Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

doi:10.1212/WNL.0000000000009093

. 2020 Mar 17;94(11):e1112-e1121.

doi: 10.1212/WNL.0000000000009093. Epub 2020 Feb 26.

Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

Tina H T Chiu¹, Huai-Ren Chang¹, Ling-Yi Wang¹, Chia-Chen Chang¹, Ming-Nan Lin², Chin-Lon Lin²

Affiliations

¹ From the Department of Nutritional Science (T.H.T.C.), Fu Jen Catholic University, New Taipei City; Division of Cardiology, Department of Internal Medicine (H.-R.C.), Epidemiology and Biostatistics Consulting Center, Department of Medical Research (L.-Y.W.), and Department of Pharmacy (L.-Y.W.), Buddhist Tzu Chi General Hospital; School of Medicine (H.-R.C., C.-L.L.), Tzu Chi University; Department of Medical Research (C.-C.C.), Buddhist Tzu Chi Medical Foundation, Hualien; Departments of Family Medicine (M.-N.L.) and Internal Medicine (C.-L.L.), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; and Department of Family Medicine, School of Medicine (M.-N.L.), Tzu Chi University, Hualien, Taiwan.
² From the Department of Nutritional Science (T.H.T.C.), Fu Jen Catholic University, New Taipei City; Division of Cardiology, Department of Internal Medicine (H.-R.C.), Epidemiology and Biostatistics Consulting Center, Department of Medical Research (L.-Y.W.), and Department of Pharmacy (L.-Y.W.), Buddhist Tzu Chi General Hospital; School of Medicine (H.-R.C., C.-L.L.), Tzu Chi University; Department of Medical Research (C.-C.C.), Buddhist Tzu Chi Medical Foundation, Hualien; Departments of Family Medicine (M.-N.L.) and Internal Medicine (C.-L.L.), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; and Department of Family Medicine, School of Medicine (M.-N.L.), Tzu Chi University, Hualien, Taiwan. cllinmd@tzuchi.com.tw.

PMID: 32102976
PMCID: PMC7220235
DOI: 10.1212/WNL.0000000000009093

Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

Tina H T Chiu et al. Neurology. 2020.

. 2020 Mar 17;94(11):e1112-e1121.

doi: 10.1212/WNL.0000000000009093. Epub 2020 Feb 26.

Authors

Tina H T Chiu¹, Huai-Ren Chang¹, Ling-Yi Wang¹, Chia-Chen Chang¹, Ming-Nan Lin², Chin-Lon Lin²

Affiliations

¹ From the Department of Nutritional Science (T.H.T.C.), Fu Jen Catholic University, New Taipei City; Division of Cardiology, Department of Internal Medicine (H.-R.C.), Epidemiology and Biostatistics Consulting Center, Department of Medical Research (L.-Y.W.), and Department of Pharmacy (L.-Y.W.), Buddhist Tzu Chi General Hospital; School of Medicine (H.-R.C., C.-L.L.), Tzu Chi University; Department of Medical Research (C.-C.C.), Buddhist Tzu Chi Medical Foundation, Hualien; Departments of Family Medicine (M.-N.L.) and Internal Medicine (C.-L.L.), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; and Department of Family Medicine, School of Medicine (M.-N.L.), Tzu Chi University, Hualien, Taiwan.
² From the Department of Nutritional Science (T.H.T.C.), Fu Jen Catholic University, New Taipei City; Division of Cardiology, Department of Internal Medicine (H.-R.C.), Epidemiology and Biostatistics Consulting Center, Department of Medical Research (L.-Y.W.), and Department of Pharmacy (L.-Y.W.), Buddhist Tzu Chi General Hospital; School of Medicine (H.-R.C., C.-L.L.), Tzu Chi University; Department of Medical Research (C.-C.C.), Buddhist Tzu Chi Medical Foundation, Hualien; Departments of Family Medicine (M.-N.L.) and Internal Medicine (C.-L.L.), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; and Department of Family Medicine, School of Medicine (M.-N.L.), Tzu Chi University, Hualien, Taiwan. cllinmd@tzuchi.com.tw.

PMID: 32102976
PMCID: PMC7220235
DOI: 10.1212/WNL.0000000000009093

Abstract

Objective: To determine how a vegetarian diet affects stroke incidence in 2 prospective cohorts and to explore whether the association is modified by dietary vitamin B₁₂ intake.

Methods: Participants without stroke in the Tzu Chi Health Study (cohort 1, n = 5,050, recruited in 2007-2009) and the Tzu Chi Vegetarian Study (cohort 2, n = 8,302, recruited in 2005) were followed until the end of 2014. Diet was assessed through food frequency questionnaires in both cohorts at baseline. Stroke events and baseline comorbidities were identified through the National Health Insurance Research Database. A subgroup of 1,528 participants in cohort 1 were assessed for serum homocysteine, vitamin B₁₂, and folate. Associations between vegetarian diet and stroke incidences were estimated by Cox regression with age as time scale, adjusted for sex, education, smoking, alcohol, physical activities, body mass index (only in cohort 1), hypertension, diabetes, dyslipidemia, and ischemic heart diseases.

Results: Vegetarians had lower serum vitamin B₁₂ and higher folate and homocysteine than nonvegetarians. In cohort 1, 54 events occurred in 30,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of ischemic stroke (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.08-0.88). In cohort 2, 121 events occurred in 76,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of overall stroke (HR, 0.52; 95% CI, 0.33-0.82), ischemic stroke (HR, 0.41; 95% CI, 0.19-0.88), and hemorrhagic stroke (HR, 034; 95% CI, 0.12-1.00). Our explorative analysis showed that vitamin B₁₂ intake may modify the association between vegetarian diet and overall stroke (p interaction = 0.046).

Conclusion: Taiwanese vegetarian diet is associated with a lower risk of ischemic and hemorrhagic strokes.

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Figures

**Figure. Inclusion and exclusion criteria**
NHIRD = National Health Insurance Research Database; TCHS = Tzu Chi Health Study; TCVS = Tzu Chi Vegetarian Study.

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Comment in

Lower risk of stroke with a vegetarian diet.
Spence JD, Tangney C. Spence JD, et al. Neurology. 2020 Mar 17;94(11):463-464. doi: 10.1212/WNL.0000000000009092. Epub 2020 Feb 26. Neurology. 2020. PMID: 32102978 No abstract available.

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References

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[1] Benjamin EJ, Virani SS, Callaway CW, et al. . Heart disease and stroke statistics: 2018 update: a report from the American Heart Association. Circulation 2018;137:e67–e492. - PubMed

[2] Benjamin EJ, Virani SS, Callaway CW, et al. . Heart disease and stroke statistics: 2018 update: a report from the American Heart Association. Circulation 2018;137:e67–e492. - PubMed

[3] Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in Taiwan. J Stroke 2014;16:59–64. - PMC - PubMed

[4] Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in Taiwan. J Stroke 2014;16:59–64. - PMC - PubMed

[5] Pohjasvaara T, Erkinjuntti T, Ylikoski R, Hietanen M, Vataja R, Kaste M. Clinical determinants of poststroke dementia. Stroke 1998;29:75–81. - PubMed

[6] Pohjasvaara T, Erkinjuntti T, Ylikoski R, Hietanen M, Vataja R, Kaste M. Clinical determinants of poststroke dementia. Stroke 1998;29:75–81. - PubMed

[7] O'Donnell MJ, Chin SL, Rangarajan S, et al. . Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016;388:761–775. - PubMed

[8] O'Donnell MJ, Chin SL, Rangarajan S, et al. . Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016;388:761–775. - PubMed

[9] Ma YH, Leng XY, Dong Y, et al. . Risk factors for intracranial atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 2019;281:71–77. - PubMed

[10] Ma YH, Leng XY, Dong Y, et al. . Risk factors for intracranial atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 2019;281:71–77. - PubMed

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Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

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Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

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