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Fat Intake and Hypertension Among Adults in China: The Modifying Effects of Fruit and Vegetable Intake

Published:November 14, 2019DOI:https://doi.org/10.1016/j.amepre.2019.09.004

      Introduction

      Evidence on the combined effect of fruit and vegetable intake and total fat intake on hypertension is scarce. This study aimed to explore the relationship among fruit and vegetable intake, fat intake, and hypertension risk among Chinese adults.

      Methods

      Individuals who participated in the China Health and Nutrition Survey (2004, 2006, 2009, and 2011) and were free of hypertension at baseline (n=4,368) were categorized into quartiles (Q1, lowest; Q4, highest) according to their dietary fruit and vegetable intake and fat intake. Generalized estimation equation models, adjusted for confounders, were used to explore the relationship of fat intake with hypertension and systolic and diastolic blood pressure among all adults and within quartiles of fruit and vegetable intake. Data analyses were performed in 2018.

      Results

      A total of 1,086 adults developed hypertension during follow-up. In the total population, the OR of the highest quartile of fat intake was 1.40 (95% CI=1.12, 1.75) compared with the lowest. Among individuals with low fruit and vegetable intake, the odds of hypertension for those in Q3 (OR=1.97, 95% CI=1.37, 2.83) and Q4 (OR=1.81, 95% CI=1.14, 2.90) of fat intake, compared with individuals in Q1, were even higher than for the overall sample. For each 50-gram increase in FI per day, the ORs of hypertension increased from fat intake Q1 to Q4 among all respondents and those with low fruit and vegetable intake, but not among those with high fruit and vegetable intake. Systolic blood pressure increased by 1.08 mm Hg (95% CI=0.03, 2.13) per 50-gram fat intake per day increment in the fruit and vegetable intake Q1 group, whereas the association was not significant in the fruit and vegetable intake Q2–Q4 groups.

      Conclusions

      Fruit and vegetable intake modifies the relationship between fat intake and hypertension, whereby high fruit and vegetable intake may offset the detrimental effect of fat intake on hypertension. Increased fruit and vegetable intake and controlled fat intake are recommended to prevent hypertension in Chinese adults.
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      REFERENCES

        • Lawes CM
        • Vander Hoorn S
        • Rodgers A
        • International Society of Hypertension
        Global burden of blood-pressure-related disease, 2001.
        Lancet. 2008; 371: 1513-1518
        • GBD 2013 Mortality and Causes of Death Collaborators
        Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990‒2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 385: 117-171
        • Forouzanfar MH
        • Alexander L
        • Anderson HR
        • et al.
        Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990‒2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 386: 2287-2323
        • GBD 2015 Risk Factors Collaborators
        Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990‒2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1659‒1724
        • Oude Griep LM
        • Seferidi P
        • Stamler J
        • et al.
        Relation of unprocessed, processed red meat and poultry consumption to blood pressure in East Asian and Western adults.
        J Hypertens. 2016; 34: 1721‒1729
        • Liu MW
        • Yu HJ
        • Yuan S
        • et al.
        Association between fruit and vegetable intake and the risk of hypertension among Chinese adults: a longitudinal study.
        Eur J Nutr. 2018; 57: 2639‒2647
        • Chiu S
        • Bergeron N
        • Williams PT
        • Bray GA
        • Sutherland B
        • Krauss RM
        Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial.
        Am J Clin Nutr. 2016; 103: 341‒347
        • Appel LJ
        • Sacks FM
        • Carey VJ
        • et al.
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
        JAMA. 2005; 294: 2455‒2464
        • Wannamethee SG
        • Lowe GD
        • Rumley A
        • Bruckdorfer KR
        • Whincup PH
        Associations of vitamin C status, fruit and vegetable intakes, and markers of inflammation and hemostasis.
        Am J Clin Nutr. 2006; 83: 567‒574
        • Root MM
        • Mcginn MC
        • Nieman DC
        • et al.
        Combined fruit and vegetable intake is correlated with improved inflammatory and oxidant status from a cross-sectional study in a community setting.
        Nutrients. 2012; 4: 29‒41
        • Baer DJ
        • Judd JT
        • Clevidence BA
        • Tracy RP
        Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study.
        Am J Clin Nutr. 2004; 79: 969‒973
        • Mills KT
        • Bundy JD
        • Kelly TN
        • et al.
        Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries.
        Circulation. 2016; 134: 441‒450
        • Li Y
        • Yang L
        • Wang L
        • et al.
        Burden of hypertension in China: a nationally representative survey of 174,621 adults.
        Int J Cardiol. 2017; 227: 516‒523
        • Elmadfa I
        • Kornsteiner M
        Dietary fat intake - a global perspective.
        Ann Nutr Metab. 2009; 54: 8‒14
        • Sun J
        • Buys NJ
        • Hills AP
        Dietary pattern and its association with the prevalence of obesity, hypertension and other cardiovascular risk factors among Chinese older adults.
        Int J Environ Res Public Health. 2014; 11: 3956‒3971
        • Popkin BM
        • Du S
        • Zhai F
        • Zhang B
        Cohort profile: the China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989‒2011.
        Int J Epidemiol. 2010; 39: 1435‒1440
        • Popkin BM
        • Lu B
        • Zhai F
        Understanding the nutrition transition: measuring rapid dietary changes in transitional countries.
        Public Health Nutr. 2002; 5: 947‒953
        • Dearth-Wesley T
        • Gordon-Larsen P
        • Adair LS
        • Zhang B
        • Popkin BM
        Longitudinal, cross-cohort comparison of physical activity patterns in Chinese mothers and children.
        Int J Behav Nutr Phys Act. 2012; 9: 39
        • van Buuren Sv
        • Groothuis-Oudshoorn K
        mice: multivariate imputation by chained equations in R.
        J Stat Soft. 2011; 45: 1‒68
        • Lipsky LM
        • Haynie DL
        • Liu D
        • et al.
        Trajectories of eating behaviors in a nationally representative cohort of U.S. adolescents during the transition to young adulthood.
        Int J Behav Nutr Phys Act. 2015; 12: 138
        • Beegom R
        • Singh RB
        Association of higher saturated fat intake with higher risk of hypertension in an urban population of Trivandrum in south India.
        Int J Cardiol. 1997; 58: 63‒70
        • Sabour H
        • Norouzi-Javidan A
        • Soltani Z
        • et al.
        The correlation between dietary fat intake and blood pressure among people with spinal cord injury.
        Iran J Neurol. 2016; 15: 121‒127
        • Shen X
        • Fang A
        • He J
        • et al.
        Trends in dietary fat and fatty acid intakes and related food sources among Chinese adults: a longitudinal study from the China Health and Nutrition Survey (1997–2011).
        Public Health Nutr. 2017; 20: 2927‒2936
        • KANWU Study Group
        Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects.
        Am J Clin Nutr. 2006; 83: 221‒226
        • Ellulu MS
        • Rahmat A
        • Ismail P
        • Khaza'ai H
        • Abed Y
        Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial.
        Drug Des Dev Ther. 2015; 9: 3405‒3412
        • González-Gallego J
        • García-Mediavilla MV
        • Sánchez-Campos S
        • Tuñón MJ
        Fruit polyphenols, immunity and inflammation.
        Br J Nutr. 2010; 104: S15‒S27
        • Pérez-Cano FJ
        • Castell M
        Flavonoids, inflammation and immune system.
        Nutrients. 2016; 8: 659
        • Nielsen FH
        Magnesium, inflammation, and obesity in chronic disease.
        Nutr Rev. 2010; 68: 333‒340
        • Grundy SM
        Inflammation, hypertension, and the metabolic syndrome.
        JAMA. 2003; 290: 3000‒3002
        • Colín-Ramírez E
        • Castillo-Martínez L
        • Orea-Tejeda A
        • Villa Romero AR
        • Vergara Castañeda A
        • Asensio Lafuente E
        Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years.
        J Am Diet Assoc. 2009; 109: 996‒1003
        • Alonso A
        • de la Fuente C
        • Martín-Arnau AM
        • de Irala J
        • Martínez JA
        • Martínez-González MA
        Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study.
        Br J Nutr. 2004; 92: 311‒319
        • Sacks FM
        • Svetkey LP
        • Vollmer WM
        • et al.
        Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.
        N Engl J Med. 2001; 344: 3‒10
        • Mozaffarian D
        • Hao T
        • Rimm EB
        • Willett WC
        • Hu FB
        Changes in diet and lifestyle and long-term weight gain in women and men.
        N Engl J Med. 2011; 364: 2392‒2404
        • Bhupathiraju SN
        • Tucker KL
        Greater variety in fruit and vegetable intake is associated with lower inflammation in Puerto Rican adults.
        Am J Clin Nutr. 2011; 93: 37‒46
        • Gorinstein S
        • Caspi A
        • Libman I
        • et al.
        Red grapefruit positively influences serum triglyceride level in patients suffering from coronary atherosclerosis: studies in vitro and in humans.
        J Agric Food Chem. 2006; 54: 1887‒1892
        • Shen Y
        • Croft KD
        • Hodgson JM
        • et al.
        Quercetin and its metabolites improve vessel function by inducing eNOS activity via phosphorylation of AMPK.
        Biochem Pharmacol. 2012; 84: 1036‒1044
        • Dragsted LO
        • Pedersen A
        • Hermetter A
        • et al.
        The 6-a-day study: effects of fruit and vegetables on markers of oxidative stress and antioxidative defense in healthy nonsmokers.
        Am J Clin Nutr. 2004; 79: 1060‒1072
        • Sowers JR
        Hypertension, angiotensin II, and oxidative stress.
        N Engl J Med. 2002; 346: 1999‒2001
        • Houston MC
        • Harper KJ
        Potassium, magnesium, and calcium: their role in both the cause and treatment of hypertension.
        J Clin Hypertens. 2008; 10: 3‒11