Higher blood pressure in middle-aged American adults with less education—role of multiple dietary factors: The INTERMAP Study

Abstract

Extensive evidence exists that an inverse relation between education and blood pressure prevails in many adult populations, but little research has been carried out on reasons for this finding. A prior goal of the INTERMAP Study was to investigate this phenomenon further, and to assess the role of dietary factors in accounting for it. Of the 4680 men and women aged 40-59 years, from 17 diverse population samples in Japan, People's Republic of China, UK, and USA, a strong significant inverse education-BP relation was manifest particularly for the 2195 USA participants, independent of ethnicity. With participants stratified by years of education, and assessment of 100+ dietary variables from four 24-h dietary recalls and two 24-h urine collections/person, graded relationships were found between education and intake of many macro-and micronutrients, electrolytes, fibre, and body mass index (BMI). In multiple linear regression analyses with systolic BP (SBP) and diastolic BP (DBP) of individuals the dependent variables (controlled for ethnicity, other possible nondietary confounders), BMI markedly reduced size of education-BP relations, more so for women than for men. Several nutrients considered singly further decreased size of this association by X10%: urinary 24-h Na and K excretion, Keys dietary lipid score, vegetable protein, fibre, vitamins C and B 6 , thiamin, riboflavin, folate, calcium, magnesium, and iron. Combinations of these dietary variables and BMI attenuated the education-SBP inverse coefficient by 54-58%, and the education-DBP inverse coefficient by 59-67%, with over half these effects attributable to specific nutrients (independent of BMI). As a result, the inverse education-BP coefficients ceased to be statistically significant. Multiple specific dietary factors together with body mass largely account for the more adverse BP levels of less educated than more educated Americans. Special efforts to improve eating patterns of less educated strata can contribute importantly to overcoming this and related health disparities in the population.

Hipertensão arterial e sua correlação com alguns fatores de risco em cidade brasileira de pequeno porte

“…Therefore, the level of schooling is an essential element to be considered in the approach of the population regarding the practices of health promotion, protection and recovery 21 . Some population-based crosssectional studies also found an inverse correlation between schooling and AH prevalence 8,18,22,23 .…”

Nutrition as the Risk Factor for Cardiovascular Pathology From Epidemiological Perspective

“…Эти выводы поддерживали стратегическую концепцию в отношении усилий здравоохранения для улучшения питания низших социально-эконо-мических слоев населения, а также помогали внести важный вклад в профилактику, контроль АГ и дру-гих основных ФР ССЗ [2,16].…”

“…Питание, в первую очередь, рассматривается с точки зрения предотвращения ожирения, артери-альной гипертензии (АГ), нарушений углеводного и липидного обменов. Нарушение пищевого пове-дения и дисбаланс между поступлением и тратой калорий являются основной причиной ожирения; чрезмерное потребление натрия и высококалорий-ной пищи, алкоголя инициирует повышение арте-риального давления (АД) [1,2]. Общепризнано, что жиры животного происхождения в рационе ассоци-ированы с развитием атеросклероза [3], их повы-шенное содержание в продуктах питания увеличи-вает вероятность инфаркта миокарда, ишемиче-ского инсульта за счет повышения концентрации липопротеидов низкой плотности [4,5].…”

Detection of Urinary Drug Metabolite (Xenometabolome) Signatures in Molecular Epidemiology Studies via Statistical Total Correlation (NMR) Spectroscopy

“…The ability to monitor exposure to xenobiotics, which may not be toxic in their own right, but which may carry a risk to certain individuals in populations after long term exposure, is an important in the broad context of epidemiological risk assessment and allows connection between 'real world' analytical data and epidemiological factors. Recently we have applied NMR spectral tools to the investigation of biochemical features of the urine samples collected as part of the INTERSALT and INTERMAP Studies [2,3], which investigate the role of nutrition in adverse population blood pressure levels [4][5][6][7][8][9]. These samples were obtained from many populations and carry unique biochemical information about those groups and individuals [4][5][6][7][8][9].…”