Associations of dietary live microbe intake with all-cause and cardiovascular mortality in middle-aged and older US stroke survivors: a prospective cohort study from NHANES 2003-2018.

内容摘要

The relationships of dietary live microbe intake (DLMI) with all-cause mortality (ACM) and cardiovascular mortality (CVM) in stroke patients remain unclear. This study examined the links of DLMI with ACM and CVM in stroke patients. A secondary analysis of the publicly available, fixed-cycle National Health and Nutrition Examination Survey (NHANES) dataset was performed in this study. As such, no a priori sample size calculation was performed. All eligible participants aged ≥ 40 years with complete data from the 2003-2018 survey cycles served as the analytical sample. The stroke history was based on self-report without further specification of subtype (ischemic vs. hemorrhagic). Participants were followed until December 31, 2019, with a median follow-up of 6.0 years. DLMI was estimated based on a single 24-hour dietary recall and classified into low, medium, and high intake categories as an indicator of a dietary pattern characterized by the consumption of live-microbe-rich foods. Cox models, stratified, and sensitivity analyses were employed to ascertain the links of DLMI with ACM and CVM in stroke patients. This study included 1,313 stroke patients, among whom 539 experienced ACM and 209 experienced CVM. In the Cox models, compared with low DLMI, high DLMI had a lower incidence of ACM [Model 1: HR = 0.63 (95% CI: 0.44-0.91, p = 0.013); Model 2: HR = 0.61 (95% CI: 0.44-0.84, p = 0.003); Model 3: HR = 0.63 (95% CI: 0.46-0.88, p = 0.007)]. However, no significant association was observed between high DLMI and CVM. Subgroup and sensitivity analyses generally supported the robustness of these results. Higher DLMI was associated with a lower risk of ACM among stroke survivors in this study. These exploratory findings highlight DLMI as a candidate for further investigation in dietary intervention strategies for this population. Future prospective studies are needed to establish its role and optimal implementation.