Associations of dietary patterns, ultra-processed food and nutrient intake with incident atrial fibrillation.

Objective: To examine the associations between specific dietary patterns and incident atrial fibrillation (AF).
Methods: Using data from the UK Biobank, dietary intakes were calculated from 24-hour diet recall questionnaires. Indices representing adherence to dietary patterns (Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH) and plant-based diets) were scored, and ultra-processed food consumption was studied as a percentage of total food mass consumed. Incident AF hospitalisations were assessed in Cox regression models.
Results: A total of 121 300 individuals were included, with 4 579 incident AF cases over a median follow-up of 8.8 years. Adherence to Mediterranean-style or DASH diets was associated with a lower incidence of AF in minimally adjusted analyses (HR for highest vs lowest quintile 0.87 (95% CI 0.80-0.96) and HR 0.78 (95% CI 0.71-0.86), respectively). However, associations were no longer significant after accounting for lifestyle factors (HR 0.95 (95% CI 0.87-1.04) and 0.94 (95% CI 0.86-1.04) respectively), with adjustment for body mass index responsible for approximately three-quarters of the effect size attenuation. Plant-based diets were not associated with AF risk in any models. Greatest ultra-processed food consumption was associated with a significant increase in AF risk even in fully adjusted models (HR 1.13 (95% CI 1.02-1.24)), and a 10% increase in absolute intake of ultra-processed food was associated with a 5% increase in AF risk (HR 1.05 (95% CI 1.01-1.08)).
Conclusion: With the possible exception of reducing ultra-processed food consumption, these findings suggest that attention to other modifiable risk factors, particularly obesity, may be more important than specific dietary patterns for the primary prevention of AF.
Competing Interests: Competing interests: GMM has received research funding from Baylis Medical, is a consultant for Johnson and Johnson and InCarda and holds equity in InCarda. DHL reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Abbott Medical, Biotronik, Medtronic and MicroPort CRM. JH is an International Advisory Board member for BMJ Heart and reports that Flinders University has received on his behalf lecture and/or consulting feels from Biotronik. PS reports having served on the Advisory Board of Boston Scientific, CathRx, Medtronic, PaceMate and Abbott Medical. PS also reports that the University of Adelaide has received on his behalf lecture, consulting fees and/or research funding from Medtronic, Boston Scientific, Abbott Medical and LivaNova. CXW reports that the University of Adelaide has received on his behalf lecture, travel and/or research funding from Abbott Medical, Bayer, Boehringer Ingelheim, Medtronic, Novartis, Servier, St Jude Medical and Vifor Pharma.
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