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Dose‒response relationships of DASH, Mediterranean, and AHEI dietary patterns with heart failure incidence: a systematic review and meta-analysis of cohort studies

European Journal of Clinical Nutrition volume 80, pages 248–262 (2026)Cite this article

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Abstract

This study aimed to quantify the associations between adherence to three dietary patterns—the Dietary Approaches to Stop Hypertension (DASH), Mediterranean diet (MED), and Alternative Healthy Eating Index (AHEI)—and the risk of heart failure (HF) through a dose–response meta-analysis. Prospective cohort studies evaluating the associations between these dietary patterns and HF incidence were systematically identified from the PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov databases. Random-effects models were used to pool effect estimates. Generalized least squares regression and restricted cubic spline models were applied to explore potential dose–response relationships between dietary adherence and HF risk. Eleven independent cohorts (n = 450,451; ≥18,877 HF events) were included in the final analysis. Combined across patterns, the highest adherence group had a 25% lower risk of HF than the lowest adherence group did (hazard ratio [HR] 0.75; 95% confidence interval [CI]: 0.67–0.84; P < 0.001). Subgroup analyses revealed significant inverse associations for the DASH (HR 0.81; 95% CI: 0.67–0.98; P = 0.034), MED (HR 0.74; 95% CI: 0.64–0.87; P < 0.001), and AHEI (HR 0.75; 95% CI: 0.63–0.89; P < 0.001) patterns, with no significant differences across patterns (P = 0.860). Dose–response analyses revealed linear associations between adherence to each dietary pattern and HF risk. High adherence to DASH, MED, and AHEI is associated with lower HF risk, with similar effects among the different dietary patterns and linear dose–response relationships. PROSPERO registration: CRD420251024001

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Fig. 1
Fig. 2
Fig. 3: Forest plot of the meta-analysis on three dietary patterns and HF risk.
Fig. 4: Dose–response relationships between dietary pattern scores and HF risk.

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Data availability

Data generated or analyzed during this study are provided in full within this manuscript and its supplementary materials. Data are available upon reasonable request from the corresponding authors.

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Acknowledgements

The graphical abstract in this article was created using BioRender.com, and we gratefully acknowledge BioRender for providing the illustration platform. We also extend our sincere appreciation to the researchers and participants of all original studies included in this meta-analysis, whose dedication and contributions laid the foundation for this work.

Funding

This study was supported by the National Mentorship Program (No. Qngg2022049), Suzhou Science and Technology Development Plan (No. SKYD2023205), Jiangsu Province Traditional Chinese Medicine Science and Technology Development Plan General Projects (No. MS2023106), and Project of Jiangsu Province Society of Traditional Chinese Medicine (No. XYLD2024036).

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  1. These authors contributed equally: Fang Yan, Lihua Fan.

Authors and Affiliations

  1. Laboratory Medicine Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China

    Fang Yan

  2. Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China

    Lihua Fan, Moqing Yin, Yunhu Chen & Lijuan Zhao

  3. Anesthesiology Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China

    Longzhi Li

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Contributions

Fang Yan: Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft. Moqing Yin: Conceptualization, Data curation, Validation, Writing – review and editing. Longzhi Li: Data curation, Software. Lihua Fan: Project administration, Supervision, Writing – review and editing. Yunhu Chen: Conceptualization, Methodology, Resources, Supervision, Writing – review and editing. Lijuan Zhao: Conceptualization, Methodology, Writing – review and editing.

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Correspondence to Yunhu Chen or Lijuan Zhao.

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Yan, F., Fan, L., Yin, M. et al. Dose‒response relationships of DASH, Mediterranean, and AHEI dietary patterns with heart failure incidence: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr 80, 248–262 (2026). https://doi.org/10.1038/s41430-025-01697-9

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