Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis

Gladys Huiyun Lim, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Nithya Neelakantan, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
Yu Qi Lee, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Su Hyun Park, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Zhi Heng Kor, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Rob M. van Dam, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Nutrition and Exercise Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Mary Foong-Fong Chong, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A∗STAR), Singapore.
Airu Chia, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. Electronic address: airu-chia@nus.edu.sg.

Document Type

Journal Article

Publication Date

7-1-2024

Journal

Advances in nutrition (Bethesda, Md.)

Volume

15

Issue

7

DOI

10.1016/j.advnut.2024.100249

Keywords

Asia; cardiovascular disease; diet; diet quality; dietary pattern; meta-analysis

Abstract

With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped "high-quality," which included high intakes of three or more of the following food groups: 1) fruits and vegetables, 2) whole grains, 3) healthy protein sources (legumes and nuts, fish and seafood, low-fat dairy, and lean meat and poultry), and 4) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped "low-quality," which included high intakes of two or more of the following: 5) ultraprocessed food, 6) beverages and foods with added sugars, 7) foods high in salt, and 8) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled "animal-based," and studies using dietary diversity scores were labeled "diet diversity indices." Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-specific effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile defined by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD. The systematic review and meta-analysis was registered at PROSPERO as CRD42021244318.

Department

Exercise and Nutrition Sciences

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