Adherence to Dietary Approaches to Stop Hypertension (DASH) Diet as a Protective Factor for Ischemic Stroke and Its Influence on Disability Level: A Case–control Study in Lebanon

Introduction: Hypertension is a major risk factor for ischemic stroke. An important strategy in controlling hypertension is through dietary modification. The present study evaluates the effect of Dietary Approaches to Stop Hypertension (DASH) diet on the risk of ischemic stroke.

Methods: A case-control study was carried out, including 214 ischemic stroke cases recruited within the first 48 hours of diagnosis and 214 controls, divided equally into hospitalized and non-hospitalized participants. Controls were matched to cases based on age and gender. Sociodemographic characteristics were assessed, in addition to the adherence to DASH diet, which was measured using a preconstructed DASH diet index (ranging from 0 (lowest) to 11 (highest)). For stroke patients, Modified Rankin Score (mRS) was measured to assess disability.

Results: Smoking, hypertension, hyperlipidemia, atrial fibrillation and myocardial infarction were significantly associated to ischemic stroke (p < 0.001). Higher adherence to DASH diet was correlated to lower rates of stroke, where cases scored 5.042 ± 1.486 compared to 6.654 ± 1.471 for controls (p < 0.001). Eating more grains, vegetables, fruits, dairy products, nuts, seeds and beans, and lower fat, sweets and sodium were associated to lower rates of ischemic stroke (p=0.038 for sweets and p< 0.001 for all the remaining), while meat, poultry and fish did not have any significant effect (p=0.46). Multivariate analysis showed that lower adherence to DASH diet (p < 0.001, OR: 0.526, CI95% 0.428-0.645) was associated to a higher incidence of ischemic stroke and to an increased likelihood of having high disability levels (mRS 5-6) (p=0.041, OR: 2.49E-08, CI95% 0-2.49E-08).

Conclusion : The relation between DASH diet and risk of stroke highlights the necessity for strict adherence to dietary restrictions, suggesting a protective role for DASH diet in stroke pathogenesis and prognosis.