Molitor John, Brown Ian J, Chan Queenie, Papathomas Michail, Liverani Silvia, Molitor NuooTing, Richardson Sylvia, Van Horn Linda, Daviglus Martha L, Dyer Alan, Stamler Jeremiah, Elliott Paul
From the Department of Epidemiology and Biostatistics, School of Public Health (J.M., I.J.B., Q.C., S.L., N.M., P.E.), MRC-HPA Centre for Environment and Health (Q.C., P.E.), Imperial College London, London, United Kingdom; College of Public Health and Human Sciences, Oregon State University, Corvallis (J.M.); School of Mathematics and Statistics, University of St Andrews, St Andrews, United Kingdom (M.P.); MRC Biostatistics Unit, Cambridge, United Kingdom (S.L., S.R.); and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (L.V.H., M.L.D., A.D., J.S.).
Hypertension. 2014 Dec;64(6):1198-204. doi: 10.1161/HYPERTENSIONAHA.114.03799. Epub 2014 Sep 8.
The Dietary Approaches to Stop Hypertension-Sodium (DASH-Sodium) trial demonstrated beneficial effects on blood pressure (BP) of the DASH diet with lower sodium intake when compared with typical American diet. The subsequent Optimal Macronutrient Intake Trial for Heart Health (OMNIHEART) trial reported additional BP benefits from replacing carbohydrate in the DASH diet with either protein or monounsaturated fats. The primary aim of this study is to assess possible BP benefits of an OMNIHEART-like diet in free-living Americans using cross-sectional US population data of the International Study of Macronutrients, Micronutrients and Blood Pressure (INTERMAP) study. The INTERMAP data include four 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP readings for 2195 individuals aged 40 to 59 years from 8 US INTERMAP population samples. Analyses are conducted using 2 approaches: (1) regression of BP on a linear OMNIHEART nutrient score calculated for each individual and (2) a Bayesian approach comparing estimated BP levels of an OMNIHEART-like nutrient profile with a typical American nutrient profile. After adjustment for potential confounders, an OMNIHEART score higher by 1 point was associated with systolic/diastolic BP differences of -1.0/-0.5 mm Hg (both P<0.001). Mean systolic/diastolic BPs were 111.3/68.4 and 115.2/70.6 mm Hg for Bayesian OMNIHEART and Control profiles, respectively, after controlling for possible confounders, with BP differences of -3.9/-2.2 mm Hg, P(difference≤0)=0.98/0.96. Findings were comparable for men and women, for nonhypertensive participants, and with adjustment for antihypertensive treatment. Our findings from data on US population samples indicate broad generalizability of OMNIHEART results beyond the trial setting and support recommendations for an OMNIHEART-style diet for prevention/control of population-wide adverse BP levels.
“终止高血压膳食方法-钠（DASH-钠）试验”表明，与典型美国饮食相比，钠摄入量较低的DASH饮食对血压（BP）具有有益影响。随后的“心脏健康最佳宏量营养素摄入试验（OMNIHEART）”报告称，用蛋白质或单不饱和脂肪替代DASH饮食中的碳水化合物可带来额外的血压益处。本研究的主要目的是利用“宏量营养素、微量营养素与血压国际研究（INTERMAP）”的美国横断面人群数据，评估类似OMNIHEART饮食对自由生活的美国人可能产生的血压益处。INTERMAP数据包括来自美国8个INTERMAP人群样本的2195名40至59岁个体的4次24小时饮食回忆、2次定时24小时尿液收集以及8次血压读数。分析采用两种方法进行：（1）对为每个个体计算的线性OMNIHEART营养素评分进行血压回归分析；（2）采用贝叶斯方法，比较类似OMNIHEART营养素谱与典型美国营养素谱的估计血压水平。在对潜在混杂因素进行调整后，OMNIHEART评分每高1分，收缩压/舒张压差异为-1.0/-0.5 mmHg（P均<0.001）。在控制可能的混杂因素后，贝叶斯OMNIHEART和对照谱的平均收缩压/舒张压分别为111.3/68.4 mmHg和115.2/70.6 mmHg，血压差异为-3.9/-2.2 mmHg，P（差异≤0）=0.98/0.96。男性和女性、非高血压参与者以及在调整抗高血压治疗后，研究结果具有可比性。我们从美国人群样本数据中得出的结果表明，OMNIHEART试验结果具有广泛的普遍性，超出了试验范围，并支持采用OMNIHEART式饮食预防/控制全人群不良血压水平的建议。
