Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis

With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped " high- quality, " which included high intakes of three or more of the following food groups: 1 ) fruits and vegetables, 2 ) whole grains, 3 ) healthy protein sources (legumes and nuts, fi sh and seafood, low-fat dairy, and lean meat and poultry), and 4 ) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped " low-quality, " which included high intakes of two or more of the following: 5 ) ultraprocessed food, 6 ) beverages and foods with added sugars, 7 ) foods high in salt, and 8 ) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled " animal-based, " and studies using dietary diversity scores were labeled " diet diversity indices. " Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-speci fi c effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile de fi ned by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD.