Diet Quality Predictors of Physical Function, Activity, and Psychosocial Health Among Individuals With a History of Stroke

Objectives: Stroke is a leading cause of disability in the US, often altering one's physical function, activity, and psychosocial health. Ability to access and consume food may also be limited following stroke, impacting diet quality (DQ). The objective of the present study was to determine diet quality predictors of stroke survivors' physical function, physical activity (PA), and psychosocial health to inform nutrition interventions aiming to improve health-related quality of life post-stroke. Methods: A cross-sectional evaluation of stroke survivors (n=632) in the 2011-2018 National Health and Nutrition Examination Survey (NHANES) is presented. Healthy Eating Index (HEI)-2015 scores were calculated from two 24-hour recalls. To account for the complex sampling design of NHANES, weighted binary logistic, ordinal, and linear regression were used as appropriate to evaluate component and total HEI scores in relation to physical function, activities of daily living, participation in social activities, meeting PA recommendations, and Patient Health Questionnaire responses. Age, gender, race, education level, and income-to-poverty ratio were also included in the models. Results: A higher greens and beans HEI score was associated with a lower odds of presence of depressive symptoms (OR=0.727, p=0.006). Higher mono- and poly-unsaturated and saturated fatty acid HEI scores were associated with lower odds of difficulty participating in social activities (OR=0.903, p=0.014; and OR=0.924, p=0.038, respectively). A higher income-to-poverty ratio was also associated with lower odds of difficulty participating in social activities in these models (OR=0.795, p=0.023; and OR=0.791, p=0.027, respectively). A higher whole fruit HEI score was associated with a higher odds of meeting PA recommendations (OR=1.190, p=0.040). Conclusions: DQ components emphasized in heart-healthy diets like the Mediterranean diet were significant predictors of measures of physical and psychosocial function in stroke survivors. However, income may be a limitation to meeting these dietary recommendations within stroke. Stroke rehabilitation interventions may benefit from Mediterranean diet-focused messages that incorporate food assistance to mitigate financial barriers. Funding Sources: None.