Folate, vitamin B6, and vitamin B12 intakes are negatively associated with the prevalence of hypertension: A national population-based study

The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007-2018)

AIM

To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management.

METHODS

Data from six NHANES cycles (2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship.

RESULTS

This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52-0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29-1.98), Q3 (1.99-3.08), and Q4 (3.09-5.56) levels compared to Q1 (0.18-1.28) were 1.41 (95% CI: 0.60-3.33), 0.48(95% CI: 0.20-1.16), and 0.35 (95% CI: 0.16-0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009).

CONCLUSION

Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.

Machine learning models identify micronutrient intake as predictors of undiagnosed hypertension among rural community-dwelling older adults in Thailand: a cross-sectional study

Objective

To develop a predictive model for undiagnosed hypertension (UHTN) in older adults based on five modifiable factors [eating behaviors, emotion, exercise, stopping smoking, and stopping drinking alcohol (3E2S) using machine learning (ML) algorithms.

Methods

The supervised ML models [random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGB)] with SHapley Additive exPlanations (SHAP) prioritization and conventional statistics (χ2 and binary logistic regression) were employed to predict UHTN from 5,288 health records of older adults from ten primary care hospitals in Thailand.

Results

The χ2 analyses showed that age and eating behavior were the predicting features of UHTN occurrence. The binary logistic regression revealed that taking food supplements/vitamins, using seasoning powder, and eating bean products were related to normotensive and hypertensive classifications. The RF, XGB, and SVM accuracy were 0.90, 0.89, and 0.57, respectively. The SHAP identified the importance of salt intake and food/vitamin supplements. Vitamin B6, B12, and selenium in the UHTN were lower than in the normotensive group.

Conclusion

ML indicates that salt intake, soybean consumption, and food/vitamin supplements are primary factors for UHTN classification in older adults.

Geographic disparities of dietary inflammatory index and its association with hypertension in middle-aged and elders in China: results from a nationwide cross-sectional study

Background

Geographic distribution of dietary inflammatory index (DII) in China has not been thoroughly evaluated and evidence on the association between DII and hypertension among Chinese middle-aged and older population was inadequate.

Objective

To investigate the geographic disparities of DII and its association with hypertension among Chinese middle-aged and elders.

Methods

Data was from the China Adults Chronic Diseases and Nutrition Surveillance (CACDNS 2015) for middle-aged and older participants. The DII for each participant was determined through a combination of 3 days 24 h dietary recall interviews and a food frequency questionnaire. Spatial analysis was employed to investigate the geographic distribution of DII in China. Restricted cubic spline models and binary logistic regression analysis were used to assess the relationship between DII and hypertension. The least absolute shrinkage and selection operator (LASSO) regression was applied for identifying key hypertension-related factors, which was then included in the establishment of a risk prediction nomogram model, with the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) being built to evaluate its discriminatory power for hypertension.

Results

A total of 52,087 middle-aged and older participants were included in the study, among whom 36.6% had hypertension. it revealed that a clear spatial correlation in the national distribution of DII scores (Moran I: 0.252, p = 0.001), with higher DII scores concentrated in the northwest region and lower DII scores concentrated in the southeast region. Hypertensive participants had higher DII scores compared to those without hypertension (OR: 1.507 vs. 1.447, p = 0.003). Restricted cubic spline models and binary logistic regression analysis demonstrated a positive association between DII and hypertension after adjusting for potential confounding factors. There was a significant increasing trend in the proportion of hypertensive individuals as DII scores increase (p for trend = 0.004). The nomogram model, constructed using key factors identified through LASSO regression, demonstrated a robust discriminative capacity, with an area under the curve (AUC) of 73.2% (95% CI, 72.4-74.0%). Decision curve analysis confirmed the reliability and effectiveness of the nomogram model. Sensitivity analysis conducted within the subpopulation aged under 45 years yielded results consistent with the primary analysis.

Conclusion

In Chinese adults middle-aged and older, geographic disparities in dietary inflammatory potential are notable, with lower levels observed in the southeastern coastal regions of China and higher levels in the northwestern regions. Meanwhile, there is a positive association between the inflammatory potential of the diet and hypertension. Additional research is needed to investigate regional disparities in dietary inflammatory potential and pinpoint specific dietary patterns associated with lower inflammation.

Does an antihypertensive diet cost more? Analysis from the Chinese Heart-Healthy diet trial

OBJECTIVE

To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC.

DESIGN

Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study.

SETTING

A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet.

PARTICIPANTS

Totally, fifty-three participants with hypertension aged 25-75 years in the Sichuan center were randomised into the control group (n 26) or the CHH diet-SC group (n 27).

RESULTS

The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v. ¥25·18 ± 2·79 equals $3·90 ± 0·34 v. $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet (P < 0·001). Intakes of vitamin B1, vitamin B6, vitamin C, Mg and phosphorus were positively correlated with the cost (P < 0·05).

CONCLUSIONS

The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B1, vitamin B6, vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.

Evidence on the use of alternative substances and therapies in hypertension

OBJECTIVE

Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT).

SEARCH STRATEGY

Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT.

SELECTION OF STUDIES

We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters.

SYNTHESIS OF RESULTS

Some studies on biological therapies show some usefulness in BP reduction with an adequate benefit-risk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence.

CONCLUSIONS

Although some therapies present a reasonable risk-benefit ratio, they should in no case replace pharmacological treatment when indicated.

A robust method for simultaneous determination of eight B vitamins in human serum by liquid chromatography tandem mass spectrometry

The level of vitamin B group in human serum is an important index of human health. Among B vitamins, cyanocobalamin in serum is unstable and its content is extremely low. Rapid and simultaneous detection of multiple B vitamins including cyanocobalamin is a challenge. Herein, we have developed a rapid and stable method that can realize the determination of thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin simultaneously in 6 min. The method was established based on protein precipitation with methanol and then chromatographic separation was achieved using Waters acquity ultra-high-performance liquid chromatography high strength silica T3 column, which was stable and sensitive especially for cyanocobalamin. Limit of quantification, precision, trueness, and matrix effect were validated according to the European Medicines Agency and United States Food and Drug guidelines and Clinical and Laboratory Standards Institute guidelines on bioanalytical method. The limit of quantification for thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxic acid, biotin, 5-methyltetrahydrofolate, and cyanocobalamin was 0.4, 0.4, 0.8, 2.0, 0.4, 0.1, 0.4, and 0.04 ng/mL separately, respectively. Intra- and interday precisions were 1.1%-12.4% and 2.0%-13.5%, respectively. The relative errors were between 0.3% and 13.3%, and the matrix effects were between 2.6% and 10.4%.

Intakes of folate, vitamin B6, and vitamin B12 and cardiovascular disease risk: a national population-based cross-sectional study

Background

Only a few studies that investigated dietary intakes of folate, vitamin B6, and vitamin B12 in relation to cariovascular disease (CVD). This study aimed to assess the association of dietary folate, vitamin B6, and vitamin B12 with CVD in the United States population.

Methods

A cross-sectional analysis of 65,322 adults aged ≥ 20 years who participated in the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2018. Before 2003, dietary intake data were assessed using a 24-hour dietary call, and two 24-hour dietary calls were used during 2003 and 2018. Odds ratios and 95% confidence intervals (CIs) for CVD associated with dietary folate, vitamin B6, and vitamin B12 were estimated using multivariate logistic regression models.

Results

Dietary vitamin B6 intake were inversely associated with the odds of CVD. In males, the multivariable OR for the highest vs. lowest quartiles of vitamin B6 was 0.77 (95%CI: 0.61-0.97, Ptrend = 0.013) for the odds of CVD. In females, the adjusted OR for the highest quartile of vitamin B6 compared with the lowest quartile was 0.73 (95%CI: 0.56-0.95, Ptrend = 0.038) for the odds of CVD. No significant association was observed between dietary folate and vitamin B12 intakes and the odds of CVD.

Conclusions

Our findings indicate that higher intake of dietary vitamin B6 may be associated with lower prevalence of CVD, suggesting that dietary vitamin B6 has major public health implications in the prevention of CVD in the United States population.

Interactions of arsenic exposure, arsenic metabolism with red blood cell folate on the risk of hypertension: NHANES 2007-2016

PURPOSE

Arsenic exposure was associated with hypertension, and arsenic metabolism might be influenced by folate concentrations. Thus, this study aimed to explore the interaction between arsenic exposure and metabolism with folate concentrations on hypertension.

METHODS

We studied 6643 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey from 2007 through 2016. Urinary total arsenic (UTAs), the percentage of urinary dimethylarsinic acid (DMA%), serum and red blood cell (RBC) folate were collected. Logistic regression and restricted cubic spline (RCS) analyses were performed to determine the association and dose-response relationship. Interaction analyses were conducted on both additive and multiplicative scales.

RESULTS

UTAs (median: 7.05 μg/L) was positively associated with hypertension risk, and the adjusted OR was 1.44 (95% CI: 1.06-1.95) when comparing the third with the lowest quartile. And participants with the highest quintile of RBC folate had increased hypertension risk than those with the lowest quintile (adjusted OR = 1.43, 95% CI: 1.06-1.94). Significant additive interaction was observed between excessive RBC folate with high UTAs (AP = 0.323, 95% CI: 0.083-0.564) and low DMA% (AP = 0.381, 95% CI: 0.119-0.643) on hypertension risk.

CONCLUSION

Our results suggested significant interactions between high UTAs and low DMA% with excessive RBC folate on hypertension risk.