Following a Mediterranean-style diet was associated with a lower risk of stroke over more than two decades of follow-up, according to a large study focused on women. The findings add to evidence that long-term eating patterns may play a role in brain health, while stopping short of proving cause and effect.
The study, published in Neurology, followed 105,614 women with no history of stroke at baseline for an average of 21 years. Researchers examined how closely participants adhered to a Mediterranean diet and tracked the occurrence of different stroke types over time.
Women with the highest adherence to the diet were 18% less likely to experience any stroke compared with those with the lowest adherence. The association extended to both major stroke subtypes, with a 16% lower risk of ischemic stroke and a 25% lower risk of hemorrhagic stroke.
Ischemic strokes, the most common type, occur when blood flow to part of the brain is blocked. Hemorrhagic strokes result from bleeding in the brain and are less frequently examined in large dietary studies. The authors noted that relatively few prior studies have assessed dietary patterns in relation to hemorrhagic stroke risk.
The Mediterranean diet score used in the study reflected higher intake of vegetables, fruits, legumes, whole grains, fish and olive oil, along with lower intake of red meat, dairy products and saturated fats. Participants received points based on whether their intake of these foods was above or below the population average, producing scores that ranged from zero to nine.
Over the course of the study, 4,083 strokes occurred, including 3,358 ischemic strokes and 725 hemorrhagic strokes. After adjusting for factors known to influence stroke risk, such as smoking, physical activity and high blood pressure, the association between higher Mediterranean diet adherence and lower stroke risk remained.
The researchers emphasized that the findings show an association rather than proof that diet directly prevents stroke. Dietary intake was self-reported, which can introduce error, and eating patterns may have changed during the long follow-up period.
Still, the results support the idea that overall eating patterns, rather than individual foods or nutrients, may matter for long-term brain health. The authors also noted that focusing on diet quality alongside other lifestyle factors could be an important component of stroke prevention strategies.
Stroke remains a leading cause of death and disability worldwide. While no single dietary approach can eliminate risk, the study suggests that sustained adherence to a Mediterranean-style pattern may be linked to lower stroke rates among women over time.
The study was supported by the National Institute of Neurological Disorders and Stroke.