In their Heart publication Rahman et al1 provide prospective evidence on the increased risk of heart failure (HF) associated with moderate-to-high sweetened beverage (SB) consumption. They conducted a population-based cohort study with 42 400 men (45–79 years) followed up for approximately 12 years. During this time period, they documented 4113 incident cases of HF. The risk of HF among participants consuming ≥2 servings (200 mL) per day was 23% relatively higher (95% CI 1.12 to 1.35) compared to their non-consumer counterparts. This relative risk was adjusted for classical cardiovascular risk factors including family history of cardiovascular disease, hypertension, diabetes, smoking, physical activity, body mass index and also for several dietary factors such as coffee, fruits, vegetables, meat and fish intake.

The high and increasing worldwide prevalence of and mortality from HF represents a new emerging and staggering cardiovascular epidemic with the potential to become a global public health crisis.2 In the UK, there are >308 000 men and 250 000 women living with HF.3 Survival estimates for these patients are only 50% and 10% at 5 years and 10 years, respectively.2 Strong evidence supports that obesity is a major risk factor for HF.4 Furthermore, type-2 diabetes is a known risk factor for HF, and the association between type-2 diabetes and HF is only partly explained by the increased atherosclerotic risk in patients with diabetes, because diabetes also directly influences the structure and function of the heart.5 Obesity and type-2 diabetes are strongly determined by nutritional exposures.

In this context, it seems surprising that the study of nutritional factors related with HF is still scarce compared to other cardiovascular clinical entities. A recent review found less than 20 observational studies on the relationship between nutritional exposures and …