Journal List > J Nutr Health > v.48(2) > 1081383

J Nutr Health. 2015 Apr;48(2):167-179. Korean.
Published online April 30, 2015.  https://doi.org/10.4163/jnh.2015.48.2.167
© 2015 The Korean Nutrition Society
Association between intakes of minerals (potassium, magnesium, and calcium) and diet quality and risk of cerebral atherosclerosis in ischemic stroke patients
Jihyun Son,1 Han-Saem Choe,2 Ji-Yun Hwang,3 Tae-Jin Song,4 Yoonkyung Chang,4 Yong-Jae Kim,4 and Yuri Kim1,2
1Department of Clinical Nutrition, The Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 120-750, Korea.
2Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea.
3Nutrition Education Major Graduate School of Education, Sangmyung University, Seoul 110-743, Korea.
4Stroke Center, Department of Neurology, Ewha Womans University, School of Medicine, Seoul 158-710, Korea.

To whom correspondence should be addressed. tel: 02-3277-4485, Email: yuri.kim@ewha.ac.kr
Received March 10, 2015; Revised April 08, 2015; Accepted April 15, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

This study was conducted to evaluate the association between intakes of potassium, magnesium, and calcium and diet quality in ischemic stroke patients.

Methods

This study analyzed data from 285 subjects recruited from February 2011 to August 2014 in Seoul, Korea. Nutrition intakes were obtained from a semi-quantitative food frequency questionnaire composed of 111 food items. The subjects were divided into 4 groups by quartiles according to intakes of potassium, magnesium, and calcium. Index of Nutritional Quality (INQ), Mean Adequacy Ratio (MAR), and DQI-International (DQI-I) were analyzed for assessment of diet quality.

Results

We found a positive association of intakes of these three minerals with MAR and DQI-I after adjustment for age, sex, education level, smoking, atrial fibrillation, and total energy intake. However, total moderation of DQI-I score in the Q4 group was significantly lower than that of the Q1 group. The age, sex, education level, and smoking, atrial fibrillation, and total energy intake-adjusted odds ratios of extensive cerebral atherosclerosis were inversely associated with intake of magnesium (Ptrend = 0.0204). However, this association did not exist with intakes of potassium and calcium.

Conclusion

Potassium, magnesium, and calcium rich and high quality diet could be associated with decreased risk of ischemic stroke, in part, via effect on extensive cerebral atherosclerosis.

Keywords: ischemic stroke; mineral intake; diet quality; cerebral atherosclerosis

Figures


Fig. 1
Comparison of intake of potassium, magnesium, and calcium with Dietary Reference Intakes for Koreans (KDRIs), 2010.
Click for larger image

Tables


Table 1
Components of Diet Quality Index-International (DQI-I)20
Click for larger image


Table 2
General characteristics of subjects according to intakes of potassium, magnesium and calcium
Click for larger image


Table 3
Anthropometric and biochemical markers according to intakes of potassium, magnesium, and calcium
Click for larger image


Table 4
Daily food intakes by food group according to the intakes of potassium, magnesium, and calcium
Click for larger image


Table 5
Daily nutrient intake according to intakes of potassium, magnesium and calcium1)
Click for larger image


Table 6
The nutritional quality (INQ and MAR) of subjects according to intakes of potassium, magnesium, and calcium
Click for larger image


Table 7
Diet Quality Index-International (DQI-I) score of subjects according to the intakes of potassium, magnesium, and calcium
Click for larger image


Table 8
The Pearsons's correlation coefficients between the intakes of potassium, magnesium, and calcium and diet quality scores (MAR, DQI-I)
Click for larger image


Table 9
Odds ratio (with 95% CIs) of extensive cerebral atherosclerosis according to intakes of potassium, magnesium and calcium1)
Click for larger image

References
1. World Health Organization (CH). The top 10 causes of death [Internet]. Geneva: World Health Organization; 2013 [cited 2015 Mar 11].
2. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014;129(3):399–410.
3. Statistics Korea. 2005 Annual data report, census population and population projection. Daejeon: Statistics Korea; 2006.
4. Mower DM. Brain attack. Treating acute ischemic CVA. Nursing 1997;27(3):34–39.
5. Prospective studies collaboration. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995;346(8991-8992):1647–1653.
6. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Epidemiology and Prevention; Council for High Blood Pressure Research; Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2011;42(2):517–584.
7. Massey LK. Dairy food consumption, blood pressure and stroke. J Nutr 2001;131(7):1875–1878.
8. Park Y, Park S, Yi H, Kim HY, Kang SJ, Kim J, Ahn H. Low level of n-3 polyunsaturated fatty acids in erythrocytes is a risk factor for both acute ischemic and hemorrhagic stroke in Koreans. Nutr Res 2009;29(12):825–830.
9. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006;367(9507):320–326.
10. Monarca S, Donato F, Zerbini I, Calderon RL, Craun GF. Review of epidemiological studies on drinking water hardness and cardiovascular diseases. Eur J Cardiovasc Prev Rehabil 2006;13(4):495–506.
11. Ma J, Folsom AR, Melnick SL, Eckfeldt JH, Sharrett AR, Nabulsi AA, Hutchinson RG, Metcalf PA. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study. J Clin Epidemiol 1995;48(7):927–940.
12. Ohira T, Peacock JM, Iso H, Chambless LE, Rosamond WD, Folsom AR. Serum and dietary magnesium and risk of ischemic stroke: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 2009;169(12):1437–1444.
13. Brancati FL, Appel LJ, Seidler AJ, Whelton PK. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. A randomized, double-blind, placebo-controlled trial. Arch Intern Med 1996;156(1):61–67.
14. Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study. Stroke 2001;32(7):1473–1480.
15. Choi MJ. Effects of exercise and calcium intake on blood pressure and blood lipids in postmenopausal women. Korean J Nutr 2001;34(4):417–425.
16. Umesawa M, Iso H, Ishihara J, Saito I, Kokubo Y, Inoue M, Tsugane S. JPHC Study Group. Dietary calcium intake and risks of stroke, its subtypes, and coronary heart disease in Japanese: the JPHC Study Cohort I. Stroke 2008;39(9):2449–2456.
17. Ackley S, Barrett-Connor E, Suarez L. Dairy products, calcium, and blood pressure. Am J Clin Nutr 1983;38(3):457–461.
18. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002;13(1):3–9.
19. Oh SY. Analysis of methods on dietary quality assessment. Korean J Community Nutr 2000;5 2 Suppl:362–367.
20. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 2003;133(11):3476–3484.
21. Persson MD, Brismar KE, Katzarski KS, Nordenström J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 2002;50(12):1996–2002.
22. Dávalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, Suñer R, Genís D. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996;27(6):1028–1032.
23. Lim H, Choue R. Dietary pattern, nutritional density, and dietary quality were low in patients with cerebral infarction in Korea. Nutr Res 2011;31(8):601–607.
24. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325(7):445–453.
25. Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators. Design, progress and challenges of a doubleblind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology 2003;22(2):106–117.
26. Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. Pediatrics 1988;82(3):309–318.
27. Oh SY, Kim EM, Shin MH, Lee SH, Kim JE, Lee HS, Jo JS, Kim WY. Development and validation of food frequency questionnaire for adults; The Proceedings of the Korean Society of Health Promotion Annual Spring Conference; 2007 May 19; Seoul. Seoul: Korean Society of Health Promotion; 2007.
28. The Korean Nutrition Society. Dietary reference intakes for Koreans, 1st revision. Seoul: The Korean Nutrition Society; 2010.
29. Song TJ, Kim J, Song D, Nam HS, Kim YD, Lee HS, Heo JH. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation. Neurology 2014;83(15):1308–1315.
30. Hansen RG, Wyse BW. Expression of nutrient allowances per 1,000 kilocalories. J Am Diet Assoc 1980;76(3):223–227.
31. Guthrie HA, Scheer JC. Validity of a dietary score for assessing nutrient adequacy. J Am Diet Assoc 1981;78(3):240–245.
32. Shin HH. Korean guidelines of hyperlipidemia treatment for prevention of atherosclerosis. J Korean Soc Lipidol Atheroscler 2002;12(3):226–228.
33. Drewnowski A. Concept of a nutritious food: toward a nutrient density score. Am J Clin Nutr 2005;82(4):721–732.
34. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, Carolei A. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005;36(6):1115–1119.
35. Park JA, Yoon JS. The effect of habitual calcium and sodium intakes on blood pressure regulating hormone in free-liveing hypertensive women. Korean J Nutr 2001;34(4):409–416.
36. Cho SH. Dietary lipid and atherosclerosis. J Korean Soc Food Nutr 1994;23(1):170–179.
37. Lee H, Kang B, Chung HK, Do HJ, Shim J, Bae SH, Kang SM, Shin MJ. The assessment for nutrient intakes of Korean patients with heart failure. Korean J Nutr 2010;43(3):224–232.
38. FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke 2003;34(6):1450–1456.
39. Davis JP, Wong AA, Schluter PJ, Henderson RD, O'Sullivan JD, Read SJ. Impact of premorbid undernutrition on outcome in stroke patients. Stroke 2004;35(8):1930–1934.
40. Oh KW, Nam CM, Park JH, Yoon JY, Shim JS, Lee KH, Suh I. A case-control study on dietary quality and risk for coronary heart disease in Korean men. Korean J Nutr 2003;36(6):613–621.
41. Larsson SC, Virtamo J, Wolk A. Dietary fats and dietary cholesterol and risk of stroke in women. Atherosclerosis 2012;221(1):282–286.
42. Altura BT, Brust M, Bloom S, Barbour RL, Stempak JG, Altura BM. Magnesium dietary intake modulates blood lipid levels and atherogenesis. Proc Natl Acad Sci U S A 1990;87(5):1840–1844.
43. Larsson SC, Orsini N, Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. Am J Clin Nutr 2012;95(2):362–366.