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Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries.

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Clarke, Robert 
Schmidt, Julie A 
Huybrechts, Inge 
Noor, Urwah 


PURPOSE: Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study. METHODS: We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants. RESULTS: After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing. CONCLUSION: Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure.


Acknowledgements: The authors thank all participants in the EPIC cohort for their invaluable contribution to the study.


Amino acids, Dietary protein, Haemorrhagic stroke, Ischaemic stroke, Nutritional epidemiology, Prospective cohort, Humans, Stroke, Brain Ischemia, Hemorrhagic Stroke, Prospective Studies, Amino Acids, Proline, Ischemic Stroke, Risk Factors

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Eur J Nutr

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Springer Science and Business Media LLC
Medical Research Council (G1000143)
Medical Research Council (G0800270)
European Research Council (268834)
Medical Research Council (MC_UU_12015/1)
Medical Research Council (MC_UU_12015/5)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
MRC (MC_UU_00006/3)
Medical Research Council (G0800270/1)