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I statistic, and publication bias was examined through funnel plots and Egger's regression test. Additionally, trial sequential analysis was conducted to determine the adequacy of the sample size. The meta-analysis revealed a significant reduction in stroke risk among individuals adhering to the Mediterranean diet, with a pooled HR of 0.88 (95% CI: 0.84-0.91). Notably, a significant heterogeneity was detected (I = 34%). The Z-score plot from trial sequential analysis confirmed that the sample sizes were sufficient to draw definitive conclusions. However, a potential publication bias was identified. The case-control studies confirmed a highly significant effect (HR = 0.54, 95% CI: 0.4-0.73). The funnel plots in both settings hinted at the presence of a potential publication bias, supported by a significant Egger's test. Our findings provide robust evidence supporting the protective effect of the Mediterranean diet against stroke. Despite the presence of some heterogeneity and potential publication bias, the cumulative evidence suggests that promoting the Mediterranean diet could serve as an effective public health strategy for stroke prevention. Further research is recommended to explore the underlying mechanisms and to assess the diet's impact across diverse populations.
中风是全球发病和死亡的主要原因之一，饮食模式已成为中风预防中一个重要的可改变因素。以大量摄入水果、蔬菜、全谷物、坚果、橄榄油和鱼类为特点的地中海饮食，因其对心血管的益处而被广泛认可。然而，其对中风风险的具体影响仍需进一步阐明。我们对30项研究进行了全面的荟萃分析，这些研究包括队列研究和病例对照研究设计，以评估坚持地中海饮食与中风风险之间的关系。我们在多个数据库中进行了系统检索，并使用随机效应模型来估计合并风险比（HR）及其95%置信区间（CI）。使用I统计量评估异质性，并通过漏斗图和Egger回归检验来检查发表偏倚。此外，还进行了试验序贯分析以确定样本量是否充足。荟萃分析显示，坚持地中海饮食的个体中风风险显著降低，合并HR为0.88（95%CI：0.84 - 0.91）。值得注意的是，检测到显著的异质性（I = 34%）。试验序贯分析的Z分数图证实样本量足以得出明确结论。然而，发现了潜在的发表偏倚。病例对照研究证实了高度显著的效应（HR = 0.54，95%CI：0.4 - 0.73）。两种研究类型中的漏斗图都暗示存在潜在的发表偏倚，Egger检验结果显著也支持了这一点。我们的研究结果提供了有力证据，支持地中海饮食对中风的预防作用。尽管存在一些异质性和潜在的发表偏倚，但累积证据表明，推广地中海饮食可作为预防中风的有效公共卫生策略。建议进一步开展研究以探索其潜在机制，并评估该饮食模式对不同人群的影响。
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