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Epidemiology

A Mediterranean-style diet, its components and the risk of heart failure: a prospective population-based study in a non-Mediterranean country

European Journal of Clinical Nutrition volume 70, pages 1015–1021 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Growing evidence emerged about the role of diet in heart failure (HF) development, but data are sparse and inconclusive. We examined the association between a Mediterranean-style diet, its components and HF risk.

Subjects/Methods:

Analyses were carried out in 24 008 middle-aged participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (Germany), including 209 incident HF cases within 8.2 years. The traditional Greek Mediterranean diet score (tMED) was used to assess dietary adherence. Cox’s proportional hazards regression was applied to estimate the relationship between the adherence to the Mediterranean-style diet, its components and HF risk.

Results:

After adjustment for age, sex and energy intake, a 2-unit increment in the tMED was associated with 26% lower risk of HF (HR (95% confidence interval (CI)): 0.76 (0.60–0.97)). After multivariable adjustment, this association was slightly attenuated and lost significance [HR (95%CI): 0.82 (0.64–1.05)]. Interestingly, we observed a significant association in multivariable adjusted models when milk products were excluded from the score (HR (95% CI): 0.75 (0.59–0.96)). Three score components were significantly associated with HF risk: alcohol (HR (95%CI): 0.73 (0.55–0.97) for moderate versus low/high intakes), meat: 2.04 (1.17–3.55) and fish: 0.59 (0.36–0.95), both for the highest versus the lowest quintile.

Conclusions:

The tMED was not significantly associated with HF risk, but low meat, high fish and moderate alcohol intake were inversely associated with HF risk in our non-Mediterranean population. Minor dietary changes could be valuable primary prevention measures, particularly the increase of fish consumption while reducing the intake of meat.

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Acknowledgements

We thank the Human Study Centre (HSC) of the German Institute of Human Nutrition Potsdam-Rehbruecke, namely the trustee and the data hub for the processing, and the participants for the provision of the data, the biobank for the processing of the biological samples and the head of the HSC, Manuela Bergmann, for the contribution to the study design and leading the underlying processes of data generation. We are, furthermore, indebted to Wolfgang Bernigau for statistical support. The recruitment phase of the EPIC-Potsdam Study was supported by the Federal Ministry of Science, Germany (01 EA 9401) and the European Union (SOC 95201408 05F02). The follow-up was supported by the German Cancer Aid (70-2488-Ha I) and the European Community (SOC 98200769 05F02).

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Authors and Affiliations

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    J Wirth

  2. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany

    J Wirth, R di Giuseppe, H Boeing & C Weikert

  3. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin/Potsdam, Potsdam, Germany

    J Wirth, R di Giuseppe & C Weikert

  4. Institute of Epidemiology, Christian-Albrechts University Kiel, Kiel, Germany

    R di Giuseppe

  5. Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany

    C Weikert

  6. Department of Food Safety, The Federal Institute for Risk Assessment, Berlin, Germany

    C Weikert

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Wirth, J., di Giuseppe, R., Boeing, H. et al. A Mediterranean-style diet, its components and the risk of heart failure: a prospective population-based study in a non-Mediterranean country. Eur J Clin Nutr 70, 1015–1021 (2016). https://doi.org/10.1038/ejcn.2016.140

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