Risk Factors and Diet Components Determining Adherence to the Mediterranean Diet in Acute Ischemic Stroke Patients: A Cross-Sectional Analysis of a Prospective Hospital Register Study

  • Verónica V. Olavarría
    Corresponding author.
    Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría y Departamento de Paciente Crítico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Avenida Vitacura 5951, Vitacura Santiago 7650568, Chile
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  • Victor H. Navia
    Servicio de Neurología, Hospital Padre Hurtado, SSSO y Departamento de Urgencia, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Clínica Alemana, Santiago, Chile
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  • Enrico Mazzon
    Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría y Departamento de Paciente Critico, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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  • Alexis Rojo
    Servicio de Neurología, Hospital Clínico Herminda Martin de Chillán, Servicio de Salud Ñuble, Chillán, Chile
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  • Alejandro M. Brunser
    Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría y Departamento de Urgencia, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Clínica Alemana, Santiago, Chile
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  • Pablo M. Lavados
    Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Chile
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      Low adherence to a Mediterranean diet (MeDi) is associated with increased incidence, mortality, and severity of acute ischemic strokes (AIS). Nevertheless, the explanatory factors associated with such results are unclear. Our aim was to investigate stroke risk factors associated with adherence to a MeDi in a prospective cohort of AIS patients.

      Materials and Methods

      Patients admitted from February 2017 to February 2020 were included in this study. Adherence was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS). Demographic and clinical characteristics were compared with adherence with a univariate analysis. A binomial regression was used to investigate the independent association of premorbid factors and MeDi components with adherence.


      There were 413 patients. Mean age was 68.6 (17.4), 176 (42.6%) women. Median MEDAS score was 6 (IQR 4–7) points. 253 patients (61.2%) had a low adherence (MEDAS ≤ 6). In the univariate analysis, a low MEDAS was associated with lower education, diabetes, sedentary lifestyle, greater body mass index (BMI), lower alcohol consumption, and higher LDLc. In the regression analysis, younger age, lower education, functional disability, hypertension, sedentary lifestyle, and higher BMI were associated with lower MEDAS scores. Six MeDi components had particularly low patient adherence: seafood, legumes, olive oil, nuts, wine, and fruit.


      These data indicate low adherence to MeDi in younger patients who are less educated and have existing cardiovascular risk factors, in particular hypertension, sedentary lifestyle, and higher BMI. Some components of the diet had a particularly low adherence.


      Tailoring diet prevention interventions to these specific populations, focusing on components with known less adherence, could improve adherence to a MeDi and the opportunity for secondary stroke prevention.

      Key Words

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