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(Stroke. 2005;36:228.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Influence of Dietary Patterns on Stroke Risk in China

Tsung O. Cheng, MD

Professor of Medicine, George Washington University Medical Center, Washington, DC

To the Editor:

I read with interest the study of dietary influence on stroke risk in women reported by the Nurses’ Health Study group.¹ The authors concluded their article by saying that "because dietary pattern may vary in different populations, our results need to be verified in other populations."¹ I wish to confirm that similar risk associations have been observed in China, just as in the case of coronary artery disease.²

Zhou³ reported in 2002 that the dramatic increase in mortality in coronary artery disease in China could be attributed to the observed changes from a traditional Chinese diet to a Western diet,⁴ such as a 5-fold increase in consumption of red meats, eggs, and oils between 1978 and 1992³ and a decrease in fruit and vegetable intake during the same period.³ This correlation holds true for stroke in China (B.F. Zhou, personal communication, September 12, 2004).

Zhou presented further confirmatory data from the International Study on Macronutrients and Blood Pressure (INTERMAP) in a Chinese medical journal.⁵ The INTERMAP included participants from China, Japan, the United Kingdom, and the United States in the late 1990s.⁶ According to Zhou,⁵ hypercholesterolemia (5.17 mmol/L) was detected in one third of the Chinese participants, in whom the incidence of coronary artery disease and stroke was 10%. Zhou⁵ contrasted this escalating trend in China with the declining trend in Japan (from a stroke mortality of 385 per 100 000 males and 225 per 100 000 females in 1970 to 79 per 100 000 males and 41 per 100 000 females in 1990s) as a result of control of the dietary risk factors in Japan.

That a Western dietary pattern, characterized by high intake of red and processed meats and high-fat dairy products and desserts and reflected by an elevated plasma cholesterol level, is associated with an increased risk of ischemic stroke¹ is also evidenced by findings reported recently from China of different subtypes of stroke in China.⁷ The Collaborative Study Group of China Multicenter Study of Cardiovascular Epidemiology⁷ found a great variance in the proportion of stroke subtypes among different populations with the same ethnic backgrounds and within the same country. High plasma cholesterol and body mass index increased the risk of ischemic stroke.⁷ In China, plasma cholesterol is higher in urban than in rural populations and higher in northern than in southern populations, thus explaining a higher proportion of ischemic stroke in urban and northern populations than in rural and southern populations.⁷

There is a price that developing countries must pay for modernization; however, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of cardiovascular disease while adapting the positive aspects of a modern Western lifestyle?⁸

References

1. Fung TT, Stampfer MJ, Manson JAE, Rexrode KM, Willett WC, Hu FB. Prospective study of major dietary patterns and stroke risk in women. Stroke. 2004; 35: 2014–2019.[Abstract/Free Full Text]
2. Cheng TO. The current state of cardiology in China. Int J Cardiol. 2004; 96: 425–439.[CrossRef][Medline] [Order article via Infotrieve]
3. Zhou BF. Chinese dietary pattern and features of cardiovascular disease 2002. Presented at: Second Five-Continent International Symposium on Cardiovascular Diseases; September 19–22, 2002; Beijing, China.
4. Critchley J, Liu J, Zhao D, Wei W, Capewell S. Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999. Circulation. 2004; 110: 1236–1244.[Abstract/Free Full Text]
5. Zhou BF. Diet and nutrition in relation to prevention of chronic diseases during the economic transit period: challenge and opportunity existing side by side. Acta Nutrimenta Sinica. 2004; 26: 241–243.
6. Zhou BF, Stamler J, Dennis B, for the INTERMAP Research Group. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom and United States in the late 1990s: the INTERMAP study. J Hum Hypertens. 2003; 17: 623–630.[CrossRef][Medline] [Order article via Infotrieve]
7. Zhang L-F, Yang J, Hong Z, for the Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology. Proportion of different subtypes of stroke in China. Stroke. 2003; 34: 2091–2096.[Abstract/Free Full Text]
8. Cheng TO. Price of modernization of China. Circulation. 2001; 103: e131.[Medline] [Order article via Infotrieve]

This Article Full Text (PDF) All Versions of this Article: 36/2/228    most recent 01.STR.0000155270.83841.9av1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O.