Habitual food choices made at the turn of the millennium show a measurable relationship with heart failure risk two decades later, according to an analysis published in the journal Nutrients. Evaluated through the ATTICA cohort study spanning 2002 to 2022, researchers tracked how baseline dietary quality among adults without initial cardiovascular disease correlated with long-term clinical outcomes.
In Plain English: The Clinical Takeaway
- Long-term tracking: Researchers evaluated dietary records from adults initially free of heart disease, following their health outcomes across a 20-year period to observe the late-stage effects of early dietary patterns.
- Dietary scoring metrics: Using the Global Diet Quality Score, the study measured the intake of health-promoting foods alongside less favorable food groups to determine overall nutritional health.
- Risk reduction: Higher scores in overall diet quality and beneficial food intake correlated with lower statistical odds of developing heart failure over the two-decade tracking period.
Longitudinal Tracking of Baseline Nutrition and Cardiovascular Health
Heart failure frequently develops as a secondary consequence of prolonged exposure to clinical risk factors, including systemic hypertension, obesity, type 2 diabetes mellitus, dyslipidemia, and established coronary heart disease. Dietary patterns actively influence these underlying pathologies by modulating blood pressure, systemic inflammation, oxidative stress, and lipid profiles. While previous epidemiological investigations, such as those focusing on the Dietary Approaches to Stop Hypertension (DASH) diet, established inverse relationships between balanced nutrition and heart disease incidence, data tracking populations over multi-decade spans remain critical.
To investigate these dynamics further, investigators utilized data from the ATTICA study, a prospective, population-based cohort established in the Attica region of Greece. Initial assessments occurred between 2001 and 2002, with subsequent follow-ups conducted at 5, 10, and 20 years. Out of 4,056 adults randomly invited to participate, 3,042 met the inclusion criteria. Individuals under 18 years of age, or those presenting with baseline cardiovascular disease, cancer, or systemic inflammatory conditions, were excluded from the analysis.
Habitual dietary intake at baseline was recorded using a validated 156-item semi-quantitative EPIC-Greek food-frequency questionnaire administered with the assistance of trained dietitians. Food intake data were mapped directly to 25 distinct Global Diet Quality Score food groups. This scoring system, ranging from 0 to 49, separates intake into health-promoting components and less favorable components. Participants were subsequently divided into three cohort-specific diet-score groups: 35 or below, above 35 to 39, and above 39.
Among 2,159 participants with ascertainable 20-year heart failure status, 241 individuals developed the condition, yielding a cumulative incidence of 11.2%. Of these diagnosed cases, 108 occurred among men, with no statistically significant variance reported between sexes. Participants in the lowest diet-score group were generally older, included a higher proportion of men, and exhibited elevated body mass indexes alongside higher rates of hypertension, diabetes, and hypercholesterolemia.
| Global Diet Quality Score Tertile | Unadjusted Heart Failure Incidence (%) | Participant Characteristics at Baseline |
|---|---|---|
| Lowest Tertile (≤35) | 20.7% | Higher BMI, older demographic, higher prevalence of metabolic risk factors |
| Intermediate Tertile (>35 to 39) | 5.1% | Moderate risk factor profile |
| Highest Tertile (>39) | 6.6% | Highest proportion of physically active participants |
In unadjusted comparisons, heart failure incidence reached 20.7% in the lowest scoring tertile, compared to 5.1% in the intermediate group and 6.6% in the highest group. When researchers adjusted for age, sex, body mass index, educational attainment, physical activity, smoking burden, hypertension, diabetes, and hypercholesterolemia, each 1-point increase in the overall score correlated with a 3% decrease in heart failure odds. Furthermore, each 1-point increase specifically in health-promoting food consumption associated with a 4% reduction in heart failure odds.
Methodological Limitations and Population Scope
The observational design of the underlying investigation prevents definitive causal conclusions regarding food intake and clinical disease onset. Because dietary assessments relied on baseline questionnaires, changes in eating habits over the subsequent 20-year period could not be accounted for. Furthermore, potential dietary reporting errors, unmeasured confounders, and missing clinical data limit the precision of the risk estimates. Investigators also noted that wide confidence intervals and weaker sensitivity models leave some uncertainty regarding the absolute magnitude of the associations.
Loss to follow-up introduced additional constraints, as participants who dropped out often differed in educational attainment, and deaths occurring without documented heart failure diagnoses were excluded. The restriction of the cohort to a Greek adult population means these findings may not directly generalize to other geographic regions or healthcare systems without further epidemiological validation.
Sources of the Study
- 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 (2002–2022). Nutrients, 18(19), 3278.
