Optimising targeted dietary intervention strategies based on regional disparities of the related burden of cardiovascular disease in China

Abstract

Cardiovascular disease (CVD) is the first leading cause of death and disability globally. China is facing the greatest challenge of CVD worldwide due to the rapid urbanization, industrialization and changing lifestyles in recent decades.1Zhou M. Wang H. Zeng X. et al.Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2019; 394: 1145-1158Summary Full Text Full Text PDF PubMed Scopus (1778) Google Scholar Suboptimal diet, as one of the most important modifiable risk factors of CVD, accounted for more than 10% of disability-adjusted life-years (DALYs) in most areas of China.2GBD 2019 Risk Factors CollaboratorsGlobal burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 1223-1249Summary Full Text Full Text PDF PubMed Scopus (2334) Google Scholar,3Vaduganathan M. Mensah G.A. Turco J.V. Fuster V. Roth G.A. The global burden of cardiovascular diseases and risk: a compass for future health.J Am Coll Cardiol. 2022; 80: 2361-2371Crossref PubMed Scopus (21) Google Scholar The Chinese government has done its best to address this challenge, promulgating and implementing the Healthy China Action (2019–2030), the National Nutrition Plan (2017–2030) and other diet-related policies to reduce the corresponding disease burden. However, given the various dietary and disease patterns across different geographical regions in China, precise strategies for diet intervention are urgently needed to facilitate cardiovascular health. In this issue of The Lancet Regional Health–Western Pacific, Fang and colleagues integrated the national representative surveys to investigate the burden of CVD deaths attributable to dietary risk factors in the provinces of China during 2002–2018.4Fang Y. Xia J. Lian Y. et al.The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study.Lancet Reg Health West Pac. 2023; https://doi.org/10.1016/j.lanwpc.2023.100784Summary Full Text Full Text PDF Google Scholar This study focused on 7 dietary risk factors related to CVD, including whole grain, soybean, nuts, vegetable, fruit, red meat, and sugar-sweetened beverage, and identified an increasing trend in intakes of these dietary factors in China from 2002 to 2018. The dietary improvements were also observed by the previous study.5He Y. Li Y. Yang X. et al.The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study.Lancet Diabetes Endocrinol. 2019; 7: 540-548Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar However, intakes of these foods remain suboptimal, and are still far from the recommendations in the Chinese national dietary guidelines. In particular, mean consumptions of whole grains and fruit are less than half of the optimal levels. Moreover, this study provided a comprehensive estimation of the geographic variation of suboptimal diet, and emphasized that the specific dietary intervention strategies should be adjusted according to the dietary characteristics of each province.4Fang Y. Xia J. Lian Y. et al.The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study.Lancet Reg Health West Pac. 2023; https://doi.org/10.1016/j.lanwpc.2023.100784Summary Full Text Full Text PDF Google Scholar As nutrition science research advances, the diet-related disease burden is of increasing concern to researchers, physicians, healthcare providers, and policymakers. Healthy diet, as one of the Life's Essential 8 metrics for the cardiovascular health,6Lloyd-Jones D.M. Allen N.B. Anderson C.A.M. et al.Life's essential 8: updating and enhancing the American heart association's construct of cardiovascular health: a presidential advisory from the American heart association.Circulation. 2022; 146: e18-e43Crossref PubMed Scopus (111) Google Scholar is recommended by the guidelines on CVD prevention from the American College of Cardiology/American Heart Association and China.7Arnett D.K. Blumenthal R.S. Albert M.A. et al.2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines.Circulation. 2019; 140: e563-e595PubMed Google Scholar,8The Joint Task Force for Guideline on the Assessment and Management of Cardiovascular Risk in China Guideline on the assessment and management of cardiovascular risk in China.Zhonghua Yufang Yixue Zazhi. 2019; 53: 13-35PubMed Google Scholar Dietary interventions and nutritional therapy can improve CVD risk factors, such as lipids, body mass index, and blood pressure, which can further translate into the reduced medication use and cost savings. Most guidelines encourage intake of fruit, vegetables, whole grains, nuts and seeds, legumes.9Cara K.C. Goldman D.M. Kollman B.K. Amato S.S. Tull M.D. Karlsen M.C. Commonalities among dietary recommendations from 2010 to 2021 clinical practice guidelines: a meta-epidemiological study from the American College of lifestyle medicine.Adv Nutr. 2023; 14: 500-515Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar This epidemiological study by Fang and colleagues elaborated the CVD burden related to these dietary risk factors, and found that more than two-thirds of the diet-related CVD deaths were attributed to low intake of whole grains, nuts, fruits, and vegetables. It highlighted that the basic national strategies should focused on these dietary factors.4Fang Y. Xia J. Lian Y. et al.The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study.Lancet Reg Health West Pac. 2023; https://doi.org/10.1016/j.lanwpc.2023.100784Summary Full Text Full Text PDF Google Scholar Furthermore, this study provided the province-specific information for the diet-related burden of CVD and its subtypes, such as ischemic heart disease and stroke. These results are crucial in helping physicians, healthcare providers, and policymakers understand the health priorities in China at the national and provincial levels. It can also help develop geographically targeted dietary intervention programs and strategies to ease the associated CVD burden. One strength of this study from Fang and colleagues is that the dietary information from three Chinese national representative surveys between 2002 and 2018 integrated with mortality data from cause-of-death reporting system in China opens up the possibility of comprehensive estimating geographic variation of CVD burden attributable to dietary risk factors at both national and provincial levels in China. It only has some limitations. For examples, there was no estimation on sodium intake-related CVD burden, which is the first leading dietary risk factor resulting in an enormous disease burden.10GBD Diet CollaboratorsHealth effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2019; 393: 1958-1972Summary Full Text Full Text PDF PubMed Scopus (2336) Google Scholar This work can enhance our understanding of regional disparities of the diet-related CVD and provide valuable information for the development of the evidence-based dietary guidelines and the province-specific effective policies to reducing the diet-related CVD burden. To achieve the goals of “Healthy China 2030”, it is urgent to optimize dietary structure, strengthen nutrition education and implement effective intervention strategies. Dr. Li wrote the original draft of the manuscript. Dr. Lu revised the work and suggested critical edits. All authors have approved the final version of the manuscript and agree to be jointly responsible for the work. None. The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002–2018: a nationwide population-based studyThis study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. Full-Text PDF Open Access