Objective: To investigate the relationship between dietary polyunsaturated fatty acid (PUFA) intake and blood lipid, C-reactive protein (CRP) and homocysteine (Hcy) in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Patients with acute ischemic stroke or TIA were enrolled consecutively from Nanjing Stroke Registry Program. The total dietary PUFA intake level was assessed by the food semi-quantitative frequency questionnaire. Venous blood samples were collected in the morning of the day after admission to the hospital to detect the levels of serum total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, Hcy, and CRP. According to the median level of total PUFA intake, the patients were divided into low PUFA group and high PUFA group. The relationship between PUFA intake and blood lipid, CRP and Hcy was analyzed by Spearman correlation analysis, and multiple linear regression analysis was used to determine the independent correlation. Results: A total of 170 patients (85.1%) with acute ischemic stroke and 31 patients with TIA (14.9%) were enrolled. Their age was 62.9±14.1 years, 143 were males (71.1%), and the median PUFA daily intake was 12.8 g (interquartile range: 8.05-17.5 g). Compared with the high PUFA group (n=100), patients in the low PUFA group (n=101) were older, serum high-density lipoprotein cholesterol levels were lower, and CRP and Hcy levels were higher. The above differences were statistically significant (all P<0.05). Spearman correlation analysis showed that total dietary PUFA intake was significantly negatively correlated with the serum CRP (r=-0.24, P=0.001) and Hcy (r=-0.17, P=0.013) levels, and there was no significant correlation with the blood lipid levels. Multiple linear regression analysis showed that CRP was significantly negatively correlated with PUFA intake after adjusting for confounding factors (B=-0.28, P=0.012). Conclusions Dietary PUFA intake in patients with acute ischemic stroke or TIA may affect blood metabolism index and oxidative stress index. It is necessary to adjust the dietary structure of patients with low PUFA intake to reduce the risk of stroke recurrence.