“Compared with the nutrient composition of a usual Chinese diet in urban China, our heart-healthy diet of traditional Chinese cuisine cut sodium in half, from 6,000 mg daily to 3,000 mg daily, reduced fat intake, and doubled dietary fiber. It also increased protein, carbohydrates, and potassium,” said the first author and co-chair of the study team Yanfang Wang, Ph.D., a nutritionist and professorial research fellow at Peking University Clinical Research Institute in Beijing, China.
According to the study, Chinese people account for more than one-fifth of the world’s population.
China’s cardiovascular disease burden has rapidly increased in recent decades, like in other parts of the world. Unhealthy changes in the Chinese diet have been a major factor driving the rise in cardiovascular disease.
According to a 2012 China National Nutrition Survey, consumption of healthy foods such as grains (34%), tubers and legumes (80%), and vegetables and fruits (15%) decreased significantly. In contrast, consumption of meat (162%), eggs (233%), and edible oil (132%) increased dramatically over the same time.
“Chinese people who live in the U.S. and elsewhere often maintain a traditional Chinese diet, which is very different from a Western diet,” said the chair of the study team Yangfeng Wu, M.D., Ph.D., professor of epidemiology and sciences in clinical research at Peking University Clinical Research Institute in Beijing, China.
“Healthy Western diets such as DASH and Mediterranean have been developed and proven to help lower blood pressure; however, until now, there has not been a proven heart-healthy diet developed to fit into traditional Chinese cuisine.”
Why Sodium Intake is Higher in China?
The study included 265 Chinese adults, with an average age of 56 years old, with systolic blood pressure equal to or greater than 130 mm Hg. Slightly more than half of the participants were women, and nearly half took at least one high blood pressure medication when the study began.
Participants were recruited from Beijing, Shanghai, Guangzhou, and Chengdu. These are four major cities in China, each with a corresponding regional cuisine: Shangdong, Huaiyang, Cantonese, and Szechuan, respectively.
The Chinese heart-healthy diet was developed with catering organizations in those areas and conformed to the four regional cuisines so that researchers could understand if the effect of the heart-healthy diet would apply and be sustainable to different Chinese dietary cultures.
This can sometimes be challenging since traditional Chinese cuisine has a long history of using salt for cooking and food preservation for thousands of years
High Blood Pressure Risk in China
At the beginning of the study, all participants consumed their local, usual diets for seven days so that the new eating plans could be customized for taste and flavor. Researchers wanted the heart-healthy diet to be as close as possible to the participant’s usual diets in terms of flavor while adjusting the nutrient intake to be heart-healthy.
After the initial seven days of eating their usual diet, 135 adults were randomly selected to consume the new Chinese heart-healthy diet for 28 days. The remaining 130 participants ate meals from their usual cuisine.
Depending on group assignment, meals were either regular or heart-healthy versions of Shangdong, Huaiyang, Cantonese, and Szechuan cuisine. Study participants and blood pressure assessors were unaware of which dietary group the participants were assigned.
Researchers measured the participants’ blood pressure before and after the study and once a week during the study. Food ingredients were weighed for each dish to calculate nutrient intake for each meal. Urine samples were collected to measure sodium and potassium intake at the study’s start and end.
The results indicated that the blood pressure-lowering effect of the Chinese heart-healthy diet might be substantial and compatible with hypertension medications.
The study found:
- Participants who ate the Chinese heart-healthy diet had lower blood pressure, with the systolic (top number) blood pressure lowered by an average of 10 mm Hg, and diastolic blood pressure fell by an average of 3.8 mm Hg, compared to the group who ate traditional cuisine.
- In the heart-healthy group, calorie intake from carbohydrates (8%) and protein (4%) increased, and fat decreased (11%). Consumption of fiber (14 grams), potassium (1,573 mg), magnesium (194 mg) and calcium (413 mg) increased, while sodium decreased (2,836 mg). However, the nutrient intake of the group that consumed regular diets remained almost unchanged from the start to the end of the study.
- Flavor and taste preferences for the Chinese heart-healthy diet were comparable to the usual local diet. Participants ate similar quantities of food and scored their diets high in both dietary groups.
- The additional cost of the heart-healthy Chinese diet was about 4 RMB (equivalent to $0.60 USD) more per day, per person, on average, compared to the usual local diet. That was considered low and generally affordable.
- The blood pressure-lowering effect was consistent among participants in the four heart-healthy Chinese cuisine groups.
Researchers noted these findings suggest the effects achieved by the heart-healthy Chinese diet, if sustained, may reduce major cardiovascular disease by 20%; heart failure by 28%, and all-cause death by 13%.
“Health professionals should recommend a heart-healthy diet with low sodium and high potassium, fiber, vegetables, and fruits as the first-line treatment to their patients with high blood pressure,” Wu said. “Because traditional Chinese dietary culture and cooking methods are often used wherever Chinese people live, I believe a heart-healthy Chinese diet and the principles we used to develop the diet would also be helpful for Chinese Americans.”
American Heart Association volunteer expert Lawrence J. Appel, M.D., M.P.H., FAHA, noted, “The results of this trial are awe-inspiring and provide a roadmap on healthy eating to people consuming a variety of Chinese cuisines – Shangdong, Huaiyang, Cantonese or Szechuan cuisines. Major public health efforts are warranted to ‘scale up’ throughout China to achieve population-wide reductions in blood pressure.”
Appel is vice-chair of the writing group for the American Heart Association’s 2021 scientific statement, Dietary Guidance to Improve Cardiovascular Health. The guidelines suggest:
- consume whole grains, lean and plant-based protein, and a variety of fruits and vegetables;
- limit salt, sugar, animal fat, processed foods, and alcohol; and
- to apply this guidance regardless of where the food is prepared or consumed.
A limitation of the study is that the heart-healthy Chinese diet was tested for only four weeks. According to Wu, a longer study period may confirm and possibly even strengthen these results.
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