Frontiers in Nutrition · Feb 20, 2026

Low serum zinc levels and risk of incident atrial fibrillation/flutter: a multi-institutional study

By Chen IW, Chang LC, Lai YC et al.

BACKGROUND: Atrial fibrillation/flutter (AF) is increasingly prevalent, and identification of modifiable risk factors is a priority. Zinc deficiency (ZD) has been implicated in cardiovascular disease, but large-scale evidence linking ZD to incident AF remains limited. METHODS: We conducted a multi-institutional retrospective cohort study using the TriNetX Research Network, analyzing patients aged ≥40 years with documented serum zinc levels (index date) between 2010 and 2023. Patients were categorized as zinc-deficient (< 70 μg/dL, n = 61,732) or zinc-sufficient (70-120 μg/dL, n = 61,732) after 1:1 propensity score matching. The primary outcome was newly diagnosed AF within two years after the index date. The secondary outcomes included risks of pneumonia (positive control), ventricular fibrillation/flutter, and ischemic stroke. Outcome events were stratified into early and late onset, defined as those occurring within 1-6 months and 6-24 months, respectively. RESULTS: ZD was associated with significantly increased AF risk during both the early (hazard ratios (HRs) 1.62, 95% confidence intervals (CIs) 1.39-1.90, p < 0.001) and late follow-up periods (HR 1.42, 95%CI 1.29-1.57, p < 0.001). A clear dose-response relationship was observed when comparing different levels of ZD to the control group. Severe ZD (< 50 μg/dL) conferred nearly two-fold higher late AF risk vs. controls (HR 2.04, 95% CI 1.67-2.49), while mild-to-moderate ZD (50-70 μg/dL) showed a modest but significant increase compared to controls (HR 1.26, 95% CI 1.14-1.41). The association between ZD and AF remained consistent across diverse patient subgroups and both pre-pandemic (2010-2019) and pandemic periods (2020-2023). The risks of pneumonia (early: HR 1.56; late: HR 1.40) and ischemic stroke (early: HR 1.19; late: HR 1.12) were also elevated in zinc-deficient patients, whereas ventricular fibrillation/flutter was not significantly associated with ZD. CONCLUSION: ZD may serve as an important independent risk factor for incident AF, highlighting the potential value of incorporating zinc status into cardiovascular risk assessment and considering zinc supplementation as a cost-effective preventive strategy.

doi.org/10.3389/fnut.2026.1746078Open accessPubMed 41798843Populations