Replacing dietary carbohydrates and refined grains with different alternatives and risk of cardiovascular diseases in a multi-ethnic Asian population.

BACKGROUND: Cardiovascular diseases (CVDs) are a major cause of deaths worldwide, but prospective data on dietary risk factors for CVD in South and Southeast Asian populations are sparse. OBJECTIVE: We aimed to evaluate the relation between macronutrient and food intakes and incidence of major adverse cardiovascular events (MACEs) in a multi-ethnic Asian population. METHODS: We used data from the Singapore Multi-Ethnic Cohort (n = 12,408), a prospective cohort of ethnic Chinese, Malay, and Indian adults aged 21‒65 y recruited between 2004 and 2010. Dietary intakes were assessed using a validated food-frequency questionnaire, and the incidence of MACEs was ascertained through data linkage with national registries. A Cox proportional hazards model was used to evaluate the associations between dietary intakes and MACE risk. RESULTS: Over a mean (SD) follow-up of 10.1 (2.3) y, 746 incident cases of MACEs were documented. We observed a direct association between carbohydrate intake and MACE risk (highest vs. lowest quartile, HR: 1.35; 95% CI: 1.07, 1.71; P-trend = 0.001). Replacing 5% of energy from carbohydrate with polyunsaturated fat (HR: 0.79; 95% CI: 0.69, 0.91) but not saturated fat (HR: 0.95; 95% CI: 0.84, 1.09) was significantly associated with a lower MACE risk. In terms of food groups, replacing 1 serving/d of refined grains with fruit (HR: 0.93; 95% CI: 0.87, 0.99), vegetables (HR: 0.92; 95% CI: 0.85, 1.00), and dairy (HR: 0.90; 95% CI: 0.82, 0.98) was associated with lower MACE risk. Cholesterol intake was associated with a higher MACE risk in ethnic Indians (highest vs. lowest quartile, HR: 2.40; 95% CI: 1.53, 3.75; P-trend < 0.001) but not in ethnic Malay or Chinese (P-interaction = 0.015). CONCLUSIONS: Moderating carbohydrate intakes by increasing polyunsaturated fat intake and replacing refined grains with fruits, vegetables, and dairy was associated with lower MACE risk in Asian populations.

Diet Quality and Lower Refined Grain Consumption are Associated With Less Weight Gain in a Multi-Ethnic Asian Adult Population.

BACKGROUND: The prevalence of obesity is increasing in many Asian countries. However, longitudinal data on the impacts of dietary factors on weight gain in Asian populations are sparse. OBJECTIVES: We evaluated the relationship between changes in intakes of nutrients, foods, and beverages and diet quality and long-term changes in body weight. METHODS: We used data (n = 3064) from the Singapore Multi-Ethnic Cohort, a prospective cohort including Chinese, Indian, and Malay residents aged 21-65 years. Dietary intakes were assessed using an FFQ, and body weight and waist circumference were measured during health examinations. Diet quality was evaluated using the Dietary Approaches to Stop Hypertension (DASH) and Alternative Healthy Eating Index (AHEI-2010) scores. Data were collected at baseline (2004-2010) and follow-up (2011-2016), with a mean follow-up of 6.0 years. Linear regression was used to assess the associations between dietary changes and weight change, adjusted for socio-demographic and lifestyle variables. RESULTS: Improvements in dietary quality scores (DASH, -0.34 kg per 5 points; AHEI-2010, -0.35 kg per 10 points) and replacement of carbohydrates with protein (-0.44 kg per 5% of energy) were significantly associated with less weight gain. Increased intakes of white rice (+0.25 kg per serving/d), soft drinks (+0.69 kg), red meat (+0.58 kg), and poultry with skin (+0.74 kg) were directly associated with weight gain. The replacement of 1 serving per day of white rice with whole grains (-0.68 kg), vegetables (-0.33 kg), poultry without skin (-0.79 kg), and eggs (-0.87 kg) was associated with less weight gain. Similar associations were observed between changes in dietary factors and changes in waist circumference. CONCLUSIONS: Among Asian adults, increasing dietary quality, reducing soft drink consumption, and replacing white rice with whole grains, vegetables, and selected high-protein foods was associated with less weight gain.

Making novel staple foods the norm: perspectives from adult consumers with and without diabetes.

Novel staple foods are staple foods that are modified with the purpose of improving their nutritional properties. However, consumers' acceptance towards novel staple foods remains to be evaluated, especially in Asian populations where staple foods like white rice are a major source of energy. The objective of this study was to explore consumers' attitudes and perceptions towards novel staple foods in a multi-ethnic Asian population. We conducted 11 focus group discussions, with 37 healthy participants and 22 participants with diabetes recruited through newspaper, email and poster advertisement and in-person recruitment at a clinic. Thematic analysis using the general inductive approach was performed. We found that participants' conceptual understanding of the modification process affected their acceptance towards novel staple foods. Plant-based modifications were considered natural and acceptable while genetic modification and use of chemicals were unnatural and undesirable. Participants expected novel staple foods to be more expensive and less tasty and this was largely due to their perceptions and experiences with healthy eating. Participants with diabetes or family history of diabetes were generally more willing to compromise taste and cost for healthier staple foods, and this appeared to be driven by concerns about diabetes and its related co-morbidities. The appearance of food was an important influence on participants' initial impression of the food, which appeared to be mediated by taste expectations. Participants' trust of novel staple foods was largely influenced by their trust in food industry, governmental authorities and nutrition science that was mediated through pathways of information and food safety.

Attitudes and beliefs regarding food in a multi-ethnic Asian population and their association with socio-demographic variables and healthy eating intentions.

BACKGROUND: Attitudes and beliefs regarding food are known to influence dietary behaviours and may reflect cultural traditions. Therefore, understanding the food culture in the population is important to inform culturally relevant and acceptable public health interventions. OBJECTIVE: (1) To evaluate attitudes towards pleasure and health with regard to eating and its association with healthy eating intentions. (2) To assess traditional beliefs about 'hot-cold balance' and its influence on food choice. METHODS: We conducted a cross-sectional study using an online research panel comprising of 787 male and female adults of Chinese, Malay and Indian ethnicity recruited from population-based cohorts and public housing estates in Singapore. A self-administered questionnaire was used to assess beliefs and attitudes towards food. To evaluate the association of beliefs and attitudes with socio-demographic determinants and potential consequences for healthy eating intentions, multivariable logistic regression was used with adjustment for age, gender and ethnicity. RESULTS: Beliefs about the importance of considering hot-cold balance for food choice were common among all three Asian ethnic groups and most prominent among the Chinese ethnic group (56.3% Malay, 64.5% Indian and 72.4% Chinese). The majority of participants (73.8%) often consider the effects of diet on health, but also value eating pleasure greatly (84.9%). Older age was associated with a shift in attitudes from valuing eating pleasure towards health. Valuing the importance of food for health was associated with a wide range of healthy eating intentions, whereas highly valuing eating pleasure was associated with a lower intention to reduce salt intake. CONCLUSION: In a cosmopolitan Asian population, both eating for health and eating for pleasure were valued highly and traditional beliefs regarding the hot-cold balance were held by the majority.