High Mediterranean Diet Adherence: A Robust Tool in Reducing Female Stroke Incidence

The cohort study was published in the journal Neurology Open Access in 2026.

Suboptimal dietary habits are a primary modifiable driver of disability and mortality; while the MeDi is known to mitigate cardiovascular risks, evidence regarding the MeDi’s impact on specific stroke subtypes remains limited. Consequently, the lead author, Ayesha Z. Sherzai, of the Charles R. Drew University of Medicine and Science, Los Angeles, California, and colleagues investigated whether high MeDi adherence correlates with a reduced risk of total, ischemic, and hemorrhagic stroke in women.

The prospective cohort study followed 105,614 women from the California Teachers Study (CTS) for 20.5 years, using a 100-item Block Food Frequency Questionnaire (FFQ) to calculate MeDi adherence scores. Multivariable Cox proportional hazard models determined hazard ratios (HR) and 95% confidence intervals (CI), adjusting for body mass index (BMI), socioeconomic status (SES), and physical activity.

Key Findings of the Study:

The study identified 4,083 incident stroke events, including 3,358 ischemic and 725 hemorrhagic cases.

• The study suggests that the high adherence to a MeDi (scores 6–9) is associated with a statistically significant 18% reduction in the risk of total stroke compared to low adherence (Hazard Ratio [HR] 0.82; 95% CI 0.74–0.92)
• Clinicians should note that a Mediterranean dietary pattern significantly lowers the incidence of ischemic stroke by 16% among women in the highest adherence category (HR 0.84; 95% CI 0.75–0.95).
• The study demonstrates a substantial 25% decrease in the hazard for hemorrhagic stroke for women consistently following MeDi guidelines (HR 0.75; 95% CI 0.58–0.97).
• Each one-unit increase in the MeDi score correlates with a 3% lower risk of total stroke, highlighting a clear dose-response benefit for primary prevention (HR 0.97; 95% CI 0.95–0.99)
• These protective associations remain robust even after adjusting for major vascular risk factors, including BMI, hypertension, diabetes, and atrial fibrillation.

The results suggest that consistent adherence to a Mediterranean dietary pattern provides a robust defense against both major stroke subtypes in women

For clinicians, these findings suggest that nutritional interventions should be prioritized alongside lifestyle management to improve primary stroke prevention outcomes. Emphasizing the consumption of plant-based foods and healthy fats may serve as a critical tool in reducing the long-term risk of cerebrovascular disability.

The study acknowledges that potential limitations include recall bias from self-reported FFQ, misclassification due to dietary shifts over the 20-year follow-up, and the possibility of residual confounding from unmeasured lifestyle factors, all of which likely biased the results toward the null.

Reference

Sherzai AZ, Cauble EL, Spielfogel ES, et al. Mediterranean Diet and the Risk of Stroke Subtypes in Women: The California Teachers Study. Neurol Open Access. 2026;2:e000062. doi:10.1212/WN9.0000000000000062