Stamler J, Elliott P, Appel L, Chan Q, Buzzard M, Dennis B, Dyer A R, Elmer P, Greenland P, Jones D, Kesteloot H, Kuller L, Labarthe D, Liu K, Moag-Stahlberg A, Nichaman M, Okayama A, Okuda N, Robertson C, Rodriguez B, Stevens M, Ueshima H, Horn L Van, Zhou B
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Hum Hypertens. 2003 Sep;17(9):655-775. doi: 10.1038/sj.jhh.1001608.
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 > or =10%: urinary 24-h Na and K excretion, Keys dietary lipid score, vegetable protein, fibre, vitamins C and B6, 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.
大量证据表明，在许多成年人群体中，教育程度与血压之间存在反比关系，但针对这一发现的原因开展的研究较少。INTERMAP研究的一个先前目标是进一步调查这一现象，并评估饮食因素在其中的作用。在来自日本、中华人民共和国、英国和美国的17个不同人群样本中选取的4680名40 - 59岁的男性和女性中，尤其是2195名美国参与者，无论种族如何，教育程度与血压之间都呈现出显著的反比关系。将参与者按受教育年限分层，并通过每人4次24小时饮食回忆和2次24小时尿液收集来评估100多种饮食变量，结果发现教育程度与多种常量和微量营养素、电解质、纤维以及体重指数（BMI）的摄入量之间存在分级关系。在以个体收缩压（SBP）和舒张压（DBP）为因变量的多元线性回归分析中（对种族和其他可能的非饮食混杂因素进行了控制），BMI显著缩小了教育程度与血压关系的幅度，女性比男性更明显。单独考虑的几种营养素使这种关联的幅度进一步降低了≥10%：24小时尿钠和钾排泄量、凯斯饮食脂质评分、植物蛋白、纤维、维生素C和B6、硫胺素、核黄素、叶酸、钙、镁和铁。这些饮食变量与BMI的组合使教育程度与SBP的反比系数降低了54 - 58%，使教育程度与DBP的反比系数降低了59 - 67%，其中超过一半的影响归因于特定营养素（独立于BMI）。结果，教育程度与血压的反比系数不再具有统计学意义。多种特定饮食因素与体重共同在很大程度上解释了受教育程度较低的美国人血压水平比受教育程度较高者更差的现象。为改善受教育程度较低阶层的饮食模式做出特别努力，对于克服这一问题以及人群中相关的健康差距具有重要意义。
