Mediterranean diet improves health outcomes in poststroke adults

Adherence to a Mediterranean diet (MD) provides several health benefits to adults who have had a stroke, suggests a recent study.

“The MD appears to be beneficial for systolic and diastolic blood pressure (BP), low-density lipoprotein (LDL) cholesterol, body mass index (BMI), and waist circumference,” the researchers said.

In this systematic literature review, the researchers identified eligible studies that assessed the role of MD on health outcomes in poststroke adults though 25 August 2021. They used the following databases for their search: Proquest, Medline, Scopus, Embase, and Cochrane Library.

A total of 5,838 studies were identified, but only six met the full inclusion criteria and were subsequently reviewed. Different health outcomes were evaluated, such as blood pathology tests, physical examinations, secondary vascular events, and mortality.

MD was associated with benefits for systolic and diastolic BP, LDL cholesterol, BMI, and waist circumference. [Eur J Clin Nutr 2023;77:551-560]

The finding that a MD could improve BP in poststroke adults was consistent with that of previous studies that explored the effect of MD in other groups, such as healthy older adults, older adults with high cardiovascular disease risk, and women with hypertension. [Hypertension 2019;73:578-586; Hypertension 2014;64:69-76; Eur J Nutr 2017;56:89-97]

“Several dietary minerals, such as sodium, magnesium, and potassium, have been implicated in modulating BP, with a meta-analysis indicating that a reduction in sodium and an increase in potassium consumption lowers BP in normotensive and hypertensive individuals,” the researchers said. [J Hum Hypertens 2003;17:471-480]

In addition, fruits and vegetables, which constitute a major part of MD, are excellent sources of magnesium and potassium and are low in sodium. [J Clin Hypertens 2005;7:165-172]

The finding that MD appeared beneficial in improving BMI and waist circumference in poststroke adults was supported by that of an earlier study, which found that adherence to MD correlated with reductions in body weight and waist circumference in healthy participants. [Nutr Diabetes 2018;8:1-10]

Stroke prevention

Notably, adiposity is strongly associated with hypertension, diabetes mellitus, and high serum cholesterol levels, all of which are risk factors for stroke and cardiovascular disease. Therefore, reducing adiposity can help prevent stroke and must be considered in secondary prevention strategies. [Hypertension 2004;43:25-30; Arch Intern Med 2004;164:892-896; Nutr Metab Cardiovasc Dis 2013;23:432-442; Circulation 2018;137:e67-e492]

“Our findings suggest that a MD may be effective at reducing body weight and waist circumference in poststroke adults, which could play an important role in reducing secondary risk factors,” the researchers said.

This review had some limitations. First, the MD used in eligible studies was implemented together with interventions such as exercise, stress management, and smoking cessation. Thus, it was difficult to conclude that the beneficial effects were specifically due to MD.

Second, data on effect sizes were lacking, affecting the ability of the researchers to obtain practical insights from the findings. Third, no cumulative statistical meta-analysis was carried out. Finally, only published trials available in the databases were reviewed.

“We also observed poor reporting of the MD intervention guidelines among all of the included studies,” the researchers said. “To ensure robust methodology and replication of results, specific details of the included and excluded foods, quantities, and serving sizes should be included in future research.”