Epidemiological and nutritional research on prevention of cardiovascular disease in China

Exploring the traditional Chinese diet and its association with health status-a systematic review

CONTEXT

Increased adherence to a traditional Chinese diet (TCD) could reduce the increasing prevalence of noncommunicable diseases. Currently, there is no consistent definition of the TCD in the literature, and its associations with health outcomes have not yet been identified.

OBJECTIVE

This systematic review aimed to assess the definition of the TCD, in the literature, and to evaluate whether the TCD, as described, is associated with health outcomes.

DATA SOURCES

Fourteen databases were searched up to April 25, 2022.

DATA EXTRACTION

Three reviewers (in pairs) independently screened and extracted data. A modified risk-of-bias tool was used to assess the quality of the studies assessing the TCD definition; the Newcastle-Ottawa Scale and the Cochrane Risk-of-Bias tool were used to assess the quality of the observational studies and randomized controlled trials assessing associations between the TCD and health outcomes.

DATA ANALYSIS

Ninety-nine studies were identified that assessed the TCD definition. In at least 75% of the studies, rice and leafy vegetables were consistently reported as food groups that characterize the TCD; the most frequently cited food items were white rice, spinach, bokchoy, and cabbage. Fish and seafood, pork, and pork products were consistently reported in studies exclusively referring to the TCD consumed in southern China (n = 21 studies), whereas wheat and wheat products were commonly reported in studies focusing on northern China (n = 14 studies). Fifteen studies reported on the quantities of food groups that are characteristic of the TCD, but their findings were inconsistent. Of the 99 studies, 54 assessed associations with health outcomes. The TCD was overall inversely associated with obesity risk and weight gain, while relationships between the TCD and other health outcomes were inconsistent.

CONCLUSION

Further studies are needed to determine the quantities of foods consumed in the TCD and to establish a consistent definition for further exploration of the TCD's potential role in preventing non-communicable diseases.

Diversity and use of medicinal plants for soup making in traditional diets of the Hakka in West Fujian, China

BACKGROUND

Wild edible and medicinal plants were an important component of traditional diets and continue to contribute to food security, nutrition, and health in many communities globally. For example, the preparation and consumption of soup made of medicinal plants for promoting health and preventing disease are a key component of the traditional diets of the Hakka socio-linguistic group of China's West Fujian Province. As environmental and socio-economic factors drive the shift away from traditional diets, there is a need for ethnobotanical documentation of the diversity of wild edible and medicinal plants as well as associated knowledge and practices.

METHOD

Ethnobotanical surveys were conducted in Hakka communities in West Fujian Province between 2017 and 2018 to document plants used in medicinal soups as well as associated traditional ecological knowledge, practices, and conservation status. Surveys included semi-structural interviews, key informant interviews, participatory rural appraisal, and focus group discussions. Quantitative indices, including cultural food significance index (CFSI) and relative frequency of citation (RFC), were calculated to evaluate the importance of documented plants to Hakka communities. The species with the highest CFSI and RFC values were ranked by informants and further evaluated according to their individual properties and growth environment.

RESULTS

A total of 42 medicinal plant species, belonging to 25 families and 41 genera, were documented for making soup by the Hakka. The Asteraceae botanical family was the most prevalent, and their root or the entire plant is used for soup making. Informants incorporate different ingredients in soups for their flavors as well as medicinal properties on the basis of the local ethnonutrition system. The most prevalent medicinal uses of the documented plants for making soups were used for clearing inner heat (58.1% of the species), treating inflammation (37.2%), and counteracting cold in the body (20.9%). Informants perceived that the medicinal properties of soup-making plants are influenced by the time of harvest, the local environment, and the climate.

CONCLUSION

Efforts are needed to preserve the ecological knowledge associated with traditional diets towards supporting both environmental and human well-being in rapidly developing communities experiencing the nutrition transition and biodiversity loss.

Hydrolysis before Stir-Frying Increases the Isothiocyanate Content of Broccoli

Broccoli is found to be a good source of glucosinolates, which can be hydrolyzed by endogenous myrosinase to obtain chemopreventive isothiocyanates (ITCs); among them, sulforaphane (SF) is the most important agent. Studies have shown that cooking greatly affects the levels of SF and total ITCs in broccoli. However, the stability of these compounds during cooking has been infrequently examined. In this study, we proved that the half-lives of SF and total ITCs during stir-frying were 7.7 and 5.9 min, respectively, while the myrosinase activity decreased by 80% after stir-frying for 3 min; SF and total ITCs were more stable than myrosinase. Thus, the contents of SF and total ITCs decreased during stir-frying largely because myrosinase was destroyed. Subsequently, it was confirmed that compared to direct stir-frying, hydrolysis of glucosinolates in broccoli for 90 min followed by stir-frying increased the SF and total ITC concentration by 2.8 and 2.6 times, respectively. This method provides large quantities of beneficial ITCs even after cooking.

Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update

OBJECTIVES

The study was conducted to investigate the prevalence, awareness, treatment, control, and risk factors of hypertension in Chongqing Province in Southwest China.

METHODS

Multistage, stratified, random cluster sampling scheme was adopted to recruit representative samples. All of the selected study participants completed a questionnaire and physical examinations. Multivariable logistic regression models were used to identify the associated factors.

RESULTS

Overall, 14 420 study participants (men = 7186) above 18 years were enrolled. The overall hypertension prevalence was 23.9%, with rural residents having a higher prevalence than urban residents (26.0 vs. 21.6%, P < 0.001). The awareness, treatment, control, and control among treated patients were 44.1, 36.6, 8.5, and 23.3%, respectively. Elderly women inhabiting urban areas had better awareness and treatment. The urban and rural areas differed in control (12.9 vs. 5.1%, P < 0.001). Age, sex, alcohol consumption, family history of hypertension, overweight/obesity, visceral adipose index, and body fat percentage were identified as risk factors for hypertension in both areas. Education levels, smoking, and daily salt intake were correlated with hypertension only among rural residents, and central obesity was correlated with hypertension only among urban residents. Sex, rurality, age, education level, alcohol consumption, overweight/obesity, central obesity, visceral adipose index, and body fat percentage were identified as associated factors of awareness, treatment, and control.

CONCLUSION

During the past decade, there is an increasing prevalence of hypertension in the general population in Chongqing Province. The levels of awareness, treatment, and control have improved, but remain extremely low. More aggressive strategies should thus be adopted.

Perinatal taurine exposure affects adult arterial pressure control

Taurine is an abundant, free amino acid found in mammalian cells that contributes to many physiologic functions from that of a simple cell osmolyte to a programmer of adult health and disease. Taurine's contribution extends from conception throughout life, but its most critical exposure period is during perinatal life. In adults, taurine supplementation prevents or alleviates cardiovascular disease and related complications. In contrast, low taurine consumption coincides with increased risk of cardiovascular disease, obesity and type II diabetes. This review focuses on the effects that altered perinatal taurine exposure has on long-term mechanisms that control adult arterial blood pressure and could thereby contribute to arterial hypertension through its ability to program these cardiovascular regulatory mechanisms very early in life. The modifications of these mechanisms can last a lifetime and transfer to the next generation, suggesting that epigenetic mechanisms underlie the changes. The ability of perinatal taurine exposure to influence arterial pressure control mechanisms and hypertension in adult life appears to involve the regulation of growth and development, the central and autonomic nervous system, the renin-angiotensin system, glucose-insulin interaction and changes to heart, blood vessels and kidney function.

Adverse trends of cardiovascular risk factors among low risk populations (1983-1994)--a cohort study of workers and farmers in Guangzhou, China

BACKGROUND

The levels and trends of cardiovascular risk factors vary greatly throughout China. We examine 10-year trends of cardiovascular risk factors (1983-1994) and the factors related to these trends among low-risk cohorts of workers and farmers in Guangzhou, China.

METHODS

This is a cohort study of 3,131 workers and 3,493 farmers aged 25-64 years at baseline with 10 years of follow-up. We performed a longitudinal analysis to account for the aging of the cohorts and the repeated measures of the same individual.

RESULTS

At baseline the prevalence of overweight (including obese) ranged from 1.0% to 11.8%, hypertension ranged from 3.8% to 10.5%, and mean serum total cholesterol (TC) ranged from 155.4 mg/dl to 187.2 mg/dl. Although prevalence of smoking declined, blood pressure levels and body mass index (BMI) increased significantly, and lipid profiles changed unfavorably during the 10-year follow-ups. The prevalence of hypertension increased from 5.0 percentage points (female farmers) to 12.3 percentage points (male farmers). Mean TC increased significantly (e.g., +22.8 mg/dl and +17.0 mg/dl in male and female farmers, respectively). In the longitudinal data analyses, increase in BMI was associated with increase in blood pressure levels and TC. Significant adverse trends of risk factors persisted after adjustment for aging, education, BMI, smoking, and alcohol intake.

CONCLUSION

Urgent action is needed to prevent and reverse the unhealthy trends occurring among these low risk Chinese workers and farmers.

Effects of different cooking methods on health-promoting compounds of broccoli

The effects of five domestic cooking methods, including steaming, microwaving, boiling, stir-frying, and stir-frying followed by boiling (stir-frying/boiling), on the nutrients and health-promoting compounds of broccoli were investigated. The results show that all cooking treatments, except steaming, caused significant losses of chlorophyll and vitamin C and significant decreases of total soluble proteins and soluble sugars. Total aliphatic and indole glucosinolates were significantly modified by all cooking treatments but not by steaming. In general, the steaming led to the lowest loss of total glucosinolates, while stir-frying and stir-frying/boiling presented the highest loss. Stir-frying and stir-frying/boiling, the two most popular methods for most homemade dishes in China, cause great losses of chlorophyll, soluble protein, soluble sugar, vitamin C, and glucosinolates, but the steaming method appears the best in retention of the nutrients in cooking broccoli.

Colonisation, the New World Order, and the eradication of traditional food habits in East Africa: historical perspective on the nutrition transition

Objective

To discuss factors which have underpinned the nutrition transition in the countries of East Africa, including Kenya, Uganda and Tanzania, from early colonisation to the current, oppressive political–economic structure.

Results

Colonisation and neocolonisation in accordance with the desires of the New World Order have ensured the systematic extirpation of indigenous and traditional food habits in East Africa. These indigenous and traditional food habits, associated with myriad health benefits, have been progressively replaced by the globalised food system of the multinational corporations, a system inherently associated with the creation of non-communicable disease (NCD) epidemics throughout this region and globally. While the simplification of the East African food culture may be most apparent today, the nutrition transition has actually occurred over the past 400 years, since the onset of colonial occupation.

Conclusions

It is imperative that greater efforts be directed towards exposing the colonial and neocolonial forces which have undermined food security and health status in East Africa. Heightened awareness of these forces is essential for proposing genuine solutions to the nutrition transition and related NCD epidemics throughout this region and, indeed, worldwide.

Ethnobotanical study of medicinal plants used by Hakka in Guangdong, China

ETHNOPHARMACOLOGICAL RELEVANCE

An ethnobotanical survey was conducted to collect information on the use of medicinal plants by the Hakka living in Guangdong.

AIM OF THE STUDY

This investigation was to document valuable knowledge represented by Hakka herbal medicine.

MATERIALS AND METHODS

Information was obtained from semi-structured interviews, personal conversations with practitioners, direct observations, and by reviewing studies of Hakka and Cantonese reported in the literature.

RESULTS

Our data covered 94 species belonging to 77 genera in 40 families. We found that most species used for medical purposes were for hepatitis (14 species) and skin diseases (12 species). These disorders are prevalent and are primarily treated with medicinal plants. For treatment, the plants were mainly used as teas (Luica, Bugingca and Lopêdca), medicinal baths and soups. The Hakka and non-Hakka people living in Guangdong use different medicinal plants and, in some cases, use the same medicinal plants differently.

CONCLUSIONS

The fast disappearance of traditional culture and natural resources due to urbanization and industrialization suggests that unrecorded information may be lost forever. Thus, there is an urgent need both to record this valuable Hakka medicinal knowledge and to encourage its transfer to the next generation.

Prognostic factors associated with the survival of oral and pharyngeal carcinoma in Taiwan

Background

In Taiwan, a distinct ethnic group variation in incidence and mortality rates has been suggested for most carcinomas. Our aim is to identify the role of prognostic factors associated with the survival of oral and pharyngeal carcinoma in Taiwan.

Methods

Taiwan Cancer Registry records of 9039 subjects diagnosed with oral and pharyngeal carcinoma were analyzed. The population was divided into three ethnic groups by residence, which were Taiwanese aborigines, Hakka and Hokkien communities. Five-year survival rates were estimated by Kaplan-Meier methods. Ethnic curves differed significantly by log-rank test; therefore separate models for Taiwanese aborigines, Hakka and Hokkien were carried out. The Cox multivariate proportional hazards model was used to examine the role of prognostic factors on ethnic survival.

Results

The five-year survival rates of oral and pharyngeal carcinoma were significantly poorer for Hokkien community (53.9%) and Taiwanese aborigines community (58.1%) compared with Hakka community (60.5%). The adjusted hazard ratio of Taiwanese aborigines versus Hakka was 1.07 (95%CI, 0.86–1.33) for oral and pharyngeal carcinoma mortality, and 1.16 (95%CI, 1.01–1.33) for Hokkien versus Hakka. Males had significantly poor prognosis than females. Subjects with tongue and/or mouth carcinoma presented the worst prognosis, whereas lip carcinoma had the best prognosis. Subjects with verrucous carcinoma had better survival than squamous cell carcinoma. Prognosis was the worst in elderly subjects, and subjects who underwent surgery had the highest survival rate.

Conclusion

Our study presented that predictive variables in oral and pharyngeal carcinoma survival have been: ethnic groups, period of diagnosis, gender, diagnostic age, anatomic site, morphologic type, and therapy.

Dietary Westernisation: conceptualisation and measurement in Mauritius

Objectives

The aims of the study were to provide information that will contribute to conceptualising what is called ‘dietary Westernisation’, and to provide an example of measuring it on an individual level.

Design

Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25–74 years) Mauritians in 1987/88, 1917 (age 30–74 years) in 1992 and 2239 (age 20–74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year.

Results

Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier.

Conclusions

This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.

Vasorelaxation induced by common edible tropical plant extracts in isolated rat aorta and mesenteric vascular bed

In this study, the vasodilatory actions of nine edible tropical plant extracts were investigated. Ipomoea batatas (sweet potato leaf), Piper betle (betel leaf), Anacardium occidentale (cashew leaf), Gynandropsis gynandra (maman leaf), Carica papaya (papaya leaf), and Mentha arvensis (mint leaf) extracts exhibited more than 50% relaxing effect on aortic ring preparations, while Piper betle and Cymbopogon citratus (lemongrass stalk) showed comparable vasorelaxation on isolated perfused mesenteric artery preparation. The vascular effect on the aortic ring preparations were mainly endothelium-dependent, and mediated by nitric oxide (NO) as supported by the inhibition of action in the presence of N(omega)-nitro-L-arginine (NOLA), an nitric oxide synthase (NOS) inhibitor, or by the removal of endothelium. In contrast, vasodilatory actions in resistance vessels (perfused mesenteric vascular beds) appear to involve several biochemical mediators, including NO, prostanoids, and endothelium-dependent hyperpolarizing factors (EDHFs). Total phenolic contents and antioxidant capacities varied among different extracts and found to be independent of vascular relaxation effects. This study demonstrates that many edible plants common in Asian diets to possess potential health benefits, affording protection at the vascular endothelium level.