As highlighted in the article by Wei et al. [4], dietary pattern analysis focuses on the overall health impact of diet rather than individual nutrients or foods. While specific nutrients and foods have been studied in relation to hypertension in Asian populations [5,6,7], there is still a gap in understanding the role of dietary diversity and food group intake in hypertension risk among Asian adults. The authors utilized data from the China Health and Nutrition Survey (CHNS) to explore the relationship between dietary diversity, food group intake, and the risk of new-onset hypertension among Chinese adults. The final sample included 11,118 participants (mean age: 41.3 years), with data from seven CHNS datasets spanning from 1997 to 2015. During a median follow-up period of 6 years, 3,867 individuals (34.8%) developed new-onset hypertension. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg or diagnosed hypertension by physician or under antihypertensive treatment during the follow-up. The study aimed to evaluate the relationship between dietary diversity (measured by dietary diversity scores) and the quantity of food group intake with the incidence of hypertension in adults.

The study found a negative correlation between the cumulative average dietary diversity scores and new-onset hypertension. Specifically, participants with higher dietary diversity scores had a significantly lower risk of developing hypertension. An L-shaped association was observed between dietary diversity scores and hypertension risk. Participants in the second to fourth quartiles of dietary diversity scores had a lower risk of developing hypertension compared to those in the first quartile (HR: 0.64, 95% CI: 0.59–0.69). Furthermore, the study identified the optimal intake ranges for various food groups, such as refined grains (346.7–375.0 g/day), vegetables (225.4–375.3 g/day), dairy products (16.7–60.0 g/day), and aquatic products (2.8–8.3 g/day), which were associated with a lower risk of hypertension. A plateau effect was observed for fruit, beans, and eggs, where consumption above certain thresholds (12.7 g of fruits, 16.1 g of legumes, and 8.3 g of eggs per day) did not further reduce the risk of hypertension.

The study used a large dataset of 11,118 adults with 6 years of follow-up, providing a robust basis for examining the long-term impact of dietary diversity on hypertension risk. The data spans several regions in China, capturing the diversity of dietary patterns across the country. The study provides concrete recommendations for the optimal intake of various food groups to minimize hypertension risk. This level of detail is a strength, offering actionable insights for public health policies and individual dietary adjustments. The study is the first to demonstrate the link between greater dietary diversity and a lower risk of developing hypertension. By focusing on the broader dietary pattern rather than isolated nutrients, the research supports the idea that a varied diet may be crucial for hypertension prevention. By supporting the concept of “dietary diversity,” the findings align with current dietary guidelines and provide evidence to inform public health strategies aimed at reducing hypertension [8].

However, there are some limitations. The dietary data was self-reported, which can lead to misclassification and recall bias. The accuracy of food intake reporting is often limited, which could affect the reliability of the findings, particularly if participants underreport or overreport their intake. As an observational study, it cannot establish causality. While the study shows an association between dietary diversity and reduced hypertension risk, it does not prove that higher dietary diversity directly causes lower hypertension risk. Further randomized controlled trials are needed to confirm this causal relationship.

The study was conducted on a Chinese population, and its results may not be directly applicable to other countries with different dietary patterns and cultural contexts. For example, dietary habits in Western countries, where food types and processing methods differ, might not exhibit the same relationships with hypertension. The median follow-up period of 6 years is relatively short for studying chronic conditions like hypertension. Longer-term studies would provide more comprehensive insights into the lasting effects of dietary diversity on hypertension risk.

This study is the first to show that greater diversity in food group intake is significantly associated with a lower risk of new-onset hypertension in general Chinese adults. It supports the idea that promoting dietary diversity can be an effective strategy for hypertension prevention. The study also identified optimal intake ranges for various food groups, offering practical guidance for dietary modifications. The 2021 Dietary Guidance to Improve Cardiovascular Health by the American Heart Association emphasizes the strong link between poor diet quality and the elevated risk of cardiovascular disease morbidity and mortality [9]. It advocates for focusing on dietary patterns rather than individual foods or nutrients, recognizing the importance of nutrition from early life. The statement outlines key elements of heart-healthy dietary patterns and identifies structural challenges that hinder adherence to these patterns. Key recommendations for promoting cardiometabolic health include: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. The statement also highlights challenges like marketing unhealthy foods, food insecurity, and structural racism that hinder adherence to heart-healthy diets. It calls for public health efforts to create environments that make it easier for individuals to follow these dietary patterns. Additionally, studies in other populations with different dietary patterns and longer follow-up periods would help determine whether these findings can be generalized beyond the Chinese context.