Objective  To analyze the burden level and trend of ischemic stroke attributed to dietary factors in China from 1990 to 2021.

Methods  Based on the Global Burden of Diseases study (GBD) 2021 database, data related to age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years rates (ASDR) associated with ischemic stroke attributed to dietary factors in China from 1990 to 2021 were extracted. The annual percentage change (APC) at the turning points for both the mortality rates and disability-adjusted life year (DALY) rates, as well as the average annual percentage change (AAPC) across the entire study period were calculated utilizing the Joinpoint regression model.

Results  In 2021, the ASMR and ASDR of ischemic stroke attributed to dietary factors in China were 11.00 per 100,000 and 253.69 per 100,000, respectively. Additionally, the ASMR for ischemic stroke related to diet in males was 16.01 per 100,000, and in females it was 7.19 per 100,000. Similarly, the ASDR for males was 344.66 per 100,000, and for females it was 175.39 per 100,000. From 1990 to 2021, the ASMR and ASDR of ischemic stroke attributed to dietary factors in China showed a decreasing trend, with AAPCs of -1.01 [95%CI (-1.27, -0.76)] and -0.95 [95%CI (-1.20, -0.70)], respectively. In the analysis of individual dietary factors, excessive sodium intake, low whole grain consumption, and low fruit consumption were the top three contributors to ASMR and ASDR. The burden of ischemic stroke associated with diets high in processed meat and sugar-sweetened beverages had shown an upward trend during this period in both metrics.

Conclusion  From 1990 to 2021, the burden of diet- related ischemic stroke in China has gradually decreased, but the disease burden in men is much higher than that in women. The disease burden caused by excessive intake of processed meat and sugar-sweetened beverages has increased, which further emphasizes the importance of developing more precise prevention and intervention strategies for different genders and dietary factors.

1.GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990—2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.

2.GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990—2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2133-2161. DOI: 10.1016/S0140-6736(24)00757-8.

3.Ma Q, Li R, Wang L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990—2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021, 6(12): e897-e906. DOI: 10.1016/S2468-2667(21)00228-0.

4.Schmidt-Pogoda A, Strecker JK, Liebmann M, et al. Dietary salt promotes ischemic brain injury and is associated with parenchymal migrasome formation[J]. PLoS One, 2018, 13(12): e0209871. DOI: 10.1371/journal.pone.0209871.

5.Tong TYN, Appleby PN, Key TJ, et al. The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries[J]. Eur Heart J, 2020, 41(28): 2632-2640. DOI: 10.1093/eurheartj/ehaa007.

6.李小辉, 魏思昂, 陈树嘉, 等. 中国城乡居民饮食结构改变与心血管疾病相关性分析[J]. 中国食物与营养, 2023, 29(2): 81-84, 89. [Li XH, Wei SA, Chen SJ, et al. Correlation analysis of dietary structure changes and cardiovascular diseases of Chinese urban and rural residents[J]. Food and Nutrition in China, 2023, 29(2): 81-84, 89.] DOI: 10.19870/j.cnki.11-3716/ts.2023.02.005.

7.GBD 2021 Nervous System Disorders Collaborators. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet Neurol, 2024, 23(4): 344-381. DOI: 10.1016/S1474-4422(24)00038-3.

8.张绍丽, 曹毛毛, 杨帆, 等. 1990—2019年中国人群肝癌各病因疾病负担变化趋势分析[J]. 中华消化外科杂志, 2023, 22(1): 122-130. [Zhang SL, Cao MM, Yang F, et al. Analysis of the change trend of etiological burden of disease of liver cancer in the Chinese population from 1990 to 2019[J]. Chinese Journal of Digestive Surgery, 2023, 22(1): 122-130.] DOI: 10.3760/cma.j.cn115610-20221112-00687.

9.郭恒,朱帅杰,师维,等. 1990—2021年中国非COVID-19下呼吸道感染疾病负担及危险因素分析[J].中国循证医学杂志, 2025, 25(3): 256-264. [Guo H, Zhu SJ, Shi W, et al. Disease burden and risk factors of non-COVID-19 lower respiratory tract infections in China from 1990 to 2021[J]. Chinese Journal of Evidence-Based Medicine, 2025, 25(3): 256-264.] DOI: 10.7507/1672-2531.202406146.

10.Ge R, You S, Zheng D, et al. Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019[J]. Int J Stroke, 2024, 19(6): 665-675. DOI: 10.1177/17474930241237932.

11.马林, 巢宝华, 曹雷, 等. 2007—2017年中国脑卒中流行趋势及特征分析[J]. 中华脑血管病杂志(电子版), 2020, 14(5): 253-258. [Ma L, Chao BH, Cao L, et al. The epidemiology and characteristics of stroke in China from 2007 to 2017: a national analysis[J]. Chinese Journal of Cerebrovascular Diseases (Electronic Edition), 2020, 14(5): 253-258.] DOI: 10.11817/j.issn.1673-9248.2020.05.001.

12.Westenhoefer J. Age and gender dependent profile of food choice[J]. Forum Nutr, 2005, (57): 44-51. DOI: 10.1159/000083753.

13.杨继, 张垚, 马腾, 等. 1990—2019年中国心血管疾病流行现状、疾病负担及发病预测分析[J]. 中国全科医学, 2024, 27(2): 233-244, 252. [Yang J, Zhang Y, Ma T, et al. Epidemic status, disease burden and prediction of cardiovascular diseases in China,1990-2019[J]. Chinese General Practice, 2024, 27(2): 233-244, 252.] DOI: 10.12114/j.issn.1007-9572.2023.0470.

14.Duckles SP, Krause DN. Mechanisms of cerebrovascular protection: estrogen, inflammation and mitochondria[J]. Acta Physiol (Oxf), 2011, 203(1): 149-154. DOI: 10.1111/j.1748-1716.2010.02184.x.

15.Brundtland GH. From the World Health Organization. Reducing risks to health, promoting healthy life[J]. JAMA, 2002, 288(16): 1974. DOI: 10.1001/jama.288.16.1974.

16.Schmidt-Pogoda A, Strecker JK, Liebmann M, et al. Dietary salt promotes ischemic brain injury and is associated with parenchymal migrasome formation[J]. PLoS One, 2018, 13(12): e0209871. DOI: 10.1371/journal.pone.0209871.

17.Islam SU, Ahmed MB, Ahsan H, et al. Recent molecular mechanisms and beneficial effects of phytochemicals and plant-based whole foods in reducing LDL-C and preventing cardiovascular disease[J]. Antioxidants (Basel), 2021, 10(5): 784. DOI: 10.3390/antiox10050784.

18.Surampudi P, Enkhmaa B, Anuurad E, et al. Lipid lowering with soluble dietary fiber[J]. Curr Atheroscler Rep, 2016, 18(12): 75. DOI: 10.1007/s11883-016-0624-z.

19.Wang Y, Zhao R, Wang B, et al. The dose-response associations of sugar-sweetened beverage intake with the risk of stroke, depression, cancer, and cause-specific mortality: a systematic review and Meta-analysis of prospective studies[J]. Nutrients, 2022, 14(4): 777. DOI: 10.3390/nu14040777.

20.de Koning L, Malik VS, Kellogg MD, et al. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men[J]. Circulation, 2012, 125(14): 1735-1741, S1. DOI: 10.1161/CIRCULATIONAHA.111.067017.

21.Aeberli I, Gerber PA, Hochuli M, et al. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial[J]. Am J Clin Nutr, 2011, 94(2): 479-485. DOI: 10.3945/ajcn.111.013540.

22.Kotopoulou S, Zampelas A, Magriplis E. Nitrite and nitrate intake from processed meat is associated with elevated diastolic blood pressure (DBP)[J]. Clin Nutr, 2023, 42(5): 784-792. DOI: 10.1016/j.clnu.2023.03.015.

23.Heianza Y, Ma W, DiDonato JA, et al. Long-term changes in gut microbial metabolite trimethylamine N-Oxide and coronary heart disease risk[J]. J Am Coll Cardiol, 2020, 75(7): 763-772. DOI: 10.1016/j.jacc.2019.11.060.

24.Macho-González A, Garcimartín A, López-Oliva ME, et al. Can meat and meat-products induce oxidative stress?[J]. Antioxidants (Basel), 2020, 9(7): 638. DOI: 10.3390/antiox9070638.