{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:51:40Z","timestamp":1791276700999,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Diet quality is a potentially modifiable determinant of heart failure (HF), yet evidence regarding its long-term association with HF incidence remains limited. This study examined the association between baseline diet quality and 20-year incident HF in the population-based ATTICA cohort. Methods: Among 3042 adults free of cardiovascular disease at baseline (2001\u20132002), HF status was available for 2159 participants in 2022, of whom 241 (11.2%) developed HF. Diet quality, including the relative contributions of healthy and unhealthy food groups, was assessed using the Global Diet Quality Score (GDQS), derived from a validated food-frequency questionnaire. Logistic regression models were sequentially adjusted for age, sex, body mass index, education, physical activity, smoking burden, hypertension, diabetes, and hypercholesterolemia. Results: HF incidence was 20.7%, 5.1%, and 6.6% among participants with low, intermediate, and high diet quality, respectively (p &lt; 0.001). In the fully adjusted analysis (n = 1973), better overall diet quality was associated with lower odds of HF (odds ratio [OR] per 1-point increment, 0.97; 95% confidence interval [CI], 0.94\u20130.99). A greater contribution of healthy foods was also inversely associated with HF (OR, 0.96; 95% CI, 0.93\u20130.98), whereas the unhealthy-food component was not independently associated with the outcome (OR, 1.04; 95% CI, 0.96\u20131.13). Conclusions: Better diet quality, particularly greater consumption of health-promoting foods, was independently associated with lower 20-year HF incidence in a Mediterranean population.<\/jats:p>","DOI":"10.3390\/nu18193278","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:06:47Z","timestamp":1791274007000},"page":"3278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Diet Quality and 20-Year Heart Failure Incidence: Findings from the ATTICA Cohort Study (2002\u20132022)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6340-3996","authenticated-orcid":false,"given":"Christina","family":"Chrysohoou","sequence":"first","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5768-9125","authenticated-orcid":false,"given":"Panagiotis","family":"Iliakis","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Ioana Christina","family":"Daha","sequence":"additional","affiliation":[{"name":"Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6992-2906","authenticated-orcid":false,"given":"Ioannis","family":"Leontsinis","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2692-095X","authenticated-orcid":false,"given":"Kyriaki","family":"Mavromoustakou","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2632-9376","authenticated-orcid":false,"given":"Evangelia","family":"Damigou","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3368-6737","authenticated-orcid":false,"given":"Konstantinos","family":"Konstantinou","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Christos","family":"Pitsavos","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7636-6725","authenticated-orcid":false,"given":"Konstantinos","family":"Tsioufis","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-153X","authenticated-orcid":false,"given":"Demosthenes B.","family":"Panagiotakos","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s41569-024-01046-6","article-title":"Global Epidemiology of Heart Failure","volume":"21","author":"Khan","year":"2024","journal-title":"Nat. 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