On the rare occasions that she finds time to cook, Dr. Cuilin Zhang tries to strike a delicate balance. As a leading expert on nutrition, she knows the value of the Mediterranean diet and its broad benefits in managing metabolic diseases. One downside: the specific flavors of any given cuisine are not, necessarily, a global preference. “When I cook, I combine East with West,” Zhang says. “I can sauté tofu, using that as a main protein source, but with olive oil as the fatty acid source. Or I can have a local fish, with a glaze of olive oil and balsamic vinegar, but also soy sauce and sesame oil.”
This effort to replace the food composition of the Mediterranean diet with culture-specific food and flavor profiles, all while maintaining nutrient composition and dietary mechanisms, goes beyond the kitchen. Zhang is currently leading a pilot study centered around this concept, developing fusion meals and then testing their effects on the metabolic health profiles of Asian populations.
“We really need to customize for different populations,” she says. “A lot of knowledge has been accumulating based on observational studies, based on trials. But how to implement it in real populations, and how to make the change sustainable—this is a big challenge.”
Zhang was born in Harbin, a city in northeast China famous for its ice sculpture festival. In high school, she found herself drawn to biochemistry, a subject with the potential to “really solve the mystery of life,” she says. Encouraged to pursue medicine by her father, she attended Beijing Medical University, now known as Peking University Health Science Center, but, remembering her old love for biochemistry, she soon became interested in clinical research above clinical practice. She ultimately earned a PhD in epidemiology from the University of Washington, followed by a postdoctoral fellowship in genetic and nutritional epidemiology at the Harvard T.H. Chan School of Public Health.
“I looked at modifiable risk factors at both lifestyle and molecular levels in pregnancy complications,” Zhang says. “At that time, such studies on gestational diabetes were scarce. So I developed my own research, based on the Nurses’ Health Study, and published a series of articles examining risk factors during prepregnancy, including nutrition factors and biomarkers, and assessed how those factors are relevant for pregnancy and susceptibility for gestational diabetes.”
The results of Zhang’s findings have been borne out time and time again: a consistent Mediterranean diet may represent one of the most effective ways to prevent metabolic complications during pregnancy.
“Reducing refined carbohydrate intake, reducing sugar-sweetened beverages, and reducing red meat intake, while increasing consumption of healthy fatty acids, whole grains, vegetables, and fibers, can lower the risk for gestational diabetes,” she says.
Zhang lived in Washington, DC, for almost 15 years, where she was the interim chief of the Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, at the National Institutes of Health. She is also an adjunct professor at both Harvard T.H. Chan School of Public Health and Johns Hopkins Bloomberg School of Public Health. But she recently took a career risk, and these days she spends most of her time in Singapore as the founding director of the Global Centre for Asian Women’s Health (GloW) and Chair Professor in Women’s Health at the Department of Obstetrics and Gynecology, part of the National University of Singapore Yong Loo Lin School of Medicine.
One of the tenets of GloW is that healthy and happy women lead to healthy and happy families and societies. At GloW, they follow women and children across generations to identify modifiable risk factors and underlying molecular mechanisms and then translate that knowledge into practice.
“We identified a group of women at high risk for type 2 diabetes—mainly women who had gestational diabetes during pregnancy. We track their habits and study risk factors and biochemical biomarkers before pregnancy, during pregnancy, and after pregnancy, in order to predict the likelihood of—and prevent—postpartum disease,” Zhang says. “In effect, to study the long-term consequences of gestational diabetes.”
This is especially important given the fact that Asian women are one of the populations most likely to develop gestational diabetes. The reasons for this remain unknown.
“One hypothesis is that Asian women, in general, carry less lean muscle mass,” Zhang says. “And pregnancy is a stress test. So another possibility is that Asian women, the genes in their bodies may be less flexible when facing glucose metabolism challenges.”
The answer can only be found by addressing research gaps.
“Children are at increased risk for metabolic issues like hypertension and obesity if the mother had gestational diabetes. So it is important to know what can be done to prevent these adverse outcomes. To end this vicious cycle,” Zhang says. “The next critical step is figuring out what can be done to cut down the risk and delay the onset of later chronic disease.
“Not much data has been collected along those lines, especially in minority populations,” she adds. “But it can be done.”
