BACKGROUND Although healthy diets are proven to reduce blood pressure, evidence from rigorously controlled dietary interventions remains scarce, offering limited insight into underlying mechanisms. OBJECTIVES This study aimed to identify metabolic mechanisms linking a healthy diet to blood pressure regulation. METHODS In this randomized feeding trial, 265 adults with systolic blood pressure (SBP) between 130 and 159 mm Hg were assigned to either the Chinese Heart-Healthy (CHH) diet or a control diet for 28 days. Untargeted metabolomic profiling of serum and urine samples was performed before and after the intervention. Differentially changing metabolites between the 2 diet groups were identified using both linear mixed models and partial least-squares discriminant analysis. Correlation, pathway enrichment, and mediation analyses were subsequently conducted to further characterize metabolites and biological pathways that may plausibly link the CHH dietary intervention to reductions in blood pressure. RESULTS Fifty-two serum and 101 urinary metabolites changed differentially with 2 diets (variable importance in projection score > 1.0 and false discovery rate-adjusted P < 0.05). Among these metabolites, 17 were either associated with changes in SBP (false discovery rate-adjusted P < 0.05) or enriched in pathways prioritized in this study based on prior and present evidence of relevance to blood pressure; 4 met both criteria. Three of the 4 metabolites (ie, 2-octenoylcarnitine, 5-methylheptanoylcarnitine, and (2Z,4E,6Z)-decatrienoylcarnitine) were medium-chain acylcarnitines enriched in fatty acid oxidation, decreased with the CHH diet, and were positively associated with SBP. The fourth, tetrahydrobiopterin, enriched in tryptophan metabolism, increased with the CHH diet and was inversely associated with SBP. Collectively, all 17 prioritized metabolites mediated 33.3% of the CHH diet's effect on SBP and 47.2% on diastolic blood pressure (DBP; corresponding to 3.3 and 1.8 mm Hg reductions). Nine metabolites enriched in the fatty acid oxidation pathway mediated 17.4% of the SBP and 17.6% of the DBP effects, whereas 3 metabolites enriched in tryptophan metabolism mediated 16.9% of the SBP reduction and 27.7% of the DBP reduction. Changes in dietary nutrients and food components, rather than sodium or potassium, largely accounted for shifts in these metabolites. CONCLUSIONS We identified robust, biologically plausible pathways that may help explain how a healthy diet lowers blood pressure. (c) 2026 by the American College of Cardiology Foundation.

BACKGROUND AND OBJECTIVES:The Nutrition Self-Assessment App (APP), a novel smartphone-based tool, was developed to enable users of oral nutritional supplements (ONSs) to self-assess total energy expenditure (TEE) and identify energy deficits, providing personalized ONS recommendations. By integrating step-count track-ing and dietary intake reporting, the app estimates physical activity levels and energy deficits. However, validation against clinician assessments is essential prior to large-scale implementation. METHODS AND STUDY DESIGN:In this multicenter cross-sectional study (October-November 2023), TEE and deficits were evaluated using both the app and clinician assessments. Statistical analyses included paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots. Clinician satisfaction was measured via a 5-point Likert scale. RESULTS:Among 423 ONS users, no significant differences were found between clinician- and app-derived estimates for TEE (1606.2 ± 287.2 vs. 1541.6 ± 300.5 kcal/day, p >0.05) or energy deficits (610.4 ± 376.9 vs. 600.1 ± 384.6 kcal/day, p >0.05). Agreement was moderate for TEE (ICC = 0.66) and excellent for deficits (ICC = 0.94). Bland-Altman analysis showed 93.9% (397/423) of deficit differences within 95% limits of agreement. Clinicians rated the app as "very satisfied" (46.1%) or "fairly satisfied" (37.1%) for most participants. CONCLUSIONS:The app demonstrated moderate agreement with clinician assessments for TEE estimation, while showing high agreement in energy deficit estimation. These findings validate its potential reliabil-ity as a supportive tool for ONS management. Its integration of activity tracking and dietary monitoring supports scalable implementation to improve ONS adherence.

This study aimed to evaluate the effects of 6-month daily supplementation with whey protein (WP) or yeast protein (YP) on anthropometric measurements, laboratory parameters, skeletal muscle mass, muscle strength, and physical function in Chinese older adults. In this randomized controlled trial, 92 participants were assigned to WP (n = 31), YP (n = 30), or control (n = 31) groups. At baseline and 24 weeks, we assessed: anthropometrics (weight, BMI, and waist/calf circumference); laboratory parameters (ALT, TG, TC, creatinine, urea, hemoglobin, and FBG); appendicular skeletal muscle mass (index); handgrip strength; and physical function (6-m walk speed, chair stand test, SPPB). Habitual diet and activity were maintained. Anthropometrics: Compared to controls, both protein groups significantly reduced body weight (WP: -5.4 kg; YP: -0.9 kg; both p < 0.05). Laboratory Parameters: TC decreased significantly from baseline in both WP (-0.15 mmol/L) and YP (-0.18 mmol/L) groups (p < 0.05). Muscle mass and strength: No intergroup differences were found in changes of ASM or handgrip strength (p > 0.05). Physical function: Both intervention groups showed greater improvement in 6-m walk speed and SPPB scores versus control (p < 0.05). The mean increase in SPPB score in the YP group (0.9 points) reached the threshold for a minimal clinically important difference. Six-month supplementation with either WP or YP improved body weight, cholesterol, and physical function in Chinese older adults, with comparable effects between the two protein sources. YP may serve as a viable alternative to WP for enhancing functional status, a finding with potential clinical relevance.

Sarcopenia, characterized by an age-associated decline in skeletal muscle mass and strength/function, is associated with multiple adverse clinical outcomes. Dietary nutrition and exercise interventions are effective ways to prevent and improve sarcopenia. Therefore, Huadong Hospital affiliated to Fudan University, Shanghai Elderly Nutrition and Health Quality Control Center, together with the Geriatric Nutrition Branch of China Nutrition Society convened experts from nutrition, geriatrics, sports medicine, rehabilitation medicine, traditional Chinese medicine and general practice medicine to jointly set up a working group to supplement and revise the 2015 edition of China Expert Consensus on Nutrition and Exercise Intervention for Sarcopenia based on evidence-based medicine evidence in the past ten years to form this consensus. The aim is to provide practical guidelines to prevent and treat the disease.

OBJECTIVES:Appendicular skeletal muscle mass (ASM), a core parameter for sarcopenia diagnosis, is difficult to measure in primary care facilities lacking specialized equipment. This study was conducted to develop and validate an ASM prediction equation based on simple anthropometric and demographic indices. DESIGN:Cross-sectional study. SETTING AND PARTICIPANTS:The study included 5016 community-dwelling older adults (mean age, 71.0 ± 5.6 years; women, 55.9%). METHODS:Anthropometric and demographic data were collected by uniformly trained medical staff. ASM was measured through bioelectrical impedance analysis (BIA). The participants were randomly divided (4:1) into a development group (n = 4013) and a validation group (n = 1003). Stepwise multivariate linear regression was performed to establish the ASM prediction equation. RESULTS:The equation for predicting ASM was as follows: ASM (kg) = 0.232 × height (cm) + 0.128 × weight (kg) + 0.128 × calf circumference (cm) - 2.039 × sex (men: 1, women: 2) - 0.021 × age (years) - 27.129. It exhibited an adjusted R2 value of 0.90 and a standard error of estimate value of 1.34 kg. In the validation group, a strong correlation was observed between ASM measured using our equation and that measured through BIA (r = 0.952; P < .001). The Bland-Altman plot showed that the mean difference between the results for our equation and for BIA was -0.03 kg, with limits of agreement (mean 1.96 SD) of -2.4 to 2.3 kg. The intraclass correlation coefficient was 0.951 (95% CI, 0.945-0.957), indicating excellent between-method consistency. CONCLUSIONS AND IMPLICATIONS:Our equation appears to have high predictive power. With rapid and simple measurement of anthropometric and demographic indices, the equation can be used to evaluate ASM in primary care facilities lacking specialized equipment.

To investigate the prevalence of sarcopenia among community-dwelling older adults and provide scientific evidence for the prevention of sarcopenia. This cross-sectional study included 5016 community-dwelling older adults (mean age, 71.0 ± 5.6 years). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 Consensus. A nutritional risk assessment was also conducted. Multivariate logistic regression analysis was used to explore factors associated with sarcopenia. Our study comprised 5016 participants (71.0 ± 5.6 years). Sarcopenia prevalence was 11.8

Although nutritional supplementation and exercise have shown independent efficacy in managing sarcopenia, data supporting their combined implementation in real-world clinical settings remain limited. This 12-week multicenter randomized controlled trial enrolled 110 older adults (≥ 65 years) with sarcopenia or possible sarcopenia. Participants were randomly allocated (1:1) to either the intervention group (n = 55) or control group (n = 55). In addition to their habitual diets, the intervention group received daily muscle-targeted oral nutritional supplementation (MT-ONS, 2 × 10 g sachets/day: containing 8.4 g protein, 0.5 g calcium β-hydroxy-β-methylbutyrate, 200 IU D3 per sachet) alongside a structured exercise programs featuring twice-weekly resistance training (20 min/session), alternate-day chair-based exercises (10 min/session), and home-based activity recommendations. Control group participants maintained their habitual dietary and physical activity patterns without intervention. All outcome measures were assessed at baseline and post-intervention. The intervention group showed modest increases in BIA-derived appendicular lean tissue (mean change + 0.60 kg, 95

OBJECTIVES:To determine whether the regular consumption of milk free from A1 β-casein (A1PF milk) improves cognitive performance to a greater extent than conventional milk, and if so, whether such improvements are associated with an increase in the serum titres of reduced glutathione (GSH). DESIGN:A multi-centre, double-blind, randomised controlled trial with two parallel arms, conducted from 7 March 2023 to 13 October 2023. SETTING:Two hospitals in Tianjin, China. PARTICIPANTS:Volunteers (N = 96) diagnosed with mild cognitive impairment (MCI) and aged between 65 and 75 years. INTERVENTION:A1PF skim milk powder or conventional skim milk powder, diluted into liquid form (200 mL) and consumed twice daily for 90 days. MEASUREMENTS:The primary outcomes were cognitive performance (assessed with the Subtle Cognitive Impairment Test [SCIT]) and serum titres of GSH. Secondary outcomes included performance on two other cognitive tests, serum levels of 25-hydroxyvitamin D3, subjective quality of life (QoL), muscle strength (hand grip scale), faecal and blood inflammatory markers. RESULTS:Data from 91 participants were analysed (A1PF milk group: n = 45; conventional milk group: n = 46). A1PF milk improved performance on all three cognitive tests to a greater extent than conventional milk; however, this improvement was not associated with an increase in serum GSH. When compared with conventional milk, A1PF milk resulted in higher increases in serum levels of 25-hydroxyvitamin D3, greater subjective improvements in QoL and improved left hand grip strength. There were no between-group differences in inflammatory markers, calcium absorption or bone density markers. CONCLUSION:Daily intake of A1PF milk for 90 days significantly improved cognition, QoL and muscle strength in a sample of older people with MCI. While these outcomes appear to be linked to increased serum titres of 25-hydroxyvitamin D3, further investigations are needed to confirm this association. CLINICAL TRIAL REGISTRATION:NCT05741047 (clinicaltrials.gov).

Background Nutrition and dietary trials are often prone to bias, leading to inaccurate or questionable estimates of intervention efficacy. However, reports on quality management practices of well-controlled dietary trials are scarce. This study aims to introduce the quality management system of the Diet, ExerCIse and CarDiovascular hEalth-Diet Study and report its performance in ensuring study quality. Methods The quality management system consisted of a study coordinating center, trial governance, and quality control measures covering study design, conduct, and data analysis and reporting. Metrics for evaluating the performance of the system were collected throughout the whole trial development and conducted from September 2016 to June 2021, covering major activities at the coordinating center, study sites, and central laboratories, with a focus on the protocol amendments, protocol deviations (eligibility, fidelity, confounders management, loss to follow-up and outside-of-window visits, and blindness success), and measurement accuracy. Results Three amendments to the study protocol enhanced feasibility. All participants (265) met the eligibility criteria. Among them, only 3% were lost to the primary outcome follow-up measurement. More than 95% of participants completed the study, they consumed more than 96% of the study meals, and more than 94% of participants consumed more than 18 meals per week, with no between-group differences. Online monitoring of nutrient targets for the intervention diet showed that all targets were achieved except for the fiber intake, which was 4.3 g less on average. Only 3% experienced a body weight change greater than 2.0 kg, and 3% had medication changes which were not allowed by the study. James’ blinding index at the end of the study was 0.68. The end digits of both systolic and diastolic blood pressure readings were distributed equally. For laboratory measures, 100% of standard samples, 97% of blood-split samples, and 87% of urine-split samples had test results within the acceptable range. Only 1.4% of data items required queries, for which only 30% needed corrections. Discussion The Diet, ExerCIse and CarDiovascular hEalth-Diet Study quality management system provides a framework for conducting a high-quality dietary intervention clinical trial.

Objective: To explore the association between the intake and changes in various types of food and the changes in blood pressure in patients with mild to moderate hypertension. Methods: Mild to moderate hypertension participants with complete baseline and outcome data were included from DECIDE-Diet study, a multicenter, randomized controlled trial. Dietary records and blood pressure measurements at both 7-day run-in (baseline) and 28-day intervention phases were collected for enrolled participants. Blood pressure change was defined as the difference between blood pressure at the end of trial and the baseline blood pressure. Baseline intake of food was the average daily intake during the run-in period, and the intake increment was defined as the difference between the average intake during the trial period and the average intake during the run-in period. After adjusting for age, sex, study center, intervention groups, baseline body mass index (kg/m2), antihypertension medication use, and baseline total calorie intake, a linear regression model was used to analyze the associations of the before-after-intervention change in blood pressure with baseline intake and intake increment of foods. Results: A total of 258 patients with mild to moderate hypertension were included, including 133 males, aged (56.5±9.9) years. (1) After adjusting for confounding factors, there was no significant association between baseline intake of food and baseline blood pressure (all P>0.05). The blood pressure change was negatively associated with baseline intakes of tubers, vegetables, and vegetable oils but positively with baseline intake of meats; and was negatively associated with intake increment of whole grains and fish (all P<0.05). (2) The multiple linear regression analysis showed that baseline intake of vegetables (β=-0.021, P=0.004), vegetable oils (β=-0.260, P=0.002), and increment in intake of fish (β=-0.128, P=0.026) were all significantly associated with changes in systolic blood pressure; baseline intake of vegetables (β=-0.017, P=0.002), vegetable oils (β=-0.182, P=0.001), dairy products (β=0.021, P=0.022), and increment in intake of fish (β=-0.092, P=0.010) were all significantly associated with changes in diastolic blood pressure. Conclusion: Increasing the intake of whole grains, vegetables, vegetable oils, and fish and decreasing the intake of meat may be beneficial for blood pressure control in patients with mild to moderate hypertension.

BackgroundChronic kidney disease (CKD) is a major public health concern. However, validated and broadly applicable biomarkers for early CKD diagnosis are currently not available. We aimed to identify serum metabolic signatures at an early stage of CKD to provide a reference for future investigations into the early diagnostic biomarkers.MethodsSerum metabolites were extracted from 65 renal dysfunction (RD) patients and 121 healthy controls (discovery cohort: 12 RD patients and 55 health participants; validation cohort: 53 RD patients and 66 health participants). Metabolite extracts were analyzed by ultraperformance liquid chromatography coupled with quadrupole-electrostatic field orbital trap mass spectrometry (UPLC-QE-Orbitrap MS) for untargeted metabolomics. Orthogonal partial least squares-discriminant analysis (OPLS-DA) was performed to detect different compounds between groups. Receiver operating characteristic (ROC) curve analysis was carried out to determine the diagnostic value of the validated differential metabolites between groups. We referred to the Kyoto Encyclopedia of Gene and Genomes (KEGG) to elucidate the metabolic pathways of the validated differential metabolites.ResultsA total of 22 and 23 metabolites had significantly different abundances in the discovery and validation cohort, respectively. Six of them (creatinine, L-proline, citrulline, butyrylcarnitine, 1-methylhistidine, and valerylcarnitine) in the RD group was more abundant than that of the health group in both cohorts. The combination of the six validated differential metabolites were able to accurately detect RD (AUC 0.86). Three of the six metabolites are involved in the metabolism of arginine and proline.ConclusionsThe present study highlights that creatinine, L-proline, citrulline, butyrylcarnitine, 1-methylhistidine, and valerylcarnitine are metabolite indicators with potential predictive value for CKD.

Objective: This study investigated the effects of a soy protein-rich meal intervention on the muscle health of older adults in long-term care facilities. Methods: A 12-week single-center randomized controlled trial with a control-group and open-label design was conducted. Eighty-four older adults from a long-term care facility participated in the study. The chefs at the facility cooked three meals using soy protein-rich recipes designed by dieticians. For 12 weeks, the intervention group participants consumed three meals with 30 g of soy protein (10 g/meal) per day, and the control group participants maintained their habitual diets. Results: The 84 participants (mean age, 84.9 +/- 7.0 years; 61.9% female) were randomly assigned to an intervention group (43 participants) and a control group (41 participants). The intervention group exhibited significant increases in several lean mass indicators, namely soft lean mass (mean, 1.43 kg; 95% confidence interval [CI]: 0.20-1.65 kg), skeletal muscle mass (mean, 1.20 kg; 95% CI: 0.43-1.96 kg), appendicular skeletal muscle mass (mean, 0.79 kg; 95% CI: 0.07-1.52 kg), and skeletal muscle index (mean, 0.37 kg/m2; 95% CI: 0.05-0.68 kg/m2) (all P < 0.05). These changes were not observed in the control group (all P > 0.05). Notably, calf circumference decreased significantly in the control group (mean, -0.98 cm; 95% CI: -1.61 to -0.36 cm) but was maintained in the intervention group. The differences in the calf circumference and 6-m walk performance of the two groups were significant (P < 0.05). Conclusions: The 12-week soy protein-rich meal intervention improved the muscle mass and 6-m walk performance of older adults in a long-term care facility. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Anorexia nervosa(AN)is a type of eating disorders characterized by self-starvation,significant loss of body mass,and malnutrition.AN has the highest mortality rate among all psychiatric disorders,leading to severe psychopathologic symptoms and life-threatening medical complications.However,AN cannot be recognized and diagnosed early in China,resulting in a prolonged course of the disease.Therefore,under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association,together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association,this expert consensus was formulated by 16 medical experts based on evidence-based medical evidence,domestic and international guidelines and expert consensus,expert experience,etc.,in order to improve the recognition,diagnosis and treatment of AN among domestic professionals.

Background Oral nutrition supplements (ONSs) play an important role in the management of malnutrition. This aim of study was to examine whether a comprehensive intervention, combining ONSs, family-centered health education, and nutrition and medical consultations, could improve the nutrition and health status of malnourished older adults living in community dwellings. Methods A randomized controlled trial was conducted from October 2017 to May 2018 in Shanghai. All participants were screened using the Mini Nutritional Assessment-Short Form (MNA-SF). Participants with MNA-SF scores <= 11 and age >= 65 were selected. Participants with potential nutrition risk were randomized into two groups: intervention group (n = 101) were prescribed ONSs (400 kcal/day) and family-centered nutrition education (once every 2 weeks) and control group (n = 100) received only family-centered nutrition education. Anthropometric measurements, including weight and height, and nutrition and functional scales, including MNA-SF, grip strength, and activities of daily living scores, were collected at the beginning of the study and 12 weeks later. Results Of the 201 study participants, 182 completed the study (mean age, 75.48 +/- 7.47 years). After 12 weeks, nutrient intake improvements in the intervention group (+370.6 +/- 432.6 kcal/day, +17.6 +/- 24.1 g/day) exceeded that of the control group (-67.5 +/- 378.2 kcal/day, -0.9 +/- 16.7 g/day). In addition, improvements in weight, body mass index, and handgrip strength were significantly higher in the intervention vs control group (P < .05). Conclusion Comprehensive nutrition interventions improved nutrition status in malnourished older people living in community dwellings. Use of ONSs may be a good strategy to improve nutrition status and strength in community-dwelling older adults.

BACKGROUND AND OBJECTIVES:Older adults residing in senior homes are at a high risk of malnutrition. In this study, we investigated the nutritional status of these individuals and factors associated with malnutrition in this population.METHODS AND STUDY DESIGN:This cross-sectional study (September 2020-January 2021) included a total of 583 older adults residing in a senior home in Shanghai (mean age, 85.0±6.6 years). The Mini Nutritional Assessment Short Form (MNA-SF) questionnaire was administered to assess the nutritional status of the participants. Patients with possible sarcopenia were identified according to the guidelines recommended by the Asian Working Group for Sarcopenia in its 2019 consensus (AWGS 2019). Moreover, the factors influencing malnutrition were determined through multivariate analyses.RESULTS:The likelihoods of having malnutrition and being at a risk of malnutrition were noted in 10.5% and 37.4% of the participants, respectively. In both male and female participants, handgrip strength (HGS) and calf circumference (CC) increased significantly with increasing scores on the aforementioned questionnaire (p<0.001). Among the participants, 44.6% had ≥3 chronic diseases and 48.2% used multiple medicines. Multivariate analyses revealed that dys-phagia (OR, 3.8; 95% CI, 1.7-8.5), possible sarcopenia (OR, 3.6; 95% CI, 2.2-5.6), and dementia (OR, 4.5; 95% CI, 2.8-7.0) were correlated with a relatively high prevalence of malnutrition/malnutrition risk. Exercise (at least thrice a week) reduced malnutrition risk.CONCLUSIONS:Malnutrition is common among older adults residing in senior homes; therefore, the associated factors must be identified, and appropriate interventions should be administered.

Background and Objectives: The Asian Working Group for Sarcopenia (AWGS) recommended various measures for identifying patients with possible sarcopenia in its 2019 consensus. The present survey aimed to as-sess older adults in a senior home to determine the prevalence and associated factors for possible sarcopenia and to compare the differences between various assessment pathways based on AWGS 2019 criteria. Methods and Study Design: This cross-sectional study examined 583 participants of a senior home. Patients with possible sar-copenia were determined through the following four pathways: [I] calf circumference (CC) + handgrip strength (HGS); [II] SARC-F+HGS; (III) SARC-CalF+HGS; and (IV) CC, SARC-F, and/or SARC-CalF+HGS. Results: The four assessment pathways revealed a high prevalence of possible sarcopenia in the older adults in the senior home ([I]=50.6%; [II]=46.8%; [III]=48.2%; [IV]=65.9%). There is significant difference in prevalence between pathway IV and the other pathways (p<0.001). A multivariate analysis revealed that advanced age, risk of malnu-trition, malnutrition, high level of care, an exercise frequency of <3 times per week, and osteoporosis were corre-lated with a higher risk of possible sarcopenia. By contrast, oral nutritional supplements (ONS) reduced the risk of possible sarcopenia. Conclusions: This survey reported a high prevalence of possible sarcopenia in the older adults of the senior home and determined the associated influencing factors. Furthermore, our findings suggested that pathway IV is the most suitable pathway for the examined older adults which enabled the detection and early intervention of more possible sarcopenia.

Up to now, there has not yet been guidance or consensus from Chinese experts in the field of personalized prevention and treatment of type 2 diabetes. In view of the above, the endocrinology diabetes Professional Committee of Chinese Non-government Medical Institutions Association, the integrated endocrinology diabetes Professional Committee of the integrated medicine branch of Chinese Medical Doctor Association, and the diabetes education and microvascular complications group of the diabetes branch of the Chinese Medical Association organized relevant experts to discuss and reach the "Chinese expert consensus on strengthening personalized prevention and treatment of type 2 diabetes" for reference in clinical practice.

BACKGROUND:Healthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown. METHODS:In this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population. RESULTS:Among 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (-0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (-1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (-0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results. CONCLUSIONS:The CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted. This trial was registered at clinicaltrials.gov as NCT03882645.