Textbook of Lifestyle Medicine - Labros S. Sidossis

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and shrimp, eggs, poultry, and meat should be eaten regularly, but in small amounts. The consumption of dairy products, beans, and bean‐derived foods should be consumed in moderation, while at the top of the pagoda is the intake of fats, oils, and salt. Moreover, the Chinese dietary guidelines highlight the need for adequate hydration, suggesting 1500–1700 ml of water everyday as well as adequate physical activity equivalent to 6000 steps/day. Large prospective studies suggest that green tea consumption is significantly and inversely associated with CVD and all‐cause mortality; black tea consumption is also significantly and inversely associated with cancer and all‐cause mortality. Vegetables, fruits, legumes, fish, and eggs are the food groups associated with reduced risk of all‐cause mortality.

      The China‐Cornell‐Oxford Project, or simply the China Study, sought to explore the dietary habits along with the prevalence of age‐related diseases in 10,200 Chinese of both genders. The study found that rural populations adhering to this traditional dietary pattern manifested very low prevalence of heart disease, breast and prostate cancer, obesity, and osteoporosis, compared to Western societies. However, urban Chinese adhering to a more Western‐type diet with high intakes of animal‐derived foods were more likely to be obese and suffer from heart disease, as well as breast and prostate cancer. When all the analyses were completed, Dr. Campbell, the principal investigator of the China Study, commented: “In the final analysis, we have strong evidence from this and other studies that nutrition becomes the controlling factor in the development of chronic degenerative diseases” Indeed, in a systematic review of 18 studies on the prevalence and trends for MetS in the Asia‐Pacific region, more than 20% of the adult population had MetS.

       Key Point

      Nutrition becomes the controlling factor in the development of chronic degenerative diseases.

Schematic illustration of the Chinese dietary guidelines launched in 2016: (a) Chinese Food Guide (CFG) G-Pagoda is the main graphical illustration; (b) CFG-Plate; and (c) CFG-Abacus function as supplementary illustrations for CFG-Pagoda.

      Source: Reprinted from Yang et al. (2018b).

      Take‐Home Messages

       The traditional Asian diet is followed in most Asian countries, and although it varies in many aspects between countries, it holds many similarities regarding the consumption of traditional Asian foods.

       The Asian diet is primarily characterized by high consumption of rice, foods of plant origin (e.g., soy products), fish and seafood, as well as fruits and vegetables.

       The Japanese and the Chinese dietary guidelines represent two well‐documented examples of healthy Asian diets.

       The incidence of several chronic diseases, such as CVD and cancer, has been shown to be lower in most Asian societies compared to most Western countries.

       The recent shift from the traditional Asian diet to a more Western‐like diet is characterized by an increase in meat consumption and a decrease in rice consumption.

      Self‐Assessment Questions

      1 What are the main characteristics of the Asian diet?

      2 State two well‐documented examples of healthy Asian diets.

      3 What kinds of foods are included at the base of the “Chinese Food Guide Pagoda”?

      1 Abaidia, A.E., Daab, W., and Bouzid, M.A. (2020). Effects of Ramadan fasting on physical performance: a systematic review with meta‐analysis. Sports Med. 50 (5): 1009–1026.

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      9 Eveleigh, E.R., Coneyworth, L.J., Avery, A., and Welham, S.J.M. (2020). Vegans, vegetarians, and omnivores: how does dietary choice influence iodine intake? A systematic review. Nutrients 12 (6): 1606.

      10 FAO. (2010). Food‐based dietary guidelines for Japanese. www.fao.org/nutrition/education/food‐dietary‐guidelines/regions/countries/Japan/en.

      11 Fernando, H.A., Zibellini, J., Harris, R.A. et al. (2019). Effect of Ramadan fasting on weight and body composition in healthy non‐athlete adults: a systematic review and meta‐analysis. Nutrients 11 (2): 478.

      12 Gonzalez‐Garcia, S., Esteve‐Llorens, X., Moreira, M.T., and Feijoo, G. (2018). Carbon footprint and nutritional quality of different human dietary choices. Sci. Total Environ. 644: 77–94.

      13 Haghighatdoost, F., Bellissimo, N., Totosy, de Zepetnek, J.O., and Rouhani, M.H. (2017). Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta‐analysis of observational studies. Public Health Nutr. 20 (15): 2713–2721.

      14 Haider, L.M., Schwingshackl, L., Hoffmann, G., and Ekmekcioglu, C. (2018). The effect of vegetarian diets on iron status in adults: a systematic review and meta‐analysis. Crit. Rev. Food Sci. Nutr. 58 (8): 1359–1374.

      15 Iguacel, I., Huybrechts, I., Moreno, L.A., and Michels, N. (2021). Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta‐analysis. Nutr. Rev. 79 (4): 361–381.

      16 Kanerva, N., Kaartinen, N.E., Schwab, U., Lahti‐Koski, M., and Männistö, S. (2014). The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries. Public Health Nutr. 17 (8): 1697–1705. doi: 10.1017/S1368980013002395.

      17 Koufakis, T., Karras, S.N., Zebekakis, P., and Kotsa, K. (2018). Orthodox religious fasting as a medical nutrition therapy for dyslipidemia: where do we stand and how far can we go? Eur. J. Clin. Nutr. 72 (4): 474–479.

      18 Landberg, R. and Hanhineva, K. (2019). Biomarkers of a healthy Nordic diet: from dietary exposure biomarkers to microbiota signatures in the metabolome. Nutrients 12 (1): 27.

      19 Lankinen,

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