Law Pui Sze Queenie, Yau Ka-Yin, Wong David Cn, Yuen Kit-San, Yu Chia-Pin, Loke Alice Yuen
School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, Hong Kong.
School of Nursing, Tung Wah College, Hong Kong, Hong Kong
BMJ Open. 2025 Sep 2;15(9):e107982. doi: 10.1136/bmjopen-2025-107982.
The prevalence of cardiovascular diseases (CVDs) is rapidly increasing across Asia, with the burden particularly high among individuals aged ≥50 years. Elevated low-density lipoprotein cholesterol (LDL-C) level is a well-established causal risk factor for CVDs. Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet is a cardioprotective diet, which is rich in plant-based foods. Combining it with stress-reducing practices, including forest bathing (FB), which involves immersive exposure to forest environments, has been shown to reduce LDL-C levels and other cardiovascular risk factors by modulating pro-inflammatory responses. However, existing evidence is limited due to small sample sizes and poor study design. Therefore, this study aims to investigate whether the MIND diet combined with FB can reduce CVD risks among Chinese adults in Hong Kong. It also compares the effects of the MIND diet combined with FB on cardiovascular and mental health.
A single-blind, randomised controlled trial involving three groups will be used to assess the impact of the MIND diet combined with FB on LDL-C levels in adults aged 50-75 years with elevated LDL-C levels. Participants (n=273) from local community centres will be randomly assigned to the MIND-plus-FB (who will receive nutrition education, follow the MIND diet for 12 weeks and participate in regular FB sessions), MIND-alone (who will receive nutrition education and follow the MIND diet for 12 weeks) or routine care (who will continue their usual activities and receive a general health talk along with pamphlets on cardiovascular risks) group. The change in LDL-C levels will be measured at weeks 4 and 12 (primary outcome). Additionally, changes in high-density lipoprotein cholesterol level, triglyceride level, glucose level, systolic blood pressure, waist circumference, body mass index, anxiety levels and emotional state will also be assessed at weeks 4 and 12. Statistical analyses will include intent-to-treat, χ test, analysis of variance and generalised estimating equations.
This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023164). Research findings will be disseminated through publication in peer-reviewed journals and presentations at academic and primary healthcare conferences.
ClinicalTrials.gov ID: NCT06222632, registered on 25 January 2024. The ClinicalTrials.gov data are available at: https://clinicaltrials.gov/study/NCT06222632?term=NCT06222632&rank=1&a=2&tab=history.
心血管疾病（CVD）在亚洲的患病率正在迅速上升，50岁及以上人群的负担尤为沉重。低密度脂蛋白胆固醇（LDL-C）水平升高是公认的心血管疾病致病风险因素。地中海式饮食预防高血压干预神经退行性延迟（MIND）饮食是一种具有心脏保护作用的饮食，富含植物性食物。将其与减压措施相结合，包括森林浴（FB），即沉浸式接触森林环境，已被证明可通过调节促炎反应来降低LDL-C水平和其他心血管风险因素。然而，由于样本量小和研究设计不佳，现有证据有限。因此，本研究旨在调查MIND饮食与森林浴相结合是否能降低中国香港成年人的心血管疾病风险。它还比较了MIND饮食与森林浴相结合对心血管和心理健康的影响。
一项涉及三组的单盲随机对照试验将用于评估MIND饮食与森林浴相结合对LDL-C水平升高的50-75岁成年人的影响。来自当地社区中心的参与者（n = 273）将被随机分配到MIND加森林浴组（将接受营养教育，遵循MIND饮食12周并参加定期森林浴课程）、单独MIND饮食组（将接受营养教育并遵循MIND饮食12周）或常规护理组（将继续其日常活动并接受一次关于心血管风险的一般健康讲座以及相关宣传册）。将在第4周和第12周测量LDL-C水平的变化（主要结局）。此外，还将在第4周和第12周评估高密度脂蛋白胆固醇水平、甘油三酯水平、血糖水平、收缩压、腰围、体重指数、焦虑水平和情绪状态的变化。统计分析将包括意向性分析、χ检验、方差分析和广义估计方程。
本研究已获得香港东华学院研究伦理委员会的批准（参考编号：REC2023164）。研究结果将通过在同行评审期刊上发表以及在学术和基层医疗会议上进行报告来传播。
ClinicalTrials.gov标识符：NCT06222632，于2024年1月25日注册。ClinicalTrials.gov数据可在以下网址获取：https://clinicaltrials.gov/study/NCT06222632?term=NCT06222632&rank=1&a=2&tab=history 。
