Recommendations for primary prevention of atrial fibrillation (AF) emphasise the role of weight loss and other lifestyle risk factors. However, there is little information on the effect of dietary patterns on AF incidence and progression. In order to assess whether incident AF was affected by specific diets, Tu and colleagues1 analysed data from the UK Biobank in 121, 3000 individuals (mean age 59.4±7.8, 56.4% female) with 4579 incident AF cases over 8.8 years follow-up. Although adherence to a Mediterranean-style or Dietary Approaches to Stop Hypertension (DASH) diet initially appeared to be associated with a lower incidence of AF (HR for highest vs lowest quintile 0.87 (95% CI 0.80 to 0.96) and HR 0.78 (95% CI 0.71 to 0.86), respectively), these associations were no longer significant after adjustment for lifestyle factors, especially body mass index which accounted for about three-quarters of the effect size attenuation. Interestingly, plant-based diets were not associated with AF incidence in any model. However, ultra-processed food consumption was associated with AF risk, even after adjustment for lifestyle factors, with a 5% increase in AF risk for a 10% increase in intake of ultra-processed foods. The definition of ultra-processed foods included fruit drinks, smoothies, processed cereal, breads and pastries, pizza, ice cream, chocolates, and breaded fish among many other food products.
In the accompanying editorial, Hall, Raju and Nalliah2 comment that “Although this study identifies that ultraprocessed foods are independently associated with incident AF, it …