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<\/a><\/p>\nStudy: Association Between Diet Quality and 20-Year Heart Failure Incidence: Findings from the ATTICA Cohort Study (2002\u20132022)<\/a>. Image Credit:\u00a0Marian Weyo \/ Shutterstock<\/p>\n In a recent study published in the journal Nutrients<\/a>, a group of researchers evaluated the association between baseline diet quality and 20-year heart failure (HF) incidence among adults initially free of cardiovascular disease (CVD).<\/p>\n Background<\/p>\n HF can develop after prolonged exposure to risk factors such as high blood pressure, obesity, diabetes, high levels of cholesterol, and coronary heart disease. Diet may influence various factors that contribute to HF development, including blood pressure, weight, blood glucose levels, blood lipids, inflammation<\/a>, and oxidative stress.<\/p>\n Previous research has linked dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet with lower HF incidence, though findings have differed across populations. The Global Diet Quality Score (GDQS) offers a broader assessment of health-promoting and less favorable foods. Further research is needed to clarify its relationship with long-term HF incidence.<\/p>\n About the study<\/p>\n The ATTICA study was a prospective, population-based cohort of adults living in the Attica region of Greece. Participants underwent baseline assessments in 2001-2002 and follow-up assessments at 5, 10, and 20 years.<\/p>\n A total of 4056 adults were randomly invited between May 2001 and August 2002, with 3042 meeting the inclusion criteria, consenting, and enrolling. Individuals younger than 18 years or with established CVD, cancer, or an inflammatory disease were excluded at baseline. The analysis included 2159 participants with ascertainable 20-year HF status; 883 without recorded outcomes were excluded.<\/p>\n Baseline data included age, sex, education level, body weight, height, body mass index (BMI), hypertension, type 2 diabetes, hypercholesterolemia, family history of CVD, physical activity, and smoking burden. Researchers assessed physical activity using the validated short version of the International Physical Activity Questionnaire.<\/p>\n Habitual dietary intake was assessed using a validated 156-item semi-quantitative EPIC-Greek food-frequency questionnaire (FFQ), administered with assistance from trained dietitians.<\/p>\n Food intake was mapped to 25 GDQS food groups. The GDQS ranged from 0 to 49 and included healthy-food (GDQS+) and unhealthy-food (GDQS\u2212) components. Higher GDQS+ scores reflected greater consumption of healthy foods, while higher GDQS\u2212 scores reflected more favorable consumption of less healthy food groups.<\/p>\n Researchers divided participants into three cohort-specific diet-score groups: 35 or below, above 35 to 39, and above 39. Participants with identical scores produced unequal group sizes, and these categories do not represent universal clinical thresholds.<\/p>\n At 20 years, physicians assessed HF using participant evaluations and available medical records, with diagnoses classified according to the International Classification of Diseases, 10th Revision (ICD-10). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), because exact diagnosis dates were unavailable.<\/p>\n Study results<\/p>\n Among the 2159 participants with ascertainable 20-year HF status, 241 individuals had developed HF, representing an 11.2% cumulative incidence. Of these cases, 108 occurred among men, with no significant sex difference reported. The median GDQS was 37.0, while the median scores were 31.0 for GDQS+ and 6.0 for GDQS\u2212.<\/p>\n Participants in the lowest GDQS group were older and included a higher proportion of men. They also had higher BMI and more hypertension, diabetes, and hypercholesterolemia than participants in the higher-scoring groups. The proportion classified as physically active was highest in the highest GDQS group.<\/p>\n A strong association was observed between diet quality and 20-year HF incidence before adjustment. HF incidence was 20.7% among participants in the lowest GDQS tertile, 5.1% among those in the intermediate tertile, and 6.6% among those in the highest tertile.<\/p>\n Pairwise comparisons showed significant differences between the lowest and intermediate tertiles and between the lowest and highest tertiles, whereas the intermediate and highest tertiles did not differ significantly. Among men, unadjusted HF incidence did not consistently decline across increasing diet-score groups; this pattern was not observed among women.<\/p>\n In regression analyses adjusted for age and sex, higher GDQS and GDQS+ were associated with lower HF odds, whereas GDQS\u2212 was not. After additional adjustment for BMI, education, physical activity, smoking burden, hypertension, diabetes, and hypercholesterolemia, each 1-point increase in GDQS was associated with 3% lower HF odds.<\/p>\n Each 1-point increase in GDQS+ was associated with 4% lower HF odds. GDQS\u2212 remained unassociated with HF. Model 3 included 1973 participants and 237 HF cases with complete data. Some adjusted factors, including BMI and metabolic conditions, may partly mediate a diet association.<\/p>\n These models examined whether the association persisted beyond established risk factors, without establishing the biological pathways involved.<\/p>\n Compared with the lowest GDQS tertile, participants in the intermediate and highest tertiles had lower adjusted HF odds in Model 3. The association remained significant for the highest tertile after additional adjustment for family history of CVD, but not for the intermediate tertile.<\/p>\n In the sensitivity model, which included 1959 participants and 232 cases, the continuous GDQS association did not meet the statistical significance threshold, whereas GDQS+ remained significant.<\/p>\n Exploratory analysis found that HF incidence increased with the number of cardiovascular risk factors assessed, ranging from 3.3% among participants with none to 8.8%, 15.6%, and 24.3% among those with one, two, or three or more risk factors, respectively.<\/p>\n Among participants with exactly one risk factor, each 1-point increase in GDQS was associated with 4% lower HF odds after age and sex adjustment.\u00a0<\/p>\n Associations in groups with more risk factors were not significant, and there was no significant evidence that the association differed by risk-factor burden. In pooled analysis among participants with at least one risk factor, accounting for risk-factor burden, higher GDQS remained associated with lower HF odds.<\/p>\n Conclusions<\/p>\n In the population-based ATTICA cohort, higher baseline diet quality was associated with lower odds of developing HF over 20 years among adults initially free of CVD. The association was particularly evident for the GDQS+, whereas the GDQS\u2212 was not independently associated with HF.<\/p>\n Limited variation in GDQS\u2212 may have restricted detection of an association; this finding does not establish that unhealthy foods are harmless. The findings support further investigation of dietary healthfulness in HF development.<\/p>\n The observational design prevents causal conclusions, and dietary intake was assessed only at baseline. Dietary reporting errors, unmeasured confounders, and missing data may have influenced the findings.<\/p>\n Wide confidence intervals for the diet-category comparisons and weaker sensitivity results also left uncertainty about the magnitude and independence of the associations. Participants lost to follow-up had higher educational attainment, and deaths without documented HF were excluded as having unknown outcomes. Missing HF-subtype information limited interpretation, and findings may not generalize beyond this Greek population.<\/p>\n Sources:<\/p>\n Journal reference:<\/p>\n Chrysohoou, C., Iliakis, P., Daha, I. C., Leontsinis, I., Mavromoustakou, K., Damigou, E., Konstantinou, K., Pitsavos, C., Tsioufis, K., & Panagiotakos, D. B. (2026). Association Between Diet Quality and 20-Year Heart Failure Incidence: Findings from the ATTICA Cohort Study (2002\u20132022). Nutrients, 18(19), 3278. DOI: 10.3390\/nu18193278, https:\/\/www.mdpi.com\/2072-6643\/18\/19\/3278<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Diet records from the early 2000s offer a window into how everyday food choices and existing health conditions…\n","protected":false},"author":2,"featured_media":929937,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[2768,8431,49,48,20841,32111,200133,2985,2771,549,2998,3376,84,2776,1955,2230,40745,190532,7429,53164,16958,1229,12093,3182,994,3378,2618],"class_list":["post-929936","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-blood","tag-blood-pressure","tag-ca","tag-canada","tag-cardiovascular-disease","tag-cholesterol","tag-coronary-heart-disease","tag-diabetes","tag-diet","tag-education","tag-food","tag-glucose","tag-health","tag-heart","tag-heart-disease","tag-heart-failure","tag-high-blood-pressure","tag-hypercholesterolemia","tag-inflammation","tag-lipids","tag-nutrients","tag-obesity","tag-oxidative-stress","tag-physical-activity","tag-research","tag-smoking","tag-stress"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/929936","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=929936"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/929936\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/929937"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=929936"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=929936"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=929936"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}