{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:39Z","timestamp":1783660419578,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Objective<\/jats:title>\n To examine whether long-term dietary background is associated with post-stroke outcomes in patients with large-artery atherosclerotic cerebral infarction (LAA-CI), and to explore the relationship between serum polyunsaturated fatty acid (PUFA) profiles and neurological, functional, and neuropsychiatric recovery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective multicenter cohort study enrolled 410 patients with LAA-CI admitted to the neurology departments of two hospitals in Zhejiang Province, China, between June 2022 and December 2024. Patients were stratified by long-term dietary background into a high-fish\/seafood dietary group (\n n<\/jats:italic>\n = 210) and a mixed\/omnivorous inland dietary group (\n n<\/jats:italic>\n = 200). All patients underwent 1-year follow-up with assessment of modified Rankin Scale (mRS) score, poor functional outcome (mRS &gt; 2), change in NIHSS score (\u0394NIHSS), post-stroke depression (HAMD), and post-stroke cognitive impairment (MMSE). In a representative subgroup (\n n<\/jats:italic>\n = 100), serum PUFA profiling was performed by gas chromatography-mass spectrometry. Multivariable logistic and linear regression models and ordinal trend analyses were applied to quantify associations between dietary background, PUFA indices, and clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline demographic and major clinical characteristics were comparable between the two groups. At 1-year follow-up, the island group showed lower mRS scores, a lower incidence of poor functional outcomes, and greater neurological improvement (all\n P<\/jats:italic>\n &lt; 0.05), along with lower rates of post-stroke depression and cognitive impairment (all\n P<\/jats:italic>\n &lt; 0.01) compared with the inland group. In the PUFA subgroup, the island group exhibited higher \u03c9-3 levels and lower \u03c9-6\/\u03c9-3 ratios (both\n P<\/jats:italic>\n &lt; 0.001). Further analyses demonstrated that higher \u03c9-6\/\u03c9-3 ratios were associated with increasing risks of poor functional outcome, post-stroke depression, and cognitive impairment (all\n P<\/jats:italic>\n for trend &lt; 0.05), and were negatively correlated with \u0394NIHSS (\u03b2 = \u22120.34,\n P<\/jats:italic>\n = 0.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Differences in long-term dietary background are associated with heterogeneity in post-stroke recovery. The \u03c9-6\/\u03c9-3 ratio may represent a metabolic marker linked to functional, neurological, and neuropsychiatric outcomes after stroke, with potential implications for risk stratification and follow-up management, providing a novel research direction for post-stroke risk stratification and follow-up management.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1864966","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:04Z","timestamp":1783657444000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary background, serum polyunsaturated fatty acid profiles, and 1-year outcomes after large-artery atherosclerotic stroke: a multicenter cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoci","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Neurology, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daijun","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurology, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guogu","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Neurology, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuri","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinyan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nutrition, First People's Hospital of Daishan County","place":["Zhoushan, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12944-025-02454-4","article-title":"Efficacy of an avocado-based Mediterranean diet on serum lipids for secondary prevention after ischemic stroke: a randomized phase 2 controlled pilot trial","volume":"24","author":"Olavarr\u00eda","year":"2025","journal-title":"Lipids Health Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.clnesp.2023.03.012","article-title":"Effect of omega-3 fatty acid ethyl esters on postprandial arterial elasticity in patients with familial hypercholesterolemia","volume":"55","author":"Ying","year":"2023","journal-title":"Clinical Nutrition ESPEN."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1016\/S0140-6736(22)00122-2","article-title":"Long-term secondary prevention of cardiovascular disease with a mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial","volume":"399","author":"Delgado-Lista","year":"2022","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1056\/NEJMoa2513032","article-title":"Fish-oil supplementation and cardiovascular events in patients receiving hemodialysis","volume":"394","author":"Lok","year":"2026","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1161\/CIRCULATIONAHA.121.056805","article-title":"Deep lipidomics in human plasma: cardiometabolic disease risk and effect of dietary fat modulation","volume":"146","author":"Eichelmann","year":"2022","journal-title":"Circulation."},{"key":"B6","doi-asserted-by":"publisher","first-page":"100037","DOI":"10.1016\/j.jnha.2024.100037","article-title":"Effects of vitamin D, omega-3 and a simple strength exercise programme in cardiovascular disease prevention: the DO-HEALTH randomized controlled trial","volume":"28","author":"Gaengler","year":"2024","journal-title":"J Nutr Health Aging."},{"key":"B7","doi-asserted-by":"publisher","first-page":"4235","DOI":"10.3390\/nu15194235","article-title":"Marine n-3 fatty acids and prevention of cardiovascular disease: a novel analysis of the VITAL trial using win ratio and hierarchical composite outcomes","volume":"15","author":"Ogata","year":"2023","journal-title":"Nutrients."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0300844","DOI":"10.1371\/journal.pone.0300844","article-title":"Mediterranean diet effects on vascular health and serum levels of adipokines and ceramides","volume":"19","author":"Daidone","year":"2024","journal-title":"PLoS ONE."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/j.ajcnut.2025.02.028","article-title":"A Bayesian analysis of the VITAL trial: effects of \u03c9-3 fatty acid supplementation on cardiovascular events","volume":"121","author":"Hamaya","year":"2025","journal-title":"Am J Clin Nutr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1089\/neu.2025.0126","article-title":"A high omega-3, low omega-6 diet reduces headache frequency and intensity in persistent post-traumatic headache: a randomized trial","volume":"42","author":"Zamora","year":"2025","journal-title":"J Neurotrauma."},{"key":"B11","doi-asserted-by":"publisher","first-page":"120228","DOI":"10.1016\/j.atherosclerosis.2025.120228","article-title":"Differential cardiovascular impact of \u03c9-3 fatty acid in patients at high cardiovascular risk in Asians versus non-Asians: sub-analysis of the strength randomized clinical trial","volume":"408","author":"Wang","year":"2025","journal-title":"Atherosclerosis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2268","DOI":"10.1001\/jama.2020.22258","article-title":"Effect of high-dose omega-3 fatty acids vs. corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial","volume":"324","author":"Nicholls","year":"2020","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1056\/NEJMoa1811403","article-title":"Marine n-3 fatty acids and prevention of cardiovascular disease and cancer","volume":"380","author":"Manson","year":"2019","journal-title":"N Engl J Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1161\/CIRCULATIONAHA.120.052209","article-title":"Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction: a randomized, controlled trial","volume":"143","author":"Kalstad","year":"2021","journal-title":"Circulation."},{"key":"B15","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/joim.13442","article-title":"Changes in eicosapentaenoic acid and docosahexaenoic acid and risk of cardiovascular events and atrial fibrillation: a secondary analysis of the OMEMI trial","volume":"291","author":"Myhre","year":"2022","journal-title":"J Intern Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12916-025-04587-w","article-title":"Urinary polyphenol signature of the Mediterranean diet is associated with lower cardiovascular disease risk: the PREDIMED trial","volume":"24","author":"Dom\u00ednguez-L\u00f3pez","year":"2025","journal-title":"BMC Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.ahj.2025.08.021","article-title":"Extra-virgin olive oil and additional cardiovascular outcomes in the PREDIMED trial: an outcome-wide perspective","volume":"291","author":"de Rojas","year":"2026","journal-title":"Am Heart J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1161\/CIRCULATIONAHA.123.065520","article-title":"Randomized trial for evaluation in secondary prevention efficacy of combination therapy-statin and eicosapentaenoic acid (RESPECT-EPA)","volume":"150","author":"Miyauchi","year":"2024","journal-title":"Circulation."},{"key":"B19","doi-asserted-by":"publisher","first-page":"117556","DOI":"10.1016\/j.atherosclerosis.2024.117556","article-title":"Remnant cholesterol, LDL cholesterol, and apoB absolute mass changes explain results of the PROMINENT trial","volume":"393","author":"Doi","year":"2024","journal-title":"Atherosclerosis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"776","DOI":"10.3390\/nu17050776","article-title":"Nutrition and lifestyle interventions in managing dyslipidemia and cardiometabolic risk","volume":"17","author":"Berisha","year":"2025","journal-title":"Nutrients."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e038656","DOI":"10.1161\/JAHA.124.038656","article-title":"Cardiovascular outcomes with icosapent ethyl by baseline low-density lipoprotein cholesterol: a secondary analysis of the REDUCE-IT randomized trial","volume":"14","author":"Aggarwal","year":"2025","journal-title":"J Am Heart Assoc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.3390\/nu17132088","article-title":"The effects of omega-3 supplementation combined with strength training on neuro-biomarkers, inflammatory and antioxidant responses, and the lipid profile in physically healthy adults","volume":"17","author":"Okut","year":"2025","journal-title":"Nutrients."},{"key":"B23","doi-asserted-by":"publisher","first-page":"100770","DOI":"10.1016\/j.jlr.2025.100770","article-title":"Inflammatory markers after supplementation with marine n-3 or plant n-6 PUFAs: a randomized double-blind crossover study","volume":"66","author":"Grytten","year":"2025","journal-title":"J Lipid Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"5721167","DOI":"10.1155\/2022\/5721167","article-title":"The effect of oleoylethanolamide (OEA) add-on treatment on inflammatory, oxidative stress, lipid, and biochemical parameters in the acute ischemic stroke patients: randomized double-blind placebo-controlled study","volume":"2022","author":"Sabahi","year":"2022","journal-title":"Oxid Med Cell Longev."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/j.amjcard.2005.11.025","article-title":"Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions","volume":"97","author":"O'Keefe","year":"2006","journal-title":"Am J Cardiol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1864966\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:05Z","timestamp":1783657445000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1864966\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":25,"alternative-id":["10.3389\/fneur.2026.1864966"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1864966","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"1864966"}}