New research published today in Circulation shows that Chinese adults with high blood pressure whose diet was modified to make it healthier for the heart and lower in sodium saw a big drop in their blood pressure.

Sodium reduction was a significant part of the Chinese heart-healthy diet, which was designed after the Dietary Approaches to Stop Hypertension (DASH) diet. A poor diet, particularly one heavy in sodium, is a major modifiable risk factor for hypertension.

“Compared with the nutrient composition of a usual Chinese diet in urban China,” says the first author Yanfang Wang, “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.”

Chinese people make for more than one-fifth of the world’s population, according to the report. Similar to other regions of the world, China has experienced a sharp rise in the burden of cardiovascular disease in recent years.

Increases in cardiovascular disease have been mostly attributed to unhealthful changes in Chinese food.

A 2012 China National Nutrition Survey found that people were consuming much fewer nutritious foods, such as grains (34 percent), tubers and legumes (80 percent), and vegetables and fruits (15 percent). Contrarily, throughout the same period, consumption of meat (162 percent), eggs (233 percent), and edible oil (132 percent) increased significantly.

According to Yangfeng Wu, the study team’s head, “Chinese people who live in the U.S. and elsewhere often maintain a traditional Chinese diet, which is very different from a Western diet.”

“Healthy Western diets such as DASH and Mediterranean have been developed and proven to help lower blood pressure, however,” the author adds, “until now, there has not been a proven heart-healthy diet developed to fit into traditional Chinese cuisine.”

In the study, 265 Chinese people with systolic blood pressure of at least 130 mm Hg and an average age of 56 were enrolled.

Nearly half of the participants were women and slightly more than half were taking at least one medication to lower their blood pressure at the start of the trial. Recruitment took place in Beijing, Shanghai, Guangzhou, and Chengdu.

There are four big cities in China, and each has its own style of food: Shangdong, Huaiyang, Cantonese, and Szechuan.

The Chinese heart-healthy diet was designed in collaboration with local catering companies and based on the four major regional cuisines so that scientists could determine whether or not its beneficial effects would be generalizable across China.

Since salt has been used for cooking and food preservation in traditional Chinese cuisine for thousands of years, this can occasionally be difficult.

This is particularly true in northern China, where people had to eat salt-preserved vegetables during the winter and spring because there were few greens available due to the region’s harsh climate.

For this reason, residents of northern China consume considerably more sodium.

All subjects followed their local, customary diets for seven days prior to the study’s start in order to personalize the new eating regimens for taste and flavor.

While altering the food intake to be heart-healthy, researchers intended the heart-healthy diet to taste as much like the participants’ regular diets as feasible.

After consuming their regular diet for the first seven days, 135 of the adults were chosen at random to follow the new Chinese heart-healthy diet for 28 days, while the other 130 participants continued to eat meals from their regular cuisine.

Dishes from Shangdong, Huaiyang, Cantonese, and Szechuan were prepared both traditionally and in heart-healthy adaptations for each study group. Both study participants and blood pressure monitors were unaware of the individuals’ assigned food group.

The participants’ blood pressure was checked before, after, and once a week while the trial was ongoing. To figure out how many nutrients were in each meal, the ingredients for each dish were weighed.

Urine samples were taken at the beginning and conclusion of the research to determine salt and potassium intake. The findings suggested that the Chinese heart-healthy diet may have a significant blood pressure-lowering effect and be compatible with drugs for hypertension.

The study revealed:

• In comparison to the group who consumed regular food, participants who followed the Chinese heart-healthy diet had lower blood pressure, with the systolic (upper number) blood pressure falling by an average of 10 mm Hg and the diastolic blood pressure falling by an average of 3.8 mm Hg.
• In the heart-healthy group, calorie consumption from protein and carbs both rose (8 percent and 4 percent, respectively), whereas calorie intake from fat dropped (11 percent ). Fiber (14 grams), potassium (1,573 mg), magnesium (194 mg), and calcium (413 mg) were all consumed at higher rates than sodium (2,836 mg). However, the group who followed a typical diet had essentially little change in their nutrient consumption during the trial.
• The Chinese heart-healthy diet’s flavor and taste preferences were comparable to those of the typical local diet, and participants consumed comparable amounts of food and gave both diets excellent ratings.
• In comparison to the typical local diet, the expense of the heart-healthy Chinese diet was, on average, roughly 4 RMB ($0.60 USD) higher per day, per person. That was regarded as being reasonable and low.
• The four heart-healthy Chinese cuisine groups’ members all experienced a decrease in blood pressure.

These results, according to researchers, imply that the heart-healthy Chinese diet may, if maintained, lower major cardiovascular disease by 20 percent, heart failure by 28 percent, and all-cause mortality by 13 percent.

“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 adds. 

“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 that we used for developing the diet would be helpful for Chinese Americans as well.”

The results of this experiment are genuinely amazing and offer a roadmap for healthy eating to those who consume a variety of Chinese cuisines, including Shangdong, Huaiyang, Cantonese, or Szechuan cuisines, according to American Heart Association volunteer specialist Lawrence J. Appel. 

“To ‘scale up’ throughout China in order to achieve population-wide reductions in blood pressure,” Appel says.

The recommendations urge limiting salt, sugar, animal fat, processed foods, and alcohol while consuming whole grains, a variety of fruits and vegetables, lean and plant-based protein, and whole grains. These recommendations should be followed wherever food is prepared or consumed.

The study’s four-week test period for the heart-healthy Chinese diet is one of its limitations. According to Wu, a lengthier study period might support and even corroborate these findings.

Image Credit: Getty

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