Rx Nutrition Resource Center

Rx Nutrition Resource Center

Disclosures: The authors and Juraschek report no relevant financial disclosures.
June 30, 2021
3 min read
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Southern diet may elevate risk for sudden cardiac death

Disclosures: The authors and Juraschek report no relevant financial disclosures.
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Higher Mediterranean diet score trended toward association with lower 10-year risk for sudden cardiac death, whereas higher Southern diet score trended toward association with higher 10-year sudden cardiac death risk, researchers reported.

The association between high Mediterranean diet score and reduced sudden cardiac death (SCD) risk was strongest in people with no history of CHD.

Higher Mediterranean diet score trended toward association with lower 10-year risk for sudden cardiac death, whereas higher Southern diet score trended toward association with higher 10-year sudden cardiac death risk. Data were derived from Shikany JM, et al. J Am Heart Assoc. 2021;doi:10.1161/JAHA.120.019158.

“We know of no published studies investigating the possible associations of dietary patterns with risk of SCD,” James M. Shikany, DrPH, professor in the division of preventive medicine at the University of Alabama at Birmingham, and colleagues wrote. “However, previous studies have investigated possible associations between individual foods and risk of SCD.”

Of 21,069 participants who were followed up for a mean duration of 9.8 years, 1.9% experienced an SCD event.

Participants were stratified by adherence to dietary patterns. The Southern diet includes added fats, fried foods, eggs, organ meats, processed meats and sugar-sweetened beverages. The Mediterranean diet includes high levels of fruits, vegetables, fish, whole grains and legumes and low levels of meat and dairy.

Dietary patterns and risk for sudden cardiac death

After adjustment for age, sex and race, the Mediterranean diet score was inversely associated with risk for SCD (HR for highest vs. lowest scores = 0.59; 95% CI, 0.45-0.78; P for trend = .0001). In the fully adjusted analysis, the association between Mediterranean diet score and SCD was attenuated, but a trend toward inverse association remained (HR for highest vs. lowest scores = 0.74; 95% CI, 0.55-1.01; P for trend = .07).

After adjustment for age, sex and race, greater adherence to the Southern dietary pattern was associated with risk for SCD (HR for highest vs. lowest quartile of adherence = 2.22; 95% CI, 1.61-3.05; P for trend < .0001). In the fully adjusted model, the association between Southern diet and SCD was attenuated, but a trend toward a positive association remained (P for trend = .06).

According to the study, no other dietary patterns were associated with risk for SCD in the overall cohort, among participants with no CHD at baseline and among participants with CHD at baseline.

Among participants with no history of CHD at baseline, the Mediterranean diet score was inversely associated with risk for SCD (HR for highest vs. lowest adherence = 0.49; 95% CI, 0.34-0.71; P for trend = .0022), but there was no relationship between Mediterranean diet score and SCD risk in patients with CHD.

Among participants with no history of CHD at baseline, adherence to the Southern dietary pattern was associated with risk for SCD (HR for highest vs. lowest adherence = 2.34; 95% CI, 1.51-3.64; P for trend = .0004); however, the association was no longer significant in the fully adjusted model (P for trend = .26).

Among participants with a history of CHD at baseline, the Southern dietary pattern was positively associated with risk for SCD (HR highest vs. lowest adherence = 1.97; 95% CI, 1.24-3.13; P for trend = .0011). The association was no longer significant in the fully adjusted model (P for trend = .18).

Benefits of a healthy diet

“These findings support the notion that a healthier diet would prevent fatal cardiovascular disease and should encourage all of us to adopt a healthier diet as part of our lifestyles,” Stephen Juraschek, MD, PhD, member of the American Heart Association’s Nutrition Committee of the Lifestyle and Cardiometabolic Health Council, said in a press release. “To the extent that they can, people should evaluate the number of servings of fruit and vegetables they consume each day and try to increase the number to at least five to six servings per day, as recommended by the American Heart Association. Optimal would be eight to nine servings per day.

“This study also raises important points about health equity, food security and social determinants of health,” Juraschek said. “The authors describe the ‘Southern Diet’ based on the U.S. geography associated with this dietary pattern, yet it would be a mistake for us to assume that this is a diet of choice. I think American society needs to look more broadly at why this type of diet is more common in the South and clusters among some racial, ethnic or socioeconomic groups to devise interventions that can improve diet quality. The gap in healthy eating between people with means and those without continues to grow in the U.S., and there is an incredible need to understand the complex societal factors that have led and continue to perpetuate these disparities.”