{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:09:01Z","timestamp":1788930541866,"version":"build-2803163510"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diet quality and biological ageing have each been linked to stroke, but whether the association between accelerated biological ageing and stroke reflects poorer diet quality, or is largely independent of it, is unknown. Treating diet quality as an upstream determinant of biological ageing, we examined the association of Phenotypic Age (PhenoAge) acceleration with stroke and how far it changed after adjusting for diet quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 400,695 UK Biobank participants, 21,754 NHANES adults and 312 adults from a hospital-based dataset (Second Xiangya Hospital). PhenoAge was derived from chronological age and nine biomarkers, and PhenoAge acceleration was PhenoAge minus chronological age. Diet quality was assessed by a Healthy Diet Score (UK Biobank, hospital) and the Healthy Eating Index-2020 (NHANES). Outcomes were incident stroke (record linkage) in the UK Biobank and prevalent stroke in NHANES (self-reported) and the hospital dataset (physician-documented). All models estimated associations; no risk-prediction model was developed or externally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median 15.83\u202fyears, 11,345 UK Biobank participants developed incident stroke; 729 NHANES and 58 hospital participants had prevalent stroke. Each 1-year increase in PhenoAge acceleration was associated with incident stroke in the UK Biobank (HR 1.060, 95% CI 1.056\u20131.064) and with prevalent stroke in NHANES (OR 1.058, 1.037\u20131.080) and the hospital dataset (OR 1.082, 1.002\u20131.169). In the UK Biobank the association was confined to ischaemic stroke (HR 1.066, 1.061\u20131.071) but showed no association with haemorrhagic stroke (HR 1.009, 0.998\u20131.020). Better diet quality was associated with lower PhenoAge acceleration (UK Biobank, high versus low adherence: \u22120.746\u202fyears, \u22120.811 to \u22120.681; NHANES: \u22120.695\u202fyears, \u22120.781 to \u22120.609). Nevertheless, adding diet quality changed the HR\/OR only modestly (11.9, 10.4 and 0.7%; HR 1.060\u202f\u2192\u202f1.053, OR 1.058\u202f\u2192\u202f1.052 and 1.082\u202f\u2192\u202f1.081).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Better diet quality was associated with slower biological ageing, yet accelerated biological ageing was associated with stroke, largely independently of measured diet quality. Because outcome definitions differed and these analyses compare adjusted models rather than decompose a causal pathway, the three estimates are complementary rather than replicative and do not support inferences about prevention or clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1895132","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:43:45Z","timestamp":1788929025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biological ageing, diet quality, and stroke: evidence from two population-based studies and an exploratory hospital-based Chinese cross-sectional dataset"],"prefix":"10.3389","volume":"13","author":[{"given":"Yiming","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"23","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/s0140-6736(16)30506-2","article-title":"Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (Interstroke): a case-control study","volume":"388","author":"O'donnell","year":"2016","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1001\/jamainternmed.2020.2176","article-title":"Association between healthy eating patterns and risk of cardiovascular disease","volume":"180","author":"Shan","year":"2020","journal-title":"JAMA Intern Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts","volume":"378","author":"Estruch","year":"2018","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"k4168","DOI":"10.1136\/bmj.k4168","article-title":"Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306\u202f473 UK biobank participants","volume":"363","author":"Rutten-Jacobs","year":"2018","journal-title":"BMJ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e1002718","DOI":"10.1371\/journal.pmed.1002718","article-title":"A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: a cohort study","volume":"15","author":"Liu","year":"2018","journal-title":"PLoS Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1136\/jnnp-2023-331917","article-title":"Clinical biomarker-based biological ageing and future risk of neurological disorders in the UK biobank","volume":"95","author":"Mak","year":"2024","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e14427","DOI":"10.1111\/acel.14427","article-title":"Accelerated biological aging, healthy behaviors, and genetic susceptibility with incidence of stroke and its subtypes: a prospective cohort study","volume":"24","author":"Zhang","year":"2025","journal-title":"Aging Cell"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1093\/ajcn\/nqab307","article-title":"Healthy eating patterns and epigenetic measures of biological age","volume":"115","author":"Kresovich","year":"2022","journal-title":"Am J Clin Nutr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1186\/s12937-024-01017-0","article-title":"Associations of healthy eating patterns with biological aging: national health and nutrition examination survey (NHANES) 1999-2018","volume":"23","author":"Wang","year":"2024","journal-title":"Nutr J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/s0140-6736(05)66379-9","article-title":"Compared to what? 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