Association between plain water intake and stroke among American adults: National health and nutrition examination survey 1999-2020

BACKGROUND: Stroke is a leading cause of disability and mortality. While plain water intake has been linked to stroke-related risk factors-including hypertension, diabetes, and obesity-its direct relationship with stroke remains unclear. This study aimed to evaluate the association between plain water intake and stroke. METHODS: We analyzed data from adults aged over 20 years who participated in the National Health and Nutrition Examination Survey between 1999 and 2020. Information on stroke status, plain water intake, and other relevant variables was collected. We used weighted logistic regression models, restricted cubic spline analysis, stratified analysis with interaction testing, threshold effect analysis, and sensitivity analyses to evaluate the association. RESULTS: A total of 29,489 participants were included, of whom 1,268 (3.18 %) reported having been diagnosed with stroke. Significant differences in stroke prevalence and participant characteristics were observed across quartiles of water intake (P < 0.001). Multivariable regression indicated a negative association between plain water intake and stroke risk in all adjusted models. The relationship followed an l-shaped curve, with an inflection point at approximately 1,382.86 mL/day (non-linearity, P = 0.005). For those consuming ≤1,382.86 mL/day, the odds ratio for stroke was 0.97 (95 % CI: 0.93 - 0.99, P = 0.03). Subgroup, interaction, and sensitivity analyses supported the stability of the results. CONCLUSION: The association between plain water intake and stroke among U.S. adults follows an L-shaped curve, with an inflection point near 1,382.86 mL/day. Further research is warranted to investigate the mechanisms underlying this association.