To avoid 1 cardiovascular event, 790 individuals would have to adopt a healthier diet, according to the results of a large study.
Researchers analyzed data from 345,533 participants across 7 European countries using the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to examine associations between dietary nutritional quality and cardiovascular disease (CVD) risk over a median follow-up of 12.3 years. Dietary quality was assessed using the updated Nutrient Profiling System (uNS-NPS) underlying the Nutri-Score, which grades foods from -17 (highest nutritional quality) to +55 (lowest) based on nutrient content per 100g,
First CVD events (16,214) occurred during 4,103,133 person-years of follow-up, according to findings published in The Lancet Regional Health - Europe. Higher uNS-NPS dietary index (DI) scores, indicating lower overall nutritional quality, were associated with a 3% higher risk of total CVD events per 1 standard deviation (SD) increase, a 3% increased risk for myocardial infarction, a 4% increased risk for cerebrovascular events, and a 4% increased stroke risk. There was no clear association found for overall coronary heart disease.
The study population comprised 63.3% women with a mean age of 51.1 years. Country distribution was UK (21.0%), Denmark (15.3%), Germany (14.6%), Sweden (13.9%), Italy (13.0%), Spain (11.6%), and the Netherlands (10.6%).
Cardiovascular events included 11,009 coronary heart disease events (6,565 myocardial infarctions) and 6,669 cerebrovascular events (6,245 strokes).
Participants in the highest quintile of uNS-NPS DI scores (lowest diet quality) had higher intakes of energy, sugar, total fats, processed meat, sweet beverages, and ultra-processed foods, and lower intakes of dietary fiber, fruit, vegetables, and fish.
Interaction analyses revealed stronger associations for cerebrovascular events and stroke in overweight and obese participants. Stronger associations for overall CVD, coronary heart diseases, and myocardial infarction were observed in current smokers.
Sensitivity analyses, including adjustment for ultra-processed food intake, generally supported the main findings. Excluding participants with prevalent cardiovascular risk factors at baseline weakened but did not eliminate associations.
Study limitations included potential measurement error in dietary assessment, lack of repeated dietary measures, and varying CVD event definitions between centers. The authors noted that while the study population was likely more health-conscious than the general public, careful adjustment for confounders and multiple sensitivity analyses supported the robustness of the results.
The authors declared no competing interests, except for one author reporting a leadership role in the National Nutrition Council (Norwegian Directorate of Health) and another reporting grants from pharmaceutical companies and various leadership roles unrelated to the present work.