ObjectivesDiet is an important target for primary prevention of stroke. There are mixed findings on the relationship between dietary fat intake and stroke. We aimed to investigate the relationship of stroke with fats, including total fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA).MethodsWe analysed data on 27,673 participants who had valid data on dietary fat intake and history of stroke from the National Health and Nutrition Examination Survey 2007-2018. History of stroke was defined according to previous diagnosis by doctors or other health professional. Data on 24-h dietary recalls was collected using Automated Multiple-Pass Method. Age, sex, race/ethnicity, total calories, body mass index, diabetes, hypertension, hypercholesterolaemia, smoking, alcohol consumption and physical activity were adjusted in multivariable models.Results3.8% (n = 1,054) of participants had a diagnosis of stroke. History of stroke was inversely associated with total fat (OR = 0.89, 95% CI = 0.79-0.99, P = 0.037), SFA (OR = 0.46, 95% CI = 0.23-0.91) and MUFA (OR = 0.08, 95% CI = 0.02-0.38, P = 0.002) from supplements. There was an inverse association between history of stroke and PUFA intake (from diet: quartile 4 vs quartile 1, OR = 0.58, 95% CI = 0.43-0.78, P for trend = 0.003; from supplements: OR = 0.44, 95% CI = 0.27-0.72, P = 0.001).ConclusionsIn this large-scale nationally representative study, stroke is inversely associated with fat intake from supplements and PUFA intake from diet. While lifestyle choices may not be the most vital health factor for stroke patients, increasing fat intake from specific supplements does provide additional motivation for undertaking the difficult challenge of stroke prevention.