Influencia de los hábitos dietéticos y de la obesidad abdominal en el ictus isquémico

Objetivos: Analizar si existen diferencias dieteticas y antropometricas entre pacientes con ictus isquemico y controles de una misma poblacion y evaluar si existen diferencias por genero y subtipos de ictus. Se estudio tambien si los patrones dieteticos de prevencion eran igual de saludables en los pacientes con ictus isquemico y en los controles. Material y metodos: Estudio prospectivo que incluyo pacientes ingresados con el diagnostico de ictus isquemico y controles sanos. Se registraron datos demograficos, antropometricos (peso, talla y perimetro abdominal), edad, sexo y factores de riesgo vascular. En un subgrupo de sujetos se evaluaron los habitos dieteticos mediante un cuestionario de frecuencia de alimentos validado, que registra la ingesta habitual de nutrientes durante el ano previo. Se cuantifico el consumo de los macronutrientes que se han descrito asociados a un aumento de incidencia de ictus, las diferentes formas de preparar los alimentos y los habitos alimenticios para controlar el riesgo vascular antes del ictus. Resultados: Se observo una mayor ingesta calorica en los pacientes con ictus que en los controles, de proteinas (p< 0.001; OR 1.02), de colesterol total (P=0.001; OR 1.04) y de alimentos rebozados (p=0.001; OR 1.94) y un menor consumo de yogur con lactobacilos (p=0.002; OR 0.88). Se observaron tambien diferencias entre los subtipos de ictus. No se constataron diferencias entre sexos respecto al consumo calorico, ingesta de nutrientes o forma de procesar los alimentos. Los controles referian una mayor propension a seguir una dieta saludable y las mujeres con ictus isquemico estaban mas concienciadas para mantener habitos dieteticos saludables que los hombres. En el estudio univariado, el incremento del IMC no se asocio con un aumento de riesgo de ictus en mujeres o de forma global, pero fue un factor protector en hombres (p=0.03; OR 0.59 [0.37-0.94]). Estratificada por sexo, la obesidad abdominal se asocio significativamente con el riesgo de ictus en las mujeres, tanto en medidas de circunferencia de cintura (p<0.001; OR 5.79 [3.10-10.85]) como de indice cintura-altura (p<0.001; OR 3.61 [1.99-6.54]), mientras que la asociacion no fue significativa en hombres. Sin embargo, en el analisis multivariado ajustado por factores de riesgo vascular, la obesidad abdominal constituyo un factor de riesgo para ambos sexos, pero la magnitud de la asociacion fue significativamente mayor en las mujeres. Conclusiones: Existen diferencias dieteticas y antropometricas entre los pacientes con ictus isquemico y una poblacion control. Los pacientes con ictus presentan un mayor consumo previo de proteinas y de colesterol total y una mayor frecuencia de formas de preparacion de alimentos descritos como perjudiciales para el desarrollo de ictus. Los pacientes con ictus estan menos concienciados para mantener habitos dieteticos saludables, especialmente los hombres. El aumento de peso mediante el indice de masa corporal no se asocia con un aumento de riesgo de ictus en mujeres o de forma global y es un factor protector en hombres. Sin embargo, la obesidad abdominal si que aumenta el riesgo de ictus isquemico y constituye un factor de riesgo para ambos sexos, mayor en las mujeres. Estos hallazgos apoyan la necesidad de insistir en patrones de dieta saludable y en la reduccion de la obesidad abdominal, en prevencion primaria, especialmente en sujetos con factores de riesgo cardiovascular. Objectives: To analyze if there are dietary and anthropometric differences between patients with ischemic stroke and controls of the same population and to evaluate if there are differences by gender and stroke subtypes. It was also studied whether dietary prevention patterns were equally healthy in patients with ischemic stroke and in controls. Material and methods: Prospective study that included hospitalized patients with a diagnosis of ischemic stroke and healthy controls. Demographic and anthropometric data (weight, height, and waist circumference), age, sex and vascular risk factors were recorded. In a subgroup of subjects, dietary habits were assessed using a validated food frequency questionnaire, recording the usual intake of nutrients during the previous year. The consumption of macronutrients described associated with an increase in the incidence of stroke, the different ways of preparing food and eating habits to control the vascular risk before the stroke were quantified. Results: A higher caloric intake was observed in patients with stroke than in controls, proteins (p <0.001; OR 1.02), total cholesterol (P = 0.001, OR 1.04), and breaded foods (p = 0.001, OR 1.94) and lower consumption of yogurt with lactobacillus (p = 0.002; OR 0.88). Differences between stroke subtypes were also observed. There were no gender differences regarding caloric intake, nutrient intake or food processing methods. The controls reported a greater propensity to follow a healthy diet and women with ischemic stroke were more aware of maintaining healthy dietary habits than men. In the univariate study, the increase in BMI was not associated with an increased risk of stroke in women or globally, but it was a protective factor in men (p = 0.03; OR 0.59 [0.37-0.94]). Stratified by gender, abdominal obesity was significantly associated with the risk of stroke in women, both in waist circumference (p <0.001; OR 5.79 [3.10-10.85]) and waist to height ratio (p <0.001; OR 3.61 [1.99-6.54]), whereas the association was not significant in men. However, in the multivariate analysis adjusted for vascular risk factors, abdominal obesity was a risk factor for both genders, but the magnitude of the association was significantly higher in women. Conclusions: There are dietary and anthropometric differences between patients with ischemic stroke and a control population. Patients with stroke have a higher consumption of protein and total cholesterol and a greater frequency of food preparation forms described as detrimental to the development of stroke. Patients with stroke are less conscious to maintain healthy dietary habits, especially men. Weight gain measured by body-mass index is not associated with an increased risk of stroke in women or globally and it is a protective factor in men. However, abdominal obesity does increase the risk of ischemic stroke and is a risk factor for both genders, higher in women. These findings support the need to emphasize healthy dietary patterns and reduction of abdominal obesity in primary prevention, especially in subjects with cardiovascular risk factors.