The cerebral neurovascular coupling and glymphatic circulation dysfunction in children with attention deficit/hyperactivity disorder.

Cardiovascular disease (CVD) remains one of the most important causes of mortality and disease burden worldwide []. By 2023, an estimated 18 million deaths annually were attributable to CVD, accounting for approximately 32% of all global deaths []. The China Cardiovascular Health and Disease Report 2024 indicates that the number of individuals living with CVD in China has exceeded 350 million []. Driven by population aging and the increasing prevalence of unhealthy lifestyles, both the prevalence of cardiovascular disease and the related mortality risk in China remain high []. Moreover, the burden of cardiovascular disease in central and western regions has been reported to exceed that in eastern coastal areas []. Epidemiological evidence further indicates that the burden of noncommunicable diseases, including cardiovascular disease and diabetes, attributable to elevated body mass index (BMI ≥ 25.0 kg/m²) has steadily increased in Hunan Province over the past three decades []. Therefore, strengthening early prevention strategies and health management for populations at high risk of cardiovascular disease is crucial for the effective prevention and control of chronic cardiovascular diseases in China []. High-risk cardiovascular individuals are defined as those with a substantially elevated risk of future major adverse cardiovascular events (MACE) or cardiovascular mortality []. This population is typically characterized by heightened chronic inflammation, metabolic dysfunction, and vascular impairment and constitutes a major source of cardiovascular mortality and recurrent events []. Updated U.S. dietary guidelines emphasize diet as a key strategy for reducing the burden of chronic diseases []. As a safe, cost-effective, and sustainable strategy, adherence to healthy dietary patterns has been shown to improve blood pressure and lipid profiles [], thereby reducing the risk of cardiovascular and cerebrovascular events [] and alleviating overall disease burden []. Moreover, dietary pattern–based interventions have also been recognized as having important implications for the primary prevention of cardiovascular disease among populations without established high cardiovascular risk []. Hunan Province, located in south-central China, has a hot, humid climate. The local diet mainly revolves around rice, with cooking methods that use a lot of oil and salt, often including pickled and high-fat foods. Previous studies have indicated that unhealthy dietary patterns-marked by excessive intake of oil, salt, fat, and sugar, alongside low consumption of vegetables and fruits-not only contribute to overweight and obesity [], but also promote chronic inflammation, impair vascular endothelial function, and increase the risk of cardiovascular mortality []. Dietary patterns such as the Mediterranean diet [], the Dietary Approaches to Stop Hypertension (DASH) diet [], and plant-based diets [] have been shown to reduce the incidence and mortality of cardiovascular disease by improving cardiometabolic indicators and exerting anti-inflammatory and antioxidant effects. However, most research on these dietary patterns has been done in Western populations. The cardiovascular effects of the Hunan dietary pattern, characterized by rice as the staple food and high consumption of oil, salt, and spices, remain incompletely elucidated. Furthermore, existing studies have mainly examined the general population, with limited evidence on dietary patterns in high-risk cardiovascular groups.