Heart-healthy and lower sodium version of traditional Chinese cuisine lowers blood pressure

DALLAS, July 11, 2022 — Blood pressure levels fell significantly among Chinese adults with high blood pressure who ate heart-healthy, low-sodium traditional Chinese cuisine for four weeks, according to new research published today in the main journal of the American Heart Association. Circulation .

A key feature of the Chinese heart-healthy diet, modeled along the lines of the Dietary Approaches to Stop Hypertension (DASH), is sodium reduction. An unhealthy diet, especially one high in sodium, is a major modifiable risk factor for high blood pressure.

“Compared to the nutritional composition of the typical Chinese diet in urban China, our heart-healthy diet of traditional Chinese cuisine cuts sodium in half, from 6,000 mg daily to 3,000 mg daily, reducing fat intake and doubling dietary fiber. It also increases protein, carbohydrates, and potassium,” said first author and co-chair of the study team Yanfang Wang, Ph.D., a nutritionist and research professor at Peking University Clinical Research Institute in Beijing, China.

According to research, Chinese people account for more than a fifth of the world’s population. As in other parts of the world, the burden of cardiovascular disease has increased rapidly in recent decades in China. Unhealthy changes in the Chinese diet have been a major factor driving the increase in cardiovascular disease.

According to the 2012 China National Nutrition Survey, consumption of healthy foods such as whole grains (34%), tubers and nuts (80%), and vegetables and fruits (15%) decreased significantly. On the other hand, consumption of meat (162%), eggs (233%), and vegetable oil (132%) increased dramatically at the same time.

“Chinese people living in the US and elsewhere often maintain a traditional Chinese diet, which is very different from the Western diet,” said study team leader Yangfeng Wu, MD, Ph.D., professor of epidemiology and science in clinical research. at the Peking University Clinical Research Institute in Beijing, China. “Healthy Western diets such as DASH and Mediterranean have been developed and shown to help lower blood pressure, however, to date, no heart-healthy diet has been shown to be developed to suit traditional Chinese cuisine.”

The study included 265 Chinese adults, mean age 56 years, with systolic blood pressure equal to or greater than 130 mm Hg. Slightly more than half of the participants were women, and nearly half were taking at least one high blood pressure medication when the study began. Participants were recruited from Beijing, Shanghai, Guangzhou and Chengdu. These are the four major cities in China, each with its corresponding regional cuisine: Shangdong, Huaiyang, Cantonese and Szechuan, respectively.

The Chinese heart-healthy diet was developed with catering organizations in the area and adapted to the four regional cuisines, so that researchers can understand if the effects of a heart-healthy diet will be applicable and sustainable for different Chinese dietary cultures. This is sometimes a challenge because traditional Chinese cuisine has a long history of using salt for cooking and food preservation, spanning thousands of years. This is especially true in northern China, where vegetables are scarce in cold climates, and people have to eat salt-cured vegetables during winter and spring. This is why sodium intake is even higher for people living in northern China.

At the start of the study, all participants consumed their usual local diet for seven days so that the new meal plan could be adapted to taste and flavour. Researchers wanted the heart-healthy diet to be as close as possible to the participants’ usual diets in terms of taste, while adjusting nutrient intake for a healthy heart. After the first 7 days of eating their usual diet, 135 adults were randomly selected to eat the new heart-healthy Chinese diet for 28 days, and the remaining 130 participants ate food from their usual diet. Depending on the group assignment, meals can be regular or heart-healthy versions of Shangdong, Huaiyang, Cantonese, and Szechuan cuisine. Study participants and blood pressure assessors did not know which diet group the participants were assigned to.

Researchers measured participants’ blood pressure before and after the study, and once a week during the study. Food ingredients are weighed for each dish to calculate the nutrient intake for each meal. Urine samples to measure sodium and potassium intake were collected at the beginning and end of the study. The results suggest the blood pressure-lowering effect of the Chinese heart-healthy diet may be substantial and compatible with hypertension drugs.

This study found:

• Participants who ate the heart-healthy Chinese diet had lower blood pressure, with systolic blood pressure (top number) lowered by an average of 10 mm Hg, and diastolic blood pressure decreasing by an average of 3.8 mm Hg, compared with the group eating regularly. Cook.
• In the healthy heart group, calorie intake from carbohydrates (8%) and protein (4%) increased and from 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). The nutrient intakes of the regular diet group, however, remained virtually unchanged from the start to the end of the study.
• Taste and taste preferences for the Chinese heart-healthy diet were comparable to those of the regular local diet, and participants ate the same amount of food and scored high in both diet groups.
• The added cost of the heart-healthy Chinese diet is about 4 RMB (equivalent to $0.60 USD) more per day, on average per person, when compared to a regular local diet. It is considered low-key and generally affordable.
• The blood pressure-lowering effect was consistent among participants in the four heart-healthy Chinese cooking groups.

The researchers note these findings demonstrate the effect achieved by a heart-healthy Chinese diet, if maintained, could reduce major cardiovascular diseases by 20%; heart failure by 28% and all-cause mortality by 13%.

“Health professionals should recommend a heart-healthy diet with low sodium and high potassium, fiber, vegetables and fruits as first-line treatment for 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 the heart-healthy Chinese diet and the principles we used to develop the diet will be of great help to Chinese Americans as well.”

American Heart Association volunteer expert Lawrence J. Appel, MD, MPH, FAHA, notes, “The results of this trial are truly impressive and provide a roadmap on healthy eating to people who consume a variety of Chinese cuisines – Shangdong, Huaiyang, Cantonese or Chinese. Szechuan cuisine. Huge public health efforts are needed to ‘step up’ across China to achieve a reduction in blood pressure across the population. ”

Appel is co-chair of the writing group for the American Heart Association’s 2021 scientific statement, Dietary Guidelines for Improving Cardiovascular Health. The guidelines recommend eating whole grains, lean and plant-based protein and a variety of fruits and vegetables; limiting salt, sugar, animal fats, processed foods and alcohol; and to apply these guidelines wherever food is prepared or consumed.

A limitation of the study was that the heart-healthy Chinese diet was tested for only four weeks. A longer study period could confirm and possibly even strengthen these results, according to Wu.

Co-authors are Yanfang Wang, MS, MHSc., RD, Ph.D.; Lin Feng PhD; Guo Zeng MS; Huilian Zhu Ph.D; Jianqin Sun, Ph.D.; Pei Gao, Ph.D.; Jihong Yuan, RD; Xi Lan, MS; Shuyi Li, MB; Yanfang Zhao, MS; Xiayan Chen, MPH; Hongli Dong, MS; Si Chen, Ph.D.; Zhen Li, MB; Yidan Zhu, Ph.D.; Ming Li, MD; Xiang Li, MS; Zhenquan Yang, Ph.D.; Huijuan Li, Ph.D.; Hi Fang, Ph.D.; Gaoqiang Xie, Ph.D.; Pao-Hwa Lin, Ph.D.; and Junshi Chen, Ph.D. The author’s disclosures are included in the manuscript.

The study was funded by the National Key Research and Development Program of the Ministry of Science and Technology of China (MOST).

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