Advances in Nutrition review assesses both Asian and non-Asian diet quality indices.
Rather than examine the relationship between individual foods or nutrients with health outcomes, researchers are increasingly examining the relationship between dietary patterns and health outcomes. This approach, which considers an individual’s overall diet, is better able to capture the complex interrelationships between foods, food groups, nutrients, and health.
Dietary patterns are often categorized using predefined dietary quality indices that measure the degree to which an individual adheres to a specific set of dietary recommendations. They can also be derived using data-driven approaches based on consumption patterns of particular populations.
Cardiovascular diseases are among the major leading causes of mortality in the world, with a high proportion of premature cardiovascular disease deaths occurring in Asia. Earlier scientific reviews and meta-analyses that examined the relationship between dietary patterns and cardiovascular disease have traditionally used dietary quality indices developed using data from primarily non-Asian populations. In recent years, however, many Asian countries have developed their own dietary quality indices, including the Japanese Food Guide Spinning Top and the Chinese Food Pagoda which capture information on specific foods that are distinct to local populations.
Recently published, Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis examined the results of 41 studies to better understand how Asian dietary patterns affect cardiovascular disease risk. Moreover, according the authors, “to our knowledge, this is the first meta-analysis to comprehensively describe the associations of non-Asian diet quality indices, Asian diet quality indices, and data-driven dietary patterns with cardiovascular disease risk among South, Southeast, and East Asian populations.” The results of their research were published in Advances in Nutrition: An International Review Journal, a publication of the American Society for Nutrition.
According to the authors’ findings, “adherence to a high-quality dietary pattern, whether defined by non-Asian indices, Asian indices or data-driven patterns, is consistently associated with lower cardiovascular disease risks in South, Southeast, and East Asian populations.” In general, these high-quality dietary patterns reflect higher intakes of fruits, vegetables, whole grains, legumes, nuts, fish, seafood, low-fat dairy, lean meat and poultry, and liquid plant oils.
The authors did find that the “associations between current Asian-derived diet quality indices and cardiovascular disease risk were weaker than those with established non-Asian diet quality indices such as the Alternative Healthy Eating Index and the Dietary Approaches to Stop Hypertension.” As a result, they believe that “there may be a need for current dietary guidelines in Asian countries and Asian diet quality indices to be optimized to reflect up-to-date dietary recommendations for cardiovascular health.”
Interestingly, this review did not find a significant association between plant-based dietary indices and cardiovascular disease. In contrast, an earlier meta-analysis consisting of studies conducted in non-Asian countries demonstrated a 13% lower cardiovascular disease risk with greater adherence to a healthful plant-based dietary pattern. The authors did note that “further investigation of plant-based indices in Asian populations is needed considering the small number of studies (n = 2) available in our meta-analysis.”
This review was published concurrently with an accompanying Editorial, Dietary Patterns in Asia: Current Evidence and Future Directions. The Editorial does note some limitations of the review, including the lack of a “formal statistical test for subgroup differences.” As a result, “the underlying results need to be interpreted with caution.” Nonetheless, the Editorial states that the systematic review is “well conducted as the authors used state-of-the-art methodologic approaches.”
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