Diet and Cardiovascular Disease: Advances and Challenges in Population-Based Studies

Abstract

In this Minireview, we provide an epidemiologist's perspective on the debate and recent advances in determining the relationship between diet and cardiovascular health. We conclude that, in order to reduce the global burden of cardiovascular disease, there should be a greater emphasis on improving overall diet quality and food sources of macronutrients, such as dietary fats and carbohydrates. In addition, building a strong evidence base through high-quality intervention and observational studies is crucial for effective policy changes, which can greatly improve the food environment and population health.

Figure 1

The typical hierarchy of study designs based on ability to infer causality

Figure 2

Trends in energy intake from carbohydrate and fat and corresponding increase in obesity-related chronic diseases in China (1992–2012). Data on percentage of carbohydrate and fat intake as well as the prevalence of overweight and obesity are from Chinese nutrition and health surveillance reports in 2002 (National Health and Family Planning Commission of the People’s Republic of China, 2004) and 2012 (Chang and Wang, 2016). The surveillance reports used the Chinese cut-off point defining overweight as 24≤BMI<28, and obesity as BMI ≥28. The data extracted here were among adults (>18 years). The prevalence of hypertension in adults was 13.6% in 1991 (Tao et al., 1995), 17.7% in 2002 (Wu et al., 2008), and 33.5% in 2010 (Li et al., 2012). The prevalence of diabetes in adults was 2.5% in 1994 (Pan et al., 1997), 5.5% in 2000 to 2001 (Gu et al., 2003), and 10.9% in 2013 (Wang et al., 2017). National Health and Family Planning Commission of the People’s Republic of China (2004). The nutrition and health status of the Chinese people [Chinese]. Available at http://www.moh.gov.cn/wsb/pzcjd/200804/21290.shtml. Chang, J.L., Wang, Y. (2016). Chinese Nutrition and Health Surveillance: 2010–2013 Report [Chinese] (Beijing, China: Peking University Medical Press). Tao, S., Wu, X., Duan, X., Fang, W., Hao, J., Fan, D., Wang, W., Li, Y. (1995). Hypertension prevalence and status of awareness, treatment and control in China. Chin. Med. J. 108, 483–489. Wu, Y., Huxley, R., Li, L., Anna, V., Xie, G., Yao, C., Woodward, M., Li, X., Chalmers, J., Gao, R., et al. (2008). Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation 118, 2679–2686. Li, Y.C., Wang, L.M., Jiang, Y., Li, X.Y., Zhang, M., Hu, N. (2012). Prevalence of hypertension among Chinese adults in 2010 [Chinese]. Chin. J. Prev. Med. 46, 409–413. Pan, X.R., Yang, W.Y., Li, G.W., Liu, J. (1997). Prevalence of diabetes and its risk factors in china, 1994. National diabetes prevention and control cooperative group. Diabetes Care 20, 1664–1669. Gu, D., Reynolds, K., Duan, X., Xin, X., Chen, J., Wu, X., Mo, J., Whelton, P.K., He, J.; InterASIA Collaborative Group. (2003). Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: international collaborative study of cardiovascular disease in Asia (InterASIA). Diabetologia 46, 1190–1198. Wang, L., Gao, P., Zhang, M., Huang, Z., Zhang, D., Deng, Q., Li, Y., Zhao, Z., Qin, X., Jin, D., et al. (2017). Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA 317, 2515–2523.