Lifestyle and stroke risk: a review

Identifying risk factors for recurrent mild ischemic stroke and high-risk population characteristics: A 1-year follow-up study

ObjectiveThis observational study examined the risk factors associated with recurrence in patients with mild ischemic stroke and determined the characteristics of high-risk groups.MethodsA total of 656 patients hospitalized for mild ischemic stroke were monitored for 1 year. Statistical analyses, including odds ratio calculations and K-means clustering, were conducted to examine risk factors for recurrence and the characteristics of high-risk groups.ResultsAfter 1 year of follow-up, 99 patients experienced recurrent mild ischemic stroke, resulting in a recurrence rate of 15.09%. The analysis revealed several significant risk factors, including type 2 diabetes mellitus, atrial fibrillation, smoking and alcohol consumption, carotid artery stenosis, cerebral vascular stenosis, and multiple lesions. Propensity score matching confirmed these associations, and K-means clustering revealed that older males with type 2 diabetes mellitus and hypertension were likely to be in the high-risk group.ConclusionsHealthcare professionals should focus on tailored treatment and prevention strategies for high-risk patients, prioritizing the management of the abovementioned risk factors to reduce recurrence and improve outcomes.

Disease burden of stroke and its subtypes attributable to low dietary fiber in China, 1990-2019

This study aimed to assess the current status and changing trends of the disease burden of stroke and its subtypes due to low dietary fiber intake in China from 1990 to 2019. In cases of stroke and its subtypes attributable to low dietary fiber, deaths, disability-adjusted life-years (DALYs), age-standardized mortality rates (ASMR), age-standardized DALYs rates (ASDR), and percentage change were used to assess disease burden. Data were obtained from the 2019 global burden of disease study. Trends were assessed using Joinpoint regression and age-period-cohort analysis. Between 1990 and 2019, there was a declining trend in stroke and its subtypes, ASDR and ASMR, as well as the corresponding number of deaths and DALYs, due to low dietary fiber intake in China. Subarachnoid hemorrhage (SH) showed the greatest decrease, followed by intracerebral hemorrhage (IH) and ischemic stroke (IS). Local drift curves showed a U-shaped distribution of stroke, IS, and IH DALYs across the whole group and sex-based groups. For mortality, the overall and male trends were similar to those for DALYs, whereas female stroke, IH, and IS showed an upward trend. The DALYs for stroke and IH showed a clear bimodal distribution, IS showed an increasing risk with age. For mortality, the SH subtype showed a decreasing trend, whereas other subtypes showed an increasing risk with age. Both the period and cohort rates of stroke DALYs and motality due to low dietary fiber have declined. Males had a higher risk of DALYs and mortality associated with low fiber levels. The burden of stroke and its subtypes associated with a low-fiber diet in China has been declining over the past 30 years, with different patterns of change for different stroke subtypes and a higher burden for males, highlighting the differential impact of fiber intake on stroke and its subtypes.

Feasibility and outcomes of a community-based, mobile health system-monitored lifestyle intervention in chronic stroke: A pilot study

BACKGROUND

People with disabilities face challenges in daily life during the COVID-19 pandemic, including limited access to care, exposure to lifestyle-related diseases, and difficulties in regular exercise. Therefore, it is important to establish health safety nets using Information and Communication Technology (ICT) in communities.

OBJECTIVE

This study aimed to develop an m-Health-based personalized lifestyle intervention algorithm targeting high-risk groups of lifestyle-related diseases (including hypertension, diabetes, and obesity) among people with hemiplegic disabilities, and to verify its feasibility.

METHODS

Six people at a high risk of lifestyle-related diseases participated in an 8-week lifestyle intervention using a wearable device and the S-Health program. The self-health management areas included walking, moderate-intensity exercise, weight, blood pressure, blood sugar, diet, calorie intake, heart rate, sobriety, no smoking. Health, physical, psychological, and social changes were measured before and after the study.

RESULTS

The intervention had a positive impact on the participants' health, with statistically significant differences found in fasting blood glucose, highest systolic blood pressure, grip strength, and motor function assessment. Quality of life, health-related quality of life, and self-efficacy improved post-intervention.

CONCLUSION

Our findings can be used as preliminary evidence for establishing m-Health-based health safety net systems for people with disabilities who live in communities.

Vagal Nerve Activity and Short-Term Clinical Outcomes after Stroke: What Is Left May Not Be Right

Stroke is a leading cause of death worldwide. Multiple factors influence the severity of stroke. Normal functional and biological differences seen between the hemispheres may also be related to stroke severity. In the present study, we examined the differences in the severity of stroke as a function of stroke side, and whether patients' vagal nerve activity moderated such differences. We included 87 patients with an ischemic stroke, whose medical records were retrospectively examined for background information (age, gender), stroke side and severity by NIHSS, length of stay in hospital, inflammation such as C-reactive protein, and vagal nerve activity. The vagal activity was indexed by patients' heart-rate variability (HRV), fluctuations in the intervals between normal heartbeats, derived from patients' ECG. Results revealed that patients with left-side stroke had significantly worse NIHSS scores (10.6) than those with right-sided stroke (7.6, p < 0.05). However, when dividing the sample into those with low versus high HRV (at the median), only when HRV was low, did patients with left-side stroke have a worse NIHSS score (10.9) compared to those with right-sided stroke (6.5, p < 0.05). In contrast, no differences in stroke severity were seen between left stroke (10.2) and right stoke (8.7, p > 0.05), when HRV was high. These results tended to remain the same when statistically controlling for age effects, which was related to NIHSS, but not to the stroke side. These findings suggest that patients with left-sided stroke may have more severe strokes than those with right-sided ones, but that adequate vagal nerve activity may protect against such differences. Possible mechanisms and suggestions for future directions are provided.

Can metformin use reduce the risk of stroke in diabetic patients? A systematic review and meta-analysis

BACKGROUND AND AIM

Stroke and cardiovascular diseases are major causes of death and disability, especially among diabetic patients. Some studies have shown that metformin has been effective in preventing cardiovascular diseases. In this study, we aim to evaluate the effect of metformin on stroke in type 2 diabetic patients.

METHODS

A comprehensive search was conducted in Medline, Embase, Scopus, and Web of Science databases from their inception till 1st July 2022. Randomized clinical trials (RCT) and cohort studies were included. Two independent researchers screened the records, extracted the data, and assessed the risk of bias and certainty of evidence. Findings were reported as risk ratio (RR) and 95% confidence interval (CI). All statistical analyses were performed using the STATA 17.0 software package.

RESULTS

Analysis of 21 included studies with 1,392,809 patients demonstrated that metformin monotherapy was effective in reducing stroke risk in both RCTs (RR = 0.66, 95% CI: 0.50, 0.87 p = 0.004) and cohort studies (RR = 0.67, 95% CI: 0.55, 0.81, p < 0.0001). However, combined administration of metformin with other antihyperglycemic agents had no significant effect on stroke risk reduction in either the RCTs (RR = 0.92, 95% CI: 0.69, 1.22 p = 0.558) or the cohort studies (RR = 0.79, 95% CI: 0.59, 1.06, p = 0.122).

CONCLUSION

Low to moderate level of evidence in RCTs showed that metformin monotherapy could reduce stroke risk in type 2 diabetic patients. However, the preventive effect of metformin in stroke was not observed in patients who received a combination of metformin plus other hypoglycemic agents.

Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase

Background

Oropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life.

Methods

A cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI).

Results

Forty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores.

Conclusion

In this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.

Burden of stroke in North Africa and Middle East, 1990 to 2019: a systematic analysis for the global burden of disease study 2019

BACKGROUND

While several studies investigated the epidemiology and burden of stroke in the North Africa and Middle East region, no study has comprehensively evaluated the age-standardized attributable burden to all stroke subtypes and their risk factors yet.

OBJECTIVE

The aim of the present study is to explore the regional distribution of the burden of stroke, including ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage, and the attributable burden to its risk factors in 2019 among the 21 countries of North Africa and Middle East super-region.

METHODS

The data of the Global Burden of Disease Study (GBD) 2019 on stroke incidence, prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) rates, and attributed deaths, DALYs, YLLs, and YLDs to stroke risk factors were used for the present study.

RESULTS

The age-standardized deaths, DALYs, and YLLs rates were diminished statistically significant by 27.8, 32.0, and 35.1% from 1990 to 2019, respectively. Attributed deaths, DALYs, and YLLs to stroke risk factors, including high systolic blood pressure, high body-mass index, and high fasting plasma glucose shrank statistically significant by 24.9, 25.8, and 28.8%, respectively.

CONCLUSION

While the age-standardized stroke burden has reduced during these 30 years, it is still a concerning issue due to its increased burden in all-age numbers. Well-developed primary prevention, timely diagnosis and management of the stroke and its risk factors might be appreciated for further decreasing the burden of stroke and its risk factors and reaching Sustainable Development Goal 3.4 target for reducing premature mortality from non-communicable diseases.

Clinical impact of cerebral infarction in patients with non-small cell lung cancer

BACKGROUND

Lung cancer patients have a high risk of cerebral infarction, but the clinical significance of cerebral infarction in advanced non-small cell lung cancer (NSCLC) remains unclear. This study aimed to comprehensively investigate the incidence, prognostic impact, and risk factors of cerebral infarction in patients with NSCLC.

METHODS

We retrospectively examined 710 consecutive patients with advanced or post-operative recurrent NSCLC treated between January 2010 and July 2020 at Kumamoto University Hospital. Cerebral infarction was diagnosed according to the detection of high-intensity lesions on diffusion-weighted magnetic resonance imaging regardless of the presence of neurological symptoms during the entire course from 3 months before NSCLC diagnosis. The prognostic impact and risk factors of cerebral infarction were evaluated based on propensity score matching (PSM) and multivariate logistic regression analysis.

RESULTS

Cerebral infarction occurred in 36 patients (5%). Of them, 21 (58%) and 15 (42%) patients developed asymptomatic and symptomatic cerebral infarction, respectively. PSM analysis for survival showed that cerebral infarction was an independent prognostic factor (hazards ratio: 2.45, 95% confidence interval (CI): 1.24-4.85, P = 0.010). On multivariate logistic regression analysis, D-dimer (odds ratio [OR]: 1.09, 95% CI 1.05-1.14, P < 0.001) and C-reactive protein (OR: 1.10, 95% CI 1.01-1.19, P = 0.023) levels were independent risk factors.

CONCLUSION

Cerebral infarction occurred in 5% of NSCLC patients, and asymptomatic cerebral infarction was more frequent. Cerebral infarction was a negative prognostic factor and was associated with hyper-coagulation and inflammation. The high frequency of asymptomatic cerebral infarction and its risk in NSCLC patients with these conditions should be recognized.

Community planning for a "healthy built environment" via a human-environment nexus? A multifactorial assessment of environmental characteristics and age-specific stroke mortality in Hong Kong

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM₁₀, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.

Chanwuyi Lifestyle Medicine Program Alleviates Immunological Deviation and Improves Behaviors in Autism

Given the association between deviated inflammatory chemokines, the pathogenesis of autism spectrum disorders (ASD), and our previous findings of the Chanwuyi Lifestyle Medicine Program regarding improved cognitive and behavioral problems in ASD, the present study aims to explore if this intervention can alter pro-inflammatory chemokines concentration. Thirty-two boys with ASD were assigned to the experimental group receiving the Chanwuyi Lifestyle Medicine Program for 7 months or the control group without a change in their lifestyle. The experimental group, but not the control group, demonstrated significantly reduced CCL2 and CXCL8, a trend of reduction in CCL5, and elevation of CXCL9. The experimental group also demonstrated significantly reduced social communication problems, repetitive/stereotypic behaviors, and hyperactive behaviors. The present findings support the potential efficacy and applicability of the Chanwuyi Lifestyle Medicine Program for reducing both behavioral problems and immunological dysfunction in ASD. Further studies are warranted to verify its treatment effect and its association with brain functions.

Imaging Biomarkers for Monitoring the Inflammatory Redox Landscape in the Brain

Inflammation is one key process in driving cellular redox homeostasis toward oxidative stress, which perpetuates inflammation. In the brain, this interplay results in a vicious cycle of cell death, the loss of neurons, and leakage of the blood–brain barrier. Hence, the neuroinflammatory response fuels the development of acute and chronic inflammatory diseases. Interrogation of the interplay between inflammation, oxidative stress, and cell death in neurological tissue in vivo is very challenging. The complexity of the underlying biological process and the fragility of the brain limit our understanding of the cause and the adequate diagnostics of neuroinflammatory diseases. In recent years, advancements in the development of molecular imaging agents addressed this limitation and enabled imaging of biomarkers of neuroinflammation in the brain. Notable redox biomarkers for imaging with positron emission tomography (PET) tracers are the 18 kDa translocator protein (TSPO) and monoamine oxygenase B (MAO–B). These findings and achievements offer the opportunity for novel diagnostic applications and therapeutic strategies. This review summarizes experimental as well as established pharmaceutical and biotechnological tools for imaging the inflammatory redox landscape in the brain, and provides a glimpse into future applications.

Motor Imagery Hand Movement Direction Decoding Using Brain Computer Interface to Aid Stroke Recovery and Rehabilitation

Motor Imagery (MI)-based Brain Computer Interface (BCI) system is a potential technology for active neurorehabilitation of stroke patients by complementing the conventional passive rehabilitation methods. Research to date mainly focused on classifying left vs. right hand/foot MI of stroke patients. Though a very few studies have reported decoding imagined hand movement directions using electroencephalogram (EEG)-based BCI, the experiments were conducted on healthy subjects. Our work analyzes MI-based brain cortical activity from EEG signals and decodes the imagined hand movement directions in stroke patients. The decoded direction (left vs. right) of hand movement imagination is used to provide control commands to a motorized arm support on which patient's affected (paralyzed) arm is placed. This enables the patient to move his/her stroke-affected hand towards the intended (imagined) direction that aids neuroplasticity in the brain. The synchronization measure called Phase Locking Value (PLV), extracted from EEG, is the neuronal signature used to decode the directional movement of the MI task. Event-related desynchronization/synchronization (ERD/ERS) analysis on Mu and Beta frequency bands of EEG is done to select the time bin corresponding to the MI task. The dissimilarities between the two directions of MI tasks are identified by selecting the most significant channel pairs that provided maximum difference in PLV features. The training protocol has an initial calibration session followed by a feedback session with 50 trials of MI task in each session. The feedback session extracts PLV features corresponding to most significant channel pairs which are identified in the calibration session and is used to predict the direction of MI task in left/right direction. An average MI direction classification accuracy of 74.44% is obtained in performing the training protocol and 68.63% from the prediction protocol during feedback session on 16 stroke patients.

Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey

Reablement is a multidisciplinary, home-based intervention implemented for people at risk of functional decline and losing independence aiming to optimise functioning and independence in activities of daily living. There is limited knowledge about what characterises the intervention and the role of different professionals. The purpose of this study was to explore the characteristics and differences of occupational therapy and physiotherapy interventions in terms of focus, content and duration within the context of reablement in Swedish municipalities. Web-based surveys were used to collect data from 43 municipalities representing 25% of the population in Sweden. Data on intervention characteristics were reported for all cases receiving occupational therapy (n = 1,395) and physiotherapy (n = 1,006) over a 15-week period. Data were presented descriptively, and differences between occupational therapy and physiotherapy were analysed using Chi-square tests. The results indicated that reablement in Sweden was implemented for adults in all ages (19-103 years, median 81.0 years); 72% had home help. For both professions, a baseline assessment was made in fewer than half of all cases. There were significant differences between occupational therapists and physiotherapists regarding the focus and content as well as the number of contacts and duration of the intervention. For occupational therapists, walking indoors and self-care were the largest focus areas, whereas for physiotherapists walking indoors and body function were the largest focus areas. For most cases, the intervention was completed within five sessions over a 6-week period. This study provides the first picture of occupational therapy and physiotherapy within Swedish reablement contexts. In relation to the results, the focus of interventions, how assessments are made and how the intervention is implemented over time are issues that can be further elaborated.

Stroke follow-up in primary care: a prospective cohort study on guideline adherence

Background

After a stroke, a person has an increased risk of recurrent strokes. Effective secondary prevention can provide significant gains in the form of reduced disability and mortality. While considerable efforts have been made to provide high quality acute treatment of stroke, there has been less focus on the follow-up in general practice after the stroke. One strategy for the implementation of high quality, evidence-based treatment is the development and distribution of clinical guidelines. However, from similar fields of practice, we know that guidelines are often not adhered to. The purpose of this study was to investigate to what degree patients who have suffered a stroke are followed up in general practice, if recommendations in the national guidelines are followed, and if patients achieve the treatment goals recommended in the guidelines.

Methods

The study included patients with cerebral infarction identified by the ICD-10 discharge diagnoses I63.0 trough I63.9 in two Norwegian local hospitals. In total 51 patients participated. They were listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ (GPs’) medical records for these patients in the first year of follow-up; in total 381 consultations.

Results

Of the 381 consultations during the first year of follow-up, 71 (19%) had stroke as the main topic. The blood pressure (BP) target value < 140/90 mmHg was reached by 24 patients (47%). The low density lipoprotein (LDL) cholesterol target value < 2.0 mmol/L was reached by 14 (27%) of the 51 patients. In total six patients (12%) got advice on physical activity and three (6%) received dietary advice. No advice about alcohol consumption was recorded.

Conclusions

The findings support earlier claims that the development and distribution of guidelines alone is not enough to implement a certain practice. Despite being a serious condition, stroke gets limited attention in the first year of follow-up in general practice. This can be explained by the complexity of general practice, where even a serious condition loses the competition for attention to other apparently equally important issues.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0872-9) contains supplementary material, which is available to authorized users.

Mean air temperature as a risk factor for stroke mortality in São Paulo, Brazil

In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12-5.28) and women RR = 1.39 (95% CI, 1.03-1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0-5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of São Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.

Chemical composition and source apportionment of PM10 at an urban background site in a high-altitude Latin American megacity (Bogota, Colombia)

Bogota registers frequent episodes of poor air quality from high PM₁₀ concentrations. It is one of the main Latin American megacities, located at 2600 m in the tropical Andes, but there is insufficient data on PM₁₀ source contribution. A characterization of the chemical composition and the source apportionment of PM₁₀ at an urban background site in Bogota was carried out in this study. Daily samples were collected from June 2015 to May 2016 (a total of 311 samples). Organic carbon (OC), elemental carbon (EC), water soluble compounds (SO₄^2-, Cl^-, NO₃^-, NH₄⁺), major elements (Al, Fe, Mg, Ca, Na, K, P) and trace metals (V, Cd, Pb, Sr, Ba, among others) were analyzed. The results were interpreted in terms of their variability during the rainy season (RS) and the dry season (DS). The data obtained revealed that the carbonaceous fraction (∼51%) and mineral dust (23%) were the main PM₁₀ components, followed by others (15%), Secondary Inorganic Compounds (SIC) (11%) and sea salt (0.4%). The average concentrations of soil, SIC and OC were higher during RS than DS. However, peak values were observed during the DS due to photochemical activity and forest fires. Although trace metals represented <1% of PM₁₀, high concentrations of toxic elements such as Pb and Sb on RS, and Cu on DS, were obtained. By using a PMF model, six factors were identified (∼96% PM₁₀) including fugitive dust, road dust, metal processing, secondary PM, vehicles exhaust and industrial emissions. Traffic (exhaust emissions + road dust) was the major PM₁₀ source, accounting for ∼50% of the PM₁₀. The results provided novel data about PM₁₀ chemical composition, its sources and its seasonal variability during the year, which can help the local government to define control strategies for the main emission sources during the most critical periods.

Lifestyle as Medicine: The Case for a True Health Initiative

The power of lifestyle as medicine was perceived thousands of years ago. There is now consistent and compelling science to support the important influence of lifestyle on health. Approximately 80% of chronic disease and premature death could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern. Cardiovascular disease, diabetes, stroke, dementia, and cancer are all influenced by lifestyle choices. Despite the ample evidence about what behaviors promote health, confusion still prevails among the general population. This is particularly true with regard to diet. Confusing nutrition messages from scientists, the media, the food industry, and other sources have made it all but impossible for any single authority to convey persuasively the fundamentals of healthful eating. The case is made here that a global coalition of diverse experts has the power to do what no individual can: clarify and popularize an understanding of the fundamentals of a health-promoting, sustainable pattern of diet and lifestyle, and rally the general public to their consistent support.

No association between fish consumption and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain): a 13·8-year follow-up study

OBJECTIVE

To prospectively assess the associations between lean fish, fatty fish and total fish intakes and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).

DESIGN

Fish intake was estimated from a validated dietary questionnaire. Cox proportional hazards regression models were used to assess the association between the intakes of lean fish, fatty fish and total fish and stroke risk. Models were run separately for men and women.

SETTING

Five Spanish regions (Asturias, San Sebastian, Navarra, Granada and Murcia).

SUBJECTS

Individuals (n 41 020; 15 490 men and 25 530 women) aged 20-69 years, recruited from 1992 to 1996 and followed-up until December 2008 (December 2006 in the case of Asturias). Only participants with definite incident stroke were considered as cases.

RESULTS

During a mean follow-up of 13·8 years, 674 strokes were identified and subsequently validated by record linkage with hospital discharge databases, primary-care records and regional mortality registries, comprising 531 ischaemic, seventy-nine haemorrhagic, forty-two subarachnoid and twenty-two unspecific strokes. After multiple adjustments, no significant associations were observed between lean fish, fatty fish and total fish consumption and the risk of stroke in men or women. In men, results revealed a non-significant trend towards an inverse association between lean fish (hazard ratio=0·84; 95 % CI 0·55, 1·29, P trend=0·06) and total fish consumption (hazard ratio=0·77; 95 % CI 0·51, 1·16, P trend=0·06) and risk of total stroke.

CONCLUSIONS

In the EPIC-Spain cohort, no association was found between lean fish, fatty fish and total fish consumption and risk of stroke.

Effectiveness of a multicomponent intervention to enhance implementation of a healthy canteen policy in Australian primary schools: a randomised controlled trial

BACKGROUND

The implementation of school nutrition policies, which govern the provision of food in schools, is recommended as a public health strategy to support the development of healthy dietary behaviours in school-aged children. Despite this, research internationally and in Australia indicates that few schools implement such policies. This study aims to examine whether a theoretically designed, multi-strategy intervention was effective in increasing the implementation of a healthy canteen policy in Australian primary schools.

METHODS

A parallel group randomised controlled trial was conducted with all government and Catholic primary schools within one region in New South Wales, Australia who had an operational canteen that provided food to primary school aged children (5-12 years) and were not currently receiving an intervention to change their canteen practices. Schools randomised to the intervention arm received a 9-month multicomponent intervention including ongoing support, provision of resources, performance monitoring and feedback, executive support and recognition. The primary outcomes were the proportion of the schools with a canteen menu that: i) did not include 'red' or 'banned' items according to the healthy canteen policy; and ii) had more than 50 % 'green' items. The primary outcome was assessed via menu audit at baseline and follow up by dietitians blinded to group allocation.

RESULTS

Fifty-three eligible schools were randomised to either the intervention or control group (28 intervention; 25 control). Analyses with 51 schools who returned school menus found that intervention schools were significantly more likely relative to control schools to have a menu without 'red' or 'banned' items (RR = 5.78 (1.45-23.05); p = 0.002) and have at least 50 % of menu items classified as green (RR = 2.03 (1.01-4.08); p = 0.03).

CONCLUSIONS

This study found that a multi-component intervention was effective in improving primary schools' compliance with a healthy canteen policy. Given the lack of evidence regarding how best to support schools with implementing evidence-based policies to improve child diet, this trial for the first time provides high quality evidence to practitioners and policy makers seeking to improve nutrition policy implementation in schools.

TRIAL REGISTRATION

This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12614001148662 ) 30th October 2014.

Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians

OBJECTIVES

To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults.

DESIGN

Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression.

SETTING

Cities of Montréal, Laval, and Sherbrooke in Quebec, CA.

PARTICIPANTS

Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge).

MEASUREMENTS

Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years.

RESULTS

170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87).

CONCLUSION

Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.

Gender-linked stem cell alterations in stroke and postpartum depression

Stroke is a significant unmet clinical need. The current stroke treatment of tissue plasminogen activator is limited to the very acute 4.5 h after disease onset which benefits only less than 3% of ischemic stroke patients. Our overarching hypothesis advances the notion that gender, which has been established as a comorbidity factor of stroke, plays a key role in regenerative medicine, in particular stem cell therapy. We hypothesize that gender is a key factor in culture-induced stemness of adult stem cells. Our goal is to provide new evidence supporting gender effects on stroke and stem cells for the purpose of enhancing our understanding of the pathophysiology of the disease and developing novel stem cell-based therapeutics targeting gender-relevant stress hormones as manifested in a stroke-postpartum depression paradigm.

Adherence to a Mediterranean diet and prediction of incident stroke

BACKGROUND AND PURPOSE

There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke.

METHODS

We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.

RESULTS

Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5-9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70-1.00; P=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65-0.96; P=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0-11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (P=0.37) on the association of adherence to MeD with incident IS.

CONCLUSIONS

High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.

Risk factor-related lifestyle habits of hospital-admitted stroke patients - an exploratory study

AIMS AND OBJECTIVES

To describe and explain the lifestyle habits of hospital-admitted stroke patients by identifying relationships between the different lifestyle habits and by examining associations between them and clinical measurements.

BACKGROUND

Stroke is associated with several risk factors that are closely intertwined. However, lifestyle factors have profound effects on its incidence. It has been shown that healthy lifestyle habits are associated with a reduced stroke risk both in combination and independently.

DESIGN

A cross-sectional, exploratory study.

METHODS

Data were collected from stroke and transient ischemic attack (TIA) patients (n = 150) in an acute neurology unit in Finland between January 2010 and October 2011 using the Lifestyle Instrument. Data analysis was performed by cross-tabulation of variables, factor analysis, analysis of variance and logistic regression.

RESULTS

Patients with a mean age of 56·5 participated. Based on their body mass index, most were overweight (43·2%) or obese (31·8%). Their waist circumference levels indicated significant health problems in most cases (70%). Their mean glucose (5·6 mmol/l) and blood pressure (149·9/86·7 mmHg) levels were also above the guideline values. The participants had diverse risk factor-related lifestyle habits. There were several statistically significant differences between the different lifestyle habits and most of the clinical data were at least partly explained by the lifestyle habits.

CONCLUSIONS

The participants in this study had many lifestyle habits that are associated with stroke risk factors, exposing them to an elevated risk of a new stroke in the future.

RELEVANCE TO CLINICAL PRACTICE

It is an important obligation for nursing staff courageously to bring up the lifestyle habits at the hospital phase and point out that there is a relationship between them and stroke incidence and that secondary stroke can be prevented or made less likely by adopting a healthy lifestyle.

Carbohydrate Intake, Glycemic Index, Glycemic Load, and Stroke

The objective of this study was to investigate associations between carbohydrate intake/glycemic index (GI)/glycemic load (GL) and stroke risk. A literature search of MEDLINE, Embase, Web of Science, and CBM databases was performed to retrieve eligible studies published up to March 2014. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were used to evaluate the strength of this association. Publication bias was assessed by the Egger’s regression asymmetry test and Begg’s rank correlation test with Begg’s funnel plot. All analyses were conducted using software STATA 12.0 (StataCorp LP, College Station, TX) and SAS version 9.1 (SAS Institute Inc, Cary, NC). We identified 7 prospective studies that met the inclusion criteria and processed data from cohort studies to update available evidence. There were 25 independent estimates and 225 000 participants free of diabetes from 6 different countries; 3046 stroke events were included; and the follow-up range was 5 to 18 years. High GI was not associated with risk of stroke events (pooled RR = 1.10; 95% CI: 0.99-1.21); GL was a risk factor for stroke (pooled RR = 1.19; 95% CI: 1.05-1.36). There was no significant association between high carbohydrate intake and stroke risk (RR = 1.12; 95% CI: 0.93-1.35). A daily high GL diet is the risk factor of stroke event, and further researches need to verify the meta-analyses results and study associated mechanisms.

Can we say what diet is best for health?

Diet is established among the most important influences on health in modern societies. Injudicious diet figures among the leading causes of premature death and chronic disease. Optimal eating is associated with increased life expectancy, dramatic reduction in lifetime risk of all chronic disease, and amelioration of gene expression. In this context, claims abound for the competitive merits of various diets relative to one another. Whereas such claims, particularly when attached to commercial interests, emphasize distinctions, the fundamentals of virtually all eating patterns associated with meaningful evidence of health benefit overlap substantially. There have been no rigorous, long-term studies comparing contenders for best diet laurels using methodology that precludes bias and confounding, and for many reasons such studies are unlikely. In the absence of such direct comparisons, claims for the established superiority of any one specific diet over others are exaggerated. The weight of evidence strongly supports a theme of healthful eating while allowing for variations on that theme. A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention and is consistent with the salient components of seemingly distinct dietary approaches. Efforts to improve public health through diet are forestalled not for want of knowledge about the optimal feeding of Homo sapiens but for distractions associated with exaggerated claims, and our failure to convert what we reliably know into what we routinely do. Knowledge in this case is not, as of yet, power; would that it were so.

Dash of faith: a faith-based participatory research pilot study

The Dash of Faith pilot used a community-based participatory research approach to design an experiential dietary intervention based on two African-American churches, one intervention and one comparison. Congregation members identified components that were incorporated into 12 weekly and 4 monthly sessions, with a goal of increasing fruit and vegetable and lowering fat intake. At 2 months, a marginally significant (p = 0.07) increase in fruit and vegetable consumption was observed in the intervention group but was not maintained at study conclusion. We propose that these mixed findings may be attributable, in part, to bias introduced by the participatory nature of the design.

Sources of vegetables, fruits and vitamins A, C and E among five ethnic groups: results from a multiethnic cohort study

OBJECTIVES

Data are limited on how dietary sources of food and nutrients differ among ethnic groups. The objective of this study was to determine the main sources of fruit, vegetables and vitamins A, C and E for five ethnic groups.

SUBJECTS/METHODS

Dietary data were collected using a validated quantitative food frequency questionnaire from participants in a multiethnic cohort in Hawaii and Los Angeles county between 1993 and 1996. Data were analyzed for 186,916 participants representing five ethnic groups: African-Americans, Japanese-Americans, native Hawaiians, Latinos and Caucasians.

RESULTS

Lettuce was the most consumed vegetable (6.0-9.9%) in all ethnic-sex groups, except among African-American women and Mexican-born Latino men and women. Oranges and bananas contributed more than one-quarter to total fruit intake among all groups. Overall, more ethnic variation in food choices was observed for the top 10 vegetables than for fruits. The top sources of vitamins A, C and E were carrots, orange/grapefruit/pomelo and combined dishes, respectively. Among the micronutrients studied, the greatest ethnic variation in foods consumed was observed for the top 10 food sources of vitamin A.

CONCLUSIONS

This is the first study providing data on the main types of fruit and vegetables consumed and the major sources of vitamins A, C and E among these ethnic groups in the U.S. Such data are valuable for developing and implementing public health strategies to meet the USDA dietary recommendations and for guiding ethnicity-specific nutrition education and intervention programs.

Prevalence, incidence, and mortality of stroke in the chinese island populations: a systematic review

BACKGROUND

In China, there are 2.5 million new stroke cases each year and 7.5 million stroke survivors. However, stroke incidence in some island populations is obviously lower compared with inland regions, perhaps due to differences in diet and lifestyle. As the lifestyle in China has changed significantly, along with dramatic transformations in social, economic and environmental conditions, such changes have also been seen in island regions. Thus, we analyzed stroke in the Chinese island regions over the past 30 years.

METHODS

We conducted a systematic review to identify reliable and comparable epidemiologic evidence about stroke in the Chinese island regions between 1980 and 2013. Two authors independently assessed the eligibility and the quality of the articles and disagreement was resolved by discussion. Owing to the great heterogeneity among individual study estimates, a random-effects or fixed-effects model was used to incorporate the heterogeneity among records into a pooled estimate for age-standardized rates. Age-standardized rates were calculated by the direct method with the 2000 world population if included records provided the necessary information.

RESULTS

During the past three decades, the overall pooled age-standardized prevalence of stroke is 6.17 per 1000 (95% CI 4.56-7.78), an increase from 5.54 per 1000 (95% CI 3.88-7.20) prior to 2000 to 8.34 per 1000 (95% CI 5.98-10.69) after 2000. However, this difference was not found to be statistically significant. The overall pooled age-standardized incidence of stroke is 120.42 per 100,000 person years (95% CI 26.17-214.67). Between 1982 and 2008, the incidence of stroke increased and mortality declined over time.

CONCLUSIONS

Effective intervention and specific policy recommendations on stroke prevention should be required, and formulated in a timely fashion to effectively curb the increased trend of stroke in Chinese island regions.

Adherence to lifestyle recommendations is associated with improved glycemic control and improved blood lipid levels in Korean adults with type 2 diabetes

We explored the association between the degree of adherence to recommendations and diabetes management in Korean adults who had type 2 diabetes for an average of 8 years. Subjects who met five or more lifestyle recommendations showed significantly lower blood lipid parameters and glycated hemoglobin than those who did not.

Prevalence of cardiovascular disorders and risk factors in two 75-year-old birth cohorts examined in 1976-1977 and 2005-2006

BACKGROUND AND AIMS

The number of older people are increasing worldwide, and cardiovascular diseases are the major causes of death in western societies. This study examines birth cohort differences in cardiovascular disorders and risk factors in Swedish elderly.

METHODS

Representative samples of 75-year-olds living in Gothenburg, Sweden, examined in 1976-1977 and in 2005-2006. Blood pressure, s-cholesterol, s-triglycerides, height, body weight, body mass index, history of myocardial infarction, angina pectoris and stroke/TIA, and diabetes mellitus were measured.

RESULTS

The prevalence of total cardiovascular disorders, hypertension and hypercholesterolemia decreased, and the prevalence of stroke increased in both genders. The prevalence of cardiovascular disorders was higher in women than in men in 1976-1977, and higher in men than in women in 2005-2006. The decrease in blood pressure occurred independently of antihypertensive treatment. The prevalence of current smokers decreased in men and increased in women. The prevalence of life-time smokers and diabetes mellitus increased only in women. The proportion on antihypertensive treatment and overweight and obesity increased only in men. Hypertension, overweight and obesity were more common in women in 1976-1977. These sex differences were not observed in 2005-2006.

CONCLUSIONS

The overall prevalence of cardiovascular disorders decreased, and sex differences reversed between the 1970s and 2000s among Swedish septuagenarians. Our findings emphasize the importance of environmental factors, not only for the prevalence of cardiovascular disorders, but also as explanations for sex differences. Reasons for changes could be increased survival in those with disorders and risk factors, changes in lifestyle and diet, and better preventive strategies, such as treatment of hypercholesterolemia and hypertension.

Fish consumption and risk of stroke and its subtypes: accumulative evidence from a meta-analysis of prospective cohort studies

BACKGROUND/OBJECTIVES

To provide a reliable assessment of the hypothesized association of fish consumption with stroke risk accumulatively, an updated meta-analysis of published prospective cohort studies was conducted.

SUBJECTS/METHODS

Prospective cohort studies through April 2012 in peer-reviewed journals indexed in MEDLINE and EMBASE were selected. Additional information was retrieved through Google or a search of the reference list in relevant articles. The main outcome measure was the weighted hazards ratio (HR) and corresponding 95% confidence interval (CI) for incident stroke according to fish consumption using a random-effects model.

RESULTS

A database was derived from 16 eligible studies (19 cohorts), including 402,127 individuals (10,568 incident cases) with an average 12.8 years of follow-up. Compared with those who never consumed fish or ate fish <1/month, the pooled adjusted HRs of total stroke risk were 0.97 (95% CI, 0.87-1.08), 0.86 (0.80-0.93), 0.91 (0.85-0.98) and 0.87 (0.79-0.96) for those who consumed fish 1-3/month, 1/week, 2-4/week and ~5/week, respectively (P(linear trend) = 0.09; P(nonlinear trend) = 0.02). Study location was a modifier. An inverse association between fish intake and stroke incidence was only found by studies conducted in North America. The modest inverse associations were more pronounced with ischemic stroke and were attenuated with hemorrhagic stroke.

CONCLUSIONS

Accumulated evidence generated from this meta-analysis suggests that fish intake may have a protective effect against the risk of stroke, particularly ischemic stroke.

Dietary sources of five nutrients in ethnic groups represented in the Multiethnic Cohort

Data are limited on how dietary sources of energy and nutrient intakes differ among ethnic groups in the USA. The objective of the present study was to characterise dietary sources of energy, total fat, saturated fat, protein, dietary fibre and added sugar for five ethnic groups. A validated quantitative FFQ was used to collect dietary data from 186,916 men and women aged 45-75 years who were living in Hawaii and Los Angeles between 1993 and 1996. Participants represented five ethnic groups: African-American; Japanese-American; Native Hawaiian; Latino; Caucasian. The top ten dietary sources of energy contributed 36·2-49·6% to total energy consumption, with rice and bread contributing the most (11·4-27·8%) across all ethnic-sex groups. Major dietary sources of total fat were chicken/turkey dishes and butter among most groups. Ice cream, ice milk or frozen yogurt contributed 4·6-6·2% to saturated fat intake across all ethnic-sex groups, except Latino-Mexico women. Chicken/turkey and bread were among the top dietary sources of protein (13·9-19·4%). The top two sources of dietary fibre were bread and cereals (18·1-22%) among all groups, except Latino-Mexico men. Regular sodas contributed the most to added sugar consumption. The present study provides, for the first time, data on the major dietary sources of energy, fat, saturated fat, protein, fibre and added sugar for these five ethnic groups in the USA. Such data are valuable for identifying target foods for nutritional intervention programmes and directing public health strategies aimed at reducing dietary risk factors for chronic disease.

High salt intake and stroke: meta-analysis of the epidemiologic evidence

Research on the potential impact of high salt intake on health has grown rapidly over the last decades. Recent studies have suggested that high salt intake could also be associated with adverse effects on cardiovascular system. The review evaluated the current level of epidemiologic evidence on the association between the level of habitual salt intake and stroke outcome. We also suggest further research direction. There were 21 independent samples from 12 studies, with 225,693 participants (follow-up, 3-19 years) and 8135 stroke events. High salt intake was associated with risk of stroke event (pooled odd ratio [OR], 1.34; 95% confidence interval [CI], 1.19-1.51), stroke death (1.40; 1.21-1.63) and stroke onset (1.11; 1.00-1.24), ischemic stroke death (2.15; 1.57-2.95), not associated with risk of ischemic stroke onset (1.07, 0.95-1.2), with no significant evidence of publication bias. High salt intake is associated with significantly increased risk of stroke event. Further research should be directed toward clarifying and quantifying these possible effects and generating testable hypotheses on plausible biologic mechanisms.

Similar cation channels mediate protection from cerebellar exitotoxicity by exercise and inheritance

Exercise and inherited factors both affect recovery from stroke and head injury, but the underlying mechanisms and interconnections between them are yet unknown. Here, we report that similar cation channels mediate the protective effect of exercise and specific genetic background in a kainate injection model of cerebellar stroke. Microinjection to the cerebellum of the glutamatergic agonist, kainate, creates glutamatergic excito-toxicity characteristic of focal stroke, head injury or alcoholism. Inherited protection and prior exercise were both accompanied by higher cerebellar expression levels of the Kir6.1 ATP-dependent potassium channel in adjacent Bergmann glia, and voltage-gated KVbeta2 and cyclic nucleotide-gated cation HCN1 channels in basket cells. Sedentary FVB/N and exercised C57BL/6 mice both expressed higher levels of these cation channels compared to sedentary C57BL/6 mice, and were both found to be less sensitive to glutamate toxicity. Moreover, blocking ATP-dependent potassium channels with Glibenclamide enhanced kainate-induced cell death in cerebellar slices from the resilient sedentary FVB/N mice. Furthermore, exercise increased the number of acetylcholinesterase-positive fibres in the molecular layer, reduced cerebellar cytokine levels and suppressed serum acetylcholinesterase activity, suggesting anti-inflammatory protection by enhanced cholinergic signalling. Our findings demonstrate for the first time that routine exercise and specific genetic backgrounds confer protection from cerebellar glutamatergic damages by similar molecular mechanisms, including elevated expression of cation channels. In addition, our findings highlight the involvement of the cholinergic anti-inflammatory pathway in insult-inducible cerebellar processes. These mechanisms are likely to play similar roles in other brain regions and injuries as well, opening new venues for targeted research efforts.

Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention

AIM

To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.

METHODS

Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).

RESULTS

After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.

CONCLUSIONS

Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.

Smoking is not a risk factor for sporadic amyotrophic lateral sclerosis in an Australian population

BACKGROUND

Controversy persists as to whether smoking is a risk factor for sporadic amyotrophic lateral sclerosis (SALS), the most common form of sporadic motor neuron disease (SMND). We therefore undertook a large case-control study of smoking and SALS in Australia.

METHODS

Cases and controls were recruited Australia-wide over a 10-year period. SALS and the other subgroups of SMND were categorised on the basis of neurologists' reports. Controls were partners or friends of SMND patients or community volunteers. Individuals filled in a questionnaire regarding smoking habits. A total of 809 patients with SMND (631 with SALS) and 779 controls were included in the study. SALS males and females were analysed separately.

RESULTS

No differences between SALS patients and control groups were found with regard to (1) the odds ratios of ever-smokers, ex-smokers or current smokers compared to never-smokers, (2) the means of numbers of cigarettes per day, years of smoking, pack years or age smoking began or (3) the proportions of their parents who had ever smoked. The proportion of ever-smokers and mean pack years did not differ between the clinical subgroups of SMND or between different sites of SALS onset. Partner smoking did not increase the risk of SMND.

CONCLUSION

This Australian case-control study does not support a link between cigarette smoking and any form of SMND.

Associations between Fatness, Fitness, IGF and IMT among Obese Korean Male Adolescents

BACKGROUND

The purpose of this study was to investigate the association between obesity, fitness levels and cardiovascular (CVD) risk factors, and to identify the correlation between of insulin-like growth factor (IGF)-1, IGF binding protein-3 (IGFBP-3), and carotid intima media thickness (IMT) in Korean adolescents.

METHODS

A total of 225 high school males with a mean age of 16.96±0.23 years participated in this study, and their fatness and fitness levels, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, IGF-1, IGFBP-3, and IMT were measured.

RESULTS

The results showed that total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting insulin, HOMA-IR, IGF-1, and IGFBP-3 levels were significantly higher in the most obese group than in the other two groups (tertiles). Muscular and cardiopulmonary fitness were negatively associated with weight, body mass index (BMI), fat mass, body fat, waist circumference (WC), fasting insulin, HOMA-IR, and IMT. IGF-1 and IGFBP-3 levels were correlated with WC, hip circumference (HC), fasting glucose, TG, HDL-C, fasting insulin, and HOMA-IR. IMT levels were significantly associated with weight, BMI, muscle mass, fat mass, percent body fat, WC, HC, systolic blood pressure, diastolic blood pressure and high-sensitivity C-reactive protein.

CONCLUSION

There was a significant association between increased obesity and decreased fitness and HOMA-IR, IGF, and IMT among adolescents.

Physical activity in the prevention and treatment of stroke

The role of physical activity in the prevention of stroke is of great interest due to the high mortality and significant impact of stroke-related morbidity on the individual and on healthcare resources. The use of physical activity as a therapeutic strategy to maximise functional recovery in the rehabilitation of stroke survivors has a growing evidence base. This narrative review examines the existing literature surrounding the use of exercise and physical therapy in the primary and secondary prevention of stroke. It explores the effect of gender, exercise intensities and the duration of observed benefit. It details the most recent evidence for physical activity in improving functional outcome in stroke patients. The review summaries the current guidelines and recommendations for exercise therapy and highlights areas in which further research and investigation would be useful to determine optimal exercise prescription for effective prevention and rehabilitation in stroke.

An analysis of admissions from 155 United States hospitals to determine the influence of weather on stroke incidence

Weather is the most frequently proposed factor driving apparent seasonal trends in stroke admissions. Here, we present the largest study of the association between weather and ischemic stroke in the USA to date. We consider admissions to 155 United States hospitals in 20 states during the five-year period from 2004 to 2008. The data set included 196,439 stroke admissions, which were classified as ischemic (n=98,930), hemorrhagic (n=18,960), or transient ischemic attack (n=78,549). Variations in stroke admissions were tested to determine if they tracked seasonal and transient weather patterns over the same time period. Using autocorrelation analyses, no significant seasonal changes in stroke admissions were observed over the study period. Using time-series analyses, no significant association was observed between any weather variable and any stroke subtype over the five-year study. This study suggests that seasonal associations between weather and stroke are highly confounded, and an association between weather and stroke is virtually non-existent. Therefore, previous studies reporting an association between specific weather patterns and stroke should be interpreted with caution.

No Time to ‘Weight’: The Link between Obesity and Stroke in Women

The obesity epidemic in the USA threatens the gains that have been made in the prevention and treatment of stroke. Both obesity and stroke disproportionately affect women more than men. Understanding the effect of obesity on stroke risk in women may be a useful stepping stone to reducing the burden of stroke in this vulnerable population. This article reviews the association between stroke and general obesity, abdominal obesity and metabolic syndrome in women. All three factors have been shown to independently increase stroke risk in women.

The allenic carotenoid fucoxanthin, a novel marine nutraceutical from brown seaweeds

Obesity and type 2 diabetes are pathologies with rapidly growing prevalence throughout the world. A few molecular targets offer the most hope for anti-obesity and anti-diabetic therapeutics. One of the keys to success will be the induction of uncoupling protein 1 (UCP1) in abdominal white adipose tissue (WAT) and the regulation of cytokine secretions from both abdominal adipose cells and macrophage cells infiltrated into adipose tissue. Anti-obesity and anti-diabetic effects of fucoxanthin, a characteristic carotenoid found in brown seaweeds, have been reported. Nutrigenomic studies reveal that fucoxanthin induces UCP1 in abdominal WAT mitochondria, leading to the oxidation of fatty acids and heat production in WAT. Fucoxanthin improves insulin resistance and decreases blood glucose levels through the regulation of cytokine secretions from WAT. The key structure of carotenoids for the expression of anti-obesity effect is suggested to be the carotenoid end of the polyene chromophore, which contains an allenic bond and two hydroxyl groups.

Transient ischaemic attack clinics and management of transient ischaemic attacks

PURPOSE OF REVIEW

The aim is to review transient ischaemic attack (TIA) clinics, other service delivery models, and current TIA management.

RECENT FINDINGS

Urgent assessment of TIA patients by stroke specialist services reduces stroke risk and is cost-effective. Almost one-third of TIA patients wait more than 24 h before presenting to medical attention, with delay associated with higher stroke risk. Risk stratification following suspected TIA may be performed by clinical assessment of individual patient characteristics, combined with the validated ABCD2 score (pre-investigation), and the ABCD3-I score (postinvestigation) in secondary care settings. Brain MRI and transcranial Doppler ultrasound add information related to vascular territory, TIA mechanism, and prognosis. Variability in systolic blood pressure in treated and untreated patients is an important predictor of stroke risk, independently of mean blood pressure.

SUMMARY

Daily specialist-provided TIA services delivered in clinic or inpatient settings have proven efficacy for stroke prevention. In addition, a rapid-access, clinic-based service is associated with cost savings and reduced hospital bed-day utilization after TIA.

Mediterranean diet and magnetic resonance imaging-assessed cerebrovascular disease

OBJECTIVE

Cerebrovascular disease is 1 of the possible mechanisms of the previously reported relationship between Mediterranean-type diet (MeDi) and Alzheimer's disease (AD). We sought to investigate the association between MeDi and MRI infarcts.

METHODS

High-resolution structural MRI was collected on 707 elderly 65 years or older community residents of New York with available dietary assessments administered an average of 5.8 years (3.22 standard deviations [SDs]) before the MRI. Participants were divided into 3 groups of adherence to MeDi (low, middle, and high tertiles). We examined the association of increasing adherence to MeDi with presence of infarcts on MRI. Models were run without adjustment, adjusted for basic demographic and clinical factors, and adjusted for vascular risk factors.

RESULTS

A total of 222 participants had at least 1 infarct. In the unadjusted model, compared to the low adherence group, those in the moderate MeDi adherence group had a 22% reduced odds of having an infarct (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.55-1.14), while participants in the highest MeDi adherence group had a 36% reduced odds (OR, 0.64; 95% CI, 0.42-0.97; p for trend = 0.04). In adjusted models, the association between MeDi adherence and MRI infarcts remained essentially unchanged. The association of high MeDi adherence with infarcts was comparable to that of hypertension (40% reduced probability), did not vary by infarct size or after excluding patients with dementia (n = 46) or clinical strokes (n = 86). There was no association between MeDi and white matter hyperintensities.

INTERPRETATION

Higher adherence to the MeDi is associated with reduced cerebrovascular disease burden.