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

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.