TY - JOUR
T1 - The association of the Mediterranean diet with heart failure risk in a Dutch population
AU - Strengers, Julia G
AU - den Ruijter, Hester M
AU - Boer, Jolanda M A
AU - Asselbergs, Folkert W
AU - Verschuren, W M Monique
AU - van der Schouw, Yvonne T
AU - Sluijs, Ivonne
N1 - Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
PY - 2021/1/4
Y1 - 2021/1/4
N2 - BACKGROUND AND AIMS: It is still unclear whether a healthy diet can prevent heart failure (HF). Therefore, this study aimed to investigate the association between adherence to a Mediterranean-style diet, reflected by modified Mediterranean Diet Scores (mMDS), and the incidence of HF in men and women.METHODS AND RESULTS: This observational study comprised 9316 men and 27,645 women from the EPIC-NL cohort free from cardiovascular disease at baseline. Dietary intakes were assessed using a validated food frequency questionnaire. mMDS was calculated using a 9-point scale based on consumption of vegetables, legumes, fruit, nuts, seeds, grains, fish, fat ratio, dairy, meat and alcohol. HF events were ascertained by linkage to nation-wide registries. Multivariable Hazard Ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression models. Over a median follow-up of 15 years (IQR 14-16), 633 HF events occurred: 144 in men (1.5%) and 489 in women (1.8%). The median mMDS was 4 (IQR 3-5). There was significant effect modification by sex (P-value for interaction <0.001), therefore results are stratified for men and women. For men, a higher mMDS associated with lower HF risk (HR: 0.88; 95% CI: 0.79, 0.98 per point increase in mMDS; HR upper category: 0.53; 95% CI: 0.33, 0.86), whereas no association was found in women (HR: 0.98; 95% CI: 0.93, 1.04 per point increase; HR upper category: 1.07; 95% CI: 0.83, 1.36).CONCLUSION: Adherence to a Mediterranean-style diet may reduce HF risk, particularly in men. The underlying reasons for the differences in findings between men and women need further study.
AB - BACKGROUND AND AIMS: It is still unclear whether a healthy diet can prevent heart failure (HF). Therefore, this study aimed to investigate the association between adherence to a Mediterranean-style diet, reflected by modified Mediterranean Diet Scores (mMDS), and the incidence of HF in men and women.METHODS AND RESULTS: This observational study comprised 9316 men and 27,645 women from the EPIC-NL cohort free from cardiovascular disease at baseline. Dietary intakes were assessed using a validated food frequency questionnaire. mMDS was calculated using a 9-point scale based on consumption of vegetables, legumes, fruit, nuts, seeds, grains, fish, fat ratio, dairy, meat and alcohol. HF events were ascertained by linkage to nation-wide registries. Multivariable Hazard Ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazards regression models. Over a median follow-up of 15 years (IQR 14-16), 633 HF events occurred: 144 in men (1.5%) and 489 in women (1.8%). The median mMDS was 4 (IQR 3-5). There was significant effect modification by sex (P-value for interaction <0.001), therefore results are stratified for men and women. For men, a higher mMDS associated with lower HF risk (HR: 0.88; 95% CI: 0.79, 0.98 per point increase in mMDS; HR upper category: 0.53; 95% CI: 0.33, 0.86), whereas no association was found in women (HR: 0.98; 95% CI: 0.93, 1.04 per point increase; HR upper category: 1.07; 95% CI: 0.83, 1.36).CONCLUSION: Adherence to a Mediterranean-style diet may reduce HF risk, particularly in men. The underlying reasons for the differences in findings between men and women need further study.
KW - Adult
KW - Aged
KW - Diet, Healthy
KW - Diet, Mediterranean
KW - Female
KW - Heart Failure/diagnosis
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Prospective Studies
KW - Protective Factors
KW - Risk Assessment
KW - Risk Factors
KW - Risk Reduction Behavior
KW - Sex Factors
KW - Time Factors
KW - Young Adult
U2 - https://doi.org/10.1016/j.numecd.2020.08.003
DO - https://doi.org/10.1016/j.numecd.2020.08.003
M3 - Article
C2 - 33127254
SN - 0939-4753
VL - 31
SP - 60
EP - 66
JO - Nutrition, metabolism, and cardiovascular diseases
JF - Nutrition, metabolism, and cardiovascular diseases
IS - 1
ER -