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Chinese Healthy Eating Index (CHEI) and risk of hypertension: A prospective cohort study in China

Hypertension Research (2025)Cite this article

Abstract

The Chinese Healthy Eating Index (CHEI) is a valuable tool for assessing dietary quality. However, the relationship between CHEI and the risk of hypertension remains unclear. Therefore, a total of 1342 adults without hypertension at baseline and provided at least two survey data from 1997 to 2018 were included. Dietary information was collected by three consecutive 24-h recalls combined with household food inventory, and long-term diet quality was evaluated by the CHEI. Hypertension was defined as DBP ≥ 90 mmHg, SBP ≥ 140 mmHg, or using antihypertensive medication. Cox proportional hazard models were applied to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) of CHEI and new-onset hypertension. A total of 557 new hypertensive events were observed during 12851.5 person-years of follow-up. Compared with individuals in the first quartile of CHEI score, the HR of hypertension was 0.49 (95% CI: 0.38-0.63) in the fourth quartile. Restricted cubic spline analysis displayed an L-shaped non-linear association between CHEI score and hypertension risk. Increased intake of whole grains, fruits, dairy, soybeans, fish/seafood, and eggs, and decreased intake of red meat and sodium, were associated with lower risk of hypertension, with HRs (95% CIs) of whole grains (0.86, 0.78–0.95), fruits (0.70, 0.60–0.81), dairy (0.85, 0.75–0.96), soybeans (0.83, 0.75–0.92), fish/seafood (0.87, 0.79–0.95), eggs (0.87, 0.79–0.96), red meat (0.83, 0.74–0.93), and sodium (0.77, 0.69–0.85), respectively. In conclusion, higher dietary quality assessed by the CHEI was associated with a lower risk of hypertension, indicating that adhering to a healthy diet in accordance with DGC might be beneficial for preventing hypertension.

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References

  1. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–49.

  2. Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Stevens GA, Gregg PEW. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957–80.

    Article  Google Scholar 

  3. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C, et al. Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey. BMJ. 2023;380:e071952.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390:2549–58.

    Article  PubMed  Google Scholar 

  6. Valenzuela PL, Carrera-Bastos P, Gálvez BG, Ruiz-Hurtado G, Ordovas JM, Ruilope LM, et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol. 2021;18:251–75.

    Article  PubMed  CAS  Google Scholar 

  7. Chang HC, Cheng HM, Chen CH, Wang TD, Soenarta AA, Turana Y, et al. Dietary intervention for the management of hypertension in Asia. J Clin Hypertens. 2021;23:538–44.

    Article  Google Scholar 

  8. Aljuraiban GS, Gibson R, Chan DS, Van Horn L, Chan Q. The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies. Adv Nutr. 2024;15:100123.

    Article  PubMed  CAS  Google Scholar 

  9. Schulze MB, Martínez-González MA, Fung TT, Lichtenstein AH, Forouhi NG. Food based dietary patterns and chronic disease prevention. BMJ. 2018;361:k2396.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhao J, Li Z, Gao Q, Zhao H, Chen S, Huang L, et al. A review of statistical methods for dietary pattern analysis. Nutr J. 2021;20:37.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Morze J, Danielewicz A, Hoffmann G, Schwingshackl L. Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: A Second Update of a Systematic Review and Meta-Analysis of Cohort Studies. J Acad Nutr Diet. 2020;120:1998–2031.e1915.

    Article  PubMed  Google Scholar 

  12. Petersen KS, Kris-Etherton PM. Diet quality assessment and the relationship between diet quality and cardiovascular disease risk. Nutrients. 2021;13:4305.

  13. Theodoridis X, Chourdakis M, Chrysoula L, Chroni V, Tirodimos I, Dipla K, et al. Adherence to the DASH Diet and Risk of Hypertension: A Systematic Review and Meta-Analysis. Nutrients. 2023;15:3261.

  14. Bakaloudi DR, Chrysoula L, Leonida I, Kotzakioulafi E, Theodoridis X, Chourdakis M. Impact of the level of adherence to the Mediterranean Diet on blood pressure: A systematic review and meta-analysis of observational studies. Clin Nutr. 2021;40:5771–80.

    Article  PubMed  Google Scholar 

  15. Pasdar Y, Hamzeh B, Moradi S, Mohammadi E, Cheshmeh S, Darbandi M, et al. Healthy eating index 2015 and major dietary patterns in relation to incident hypertension; a prospective cohort study. BMC Public Health. 2022;22:734.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Xu X, Hall J, Byles J, Shi Z. Do older Chinese people’s diets meet the Chinese Food Pagoda guidelines? Results from the China Health and Nutrition Survey 2009. Public Health Nutr. 2015;18:3020–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stookey JD, Wang Y, Ge K, Lin H, Popkin BM. Measuring diet quality in china: the INFH-UNC-CH diet quality index. Eur J Clin Nutr. 2000;54:811–21.

    Article  PubMed  CAS  Google Scholar 

  18. Kojima T, Potkin SG, Kharazmi M, Matsushima E, Herrera J, Shimazono Y. Limited eye movement patterns in chronic schizophrenic patients. Psychiatry Res. 1989;28:307–14.

    Article  PubMed  CAS  Google Scholar 

  19. Liu R, Zhao Y, Yan H, Dang S, Pang S, Wang X, et al. Using the revised Chinese diet balance index Quality of Diet to evaluate the quality of diet among rural residents in Hanzhong, Shaanxi province and relative influencing factors]. Zhonghua Liu Xing Bing Xue Za Zhi. 2014;35:1087–90.

    PubMed  Google Scholar 

  20. Yuan YQ, Li F, Dong RH, Chen JS, He GS, Li SG, et al. The Development of a Chinese Healthy Eating Index and Its Application in the General Population. Nutrients. 2017;9:1–17.

    Article  Google Scholar 

  21. Zheng J, Zhu T, Li F, Wu H, Jiang S, Shivappa N, et al. Diet quality and mortality among Chinese adults: findings from the China Health and Nutrition Survey. Nutrients. 2023;16:94.

  22. Liu MW, McNaughton SA, He QQ, Leech R. Longitudinal trajectories of diet quality and subsequent mortality among Chinese adults: results from the China Health and Nutrition Survey 1997–2015. Int J Behav Nutr Phys Act. 2021;18:51.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zhang Z, Liu F, Yin X, Wu B, Li H, Peng F, et al. Chinese Healthy Eating Index (CHEI) and risk of diabetes in Chinese adults: a prospective cohort study. Eur J Nutr. 2024(e-pub ahead of print 2024/01/22; https://doi.org/10.1007/s00394-023-03321-7).

  24. Xu Z, Chen S, Guo M, Zhang T, Niu X, Zhou Y, et al. The impact of diet quality on cognitive ability of Chinese older adults: evidence from the China Health and Nutrition Survey (CHNS). BMC Geriatr. 2024;24:55.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zhang B, Zhai FY, Du SF, Popkin BM. The China Health and Nutrition Survey, 1989-2011. Obes Rev. 2014;15 Suppl 1:2–7.

    Article  PubMed  CAS  Google Scholar 

  26. Wang SS, Lay S, Yu HN, Shen SR. Dietary Guidelines for Chinese Residents (2016): comments and comparisons. J Zhejiang Univ Sci B. 2016;17:649–56.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Revision JCfG. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension-A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol. 2019;16:182–241.

    Google Scholar 

  28. Liu Z, Zhao D, Dai S, Liang Y, Zhao M, Liu M, et al. Inverse Association between the Global Diet Quality Score and new-onset hypertension in adults: a nationwide cohort study. J Nutr. 2024(e-pub ahead of print 2024/02/16; https://doi.org/10.1016/j.tjnut.2024.02.008).

  29. Zhang J, Wang Z, Du W, Huang F, Jiang H, Bai J, et al. Twenty-Five-Year Trends in Dietary Patterns among Chinese Adults from 1991 to 2015. Nutrients. 2021;13:1327.

  30. He Y, Li Y, Yang X, Hemler EC, Fang Y, Zhao L, et al. The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study. Lancet Diabetes Endocrinol. 2019;7:540–8.

    Article  PubMed  Google Scholar 

  31. Schwingshackl L, Chaimani A, Schwedhelm C, Toledo E, Pünsch M, Hoffmann G, et al. Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis. Crit Rev Food Sci Nutr. 2019;59:2674–87.

    Article  PubMed  CAS  Google Scholar 

  32. Hussain BM, Deierlein AL, Kanaya AM, Talegawkar SA, O’Connor JA, Gadgil MD, et al. Concordance between Dash Diet and Hypertension: Results from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Nutrients. 2023;15:3611.

  33. Motamedi A, Ekramzadeh M, Bahramali E, Farjam M, Homayounfar R. Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study. Nutr J. 2021;20:57.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Wu H, Yi MH, Liu BG, Xu Y, Wu Q, Liu YH, et al. Association of gestational metabolic syndrome with the Chinese Healthy Eating Index in mid-pregnancy: a cross-sectional study. Nutr Metab. 2024;21:8.

    Article  Google Scholar 

  35. Zhang W, He Y, Chen F, Wang C, Kang X, Peng Y, et al. Chinese dietary indices and glioma: new insights of a case-control study in the Chinese population. Nutrients. 2023;15:3602.

  36. Sukhato K, Akksilp K, Dellow A, Vathesatogkit P, Anothaisintawee T. Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review. Am J Clin Nutr. 2020;112:1584–98.

    Article  PubMed  Google Scholar 

  37. Jackson JK, MacDonald-Wicks LK, McEvoy MA, Forder PM, Holder C, Oldmeadow C, et al. Better diet quality scores are associated with a lower risk of hypertension and non-fatal CVD in middle-aged Australian women over 15 years of follow-up. Public Health Nutr. 2020;23:882–93.

    Article  PubMed  Google Scholar 

  38. Son M, Heo YJ, Hyun HJ, Kwak HJ. Effects of Marital Status and Income on Hypertension: The Korean Genome and Epidemiology Study (KoGES). J Prev Med Public Health. 2022;55:506–19.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ramezankhani A, Azizi F, Hadaegh F. Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: A long term follow-up study. PLoS ONE. 2019;14:e0215593.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: a meta-analytic review. Psychol Bull. 2014;140:140–87.

    Article  PubMed  Google Scholar 

  41. Jones DW, Hall JE. Racial and ethnic differences in blood pressure: biology and sociology. Circulation. 2006;114:2757–9.

    Article  PubMed  Google Scholar 

  42. Na M, Wang Y, Zhang X, Sarpong C, Kris-Etherton PM, Gao M, et al. Dietary Approaches to Stop Hypertension (DASH)-Style Dietary Pattern and 24-Hour Ambulatory Blood Pressure in Elderly Chinese with or without Hypertension. J Nutr. 2022;152:1755–62.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chen M, Xu Y, Wang X, Shan S, Cheng G. Association between the prudent dietary pattern and blood pressure in Chinese adults is partially mediated by body composition. Front Nutr. 2023;10:1131126.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Allen TS, Bhatia HS, Wood AC, Momin SR, Allison MA. State-of-the-Art Review: evidence on red meat consumption and hypertension outcomes. Am J Hypertens. 2022;35:679–87.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. He Z, Jia Y, Li J, Cao J, Liu F, Li H, et al. Fruit and vegetable intake and the risk of arterial hypertension in China: A prospective cohort study. Chronic Dis Transl Med. 2023;9:309–19.

    PubMed  PubMed Central  Google Scholar 

  46. Heidari Z, Rashidi Pour Fard N, Clark CCT, Haghighatdoost F. Dairy products consumption and the risk of hypertension in adults: An updated systematic review and dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis. 2021;31:1962–75.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the Hubei Provincial Natural Science Foundation of China (Grant No.2024AFB526), the National Natural Science Foundation of China (82304141), and the China Postdoctoral Program (2023M741256).

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  1. These authors contributed equally: Zhuangyu Zhang, Hongxia Li

Authors and Affiliations

  1. Jiang’an County Health Bureau, Yibin, 644299, China

    Zhuangyu Zhang

  2. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education (MOE); Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Hongxia Li, Mengyang Xia, Zhiqiang Cao, Yuhan Tang & Ping Yao

  3. Institute of Health Surveillance Analysis and Protection, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China

    Jingjing Li, Ling Liu, Yingying Ouyang, Chenrui Gong & Shuang Liu

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Zhang, Z., Li, H., Xia, M. et al. Chinese Healthy Eating Index (CHEI) and risk of hypertension: A prospective cohort study in China. Hypertens Res (2025). https://doi.org/10.1038/s41440-025-02369-8

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