Two healthy diets stood out in a study of more than 7,000 adults

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Nov 2 2026

Can what you eat influence the subtle rhythms of your heart? Researchers examined four popular dietary patterns and 24-hour heart recordings from more than 7,000 adults, investigating how diet and medication use relate to cardiac autonomic function.

Study: Healthy diets and heart rate variability in a cross-sectional analysis of over 7000 adults attending the Maastricht study. Image Credit: CL STOCK / Shutterstock

In a recent study published in the journal Scientific Reports, researchers investigated the associations between adherence to four healthy dietary patterns and heart rate variability (HRV) among adults participating in the Maastricht Study.

Background

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, which highlights the need to identify individuals at cardiovascular risk early. HRV reflects cardiac autonomic function and serves as a marker of cardiovascular regulation, with reduced HRV associated with higher cardiovascular mortality risk. Factors such as age, hypertension, type 2 diabetes mellitus (T2DM), current smoking, physical inactivity, stress, and eating habits can affect HRV.

Healthy dietary patterns, including the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Dutch Healthy Diet (DHD) diets, have been associated with cardiovascular benefits. But evidence linking overall dietary patterns with HRV remains limited and inconsistent, and further large-scale prospective research is needed.

About the study

The researchers conducted a cross-sectional analysis using baseline data derived from the Maastricht Study, an observational, population-based cohort of adults aged 40-75 years in the southern Netherlands. Of the 9,187 participants recruited between November 2010 and October 2020, 7,256 were included after excluding individuals with missing data, arrhythmia, previous heart or heart-vessel surgery, or interleukin-6 (IL-6) concentrations above 10 pg/mL.

Dietary intake was assessed using a validated, self-administered food frequency questionnaire (FFQ) covering 253 food items across 23 food groups. Adherence scores were obtained for Mediterranean, DASH, DHD, and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets with participants being classified into quartiles based on their dietary score.

To assess participants' HRV, 24-hour electrocardiogram (ECG) recordings were obtained using a 12-lead Holter monitoring system. Time-domain and frequency-domain parameters were calculated from normal-to-normal (NN) intervals. These included the standard deviation of NN intervals (SDNN), the root mean square of successive differences (RMSSD), total power (TP), and very-low-frequency (VLF), low-frequency (LF), and high-frequency (HF) power.

The researchers used analysis of covariance and linear regression, adjusting for demographic, lifestyle, clinical, and medication-related factors. Subgroup analyses examined differences according to beta-blocker use and other participant characteristics. A Bonferroni-adjusted significance threshold of P < 0.00125 was used to account for 40 primary comparisons. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 29.

Study results

The final analysis included 7,256 participants, with a mean age of 59.19 ± 8.66 years. The findings showed that higher scores for the Mediterranean, DASH, and DHD diet patterns were associated with several favorable cardiometabolic characteristics, but not uniformly better lipid profiles.

Across all four dietary patterns, higher adherence was generally linked to lower smoking rates and lower systolic and diastolic blood pressure, while education and energy intake differed between diets. Greater adherence to these three diets was also associated with lower body mass index (BMI) and serum triglyceride concentrations and higher physical activity, total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. Those with higher adherence to the MIND diet tended to have higher BMI and lower levels of total, HDL, and LDL cholesterol.

Dietary intake comparisons showed that higher diet scores were linked to greater consumption of fruits, vegetables, whole grains, dietary fiber, and magnesium. The DASH and DHD diets were also associated with higher dairy and calcium intake and lower sodium consumption. Intake of other dietary components, including meat, sugar, saturated fat, and protein, also varied between dietary patterns.

HRV measurements varied according to participant characteristics. Women generally had lower HRV than men, but they had higher HF power and more adjacent NN interval pairs differing by more than 50 milliseconds (NN50).

Participants younger than 60 years had higher HRV than older individuals. Lower HRV was also observed among participants with T2DM, obesity, and current or former smoking histories. Beta-blocker users generally demonstrated lower HRV than non-users.

After adjusting for potential confounders, none of the four dietary patterns showed significant associations with time-domain HRV measures, which assess variations in the intervals between successive heartbeats.

Frequency-domain analyses identified significant positive linear associations between adherence to DASH and DHD and VLF power, a measure of slow fluctuations in the intervals between heartbeats. The regression coefficients per point on each dietary adherence scale were 11.81 ± 3.58 for DASH and 4.66 ± 1.20 for DHD, with statistical significance at P ≤ 0.001. These coefficients cannot be directly compared because the diets' adherence scales differ.

No comparable significant associations were identified for the Mediterranean or MIND diets after full adjustment. The physiological meaning of VLF power in 24-hour recordings remains debated, and higher VLF does not necessarily indicate better cardiovascular health.

Subgroup analyses revealed that beta-blocker use modified several associations between dietary patterns and HRV. A significant interaction was identified between DASH adherence and beta-blocker use in relation to VLF power. Among participants not using beta-blockers, greater adherence to both DASH and DHD diets was associated with higher VLF power.

Additional analyses identified associations between DHD adherence and NN50 among women, and between DASH adherence and root mean square of successive differences, HF, and VLF among men. DHD adherence was also associated with higher VLF among men. 

Among adults without obesity, DASH and DHD adherence were associated with higher VLF power. DASH adherence was also associated with VLF among individuals without T2DM. Among never-smokers, Mediterranean diet adherence was associated with higher SDNN and LF/HF; no such associations were found among former or current smokers.

No significant dietary associations were identified in age-stratified analyses. Formal interaction tests found no significant differences by sex, obesity, smoking, diabetes, or age, so these subgroup findings remain exploratory.

Conclusions

The findings suggest that greater adherence to DASH and DHD dietary patterns was associated with higher VLF power, particularly among adults not receiving beta-blocker therapy. Yet these associations were not observed across HRV time-domain measurements or consistently across all dietary patterns.

The interaction between beta-blocker use and DASH adherence indicates that medication use should be considered when examining associations between diet and HRV. While the results provide evidence of associations between specific healthy dietary patterns and HRV, the cross-sectional design prevents establishing causality. 

Self-reported dietary intake, residual confounding, and oversampling of adults with T2DM may also limit interpretation and generalizability. Prospective research, including randomized controlled trials, is needed to determine the clinical significance of these findings.