The healthy Chinese diet similar to DASH reduces blood pressure in adults with hypertension

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Researchers report that a heart-healthy diet based on Chinese cuisine reduces sodium intake by half, and significantly reduces systolic and diastolic blood pressure compared to traditional Chinese diets in adults with mild hypertension.

More than a fifth of the world’s population consumes Chinese food regularly, but there are no evidence-based healthy diets that fit Chinese food culture available for implementation. Yangfeng Wu, MD, PhD, Professor of Epidemiology and Science in Clinical Research at Peking University Clinical Research Institute in Beijing, and colleagues wrote in Rotation.

Graphical depiction of the data presented in the article

Data were derived from Wang Y, et al. Rotation. 2022; doi: 10.1161/CIRCULATIONAHA.122.059045.

“The most important message is that a healthy diet can be highly effective and able to significantly lower blood pressure among hypertensive patients, which will ultimately reduce the risk of cardiovascular disease,” Wu told Helio. “The key is to reduce the intake of sodium and fat while increasing the intake of carbohydrates, protein, fiber and potassium. This can be achieved by reducing the use of regular salt, edible oil and red meat; increasing the intake of whole grains, low-fat dairy products, fruits, vegetables, nuts, and beans, and replacing reduced regular salt with salt substitutes.”

Yangfeng woo

For the DECIDE-Diet randomized, double-blind trial, Wu and colleagues analyzed data from 265 participants with baseline systolic blood pressure between 130 mm Hg and 159 mm Hg from four study centers across China representing four major Chinese restaurants: Shandong, Huayang, Cantonese. and Sichuan. The average age of the participants was 57 years. 52% of the women had average systolic and diastolic blood pressures of 139.4 mm Hg and 88.1 mm Hg, respectively. Each center selected a local catering cooperative to provide a kitchen to conduct the study; Chefs were selected from catering organizations, trained and supervised by research staff.

Heart-healthy Chinese diet design

The heart-healthy Chinese diet includes four versions of Chinese cuisine, with each version featuring a combination of breakfast, lunch and dinner menus with non-recurring dishes over a course of at least two weeks. The nutritionists, dietitians and chefs on the study team pre-developed the recipes according to the heart-healthy Chinese diet, daily nutrients and energy components, taking into account the availability and interchangeability of foods during the season. The diet was created to reduce sodium intake in half, from approximately 6000 mg per day to about 3,000 mg per day, reduce fat, increase protein and carbohydrates and include twice the amount of dietary fiber and potassium.

“The targets for the daily nutrients and energy components of the heart-healthy Chinese diet were based on Chinese dietary guidelines, knowledge obtained from previous successful healthy diets, in particular the Dietary Approaches to Stop Hypertension (DASH), Chinese food and nutrient intake levels from the Nutrition Survey. The last national, and the most popular local foods and dishes from our surveys,” the researchers wrote. Compared with the nutrient composition of a typical Chinese diet in urban China, the Chinese heart-healthy diet reduced energy from fat by 5% to 8%, increased energy intake from protein by 3.5% to 5.5%, and increased energy from carbohydrates by 0. to 5%, respectively.

Intervention evaluation

After a 7-day run on a control diet that matched their usual local diets, the researchers assigned participants to continue their control diet (n=130) or the heart-healthy Chinese diet (n=135) for another 28 days. All participants were asked to eat study meals at breakfast, lunch, and dinner; No other intervention was offered to participants in both groups. The primary outcome was systolic blood pressure. Secondary outcomes included diastolic blood pressure and food preference score. The researchers also calculated the additional cost per 1 mmHg of reduction in systolic blood pressure.

The mean changes in systolic blood pressure from baseline to the end of the intervention were -15 mmHg (95% confidence interval, -16.5 to -13.5) for the Chinese Heart Health Diet and -5 mmHg (95% confidence interval, -6.5 to -6.5 to -3.5) for the control regimen, for a net difference in systolic blood pressure change of -10 mm Hg (95% confidence interval, -12.1 to -7.9) compared to the control diet group (P .001).

For diastolic blood pressure, mean changes were -6.7 mm Hg (95% CI, -7.5 to -5.7) for the heart-healthy Chinese diet and -2.8 mm Hg (95% CI, -3.7 to -1.9) for the control regimen. , for a net difference of -3.8 mm Hg (95% confidence interval, -5 to -2.5) compared to the control diet group.

In the subgroup analysis, women experienced a greater decrease in systolic blood pressure compared to me (-12 mm Hg vs -7.6 mm Hg; s for reaction = .037).

The mean food preference score was 9.5 (with 10 being the best preferred) at baseline and the net change during the intervention was 0.1 (q = .558). According to the researchers, the additional cost-effectiveness ratio for each 1 mm Hg reduction in systolic blood pressure was 60 cents per day.

“Our findings have strong clinical implications,” Wu told Healio. “The large effect size on blood pressure means that for patients with mild hypertension, blood pressure can be controlled by following the heart healthy Chinese diet alone. Thus, clinicians should consider the heart healthy Chinese diet in the clinical management of all patients. hypertensive patients, and may use the heart-healthy Chinese diet as the first-only treatment for patients with mild hypertension.”

The researchers noted that the study did not reach the planned recruitment target due to the COVID-19 pandemic and China’s strict quarantine policy.

“Although the sample size was statistically adequate in detecting the effect of the main intervention, the study may not have sufficient power to detect the effect of cuisine type on the effect,” the researchers wrote.

Wu said that implementation research is needed to better understand how the heart-healthy Chinese diet is widely described.

“Research on biomedical mechanisms should help develop new strategies for treating hypertension,” Wu said.

A diet that includes switching to a salt substitute has previously been shown to be effective. As previously reported by Healio, adults in rural China with a history of stroke who switched from regular salt to salt substitute had a 14% lower incidence and 13% lower rate of major adverse CV events during 4.74 years of follow-up. . above.

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