Supplementary Material for: Dietary Flavonoid Intake and Carotid Calcification in Patients with Ischemic Stroke

Introduction: Owing to the antioxidant and anti-inflammatory effects, flavonoids can influence the initiation and development of atherosclerosis, but the underlying mechanisms remain largely undetermined. This study aimed to evaluate the associations between dietary flavonoids and carotid calcification in patients with ischemic stroke. Methods: This study screened consecutive patients with ischemic stroke via Nanjing Stroke Registry Program during February 2016 and April 2021. A semi-quantitative food frequency questionnaire was used to evaluate dietary consumption of flavonoids and other nutritional components. Presence and degree of carotid calcification were determined according to Agatston scores on computer tomography angiography. Logistic regression was performed to evaluate the association between dietary flavonoids (total flavonoids, flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and isoflavones) and carotid calcification. Results: Of the 601 enrolled patients, 368 (61.2%) were detected with carotid calcification. Patients with high intake of total flavonoids (the fifth quintile) had a 52% lower carotid calcification risk than those with low intake (the first quintile; OR =0.48; 95% CI, 0.26 -0.90; P =0.007 for trends) after adjusting for major confounders. Patients with high intake of flavan-3-ols (the fifth quintile) had a 51% lower carotid calcification risk than those with low intake (the first quintile; OR =0.49; 95% CI, 0.25 -0.97; P =0.016 for trends). Discussion/Conclusion: Dietary flavonoid intake is associated with carotid calcification, and, therefore, may influence the risk of stroke occurrence and recurrence.引言：类黄酮（flavonoids）具有抗氧化与抗炎活性，可影响动脉粥样硬化的发生与发展，但其具体潜在机制尚未完全明确。本研究旨在探讨缺血性脑卒中患者膳食摄入类黄酮与颈动脉钙化之间的关联。 方法：本研究于2016年2月至2021年4月期间，通过南京脑卒中登记项目（Nanjing Stroke Registry Program）筛选连续性缺血性脑卒中患者。采用半定量食物频率问卷（semi-quantitative food frequency questionnaire）评估受试者的类黄酮及其他营养成分膳食摄入量。根据计算机断层血管造影（computer tomography angiography）所得的阿加斯顿评分（Agatston scores）判定颈动脉钙化的存在与否及其严重程度。采用逻辑回归分析评估膳食类黄酮（总类黄酮、黄酮醇、黄酮、黄烷酮、黄烷-3-醇、花青素及异黄酮）与颈动脉钙化之间的关联。 结果：纳入的601例患者中，368例（61.2%）检出颈动脉钙化。校正主要混杂因素后，总类黄酮摄入量最高组（第五五分位组）患者的颈动脉钙化风险较最低组（第一五分位组）降低52%（比值比（Odds Ratio，OR）=0.48；95%置信区间（Confidence Interval，CI）：0.26~0.90；趋势检验P=0.007）。黄烷-3-醇摄入量最高组（第五五分位组）患者的颈动脉钙化风险较最低组（第一五分位组）降低51%（OR=0.49；95%CI：0.25~0.97；趋势检验P=0.016）。 讨论与结论：膳食类黄酮摄入量与颈动脉钙化存在关联，因此或可影响脑卒中发生及复发风险。