Diet and blood pressure in 18-74-year-old adults: the French Nutrition and Health Survey (ENNS, 2006-2007)

Assessing the Hypertension Risk: A Deep Dive into Cereal Consumption and Cooking Methods-Insights from China

BACKGROUND

Cereal grains are rich in carbohydrates and could trigger a hyperglycemic response which is closely linked to blood pressure status. We aim to examine the associations between the consumption of cereals with different cooking methods and hypertension risk.

METHODS

We conducted a prospective analysis utilizing the nationwide data of 11,080 adult participants who were free of hypertension at baseline. Cereal intake was assessed using 3-day 24 h dietary recalls with a weighing technique. Hypertension incidence was identified in adherence with the Seventh Joint National Commission guidelines during the follow-up. Cox proportional hazards regression models were used to extrapolate hazard ratios associated with hypertension risk.

RESULTS

Over an average follow-up span of 7 years (77,560 person-years), we identified 3643 new hypertension cases. The intake of total, fried, and baked cereals was associated with 15%, 20%, and 20% higher risk of hypertension, respectively. Whole grain consumers had an 8% lower risk of hypertension compared with non-consumers, while total refined grain consumers showed no significant association. Replacing one daily serving of fried or baked cereals with an equivalent serving of boiled cereals was related to a 28% or 14% lower risk, respectively.

CONCLUSIONS

Total, fried, and baked cereal consumption was positively associated with hypertension risk, while consuming whole grains was related to a lower risk. Modifying cooking methods from frying or baking to boiling for cereals may be beneficial to lower risk. The current study underscores the significance of considering both the degree of processing and cooking methods applied to cereals in addressing hypertension prevention and management.

Associations between whole grains intake and new-onset hypertension: a prospective cohort study

IMPORTANCE

Epidemiological evidences regarding the association between whole grain intake and the risk of new-onset hypertension are still controversial.

OBJECTIVE

We aimed to investigate the relationship between whole grain intake and new-onset hypertension and examine possible effect modifiers in the general population.

METHODS

A total of 10,973 participants without hypertension from the China Health and Nutrition Survey were enrolled, with follow-up beginning in 1997 and ending in 2015. Whole grain intake was assessed by 3 consecutive 24-h dietary recalls combined with a household food inventory. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression model after adjusting for potential risk factors.

RESULTS

During a median follow-up of 7.0 years, 3,733 participants developed new-onset hypertension. The adjusted HRs (95% CIs) were as follows: for quartile 2 (HR: 0.52; 95% CI: 0.47-0.57), quartile 3 (HR: 0.46; 95% CI: 0.42-0.51), and quartile 4 (HR: 0.35; 95% CI: 0.31-0.38), compared with quartile 1. Different types of whole grain types, including wheat (adjusted HR, 0.35; 95% CI, 0.32-0.39), maize (adjusted HR, 0.50; 95% CI, 0.42-0.59), and millet (adjusted HR, 0.38; 95% CI, 0.30-0.48), showed significant associations with a reduced risk of hypertension. The association between whole grain intake and new-onset hypertension was stronger in individuals with older age (P for interaction < 0.001) and higher BMI (P for interaction < 0.001).

CONCLUSION

Higher consumption of whole grains was significantly associated with a lower risk of new-onset hypertension. This study provides further evidence supporting the importance of increasing whole grain intake for hypertension prevention among Chinese adults.

Dietary fiber and the microbiota: A narrative review by a group of experts from the Asociación Mexicana de Gastroenterología

Dietary fiber intake is one of the most influential and efficacious strategies for modulating the gut microbiota. Said fiber can be digested by the microbiota itself, producing numerous metabolites, which include the short-chain fatty acids (SCFAs). SCFAs have local and systemic functions that impact the composition and function of the gut microbiota, and consequently, human health. The aim of the present narrative review was to provide a document that serves as a frame of reference for a clear understanding of dietary fiber and its direct and indirect effects on health. The direct benefits of dietary fiber intake can be dependent on or independent of the gut microbiota. The use of dietary fiber by the gut microbiota involves several factors, including the fiber's physiochemical characteristics. Dietary fiber type influences the gut microbiota because not all bacterial species have the same capacity to produce the enzymes needed for its degradation. A low-fiber diet can affect the balance of the SCFAs produced. Dietary fiber indirectly benefits cardiometabolic health, digestive health, certain functional gastrointestinal disorders, and different diseases.

Dietary fiber and the microbiota: A narrative review by a group of experts from the Asociación Mexicana de Gastroenterología

Dietary fiber intake is one of the most influential and efficacious strategies for modulating the gut microbiota. Said fiber can be digested by the microbiota itself, producing numerous metabolites, which include the short-chain fatty acids (SCFAs). SCFAs have local and systemic functions that impact the composition and function of the gut microbiota, and consequently, human health. The aim of the present narrative review was to provide a document that serves as a frame of reference for a clear understanding of dietary fiber and its direct and indirect effects on health. The direct benefits of dietary fiber intake can be dependent on or independent of the gut microbiota. The use of dietary fiber by the gut microbiota involves several factors, including the fiber's physiochemical characteristics. Dietary fiber type influences the gut microbiota because not all bacterial species have the same capacity to produce the enzymes needed for its degradation. A low-fiber diet can affect the balance of the SCFAs produced. Dietary fiber indirectly benefits cardiometabolic health, digestive health, certain functional gastrointestinal disorders, and different diseases.

Associations of Coarse Grain Intake with Undiagnosed Hypertension among Chinese Adults: Results from the China Kadoorie Biobank

Whole grain intake was associated with better blood pressure control, but evidence is lacking in non-Western populations with different grain intake patterns. We aimed to determine the associations between coarse grain intake, usually considered as the best proxy of whole grain intake for Chinese diets, with blood pressure and undiagnosed hypertension using baseline data from the China Kadoorie Biobank study. After excluding participants with clinically diagnosed hypertension or use of antihypertensive dugs, 435,907 participants were included in our analysis. A self-reported questionnaire was used to measure coarse grain intake frequency. Overall, 12.8% and 29.2% of the participants reported daily consumption and never consumption, respectively. With multivariable adjustments including BMI, outdoor temperature, and physical activity, higher frequency of coarse grain intake was associated with lower systolic and diastolic blood pressure in those older than 40 years, p trend < 0.05. Compared to never consumers, the odds ratio (95% CI) of hypertension was 0.78 (0.73–0.84), 0.84 (0.77–0.91), 0.91 (0.88–0.94), and 0.97 (0.95–0.99) for daily, 4–6 days/week, 1–3 days/week, and monthly groups, P trend < 0.001. Our cross-sectional study in a nationwide sample of Chinese adults suggests that higher coarse grain intake was associated with lower blood pressure and lower hypertension risk.

Plasma metabolites mediate the association of coarse grain intake with blood pressure in hypertension-free adults

BACKGROUND AND AIMS

Increased intake of whole/coarse grains was associated with improved blood pressure control, but concurrent metabolism alterations are less clear. We sought to identify metabolomic profiles of blood pressure, and to explore their mediation effects on the coarse grain intake-blood pressure association among young adults free of hypertension.

METHODS AND RESULTS

Plasma metabolome of 86 participants from the Carbohydrate Alternatives and Metabolic Phenotypes study was characterized by untargeted lipidomics and metabolomics using liquid chromatography-high-resolution mass spectrometry. We identified 24 and 117 metabolites associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively, using random forest modeling and partial correlation analysis. Moreover, metabolite panels for highly specific prediction of blood pressure (8 metabolites for SBP and 11 metabolites for DBP) were determined using ten-fold cross-validated ridge regression (R² ≥ 0.70). We also observed an inverse association between metabolite panel of SBP (β ± SE = -0.02 ± 0.01, P = 0.04) or DBP (β ± SE = -0.03 ± 0.01, P = 0.02) and coarse grain intake. Furthermore, we observed significant mediating effects of metabolites, in particular, sphingolipid ceramides, on the association between coarse grain exposure and blood pressure using both bias-corrected bootstrap tests and high-dimensional mediation analysis adapted for large-scale and high-throughput omics data.

CONCLUSIONS

We identified metabolomic profiles specifically associated with blood pressure in young Chinese adults without diagnosed hypertension. The inverse association between coarse grain intake and blood pressure may be mediated by sphingolipid metabolites.

Relationship between Nutrition and Alcohol Consumption with Blood Pressure: The ESTEBAN Survey

BACKGROUND

Dietary interventions are recommended for the prevention of hypertension. The aim of this study was to evaluate and quantify the relationship between alcohol consumption and the DASH (Dietary Approaches to Stop Hypertension) score with blood pressure (BP) stratified by gender.

METHODS

Cross-sectional analyses were performed using data from 2105 adults from the ESTEBAN survey, a representative sample of the French population. Pearson correlation analyses were used to assess the correlation between the DASH score and alcohol with BP. Regressions were adjusted by age, treatment, socio-economic level, tobacco, exercise, Body mass index (BMI), and cardiovascular risk factors and diseases.

RESULTS

The DASH score was negatively correlated with systolic (SBP) and diastolic BP (DBP) (p < 0.0001). Alcohol was positively associated with increased BP only in men. The worst quintile of the DASH score was associated with an 1.8 mmHg increase in SBP and an 0.6 mmHg increase in SBP compared to the greatest quintile in men and with a 1.5 mmHg increase in SBP and an 0.4 mmHg increase in SBP in women. Male participants in the worst quintile of alcohol consumption showed an increase of 3.0 mmHg in SBP and 0.8 mmHg in DBP compared to those in the greatest quintile.

CONCLUSION

A high DASH score and a reduction in alcohol consumption could be effective nutritional strategies for the prevention of hypertension.

A self-monitoring urinary salt excretion level measurement device for educating young women about salt reduction: A parallel randomized trial involving two groups

To prevent and treat hypertension, it is important to restrict salt in one's diet since adolescence. However, an effective salt-reduction education system has yet to be established. Besides accurate evaluation, we believe that the frequent usage of a measurement device may motivate individuals to avoid high salt intake. The present study evaluated the use of a urinary salt excretion measurement device for salt-reduction education in a parallel randomized trial of two groups. The sample comprised 100 university students who provided consent to participate. A survey with 24-hour home urine collection and blood pressure measurement was conducted. Participants in the self-monitoring group measured their own urinary salt excretion level for 4 weeks, using the self-measurement device. Analyses were conducted on 51 participants in the control group and 49 in the self-monitoring group. At baseline, there was no significant difference between the two groups in terms of their characteristics and 24-hour urinary salt excretion levels. After intervention, 24-hour urinary sodium/potassium ratio showed no change in the control group [baseline score: 4.1 ± 1.5; endline score: 4.2 ± 2.0; P = 0.723], but it decreased significantly in the self-monitoring group [baseline score: 4.0 ± 1.7; endline score: 3.5 ± 1.4; P = 0.044]. This change was significant even after adjusting for baseline and endline differences between groups using analysis of covariance (P = 0.045). The self-monitoring urinary salt excretion measurement device improved the 24-hour urinary sodium/potassium ratio. The device is a useful and practical tool for educating young individuals about dietary salt reduction.

Inverse Relationship Between Coarse Food Grain Intake and Blood Pressure Among Young Chinese Adults

BACKGROUND

Coarse food grains are rich in dietary fiber and contain a wide range of nutrients with potential health benefits, such as blood pressure control. Coarse food grains are very popular in China, where hypertension is a major challenge. We evaluated the associations between coarse food grain consumption and blood pressure among young Chinese adults.

METHODS

A total of 104 men and women aged 18-35 years, who participated in a pilot study of the Carbohydrate Alternatives and Metabolic Phenotypes study, were included in the present analysis. Food frequency questionnaires were used to collect dietary intake data. Blood pressure was measured using a digital monitor. A multivariate general linear model was used to evaluate the putative associations.

RESULTS

Overall, 12.5% of our participants have regular habits of coarse food grain intake (at least 4 days/week). Age was positively associated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (all Ps for trend < 0.05). With multivariable adjustment, including for body mass index and physical activity level, the frequency of coarse food grain intake was inversely associated with both SBP and DBP (all Ps for trend < 0.05). Similar associations were observed for estimated daily coarse food grain intake with SBP (β coefficient ± SE = -0.039 ± 0.017, P = 0.024) and DBP (β coefficient ± SE = -0.033 ± 0.013, P = 0.016).

CONCLUSIONS

In our sample of young Chinese adults, higher coarse food grain intake was associated with lower SBP and DBP.

Exploration of the Association between Dietary Fiber Intake and Hypertension among U.S. Adults Using 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines: NHANES 2007⁻2014

This study aimed to explore the association between dietary fiber intake and hypertension risk using 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines. Data from the National Health and Nutrition Examination Survey 2007⁻2014 were used in this study. Dietary fiber data were obtained through two 24-h dietary recall interviews. Hypertension was defined as systolic blood pressure (SBP) ≥ 130 mmHg or diastolic blood pressure (DBP) ≥ 80 mmHg or treatment with hypertensive medications. Logistic regression models and restricted cubic spline models were applied to evaluate the associations between dietary intakes of total, cereal, vegetable, and fruit fiber and hypertension. A total of 18,433 participants aged 18 years or older were included in the analyses. After adjustment for age, gender, body mass index (BMI), race, educational level, smoking status, family income, and total daily energy intake, compared with the lowest tertile, the odds ratios (95% confidence intervals) of hypertension for the highest tertile intakes of total, cereal, vegetable, and fruit fiber were 0.62 (0.52⁻0.75), 0.80 (0.67⁻0.96), 0.82 (0.69⁻0.98), and 0.86 (0.71⁻1.04), respectively. Dose-response analyses revealed that the risk of hypertension was associated with total fiber intake in a nonlinear trend, while the relationships were linear for cereal and vegetable fiber intakes. Our results suggested that the intakes of total, cereal, and vegetable fiber, but not fruit fiber, were associated with a decreased risk of hypertension in U.S. adults.

Dietary Fibre as a Unifying Remedy for the Whole Spectrum of Obesity-Associated Cardiovascular Risk

Obesity is a pandemic carrying the heavy burden of multiple and serious co-morbidities including metabolic syndrome, type 2 diabetes and cardiovascular diseases. The pathophysiological processes leading to the accumulation of body fat slowly evolve to fat accumulation in other body compartments than subcutaneous tissue. This abnormal fat deposition determines insulin resistance which in turn causes blood glucose and lipid metabolism derangement, non-alcoholic fatty liver disease, hypertension, and metabolic syndrome. All these conditions contribute to increase the cardiovascular risk of obese people. Several randomized clinical trials demonstrated that moderate weight loss (5⁻10%) in obese patients improves obesity-related metabolic risk factors and coexisting disorders. Therefore, nutritional strategies able to facilitate weight management, and in the meantime positively influence obesity-associated cardiovascular risk factors, should be implemented. To this aim, a suitable option could be dietary fibres that may also act independently of weight loss. The present narrative review summarizes the current evidence about the effects of dietary fibres on weight management in obese people. Moreover, all of the different cardiovascular risk factors are individually considered and evidence on cardiovascular outcomes is summarized. We also describe the plausible mechanisms by which different dietary fibres could modulate cardio-metabolic risk factors. Overall, despite both epidemiological and intervention studies on weight loss that show statistically significant but negligible clinical effects, dietary fibres seem to have a beneficial impact on main pathophysiological pathways involved in cardiovascular risk (i.e., insulin resistance, renin-angiotensin, and sympathetic nervous systems). Although the evidence is not conclusive, this suggests that fibre would be a suitable option to counteract obesity-related cardio-metabolic diseases also independently of weight loss. However, evidence is not consistent for the different risk factors, with clear beneficial effects shown on blood glucose metabolism and Low Density Lipoprotein (LDL) cholesterol while there is fewer, and less consistent data shown on plasma triglyceride and blood pressure. Ascribing the beneficial effect of some foods (i.e., fruits and vegetables) solely to their fibre content requires more investigation on the pathophysiological role of other dietary components, such as polyphenols.

Association of Habitually Low Intake of Dietary Calcium with Blood Pressure and Hypertension in a Population with Predominantly Plant-Based Diets

This study aimed to assess the association of habitually low dietary calcium intake with blood pressure or hypertensive risk using data from the China Health and Nutrition Survey (CHNS) in 2009. We included 6298 participants (2890 men and 3408 women) aged 18 years or older in this analysis. Food intakes were measured by 3-day 24-h individual recalls combined with a weighing and measuring of household food inventory. The participants were divided into normotensive, pre-hypertensive and hypertensive groups according to their mean blood pressure of three repeated measurements. Six intake levels were decided by percentiles of gender-specific dietary calcium intakes (P0⁻10, P10⁻30, P30⁻50, P50⁻70, P70⁻90, and P90⁻100). Average dietary calcium intakes were 405 mg/day for men and 370 mg/day for women, 80% and 84% of which were derived from plant-based food in men and women, respectively. Multiple linear regression analyses showed that dietary calcium intakes were not related with blood pressure in both genders (all P > 0.05). Logistic regression analyses showed a lower risk of pre-hypertension with higher dietary calcium intakes in women (all Pfor trend < 0.001), but not in men; no association between dietary calcium intake and hypertensive risk was found in both genders (all Pfor trend > 0.05). This study suggests that there are no conclusive associations of habitually low dietary calcium intake with blood pressure or hypertensive risk in Chinese individuals consuming predominantly plant-based diets.

Increased Risk of Persistent Glucose Disorders After Control of Acromegaly

Purpose:

Combining surgery and medical treatments allows the control of growth hormone hypersecretion in 80% of cases. Our objective was to determine the rate of acromegaly comorbidities once hypersecretion of growth hormone is controlled.

Methods:

Our retrospective monocentric study was based on 130 patients followed on a regular basis, with acromegaly controlled by medical treatments or cured by surgery or radiation technique. Our main outcome measures were the prevalence of major metabolic complications of acromegaly (diabetes, hypertension, low-density lipoprotein cholesterol, triglycerides) at diagnosis and last follow-up in comparison with French epidemiological data.

Results:

As expected, controlling hypersecretion significantly improved the metabolic complications of acromegaly. However, the proportion of patients having at least one metabolic complication of acromegaly at last follow-up (mean, 72 months after remission) was 27% for altered glucose tolerance or diabetes, 39% for hypertension, 34.3% for hypercholesterolemia, and 13.3% for hypertriglyceridemia. Interestingly, our data showed that diabetes was the only comorbidity different with a higher prevalence in patients in remission versus a general population of a similar median age (21.6% vs 6.9%, respectively).

Conclusions:

The follow-up of glucose disorders needs to be maintained on a long-term basis in patients controlled for acromegaly.

Relationship between urinary sodium with blood pressure and hypertension among a Kazakh community population in Xinjiang, China

Urinary sodium levels are reported to be associated with blood pressure in clinical trials and epidemiology studies. Nevertheless, the public health message of reducing sodium intake in free-living community populations remains under debate. Based on an ongoing prospective study initiated in 2012 with a community-based design in Xinjiang, China, 1668 adults (⩾30 years old) were assessed in the current study for associations between urinary sodium and blood pressure and hypertension in a free-living population of Kazakh people. After excluding 223 people on antihypertensive medication, 1445 participants were analyzed. Second urine samples after waking were used to estimate 24-h urinary sodium excretion, which is a marker for sodium intake. Following analyses, we found that the distribution of systolic and diastolic blood pressures moved upward with increasing quartiles of urinary sodium. After adjusting for age, differences in median systolic blood pressure were 8.5 mm Hg for men and 8.0 mm Hg for women between the top and bottom urinary sodium quartiles, and differences for diastolic blood pressure were 4.7 mm Hg for men and 4.3 mm Hg for women. A significant increased risk for hypertension was observed for the top quartile of urinary sodium after adjusting for age, body mass index, smoking, alcohol consumption, fruit and vegetable consumption, with corresponding odds ratios being 1.61 (95% confidence interval (CI): 1.02-2.54) for men and 1.92 (95% CI: 1.13-3.27) for women. Improving education about reducing salt intake is of particular public importance to reduce blood pressure and the risk for hypertension among the Kazakh people.

Pregnancy as a critical window for blood pressure regulation in mother and child: programming and reprogramming

Pregnancy is a critical time for long-term blood pressure regulation in both mother and child. Pregnancies complicated by placental insufficiency, resulting in pre-eclampsia and intrauterine growth restriction, are associated with a threefold increased risk of the mother to develop hypertension later in life. In addition, these complications create an adverse intrauterine environment, which programmes the foetus and the second generation to develop hypertension in adult life. Female offspring born to a pregnancy complicated by placental insufficiency are at risk for pregnancy complications during their own pregnancies as well, resulting in a vicious circle with programmed risk for hypertension passing from generation to generation. Here, we review the epidemiology and mechanisms leading to the altered programming of blood pressure trajectories after pregnancies complicated by placental insufficiency. Although the underlying mechanisms leading to hypertension remain the subject of investigation, several abnormalities in angiotensin sensitivity, sodium handling, sympathetic activity, endothelial function and metabolic pathways are found in the mother after exposure to placental insufficiency. In the child, epigenetic modifications and disrupted organ development play a crucial role in programming of hypertension. We emphasize that pregnancy can be viewed as a window of opportunity to improve long-term cardiovascular health of both mother and child, and outline potential gains expected of improved preconceptional, perinatal and post-natal care to reduce the development of hypertension and the burden of cardiovascular disease later in life. Perinatal therapies aimed at reprogramming hypertension are a promising strategy to break the vicious circle of intergenerational programming of hypertension.

Association of Sasang Constitutional Types with Incident Hypertension: A 12-Year Follow-Up Study

OBJECTIVES

Sasang constitutional types (SCTs) are four distinct classifications of people based on physiologic and physical characteristics. The different types have been reported to have different disease susceptibility, but there are no studies reporting the association of SCT and hypertension (HTN) over a long-term follow-up period. This study prospectively investigated the association between SCT and incidence of HTN.

DESIGN

This was a prospective study in a population-based cohort study in Korea.

SUBJECTS

Data from two independent population-based cohorts that are embedded within the Korean Genome and Epidemiology Study were used. A total of 2083 subjects who were free of HTN at baseline were selected for the analysis.

OUTCOME MEASURES

HTN was diagnosed as systolic blood pressure (BP) ≥140 mmHg and diastolic BP ≥90 mmHg, use of antihypertensive medication, or diagnosis by doctor. The SCTs were classified using an integrated diagnostic method that included facial features, body shape, voice, and questionnaire responses. The association between the SCT and the incidence of HTN was investigated by Cox proportional hazard regression analysis and calculation of estimated survival functions.

RESULTS

The Tae-eum (TE) type showed a significantly increased risk for HTN (hazard ratio [HR] = 1.55, 95% confidence interval [CI] 1.15-2.10; p = 0.005), even after adjusting for all possible confounders. In a stratified analysis by body mass index (BMI) conducted only in the TE type, even those in the TE type with normal BMI had a significantly higher risk for HTN (HR = 1.47, 95% CI 1.07-2.03; p = 0.016). Furthermore, survival analysis showed that the TE type had a higher rate of developing HTN than the So-eum and So-yang types had, regardless of obesity status.

CONCLUSIONS

These results show that the TE type is an independent risk factor for HTN. Thus, early prevention and treatment for HTN in this type are needed.

Position of the Academy of Nutrition and Dietetics: Health Implications of Dietary Fiber

It is the position of the Academy of Nutrition and Dietetics that the public should consume adequate amounts of dietary fiber from a variety of plant foods. Dietary fiber is defined by the Institute of Medicine Food Nutrition Board as "nondigestible carbohydrates and lignin that are intrinsic and intact in plants." Populations that consume more dietary fiber have less chronic disease. Higher intakes of dietary fiber reduce the risk of developing several chronic diseases, including cardiovascular disease, type 2 diabetes, and some cancers, and have been associated with lower body weights. The Adequate Intake for fiber is 14 g total fiber per 1,000 kcal, or 25 g for adult women and 38 g for adult men, based on research demonstrating protection against coronary heart disease. Properties of dietary fiber, such as fermentability and viscosity, are thought to be important parameters influencing the risk of disease. Plant components associated with dietary fiber may also contribute to reduced disease risk. The mean intake of dietary fiber in the United States is 17 g/day with only 5% of the population meeting the Adequate Intake. Healthy adults and children can achieve adequate dietary fiber intakes by increasing their intake of plant foods while concurrently decreasing energy from foods high in added sugar and fat, and low in fiber. Dietary messages to increase consumption of whole grains, legumes, vegetables, fruits, and nuts should be broadly supported by food and nutrition practitioners.

Television viewing duration and blood pressure among 18-74-year-old adults. The French nutrition and health survey (ENNS, 2006-2007)

OBJECTIVES

To describe Blood Pressure (BP) according to the time spent viewing television and examine whether the associations between television viewing and systolic and diastolic BP differed depending on sex, age and BMI.

DESIGN

The French health and nutrition survey (ENNS) was conducted in 2006-2007 on a multistage stratified random sample of 18-74-year-old adults.

METHODS

Systolic (SBP) and diastolic BP (DBP) were assessed using three measurements. Among subjects without BP-lowering drugs and lifestyle measures, adjusted means of SBP and DBP were estimated for each television viewing category (<3h and ≥3h).

RESULTS

Among 2050 ENNS participants, 81.2% declared neither drug medication nor lifestyle change to lower BP. In women without BP-lowering measure, viewing television 3h/day or more increased significantly SBP and DBP adjusted means (+2mmHg) compared to women who spent less than 3h/day in front of the television. These associations were stronger in obese or 35-54-year-old women. In men, no relationship between DBP and television-viewing has been observed. Though, SBP was positively associated with television-viewing in non-overweight, 18-29 or 55-74 year-old men.

CONCLUSIONS

These results show that the association between television viewing duration and BP must be evaluated differently between gender, age group and BMI category.

Lost in translation: dietary management of cardiovascular risk factors is seldom implemented

OBJECTIVE

To assess dietary management of cardiovascular risk factors (CVRFs) in the general population.

METHOD

Cross-sectional study conducted between 2009 and 2012 on 4811 participants (2567 women, 58±11years) living in Lausanne, Switzerland.

RESULTS

Sixteen percent of participants diagnosed with overweight/obesity reported a slimming diet. Slimming diet was associated with diagnosis of hypertension: Odds ratio and (95% confidence interval): 0.61 (0.40-0.93); older age [0.84 (0.58-1.21), 0.79 (0.53-1.18) and 0.47 (0.27-0.81) for [50-60[, [60-70[ and [70+ years, respectively]; female gender [1.84 (1.36-2.48)] and diagnosis of diabetes [2.16 (1.13-4.12)]. Only 8% of participants diagnosed with hypertension reported a low-salt diet. Low-salt diet was associated with antihypertensive drug treatment [2.17 (1.28-3.68)] and diagnosis of diabetes [2.72 (1.26-5.86)]. One-third of participants diagnosed with dyslipidemia reported a low-fat diet. Low-fat diet was associated with female gender [1.47 (1.17-1.86)]; older age [1.29 (0.89-1.87), 1.71 (1.18-2.48) and 2.01 (1.33-3.03) for [50-60[, [60-70[ and [70+ years, respectively]; hypolipidemic drug treatment [OR=1.68 (1.29-2.18)]; current smoking [0.70 (0.51-0.96)] and obesity [0.67 (0.45-1.00)]. Approximately half of participants diagnosed with diabetes reported an antidiabetic diet. Antidiabetic diet was associated with current smoking [0.44 (0.22-0.88)] and antidiabetic drug treatment [OR=3.26 (1.81-5.86)].

CONCLUSION

Dietary management of CVRFs is seldom implemented in Switzerland.

Relationship between nutrition and blood pressure: a cross-sectional analysis from the NutriNet-Santé Study, a French web-based cohort study

BACKGROUND

Hypertension is the most prevalent chronic disease worldwide. Lifestyle behaviors for its prevention and control are recommended within worldwide guidelines. Nevertheless, their combined relationship with blood pressure (BP) level, particularly in the general population, would need more investigations. Our aim in this study was to evaluate the relative impact of lifestyle and nutritional factors on BP level.

METHODS

Cross-sectional analyses were performed using data from 8,670 volunteers from the NutriNet-Santé Study, an ongoing French web-based cohort study. Dietary intakes were assessed using three 24-hour records. Information on lifestyle factors was collected using questionnaires and 3 BP measurements following a standardized protocol. Age-adjusted associations and then multivariate associations between systolic BP (SBP) and lifestyle behaviors were estimated using multiple linear regressions.

RESULTS

SBP was higher in participants with elevated body mass indices (BMIs). Salt intake was positively associated with SBP in men but not in women. The negative relationship between consumption of fruits and vegetables and SBP was significant in both sexes. Alcohol intake was positively associated with SBP in both sexes; physical activity was not. The 5 parameters representing the well-accepted modifiable factors for hypertension reduction plus age and education level, accounted for 19.7% of the SBP variance in women and 12.8% in men. Considering their squared partial correlation coefficient, age and BMI were the most important parameters relating to SBP level. Salt intake was not associated with SBP in either sex after multiple adjustments.

CONCLUSIONS

BMI was the main contributory modifiable factor of BP level after multiple adjustments.

Risk factors of superimposed preeclampsia in women with essential chronic hypertension treated before pregnancy

Objective

To determine risk factors of superimposed preeclampsia in women with essential chronic hypertension receiving antihypertensive therapy prior to conception.

Methods

A retrospective study of 211 patients that analyzed risk factors of superimposed preeclampsia at first prenatal visit. Variables with a p<.1 at univariate analysis were included in a logistic regression analysis. P<.05 was considered as significant.

Results

Superimposed preeclampsia occurred in 49 (23.2%) women. In logistic regression analysis, previous preeclampsia [OR: 4.05 (1.61–10.16)], and mean arterial blood pressure of 95 mmHg or higher [OR: 4.60 (1.94–10.93)] were associated with increased risk of superimposed preeclampsia. When both variables were present, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for superimposed preeclampsia were 43%, 94%, 70%, 85%, and 7.71 (95% CI: 3.20–18.57), respectively.

Conclusion

In essential chronic hypertensive women, previous preeclampsia and mean arterial blood pressure of 95 mmHg or higher are associated with increased risks of superimposed preeclampsia.

The role of dietary protein in blood pressure regulation

PURPOSE OF REVIEW

Despite a considerable amount of research, the blood pressure (BP) lowering effect of dietary proteins is still not fully established. This review discusses the most recent findings on BP lowering of dietary proteins and protein sources, the possible mechanisms and the safety of increasing protein intake.

RECENT FINDINGS

Recent short-term, strictly controlled, randomized clinical trials show a BP lowering effect of increased protein intake. Longer-term trials, however, show inconsistent results. Because all recent trials exchanged carbohydrates, and not fats, for proteins, the question remains whether potential beneficial effects of high protein diets are due to increased protein intake or decreased carbohydrate intake. No clear differences between plant protein and animal protein are found in observational studies, and trials comparing plant versus animal protein are lacking. Different protein sources may lower BP via different mechanisms, which might explain divergent findings. Potential harms of high protein diets are not confirmed in recent trials in healthy persons.

SUMMARY

Increasing dietary protein intake or decreasing carbohydrate intake within reasonable limits may be beneficial for BP. The most and least beneficial protein sources still need to be determined.

Dietary fiber future directions: integrating new definitions and findings to inform nutrition research and communication

The CODEX Alimentarius definition of dietary fiber includes all nondigestible carbohydrate polymers with a degree of polymerization of 3 or more as dietary fiber with the proviso that they show health benefits. The global definition, if accepted by all authoritative bodies, offers a chance for international harmonization in research, food composition tables, and food labeling. Its nonacceptance highlights problems that may develop when definitions vary by region. The definition requires that the research community agrees upon physiological effects for which there is substantial scientific agreement, e.g., fibers' effects on laxation and gut health, on attenuating blood lipids and blood glucose and insulin, and in promoting fermentation in the large bowel. The definition also necessitates the delineation of research protocols to prove the benefits of various isolated and synthesized fibers. These should emanate from evidence-based reviews that fairly weigh epidemiological data while considering that added fibers are not reflected in many food composition databases. They then should include well-controlled, randomized, control trials and utilize animal studies to determine mechanisms. Agreement on many study variables such as the type of subject and the type of baseline diet that best fits the question under investigation will also be needed. Finally, the definition establishes that all types of fiber can address the severe fiber consumption gap that exists throughout the world by recognizing that the combination of fiber-rich and -fortified foods increases fiber intake while allowing consumers to stay within allowed energy levels.