Cardiovascular disease (CVD) is a global health challenge and a leading cause of death in Asia.1 Dietary factors play a significant role in CVD causation, with 11 million deaths and 255 million disability-adjusted life years being attributed to poor diet in 2017 alone.2 Based on data, there exists a large gap between the optimal intake of healthy foods and the actual intake of these foods in Asian populations.2 Hence, to combat CVD in Asia, effective dietary strategies are crucial.
Internationally, several diets have garnered attention for their potential to reduce cardiovascular risk. Among them, plant-based diets, the Dietary Approaches to Stop Hypertension diet and the Mediterranean diet (Med-diet) stand out.3,4 Notably, the Med-diet – rich in plant-derived foods – has emerged as the most robustly supported option.5–7
Randomised controlled trials (RCTs) have demonstrated benefits of the Med-diet in both primary and secondary prevention of fatal and non-fatal CVD.5,7,8 Compared to heart-healthy alternatives (e.g. low-fat diets), the Med-diet led to significant reductions in fatal and non-fatal cardiovascular events. Other diets have been shown in RCTs to have cardiometabolic, but not cardiovascular, event reduction.9 Core principles of the heart healthy Med-diet shown to bring about cardiovascular event reduction in these studies are summarised in Table 1.
Beyond cardiovascular health, the Med-diet also offers cardiometabolic benefits, including reduced diabetes incidence, lowered cancer risk and improved cognitive function.8,10,11 Moreover, it proves sustainable for long-term weight maintenance in obese individuals.12
However, RCTs specific to Asian diets targeting cardiovascular outcomes are lacking. Consequently, in the absence of proven Asian dietary interventions, if Med-diet principles can be applied in a culturally appropriate, evidence-based way, this will benefit Asian populations. Cultural adaptation will be key to populations adopting new diets.13
This review aims to summarise the literature to enable evidence-based adaptation of the Med-diet for Asians, focusing on two main areas. First, Mediterranean-like diets and their benefits in Asia. This section examines evidence for Asian diets that align with Med-diet principles, assessing their cardiometabolic benefits and their impact on CVD. Second, promising Asian-specific ingredients to incorporate in a Heart Healthy Asian Mediterranean (HHAM) diet. Asian cuisines offer an array of ingredients with heart health benefits. This review summarises the evidence on the cardiometabolic benefits of healthy Asian ingredients, which can be substituted for Mediterranean counterparts from similar food groups. Finally, this review suggests a HHAM dietary pattern. The HHAM, while staying within the confines of the Med-diet principles proven for CVD event reduction, has evidence-based incorporation of healthful Asian food ingredients. By bridging the gap between Med-diet research and Asian data, this review paves the way to improve CVD health in Asia through diet.14
Methods
A systematic literature search of PubMed was conducted to identify relevant studies published in English up to 19 May 2024. The search focused on studies conducted in Asian populations or those investigating Asian food ingredients or dietary patterns in relation to CVD incidence or markers of cardiometabolic health (e.g. insulin resistance, lipid levels, blood pressure, waist–hip circumference).
Search Strategy
The search strategy was designed using a combination of MeSH terms and free-text keywords related to dietary patterns, specific food components, and cardiometabolic outcomes. Keywords included, but were not limited to, “Mediterranean diet Asia”, “tea”, “green tea”, “black tea”, “cardiovascular disease”, “soy”, “tofu”, “mushroom”, “nuts”, “cashew nuts”, “pistachios”, “vegetables”, “Asian”, “kimchi”, “stroke”, “Lp(a)”, “cumin”, “curcumin”, “randomised controlled trial”, “meta analysis”, “China”, “Japan”, “Korea”, “Singapore”, and “India”.
Boolean operators (AND, OR) were applied to refine the search, ensuring a comprehensive retrieval of relevant studies. Additionally, reference lists of retrieved studies and relevant systematic reviews were manually screened to identify any additional studies.
Eligibility Criteria
Studies were included if they met the following criteria:
- Study design: RCTs, prospective cohort studies, or systematic reviews and meta-analyses that incorporated these two types of studies.
- Population: Studies conducted in Asian populations or evaluating Asian food ingredients or dietary patterns.
- Outcomes: Primary outcomes included CVD incidence, while secondary outcomes included cardiometabolic markers such as insulin resistance, lipid levels, blood pressure, and waist–hip circumference.
- Language and date: Articles published in English up to 19 May 2024.
Study Selection Process
The study selection process followed the PRISMA guidelines. Titles and abstracts were independently screened by two investigators. Full-text articles were then reviewed to determine final inclusion based on eligibility criteria. Any discrepancies were resolved through discussion or consultation with a third reviewer.
Risk of Bias Assessment
For RCTs, the Cochrane risk of bias (RoB 2) tool was used to assess potential biases in randomisation, blinding, allocation concealment, selective reporting, and incomplete outcome data. For cohort studies, the Newcastle-Ottawa scale was used to evaluate selection bias, comparability of groups, and outcome assessment. Systematic reviews and meta-analyses were assessed using the AMSTAR 2 appraisal tool. The risk of bias assessment was conducted independently by two investigators, with disagreements resolved by a third reviewer. Assessments are listed in Supplementary Tables 1 and 2 and Supplementary Figures 1–4, and show that most of the papers included are at low risk of bias, or in some cases, with some concerns.
Mediterranean-like Diets and Their Benefits in Asia
Mediterranean-like diets, which are rich in fibre, plant protein sources such as nuts and legumes, and low in meat products, have been applied throughout Asia. These Asian diets fulfil many of the Med-diet principles as summarised above and have been shown to have cardiometabolic benefits. These are discussed below and summarised in Table 2.
Japan
The traditional Japanese diet, i.e. the “1975 diet”, shares many traits with the Med-diet. It emphasises vegetables, fruit, fish, soybeans and soybean products (legumes) and green tea (rather than sweetened drinks). It features less meat and includes more seafood, fish and soybeans in place of meat.15 This traditional Japanese diet has been shown to be associated with better CVD outcomes by a meta-analysis that incorporated prospective cohort studies. There was decreased risk of CVD with increased adherence to the Japanese-style diet (pooled RR 0.83; 95% CI [0.77–0.89]).16
In these Japanese prospective cohort studies, higher consumption of fish, green tea, fruit, vegetables, milk and dairy products was associated with decreased risk of CVD and cardiac death, while increased salt intake was associated with increased risk of CVD and mortality from stroke.16
RCTs have also been conducted comparing the traditional Japanese diet to the modern Japanese diet. These showed a reduction in BMI, body fat mass, haemoglobin A1C (HbA1c), HDL and LDL with the traditional diet. The traditional Japanese diet contained more soybean products, seafood, vegetables, fruit, green tea, seaweed, fish (including shellfish) and mushrooms than the modern Japanese diet.15,17
Singaporean Chinese
In a meta-analysis that included the Singapore Chinese Health Study, diet was assessed by MedDiet score and found an associated significant reduction in fatal stroke with each 4-point increment of MedDiet score.18
Higher MedDiet score was achieved by higher fruit, vegetable, legume and fish intake, and by lower meat, poultry, cheese and alcohol intake (<300 ml/day).
South Korea
A prospective cohort study from South Korea showed that higher seafood intake, which is encouraged in the Med-diet, was associated with a significant decrease in CVD events. The effect was especially pronounced among female participants (HR 0.718; 95% CI [0.519–0.993]). Participants with higher seafood intake also had higher beneficial nutrients, such as eicosapentaenoic acid and docosahexaenoic acid, which are known to support cardiovascular health.14
A Korean Mediterranean-style diet has also been shown in a randomised crossover trial to reduce insulin resistance, LDL cholesterol, fatty liver index and inflammation.19 Participants in the intervention arm of this study were asked to eat a diet compliant with core Med-diet principles. Participants were asked to eat four servings of vegetables a day, 1.5 servings of fruit a day, one serving of nuts a day, salad for breakfast, fish and meat 3.5 servings a day, use olive oil, and have nuts, low-fat milk and fruits for snacks.19
China
In Chinese cohorts, diets in line with Med-diet principles have also been found to be associated with reduced cardiovascular events.
Higher intake of legumes has been found to be associated with reduced heart disease mortality in a Chinese prospective cohort study of 2,445 individuals. As reported by Wang et al., a higher intake of beans four times a week was associated with 37% (95% CI [17–52%]) reduction in heart disease mortality. Examples of beans in the study were soybean, any other kind of beans or peas, bean curd and bean sprouts.20 In the same study, increased intake of vegetables, nuts and fruit was associated with significantly decreased heart disease mortality with every one serving of vegetable increase per day, increase of three servings of nuts per month and increase of three servings of fruit per month, respectively. Analyses were adjusted for possible confounders.
The Med-diet emphasises plant-based ingredients, including nuts, seeds, legumes and unprocessed or minimally processed grains. An RCT from China conducted in people with diabetes compared a standard diabetic diet to the intervention diet, which included whole grains and traditional Chinese medicinal foods. The intervention diet comprised whole grains, tartary buckwheat, Chinese pearl barley, yellow corn, red beans, yams, peanuts, lotus seeds, fresh vegetables, fruits and nuts. Significantly more patients in the intervention group brought their HbA1c to target compared to controls. Fibre from the intervention diet was found to stimulate gut bacteria to produce short-chain fatty acids, helping glucose metabolism.21
India
In MASALA, a prospective cohort study of South Asian subjects, the study team created a South Asian Mediterranean-style (SAM) diet score, which grouped foods into categories (e.g. fish, vegetables, fruits, legumes), including commonly consumed South Asian food ingredients. Points were given for increase in intake over median amount for each healthful food category. The summed score of points gave the SAM score, with higher SAM scores reflecting higher adherence to a SAM diet. This study found that each 1-unit increase in SAM score was associated with 25% lower odds of diabetes (OR 0.75; 95% CI [0.59–0.95]).22
Promising Asian Ingredients for a Heart Healthy Asian Mediterranean Diet
Asian implementation of the Med-diet would benefit from knowledge of Asian equivalents of dietary components to be used to meet the Med-diet principles. Several common Asian food ingredients have been shown individually to have significant cardiometabolic benefits and are promising for use in an Asian adaptation of the Med-diet. These are discussed below and summarised in Table 3.
Nuts and Seeds
In the Med-diet, consumption of nuts is recommended, up to 30 g/day (almonds, hazelnuts and walnuts).6 Nut consumption in Asia tends to be higher for certain types of nuts, such as peanuts and cashew nuts.23 In prospective cohort studies in China and Japan, most of the nuts consumed were peanuts.
In two prospective cohort studies conducted in China, the Shanghai Men’s Health Study (SMHS) and Shanghai Women’s Health Study (SWHS), nut consumption was mostly from peanuts, with very little tree nut consumption. In the SMHS and SWHS, the highest quartile of peanut consumption compared with the lowest quartile was associated with 30% reduction of ischaemic heart disease. There was also a decrease in ischaemic stroke of 23%, and a decrease of haemorrhagic stroke of 23%. Total mortality was decreased by 17%. These results were adjusted for possible confounders.24
Notably, there were much lower levels of nut consumption in this study, compared to the recommended 30 g/day of nuts in the Med-diet.6 In the Shanghai cohort, peanut consumption was at a mean of 2.4 g/day for men, and 1.6 g/day for women, with the highest quartile of consumption being at ≥2.54 g/day. However, the results still showed an inverse association between the amount of peanut consumption and total mortality as well as cardiovascular mortality at this lower level of nut consumption compared to the Med-diet.
The Takayama study was a prospective cohort study (n=29,079) conducted in Japan. In this cohort, 80% of the nuts consumed were peanuts. Men in the study who were in the highest quartile level of total nuts consumed, had an HR of 0.85 (95% CI [0.75–0.96]; p for trend=0.034) for all-cause mortality compared to those in the lowest quartile. In women, results were similar. These results were adjusted for possible confounders. Like the study from Shanghai, the mean amount of total nut intake was much lower than in the Med-diet, with men consuming a mean of 1.4 g/day and women consuming a mean of 1.2 g/day.25
In the JPHC, a larger Japanese prospective study of 75,000 participants, those in the highest quartile of peanut consumption had a 20% lower risk of ischaemic stroke compared to those in the lowest quartile.26 These results show that in Asia, where peanut is commonly consumed, increasing peanut consumption is associated with significant decrease in cardiovascular mortality and morbidity, even at much lower levels than 30 g/day.
Commonly consumed nuts in Asia such as peanuts and cashew nuts have also been found in RCTs to have cardiometabolic benefits.
In Iran, a crossover study of peanut supplementation was conducted in hypercholesterolaemic men. Participants in the intervention group were given peanuts to supplement their usual diets. Those who were supplemented with peanuts were not told to make any changes to their diet (though they were found to reduce their dairy intake). Peanut supplementation significantly reduced LDL:HDL ratio and atherogenic index of plasma and predicted 10-year ischaemic heart disease risk based on systolic and diastolic blood pressures.27
Cashew nuts, which are widely used in Indian cuisine, have also been studied in an RCT of cashew nut supplementation in Asian Indians. Adults with type 2 diabetes were randomised to either a control arm where they were advised to follow a standard diabetic diet, or the intervention arm and given similar advice and supplemented with 30 g of cashew nuts per day. Participants in the intervention group had a greater decrease in systolic blood pressure compared to controls and a greater increase in HDL compared to controls.28
Pistachio supplementation in Asian Indians with metabolic syndrome has also been found in an RCT to significantly reduce C-reactive protein, waist circumference, fasting blood glucose, total cholesterol and LDL cholesterol, and increase adiponectin levels.29 In this study, pistachios were substituted for oil, butter, dairy and a proportion of carbohydrates in the diet.
A study conducted in Chinese subjects tested pistachio supplementation in participants with metabolic syndrome. The authors found that participants in the group supplemented with 42 g/day of pistachios significantly reduced their triglyceride levels from baseline, while participants in the 70 g/day group showed lower glucose levels following a glucose challenge test.30
When it comes to seeds, sesame seeds are often consumed in Asia in the form of sesame seeds or sesame oil.23 Sesame is rich in unsaturated fatty acids and bioactive lignans. Sesame supplementation has been shown in a meta-analysis of RCTs to significantly reduce total cholesterol, blood pressure, triglycerides, waist–hip circumference and BMI.31
Legumes
Legumes are emphasised in the Med-diet, with the study diets recommending intake of >3 servings of legumes a week. Legumes commonly consumed in Asia differ from those in the Mediterranean region. Asian legume choices include mung beans, adzuki beans, lentils, edamame, black beans, soybean products such as tofu and soy milk, and fermented soybeans such as miso, natto and tempeh.23
Soy
A meta-analysis of prospective cohort studies from Japan, China, Hong Kong, Singapore, the UK and the US showed that the highest level of soybean product intake of ≥7 portions a week, compared with the lowest, was associated with lower all-cause and CVD mortality (pooled HR; 95% CI, 0.92 [0.88–0.96] and 0.92 [0.87–0.98], respectively).32
Black Beans
Favoured for use in Asian cuisine, dark coloured beans such as black beans were also found in a randomised crossover trial to result in improved vascular relaxation with significantly lower pulse wave velocity, augmentation pressure and wave reflection magnitude compared to white rice or pinto beans.33 LDL cholesterol was significantly lower 6 hours after consumption of black beans compared to rice.33
Green Mung Beans
These are commonly used in Asian soups and snacks. A controlled feeding study in healthy subjects found that green mung bean protein supplementation compared to a placebo of milk protein (casein), significantly decreased homeostatic model assessment of insulin resistance values, and mean triglyceride level, while significantly increasing serum adiponectin levels and improving liver function enzymes.34
Red Adzuki Beans
The red adzuki bean is a popular legume consumed in Asia. In an RCT in diabetic patients, red adzuki beans were found to have anti-inflammatory effects. There were significantly lower tumour necrosis factor α levels in the group taking red adzuki beans compared to the group taking standard low glycaemic diabetic diet.35
Beverages
In the Med-diet, it is recommended that in place of sugar-sweetened beverages, healthy beverages such as water, tea, coffee or herbal infusions should be consumed. In Asia, green tea is a popular beverage, and its consumption is associated with significant cardiovascular benefits.
A pooled analysis on green tea was conducted by the Asian Cohort Consortium, and included prospective cohort studies from Japan, South Korea, China and Singapore.36 Green tea consumption was associated with reduced mortality from CVD, after adjusting for confounders. There was progressive reduction in CVD mortality with increasing amounts of green tea consumption up to the category with maximum consumption of ≥5 cups a day. Compared to those who almost never drank green tea, men who drank <1 cup/day or those who drank 1 to 3 cups a day had an HR of 0.9 (95% CI [0.83–0.98]) and an HR of 0.85 (95% CI [0.80–0.91]), respectively. Men who drank the most amount of green tea (≥5 cups a day), had the lowest HR of 0.79 (95% CI [0.68–0.91]). There was a similar pattern in women.36 For black tea, there was decreased CVD mortality with 1 to 3 cups of black tea consumption compared to no consumption; this was found in men but not in women.
A meta-analysis of green tea consumption and stroke risk which included prospective cohort studies from Japan and China, found a non-linear relationship between amount of green tea consumed and stroke risk. Moderate green tea intake was associated with the lowest stroke risk, at an amount of approximately 800 ml/day of green tea or 3 to 4 cups a day.37 Compared with non-consumers, green tea intake was associated with reduced relative risk for stroke.
In adapting the Med-diet for Asia, not all Med-diet characteristics are equally helpful to adopt. Alcohol was allowed at ≥7 glasses a week in some Med-diet RCTs. However, alcohol is flagged as a carcinogen by WHO, which states that no amount of alcohol consumption is safe for health.38 Cancer risk starts at low levels of consumption and increases as consumption increases. The evidence for the CVD benefits of alcohol is conflicting and in young individuals (≤40 years old), no such benefits were found.39 One of the Med-diet RCTs which did not include alcohol use showed the best cardiovascular benefits compared to the other RCTs that did include alcohol use.7 Hence, alcohol consumption is not added as a criterion to be met in the HHAM diet (Figure 1).
Vegetables
Vegetables are emphasised in the Mediterranean diet, with a recommended intake of 400 g/day, as defined in RCTs on the Med-diet.5,6
Vegetables commonly consumed in East Asia have been found to be associated with improved CVD outcome. Two prospective cohort studies, the Shanghai Women’s Health Study and the Shanghai Men’s Health Study, found that high intake of cruciferous vegetables (bok choy, cauliflower, cabbage, napa cabbage and turnip) was associated with a significantly reduced risk of CVD mortality, after adjustment for confounders.40
Another prospective cohort study, the NIT cohort study, found that each increase in intake of leafy green vegetables twice a week was associated with decreased stroke mortality, with an adjusted HR of 0.62 (95% CI [0.43–0.91]).24 Examples of leafy green vegetables are spinach, sweet potato leaves, radish or mustard greens and Chinese parsley (coriander). For the same cohort, once-a-day consumption of yellow/orange vegetables and other vegetables significantly reduced the risk of heart disease mortality.20 Examples of yellow/orange vegetables are sweet potatoes, carrots, pumpkins and gourds. Other vegetables include radish, turnip, celery, tomatoes, eggplants, green peppers, cucumbers and winter melons.21
Some specific Asian vegetables have been individually found to bring cardiometabolic benefits. Bitter gourd has been tested in a randomised crossover trial, where bitter gourd juice compared to a placebo of cucumber juice in prediabetics, significantly reduced fasting glucose.41 In diabetics, an RCT trial found bitter gourd extract compared to placebo significantly reduced fasting blood glucose and HbA1c.42
Mushrooms are part of traditional diets, especially in East Asia. The types of mushrooms (shiitake, oyster and maitake) consumed in Asia also contain higher levels of the antioxidant ergothioneine compared to those consumed in western countries (e.g. button mushrooms).43
Ergothioneine, a metabolite existing in high levels in mushrooms, tempeh and garlic has been found in a prospective cohort study to be associated with a lower risk of coronary disease (HR 0.85 per 1 SD increment of ergothioneine; p=0.01) and CVD mortality (HR 0.79; p=0.002), after adjustment for possible confounders.44
In a South Korean prospective cohort study, men who consumed <1 and 1–3 servings of mushrooms per week had decreased CVD mortality compared to non-consumers after adjusting for confounders. There was no significant difference for women.45 The mushrooms consumed included shiitake, oyster, enoki, wood ear and button.
Kimchi, a fermented vegetable consumed in Korea, has been growing in popularity elsewhere in the world. It has been shown in an RCT conducted in young adults in South Korea, that fermented kimchi reduces total and LDL cholesterol, as well as fasting glucose.46
Fermentation in the process of making kimchi also appears important. In a study of overweight and obese subjects, participants were given 100 g/meal of either fresh or fermented kimchi. Participants randomised to the fermented kimchi group had significantly greater decrease in percentage body fat, waist–hip ratio, total cholesterol, blood pressure and fasting glucose compared to those taking fresh kimchi.47
Kelp (Laminaria japonica) is another vegetable popular in Korean, Japanese and Chinese cuisine. Supplementation with 6 g of iodine-reduced kelp powder as compared to placebo resulted in significant reduction in body fat percentage in overweight Japanese men.48
Aromatic Herbs and Spices
The Med-diet includes the use of aromatic herbs and spices to flavour food in place of salt, and uses garlic and onion in combination with colourful vegetables (e.g. tomatoes and capsicums) cooked in olive oil to make sofrito. It is recommended that sofrito be eaten ≥2 times a week in the Med-diet.6,49 This provides phytonutrients which are associated with improved vessel health and other benefits. Garlic and onion are rich in flavonoids, such as quercetin and kaempferol, which protect against atherosclerosis progression through multiple pathways.50
The red and orange vegetables used in sofrito provide antioxidants such as carotenoids, and a Med-diet RCT found that the amount of carotenoids, vitamin E, vitamin C and zinc taken in the diet was inversely associated with increase in carotid artery intimal media thickness.51
In Asia, garlic and onion are commonly used and other aromatic spices are favoured. In South Asia, curry is used, comprising of a mix of spices such as turmeric, ginger, garlic and cumin.
Cumin consumption has been shown significantly to reduce total cholesterol and LDL, while increasing HDL in a meta-analysis.52 Turmeric contains curcumin. An umbrella meta-analysis which included RCT, found that in non-alcoholic fatty liver disease patients, curcumin/turmeric supplementation significantly reduced aspartate aminotransferase, alanine transaminase, homeostatic model assessment of insulin resistance, BMI, and waist circumference.53
Consumption of ginger has been found by a meta-analysis to significantly reduce HbA1c in people with diabetes.54
Incorporating red and orange vegetables into sauces and seasonings can be encouraged in Asian cuisine adaptations of the Med-diet. Many Asian cultures already share this culinary practice with dishes such as Indian onion tomato masala, Singaporean chilli crab sauce (rich in carotenoids from large red chillies), Chinese tomato hotpot soup base, and Korean gochujang (packed with carotenoids from chilli peppers). To meet Med-diet criteria, Asian-equivalent sauces or soup bases could be consumed ≥2 times a week or 100 g of red or orange vegetables a day can be consumed, congruous with the latest universal healthy reference diet.55
Meat and Eggs
In the Med-diet, the recommended consumption of red meat or processed meat is <1 serving a day. White meat is recommended to be consumed in place of red meat. However, the amount of white meat in the Med-diet is not specified.6,7,49
Asian studies suggest that limited white meat consumption may be associated with better CVD outcomes, at levels of ≤3 servings per week, consistent with quantities in the universal healthy reference diet.18,55
Egg consumption is limited in the Med-diet, with studies recommending consumption of 2 to 4 units of egg per week.49
Fats
The use of canola oil and olive oil is recommended in the Med-diet. These oils are higher in monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) while being lower in saturated fatty acids.
In Asia, olive oil may not be commonly used in some regions. The use of other oils that are low in saturated fat and high in MUFA or PUFA can be considered, such as soybean, corn and sunflower oils. RCTs have shown that replacing saturated fatty acids with MUFA or PUFA reduces cardiovascular events and even reduces atherosclerosis.56,57 Such substitutions also improve blood lipids.58
Heart Healthy Asian Mediterranean Diet
Based on our review of the literature, we created the HHAM diet. These HHAM recommendations sum up the research-proven Med-diet principles that have been shown to reduce CVD events. The recommendations also include adaptations of the Med-diet for the Asian context based on current evidence.
We present the recommendations in a checklist-like form in Table 4, where HHAM recommendations are listed alongside the original Med-diet recommendations for comparison. The HHAM diet is also featured in Figure 1.
Supplementary Material 1 details how HHAM can be applied clinically, and the roles various healthcare professionals can play in facilitating the adoption of HHAM by patients. These include creating educational materials, programmes and promoting HHAM at health institutions or national levels.
Conclusion
There is compelling evidence supporting the adaptation of the Med-diet to bring cardiovascular benefits to various ethnicities in Asia, as seen from data across several Asian countries. By adopting Med-diet principles, Asian dietary practices can significantly shift towards more heart-healthy ways, thereby reducing CVD risk.
Asia also boasts unique food products and culinary preferences. This review summarises the literature on culturally sensitive adaptation of the Med-diet in Asia while leveraging the health benefits of familiar Asian foods. The HHAM dietary pattern proposed by this review combines proven Med-diet principles with Asian ingredients. While RCTs on individual components provide support for cardiometabolic benefits of these Asian ingredients, original research on this diet as a whole has yet to be performed and future RCTs would help show the impact of the HHAM diet in improving cardiovascular health in Asia.
Clinical Perspective
- Applying Mediterranean diet principles in Asian populations, including Japan, Korea, China, Singapore, and India has been associated with reductions in cardiovascular disease and improvements in cardiometabolic markers.
- Several traditional Asian foods, beverages and spices (e.g. green tea, tofu, kimchi, sesame, turmeric) have demonstrated cardiometabolic benefits in randomised controlled trials, offering culturally relevant alternatives to traditional Mediterranean ingredients.
- The Heart Healthy Asian Mediterranean diet integrates evidence-based Mediterranean diet principles with validated Asian ingredients to support cardiovascular disease prevention in Asian contexts.