Objective:

To examine the association between long-term dietary background and 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 recovery.

Approach:

• Study Design: Retrospective multicenter cohort study involving 410 patients with LAA-CI from two hospitals in Zhejiang Province, China.
• Patient Stratification: Patients were divided into a high-fish/seafood dietary group (island group) and a mixed/omnivorous inland dietary group.
• Follow-Up Assessment: Patients underwent a 1-year follow-up assessing modified Rankin Scale (mRS), NIHSS score changes, post-stroke depression, and cognitive impairment.
• Serum PUFA Profiling: In a subgroup of 100 patients, serum PUFA levels were analyzed using gas chromatography-mass spectrometry.
• Statistical Analysis: Multivariable logistic and linear regression models and ordinal trend analyses were used to assess associations.

Key Findings:

• The island group had lower mRS scores and a lower incidence of poor functional outcomes compared to the inland group (all P < 0.05).
• The island group showed greater neurological improvement and lower rates of post-stroke depression and cognitive impairment (all P < 0.01).
• Higher ω-6/ω-3 ratios were linked to increased risks of poor functional outcomes, post-stroke depression, and cognitive impairment (all P for trend < 0.05).

Interpretation:

Limitations:

• Retrospective design may introduce selection bias.
• Dietary assessment relied on historical data which may not reflect current habits.

Conclusion: