Stamler J, Elliott P, Dennis B, Dyer A R, Kesteloot H, Liu K, Ueshima H, Zhou B F
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Hum Hypertens. 2003 Sep;17(9):591-608. doi: 10.1038/sj.jhh.1001603.
Blood pressure (BP) above optimal (< or =120/< or =80 mmHg) is established as a major cardiovascular disease (CVD) risk factor. Prevalence of adverse BP is high in most adult populations; until recently research has been sparse on reasons for this. Since the 1980s, epidemiologic studies confirmed that salt, alcohol intake, and body mass relate directly to BP; dietary potassium, inversely. Several other nutrients also probably influence BP. The DASH feeding trials demonstrated that with the multiple modifications in the DASH combination diet, SBP/DBP (SBP: systolic blood pressure, DBP: diastolic blood pressure) was sizably reduced, independent of calorie balance, alcohol intake, and BP reduction with decreased dietary salt. A key challenge for research is to elucidate specific nutrients accounting for this effect. The general aim of the study was to clarify influences of multiple nutrients on SBP/DBP of individuals over and above effects of Na, K, alcohol, and body mass. Specific aims were, in a cross-sectional epidemiologic study of 4680 men and women aged 40-59 years from 17 diverse population samples in China, Japan, UK, and USA, test 10 prior hypotheses on relations of macronutrients to SBP/DBP and on role of dietary factors in inverse associations of education with BP; test four related subgroup hypotheses; explore associations with SBP/DBP of multiple other nutrients, urinary metabolites, and foods. For these purposes, for all 4680 participants, with standardized high-quality methods, assess individual intake of 76 nutrients from four 24-h dietary recalls/person; measure in two timed 24-h urine collections/person 24-h excretion of Na, K, Ca, Mg, creatinine, amino acids; microalbuminuria; multiple nutrients and metabolites by nuclear magnetic resonance and high-pressure liquid chromatography. Based on eight SBP/DBP measurements/person, and data on multiple possible confounders, utilize mainly multiple linear regression and quantile analyses to test prior hypotheses and explore relations of multiple dietary and urinary variables to SBP/DBP of individuals. The 4680 INTERMAP participants are equally divided across four age/gender strata: diverse in ethnicity, education, occupation, physical activity; use of cigarettes, alcohol; diagnosed high BP, CVD, diabetes; CVD family history; women vary in parity, use of contraceptive medication and hormone replacement therapy.
血压高于理想水平（收缩压≤120mmHg和/或舒张压≤80mmHg）已被确认为主要的心血管疾病（CVD）危险因素。大多数成年人群中不良血压的患病率很高；直到最近，关于其原因的研究还很稀少。自20世纪80年代以来，流行病学研究证实，盐、酒精摄入量和体重与血压直接相关；膳食钾则与之呈负相关。其他几种营养素可能也会影响血压。DASH饮食试验表明，通过对DASH组合饮食进行多种调整，收缩压/舒张压（SBP：收缩压，DBP：舒张压）显著降低，这与热量平衡、酒精摄入量以及因减少膳食盐摄入而导致的血压降低无关。该研究的一个关键挑战是阐明导致这种效果的具体营养素。该研究的总体目标是明确多种营养素对个体收缩压/舒张压的影响，这种影响超出了钠、钾、酒精和体重的影响。具体目标是，在中国、日本、英国和美国的17个不同人群样本中，对4680名年龄在40 - 59岁的男性和女性进行横断面流行病学研究，检验关于常量营养素与收缩压/舒张压关系以及膳食因素在教育与血压的反向关联中作用的10个先前假设；检验4个相关的亚组假设；探索多种其他营养素、尿液代谢物和食物与收缩压/舒张压的关联。为了实现这些目标，对所有4680名参与者，采用标准化的高质量方法，通过每人4次24小时饮食回顾评估76种营养素的个体摄入量；通过每人2次定时24小时尿液收集测量钠、钾、钙镁、肌酐、氨基酸的24小时排泄量；微量白蛋白尿；通过核磁共振和高压液相色谱法测量多种营养素和代谢物。基于每人8次收缩压/舒张压测量值以及多种可能的混杂因素数据，主要利用多元线性回归和分位数分析来检验先前假设，并探索多种膳食和尿液变量与个体收缩压/舒张压的关系。4680名INTERMAP参与者在四个年龄/性别分层中平均分配：在种族、教育程度、职业、身体活动、吸烟、饮酒、是否被诊断为高血压、心血管疾病、糖尿病、心血管疾病家族史等方面存在差异；女性在生育状况、避孕药物使用和激素替代疗法方面存在差异。
