Statins may have anti-cancer effects against breast cancer, but evidence regarding their influence on the risk of contralateral breast cancer (CBC) remains inconclusive. In this updated study, incorporating a larger samp...Statins may have anti-cancer effects against breast cancer, but evidence regarding their influence on the risk of contralateral breast cancer (CBC) remains inconclusive. In this updated study, incorporating a larger sample, extended follow-up, and landmark analyses, we reevaluated the association between post-diagnosis statin use and CBC incidence among women with breast cancer. Utilising the Danish Breast Cancer Group clinical database, we ascertained data on a nationwide cohort of women aged ≥ 20 years and diagnosed with primary invasive unilateral breast cancer between 1996 and 2019. Data on tumour characteristics, drug use, primary breast cancer therapy, and socioeconomic parameters were retrieved from nationwide health and administrative registries. Using Cox regression, we estimated multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CBC through 2021 associated with post-diagnosis statin use (≥ 1 prescription) defined at landmark time points of 1, 5, and 10 years after first primary breast cancer. Follow-up began at each respective landmark. Among 77,675 women with breast cancer, 2758 were diagnosed with CBC during median follow-up of 7.2 years (interquartile range 3.4-12.0 years) from the 1-year landmark. Post-diagnosis statin use was not associated with the rate of CBC at any of the landmarks (1-year: HR, 1.01; 95% CI 0.88-1.16; 5-year: 1.08; 0.95-1.24; 10-year: 0.95; 0.80-1.12). Additionally, we observed no consistent trends with duration or consistency of post-diagnosis statin use. Stratification by oestrogen receptor status and pre-diagnosis statin use had no substantial influence on the associations. In conclusion, our study did not support an inverse association between statin use and CBC incidence following a breast cancer diagnosis.
Cocoa flavanols may reduce cardiovascular disease (CVD) risk, yet large randomized trials remain inconclusive. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) suggested a modest, nonsignificant benefit usin...Cocoa flavanols may reduce cardiovascular disease (CVD) risk, yet large randomized trials remain inconclusive. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) suggested a modest, nonsignificant benefit using Cox models, which do not account for event severity in composite outcomes. To address this, we applied generalized pairwise comparison (GPC), or "win ratio" (WR), to assess cocoa flavanols versus placebo on hierarchical CVD outcomes among healthy older US adults. This secondary analysis of COSMOS, a randomized, placebo-controlled, 2 × 2 factorial trial of cocoa extract and multivitamins for preventing CVD and cancer, included 21,442 adults (women ≥ 65, men ≥ 60 years) followed for a median of 3.6 years. The primary outcome was a hierarchical composite of total CVD, prioritizing: fatal CVD, non-fatal myocardial infarction (MI), non-fatal stroke, coronary revascularization, carotid surgery, peripheral artery surgery, and hospitalized unstable angina. Analyses followed the intention-to-treat principle. GPC estimated WRs and net treatment benefits (NTBs) for cocoa flavanols versus placebo. GPC analyses showed cocoa flavanol wins of 3.41% and placebo wins of 2.87%, yielding a reciprocal WR of 0.84 (95% CI 0.72-0.99) and negative NTBs of - 0.54% (- 1.04 to - 0.03), p = 0.037. Sensitivity analyses prioritizing stroke over MI produced similar findings. By contrast, Cox regression of the same composite yielded a nonsignificant hazard ratio of 0.90 (95% CI 0.79-1.03), suggesting standard time-to-first-event models underestimated benefit. GPC "WR" analyses showed cocoa flavanols significantly reduced CVD events by accounting for event severity in the composite CVD outcome, whereas Cox regression marginally missed these effects.
Diet likely plays a crucial role in the aetiology of chronic kidney disease (CKD), a growing global health problem. We prospectively examined sex-specific associations between different dietary patterns and CKD. Among 27...Diet likely plays a crucial role in the aetiology of chronic kidney disease (CKD), a growing global health problem. We prospectively examined sex-specific associations between different dietary patterns and CKD. Among 27,126 adults (66.5% females) followed from 1997 to 2016, baseline dietary intake was assessed using a semi-quantitative food frequency questionnaire. We estimated the Dietary Approaches to Stop Hypertension (DASH) and the Nordic Nutrition Recommendations (NNR) scores, and derived three dietary patterns via reduced rank regression using protein, phosphorus, potassium, and sodium as mediators: DP1 (high levels of all nutrients), DP2 (high potassium and phosphorus, low sodium), and DP3 (low potassium and sodium, high phosphorus). Sex-stratified multivariable Cox models were used to evaluate linear, non-linear, and categorical associations with CKD incidence, with categorical exposure defined by tertiles of adherence (low, medium, high). During a 17.9-year mean follow-up, we identified 687 incident cases of CKD. In males, DP1 showed a U-shaped association with CKD risk (HRlow/medium = 1.41; 95%CI: 1.06, 1.89, HRhigh/medium = 1.39; 95%CI:1.05, 1.85). DP3 was associated with higher CKD risk in females (HRlinear = 1.12; 95%CI: 1.01, 1.25). The NNR was associated with lower CKD risk in both females (HRlinear = 0.90, 95% CI: 0.81–1.00; HRmedium/low = 0.77, 95% CI: 0.61–0.99) and males (HRlinear = 0.86; 95%CI: 0.77, 0.97), while the DASH was associated with lower CKD risk in females only (HRlinear = 0.86; 95%CI: 0.78, 0.96, HRhigh/low = 0.70; 95%CI: 0.54, 0.91). Higher adherence to the NNR reduced CKD risk in both sexes, whereas sex-specific associations were observed between the DASH diet, CKD-oriented dietary patterns, and CKD risk.
Cardiovascular disease (CVD) remains the leading global cause of death, despite being partially preventable. Emerging evidence suggests psychological traits, such as trait impulsivity, may influence disease onset. Howeve...Cardiovascular disease (CVD) remains the leading global cause of death, despite being partially preventable. Emerging evidence suggests psychological traits, such as trait impulsivity, may influence disease onset. However, associations between impulsivity and CVD remain understudied. This study investigates associations between trait impulsivity and CVD incidence. We conducted a prospective analysis within the French NutriNet-Santé cohort between May 2014 (time of impulsivity assessment) and February 2023, including adults aged ≥ 18 years without prevalent CVD. Data were collected via a web-based platform. Trait impulsivity was assessed using the Barratt Impulsiveness Scale 11 and categorized as low, moderate (reference), or high. Incident CVD events, including coronary heart disease and cerebrovascular disease, were identified through follow-up assessments and confirmed by NutriNet-Santé experts using medical records. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (HR [95%CI]). Potential interactions, such as prevalence of type 2 diabetes (T2D), were assessed. Among 48,135 participants (78.1% women; mean age: 50.5 ± 14.5 years), 1,184 developed CVD over a median follow-up period of 7.84 years (IQR: 4.04-8.50). High impulsivity was associated with increased CVD risk (HR = 1.27 [1.01, 1.59], P = 0.039), compared to moderate impulsivity. Among participants with T2D (n = 1,301), low impulsivity was associated with reduced CVD risk (HR = 0.42 [0.20, 0.88], P = 0.022); no such association was observed in those without T2D (P for interaction = 0.014). Higher trait impulsivity was associated with greater CVD risk, while lower impulsivity exhibited protection in individuals with T2D. Trait impulsivity may represent a relevant psychological risk factor for CVD and could inform prevention strategies.
The study aimed to explore the impact of using a single baseline measure versus repeated exposure measures on the independent and joint associations of diet and physical activity with mortality risk. We analyzed 106,387...The study aimed to explore the impact of using a single baseline measure versus repeated exposure measures on the independent and joint associations of diet and physical activity with mortality risk. We analyzed 106,387 adults from the Nurses' Health Study and Health Professionals Follow-up Study (1990-2020), with a 4-year lag applied between exposure assessment and time at risk of death using multivariable Cox proportional hazards models. Cumulative averages of the Alternative Healthy Eating Index (AHEI) and moderate-to-vigorous physical activity (MVPA) were calculated from up to 15 repeated measures. Outcomes were all-cause mortality, cardiovascular disease (CVD) mortality, and physical activity, diet, and adiposity-related (PDAR) cancer mortality. During a median follow-up of 29.3 years, 50,844 deaths occurred. Higher AHEI and MVPA (multivariable-adjusted HR [95% CI] comparing the 90th to the 10th percentile for each, respectively) were associated with lower risks of all-cause mortality (0.82 [0.80, 0.84]; 0.78 [0.77, 0.80]); CVD mortality (0.88 [0.84, 0.92]; 0.72 [0.69, 0.76]) and PDAR cancer mortality (0.87 [0.80, 0.94]; 0.88 [0.82, 0.95]). The greatest risk reductions in all-cause (38%), CVD (41%), and PDAR cancer mortality (29%) were observed in the highest AHEI and MVPA categories combined versus the lowest. The strongest inverse associations for MVPA were observed when AHEI was low, and the strongest inverse associations for AHEI were seen when MVPA was low. All associations were substantially attenuated when using single baseline measures instead of cumulative averages. Both diet and MVPA contribute to the lowest mortality risk, which is observed most clearly using repeated measures.
Bui DS, Tai A, Liu J
… +6 more, Perret JL, Lodge CJ, Idrose NS, Roberts M, Robertson C, Dharmage SC
Eur J Epidemiol
· 2026 Apr · PMID 41849083
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The Melbourne Epidemiological Study of Childhood Asthma (MESCA) is one of the longest-running respiratory studies in the world. The study aimed to determine the prevalence and describe the natural history of childhood as...The Melbourne Epidemiological Study of Childhood Asthma (MESCA) is one of the longest-running respiratory studies in the world. The study aimed to determine the prevalence and describe the natural history of childhood asthma and wheezy bronchitis. MESCA started in 1964, when four asthma/wheeze groups and a control group, all aged 7, were recruited and have been followed into their seventh decade. The study has collected unique, repeated data on asthma, respiratory symptoms, and lung function over seven decades. It has provided critical insights into the natural history and long-term outcomes of childhood asthma. MESCA is the first prospective study to provide robust evidence for the link between childhood asthma and the development of COPD. Participants are now entering their seventh decade of life, and their rich, lifetime data provides a unique opportunity to investigate a wide range of outcomes, including multimorbidity and healthy aging.
Feiler MO, Salerno M, Quataert SA
… +6 more, Tellez-Rojo MM, Lamadrid-Figueroa H, Estrada G, Wright RO, Jusko TA, Colicino E
Eur J Epidemiol
· 2026 Apr · PMID 41817940
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The objective of this study was to estimate the association between gestational phthalate metabolite concentrations and mixtures and pediatric antibody response at 4-years of age to common childhood vaccines, while also...The objective of this study was to estimate the association between gestational phthalate metabolite concentrations and mixtures and pediatric antibody response at 4-years of age to common childhood vaccines, while also exploring sexually dimorphic effects. This study utilized data from the Programming, Research, Obesity, and Social Stressors (PROGRESS) Study, an ongoing, longitudinal cohort of mother-child pairs residing in Mexico City. Fifteen phthalate metabolites were measured in spot urine samples collected from mothers during their second and third trimesters. Children have been regularly followed, with data collection on lifestyle, clinical, socio-economic, and demographic factors, and archived biologic specimen. IgG-specific antibody serum levels to measles, mumps, rubella, diphtheria, tetanus, and pertussis were quantified from children at the mean 4.7 years of age. Linear regression models, with log2 transformation of both the outcome and exposure variables, estimated the association between individual phthalate metabolites and antibody concentrations. Phthalate mixtures were analyzed using the Quantile G-Computational approach and Bayesian Kernel Machine regression. All analyses were also sex-stratified to investigate sexually dimorphic effects. The present analysis included 362 mother-child pairs. During the second trimester of pregnancy, a doubling increase of mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) concentrations was associated with a 6.98% decrease (95% CI: - 11.68%, - 2.04%) in diphtheria and a 2.57% decrease (95% CI: - 4.74%, - 0.35%) in mumps antibody levels, respectively. No statistically significant sex-differences were observed. Mixtures analyses did not reach statistical significance but observed similar associations with MECPTP. Concentrations of MECPTP, a replacement phthalate, were negatively associated with anti-diphtheria antibody levels in Hispanic children indicating a potential detrimental effect of newer alternative phthalates on pediatric health.
Eur J Epidemiol
· 2026 Feb · PMID 41733776
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Good sleep quality is known to be associated with improved mental health, and vice-versa. However, the longitudinal association between mental health early in life and sleep later in life has not yet been rigorously inve...Good sleep quality is known to be associated with improved mental health, and vice-versa. However, the longitudinal association between mental health early in life and sleep later in life has not yet been rigorously investigated. The existence of such a relationship could imply that poor childhood mental health has lasting effects on sleep and, by extension, on physical health and mortality in the longer term. We used data from the 1970 British Cohort Study (N = 16 585). To operationalise childhood mental health, we separately analysed seven measures collected between the ages of 5 and 16. The outcome measures were self-reported, diary-derived and accelerometry-derived median nightly sleep duration at age 46. We conducted modified Poisson regression analyses with multiple imputation by chained equations. All seven measures of childhood mental health were positively associated with abnormal self-reported sleep duration. Five were associated with abnormal diary-derived estimates and four were associated with abnormal estimates from an accelerometry-based algorithm. Controlling for adult mental health symptoms post hoc attenuated the associations with self-reported sleep duration but not with the more objective estimates. This study provides clear evidence that poor mental health in childhood is associated with abnormal nightly sleep duration at age 46. Post-hoc analyses suggest that this effect might not be entirely mediated by mental health in adulthood. Presence of adult mental health symptoms may instead drive measurement error in self-reported sleep duration, and therefore result in biased estimates of the association with mental health earlier in life.
The recent Swedish study by Rietz Liljedahl et al. examining melanoma riskamong tattooed individuals has prompted critical discussion regarding a potential causal linkbetween tattoos and melanoma. While concerns persist...The recent Swedish study by Rietz Liljedahl et al. examining melanoma riskamong tattooed individuals has prompted critical discussion regarding a potential causal linkbetween tattoos and melanoma. While concerns persist that tattoo pigments deposited in thedermis may induce melanoma, several lines of evidence argue against this hypothesis, includingthe rarity of melanomas arising within tattoos, low incidence reported in nationwide studies, andthe absence of cases involving multiple melanomas within a single tattoo. Importantly, mostmelanomas in the Swedish study were not located at tattoo sites, and recent studies from theUnited States and France failed to demonstrate a positive association, with one reporting adecreased melanoma risk among individuals with multiple large tattoos. Experimental data evensuggest a possible protective effect of black ink on UV penetration. The study's interpretation isfurther limited by insufficient consideration of established melanoma risk factors, includingfamilial history, number of nevi, childhood sunburns, and sunbed use, the latter showing a highlysignificant association. Methodological issues also arise from the inclusion of dysplastic nevi withhigh-grade atypia as melanoma in situ, despite the lack of diagnostic consensus and poorinterobserver reliability. Moreover, comparisons between tattoo-related hydrocarbon exposureand occupational exposure in the petroleum industry are inappropriate due to substantialdifferences in magnitude, duration, and route of exposure. Overall, the study appears tooveremphasize hypothetical systemic effects of tattoo pigments while underestimating well-established behavioral and phenotypic risk factors. Current evidence does not support a directcausal link between tattoos and melanoma.
Zhang J, Tran DT, El Ghoul T
… +6 more, Strohmaier S, Żebrowska M, Redline S, Saxena R, Rutter MK, Schernhammer ES
Eur J Epidemiol
· 2026 Apr · PMID 41721995
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UNLABELLED: To examine the association between combined circadian imbalance related traits and cardiovascular-kidney-metabolic (CKM) disease risk, and their potential interaction with night shift work. This study include...UNLABELLED: To examine the association between combined circadian imbalance related traits and cardiovascular-kidney-metabolic (CKM) disease risk, and their potential interaction with night shift work. This study included 191,764 UK Biobank participants without major chronic diseases who were employed at baseline (2006–2010). The Circadian Imbalance Index (CII) was developed by combining several factors indicative of a propensity for circadian misalignment. One point was assigned for each of the following components if present: evening chronotype, sleep duration ≤ 6 or ≥ 9 h/day, high neuroticism (score ≥ 7), atypical caffeinated coffee consumption (0 or ≥ 5 cups/day), and vitamin D (< 50 nmol/L), resulting in a composite scale from 0 to 5. CKM outcome (type 2 diabetes, cardiovascular diseases, chronic kidney diseases) identified by ICD codes, self-reports, or death records. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the multivariable (MV)-adjusted association between the CII and CKM risk, including effect modification by night shift work. During a median follow-up of 13.5 years (through 2022), 16,907 incident CKM cases were identified. Among participants with European ancestry, for highest versus lowest (0–1) CII, the MV-adjusted risk of CKM was 1.95 (95%CI: 1.70–2.23; <0.001). A significant positive relationship between CII and CKM risk was also observed in participants of Asian (HR = 2.03, 95%CI, 1.07–3.86; =0.002), but not African ancestry (HR = 1.43, 95%CI, 0.67–3.06; =0.35). Risks were higher in shift and night workers than day workers. Among Europeans, the HR for highest CII combined with current night shift work was 2.22 (95%CI, 1.95–2.53), with significant additive interaction ( < 0.05). In this large prospective study, Circadian Imbalance Index (CII) was associated with higher CKM risk in Europeans and Asians. Among Europeans, high CII plus night shift work posed the greatest risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10654-026-01373-7.
Steponenaite A, Wallraff JP, Wild U
… +9 more, Brown L, Bullock B, Lall GS, Ferguson S, Foster RG, Walsh J, Murray G, Erren TC, Lewis P
Eur J Epidemiol
· 2026 Apr · PMID 41721993
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Our objective was to systematically review the epidemiological evidence regarding health effects of daylight-saving time (DST) practices - the abolition of which have been called for without the epidemiology having been...Our objective was to systematically review the epidemiological evidence regarding health effects of daylight-saving time (DST) practices - the abolition of which have been called for without the epidemiology having been comprehensively reviewed. We searched PubMed, Web of Science, Scopus, PsychINFO, and EconLit up to June 2025. The primary inclusion criterion was human studies that consider either acute effects of transitions or DST vs standard time at a given time of year. Included studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. We narratively synthesize by broader outcome categories in Supplementary Material and provide a synthesis of syntheses in the main text. From 157 studies of varying designs and quality from 36 countries, we find that the messaging of transitions and DST during summer months being uniformly detrimental is not supported. DST-Onset transitions appear associated with increased acute myocardial infarction and fatal traffic accidents, but also with decreased crimes involving physical harm. DST-Offset transitions appear associated with decreased all-cause mortality and workplace accidents, but also with increased crimes involving physical harm. Living with DST (compared to Standard Time) appears associated with decreased all-cause mortality and traffic accidents in summer. Standard Time appears is potentially associated with decreased sleep duration during winter. No clear and consistent effects on psychiatric outcomes are identified. Limited studies prevent clear conclusions being drawn regarding other sleep parameters or circadian rhythms. This review indicates that transitions and living with DST (as opposed to Standard Time) during summer months are not uniformly detrimental; however, the evidence base remains limited and heterogeneous. Rather than advocating for maintaining or removing transitions, our synthesis supports a balanced approach. We recommend recognising both adverse and beneficial patterns and prioritising strategies to mitigate risks while awaiting more robust evidence.Registration https://doi.org/10.17605/OSF.IO/R4W6M.
BACKGROUND: Standardized definitions of autoimmune disease (AD) are lacking. Therefore, we aim to propose a definition of AD for register-based research and estimate the burden of AD in Sweden as registered in the Nation...BACKGROUND: Standardized definitions of autoimmune disease (AD) are lacking. Therefore, we aim to propose a definition of AD for register-based research and estimate the burden of AD in Sweden as registered in the National Patient Register (NPR) from 1980 to 2023. METHODS: Leveraging the NPR, we defined AD as having at least two relevant International Classification of Diseases (ICD) codes representing AD. These codes could either represent the same disease or two different diseases. Age-standardized and age-specific incidence rates (IRs) of AD were calculated, along with prevalence on December 31, 2023. RESULTS: From 1980 to 2023, the mean age-standardized IR of AD was 318 cases per 100,000 person-years (95% CI: 294–342). The IR decreased with the introduction of ICD-10 (1997), but then sharply increased in 2001 following the addition of specialized outpatient data to the NPR that year, likely reflecting improved case ascertainment rather than a sudden true rise in incidence. As of December 31, 2023, the prevalence of AD in Sweden was 6.6% overall, 7.9% in adults, and 1.5% in children. CONCLUSIONS: In a nationwide study spanning more than 40 years, the IR of AD was 318 per 100,000 person-years but with substantial variation correlating to administrative changes in coding and content of the NPR. In 2023, the point prevalence of AD in Sweden was 1 in 15 individuals across all ages, 1 in 13 adults, and 1 in 67 children.
Zarén P, Kitlinski M, Giwercman A
… +2 more, Giwercman YL, Elenkov A
Eur J Epidemiol
· 2026 Apr · PMID 41721991
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Whereas the link between impaired male fertility and risk of testicular and prostate cancer is well established, studies investigating non-reproductive cancer risk among men with impaired reproductive function are scarce...Whereas the link between impaired male fertility and risk of testicular and prostate cancer is well established, studies investigating non-reproductive cancer risk among men with impaired reproductive function are scarce and show conflicting results. The aim of the study was to compare the risk of developing non-reproductive cancers in men achieving paternity through assisted reproduction as compared to those conceiving naturally. All first-time fathers n = 1 137 829 in Sweden during the period January 1994 to December 2014 were included and followed from the time of conception until date of cancer diagnosis, death, or end of follow-up (31st of December 2014). Conception by intracytoplasmic sperm injection (ICSI) or use of donated spermatozoa was used as proxy for impaired male fertility. As controls we used males who conceived spontaneously. National register based cohort study. By linking the Swedish multigeneration register with the Swedish medical birth register (MBR), all men conceiving their 1st child between 1994 and 2014 in Sweden were identified (n = 1 181 490). Information on mode of conception was derived from the MBR or the Q-IVF register. Men with history of cancer prior to conception, missing covariate data, and those with missing information to estimate gestational age were excluded (n = 43 661). From the Swedish cancer registry data was retrieved on cancer diagnoses during follow-up. Fathers´ fertility status was based on mode of conception i.e. naturally, standard in-vitro fertilization (IVF) or ICSI. Diagnosis of any type of non-reproductive cancer according to International Classification of Diseases 7th revision (ICD-7) after the time of conception. Among 1 137 829 men, 20 142 and 14 540 achieved paternity through IVF and ICSI treatment, respectively. ICSI-fathers and those using donated spermatozoa were, as compared to those conceiving spontanouesly, at an increased risk of non-reproductive cancers (adjusted hazardo ratio (aHR) 1.3; 95%CI 1.1-1.5), foremost colon (aHR 1.7; 95%CI 1.1-2.7), rectum (aHR 1.8. 95%CI 1.1-3.0) or thyroid gland cancer (aHR 3.3; 95%CI 1.7-6.2). Men achieving paternity after ICSI treatment or by using donated spermatozoa, in other words those with most severely hampered fertility, were at increased risk of colorectal and thyroid cancer. For this subpopulation of men, an extended health check-up at the time of fertility treatment as well as at long-term follow-up, should be considered.
Nôga DA, Meth EMS, Pacheco AP
… +3 more, Cedernaes J, Xue P, Benedict C
Eur J Epidemiol
· 2026 Apr · PMID 41721990
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Shift workers exhibit a higher incidence of coronary heart disease (CHD) than daytime workers. We examined whether this difference in CHD incidence between shift workers and daytime workers is associated with two dietary...Shift workers exhibit a higher incidence of coronary heart disease (CHD) than daytime workers. We examined whether this difference in CHD incidence between shift workers and daytime workers is associated with two dietary factors linked to lower CHD risk-daily fiber intake and meat avoidance-using UK Biobank data. The study included 222,801 participants (53.8% women; mean age 52.6 years), categorized as daytime workers, shift workers with no or occasional night shifts, or regular night shift workers. Dietary habits were assessed via touchscreen dietary questionnaires. During a median follow-up of 12.6 years, 12,265 fatal and non-fatal CHD events occurred. Compared with daytime workers, regular night shift work-but not shift work with no or occasional night shifts-was associated with higher CHD incidence (hazard ratio [HR] 1.10, 95% CI 1.01-1.20). HRs for CHD were higher (vs. daytime work) in both shift work groups among participants with lower daily fiber intake, whereas they were attenuated among those with higher fiber intake (p < 0.05 for interaction). Meat avoidance was associated with a 10.4% lower CHD HR compared with meat consumption (p = 0.020), although no significant interaction with work schedule was observed. In summary, while our finding that meat avoidance is associated with modestly lower CHD HR across work schedules aligns with established cardiovascular recommendations, our observation that higher fiber intake may reduce CHD differences specifically linked to night shift work highlights an additional, shift-specific dietary consideration that could complement the American Heart Association's Life's Essential 8.