Diet quality and cardiovascular outcomes: A systematic review and meta‐analysis of cohort studies

Aims To evaluate relationships between diet quality and cardiovascular outcomes. Methods Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta‐analyses using a random effects model. Results Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta‐analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82–0.84, p