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2018 ; 3
(2
): 44-50
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Diet for stroke prevention
#MMPMID30022800
Spence JD
Stroke Vasc Neurol
2018[Jun]; 3
(2
): 44-50
PMID30022800
show ga
Lifestyle is far more important than most physicians suppose. Dietary changes in
China that have resulted from increased prosperity are probably responsible for a
marked rise in coronary risk in the past several decades, accelerating in recent
years. Intake of meat and eggs has increased, while intake of fruits, vegetables
and whole grains has decreased. Between 2003 and 2013, coronary mortality in
China increased 213%, while stroke mortality increased by 26.6%. Besides a high
content of cholesterol, meat (particularly red meat) contains carnitine, while
egg yolks contain phosphatidylcholine. Both are converted by the intestinal
microbiome to trimethylamine, in turn oxidised in the liver to trimethylamine
n-oxide (TMAO). TMAO causes atherosclerosis in animal models, and in patients
referred for coronary angiography high levels after a test dose of two
hard-boiled eggs predicted increased cardiovascular risk. The strongest evidence
for dietary prevention of stroke and myocardial infarction is with the
Mediterranean diet from Crete, a nearly vegetarian diet that is high in
beneficial oils, whole grains, fruits, vegetables and legumes. Persons at risk of
stroke should avoid egg yolk, limit intake of red meat and consume a diet similar
to the Mediterranean diet. A crucial issue for stroke prevention in China is
reduction of sodium intake. Dietary changes, although difficult to implement,
represent an important opportunity to prevent stroke and have the potential to
reverse the trend of increased cardiovascular risk in China.
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