The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here:

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Emily Sonestedt

Emily Sonestedt

Associate senior lecturer

Emily Sonestedt

Components of a healthy diet and different types of physical activity and risk of atherothrombotic ischemic stroke : A prospective cohort study


  • Anna Johansson
  • Stefan Acosta
  • Pascal M. Mutie
  • Emily Sonestedt
  • Gunnar Engström
  • Isabel Drake

Summary, in English

Background: Diet and physical activity (PA) are modifiable risk factors thought to influence the risk of ischemic stroke (IS). However, few studies have examined their effect on different subtypes of IS. Aim: To examine components of overall diet quality and different types of PA in relation to the risk of atherothrombotic IS (aIS). Materials and methods: The study population included 23,797 participants (mean age 58 years; 63% women) from the Malmö Diet and Cancer Study cohort. Participants were enrolled between 1991 and 1996 and followed until end of 2016 (median follow-up 21.5 years). Incident aIS events were identified using national registries (total cases 1,937). Measures of PA (total, leisure-time, occupational, and domestic) were assessed using a baseline questionnaire and dietary intakes were estimated using a modified diet history method. Overall diet quality was assessed using a diet quality index. Intake of key food groups and beverages associated with overall diet quality were investigated separately. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression models adjusting for confounders. Results: A high diet quality with high intake of fruit and vegetables, fish and shellfish and low intake of sugar-sweetened beverages and red and processed meat compared to a low diet quality was associated with lower risk of aIS (HR = 0.82, 95% CI = 0.69–0.97; p = 0.015). Leisure-time PA was associated with reduced risk of aIS (HR = 0.95 per SD increase in MET-hours/week, 95% CI = 0.91–0.99; p = 0.028) with null associations observed for total, occupational and domestic PA level. We observed no significant interaction between diet and PA on the risk of aIS. The standardized 20-year risk of aIS among subjects with low leisure-time PA and low diet quality was 8.1% compared to 6.1% among those with high leisure-time PA and high diet quality. Conclusion: Several components of a healthy diet and being physically active may reduce the risk of aIS, however, the absolute risk reduction observed was modest. A high diet quality seemed to have a risk reducing effect regardless of level of PA suggesting that individuals with a sedentary lifestyle may still gain some positive health benefits through a healthy diet.


  • Vascular Diseases - Clinical Research
  • Genetic and Molecular Epidemiology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Nutrition Epidemiology
  • EpiHealth: Epidemiology for Health
  • Cardiovascular Research - Epidemiology
  • Diabetes - Cardiovascular Disease
  • LUCC: Lund University Cancer Centre

Publishing year





Frontiers in Cardiovascular Medicine



Document type

Journal article


Frontiers Media S. A.


  • Nutrition and Dietetics


  • atherothrombotic ischemic stroke
  • cohort study
  • epidemiology
  • healthy diet
  • lifestyle
  • physical activity



Research group

  • Vascular Diseases - Clinical Research
  • Genetic and Molecular Epidemiology
  • Nutrition Epidemiology
  • Cardiovascular Research - Epidemiology
  • Diabetes - Cardiovascular Disease


  • ISSN: 2297-055X