Tu, S.J.Gallagher, C.Elliott, A.D.Bradbury, K.E.Marcus, G.M.Linz, D.Pitman, B.M.Middeldorp, M.E.Hendriks, J.M.Lau, D.H.Sanders, P.Wong, C.X.2023-08-172023-08-172023Heart, 2023; 109(22):1683-16891355-60371468-201Xhttps://hdl.handle.net/2440/139166Published Online First 17 July 2023OBJECTIVE: 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.en© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.atrial fibrillationepidemiologyrisk factorsJournal article10.1136/heartjnl-2023-3224122023-08-17651121Tu, S.J. [0000-0003-4137-1978]Gallagher, C. [0000-0002-5114-400X]Elliott, A.D. [0000-0002-5951-4239]Linz, D. [0000-0003-4893-0824]Pitman, B.M. [0000-0001-6610-3473]Middeldorp, M.E. [0000-0002-4106-9771]Hendriks, J.M. [0000-0003-4326-9256]Lau, D.H. [0000-0001-7753-1318] [0000-0002-1564-439X]Sanders, P. [0000-0003-3803-8429]Wong, C.X. [0000-0002-1913-6675]