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Zhou L, Stamler J, Chan Q, Van Horn L, Daviglus ML, Dyer AR, Miura K, Okuda N, Wu Y, Ueshima H, Elliott P, Zhao L. Salt intake and prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States: the INTERMAP Study. Am J Clin Nutr 2019; 110:34-40. [PMID: 31111867 PMCID: PMC6599742 DOI: 10.1093/ajcn/nqz067] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several studies have reported that dietary salt intake may be an independent risk factor for overweight/obesity, but results from previous studies are controversial, reflecting study limitations such as use of a single spot urine or dietary recall to estimate daily salt intake rather than 24-h urine collections, and population samples from only a single country or center. OBJECTIVE The aim of this study was to use data from the International Study of Macro-/Micro-nutrients and Blood Pressure (INTERMAP Study) to explore the relation between dietary salt intake estimated from 2 timed 24-h urine collections and body mass index (BMI; in kg/m2) as well as prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States. METHODS Data were from a cross-sectional study of 4680 men and women aged 40-59 y in Japan (n = 1145), China (n = 839), the United Kingdom (n = 501), and the United States (n = 2195). General linear models were used to obtain the regression coefficients (β) of salt intake associated with BMI. Multivariable logistic regression models were used to determine the ORs and 95% CIs of overweight/obesity associated with a 1-g/d higher dietary salt intake. RESULTS After adjustment for potential confounding factors including energy intake, salt intake 1 g/d higher was associated with BMI higher by 0.28 in Japan, 0.10 in China, 0.42 in the United Kingdom, and 0.52 in the United States, all P values < 0.001. Salt intake 1 g/d higher was associated with odds of overweight/obesity 21% higher in Japan, 4% higher in China, 29% higher in the United Kingdom, and 24% higher in the United States, all P values < 0.05. CONCLUSIONS Salt intake is positively associated with BMI and the prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States. This association needs to be further confirmed in well-designed prospective studies with repeated dietary and BMI measurements.This trial was registered at clinicaltrials.gov as NCT00005271.
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Affiliation(s)
- Long Zhou
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, IL
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Yangfeng Wu
- School of Public Health and Clinical Research Institute, Peking University, Beijing, China
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aljuraiban GS, Stamler J, Chan Q, Horn LV, Daviglus ML, Elliott P, Oude Griep LM. Relations between dairy product intake and blood pressure: the INTERnational study on MAcro/micronutrients and blood Pressure. J Hypertens 2018; 36:2049-2058. [PMID: 29927842 PMCID: PMC6591711 DOI: 10.1097/hjh.0000000000001779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiologic evidence suggests that low-fat dairy consumption may lower risk of hypertension. Dairy products may be distinctly linked to health, because of differences in nutritional composition, but little is known about specific nutrients that contribute to the dairy-blood pressure (BP) association, nor to underlying kidney function. METHODS We examined cross-sectional associations to BP of dairy product intakes, total and by type, from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) including 2694 participants aged 40-59 years from the UK and the USA. Eight BP, four 24-h dietary recalls and two 24-h urine samples were collected during four visits. Linear regression models adjusted for lifestyle/dietary factors to estimate BP differences per 2SD higher intakes of total-and-individual-types of dairy were calculated. RESULTS Multivariable linear regression coefficients were estimated and pooled. In contrast to total and whole-fat dairy, each 195 g/1000 kcal (2SD) greater low-fat dairy intake was associated with a lower SBP -2.31 mmHg and DBP -2.27 mmHg. Significant associations attenuated with adjustment for dietary phosphorus, calcium, and lactose, but strengthened with urinary calcium adjustment. Stratification by median albumin-creatinine ratio (ACR; high ACR indicates impaired kidney function) showed strong associations between low-fat dairy and BP in participants with low ACR (SBP: -3.66; DBP: -2.15 mmHg), with no association in participants with high ACR. CONCLUSION Low-fat dairy consumption was associated with lower BP, especially among participants with low ACR. Dairy-rich nutrients including phosphorus and calcium may have contributed to the beneficial associations with BP.
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Affiliation(s)
- Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Martha L. Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Linda M. Oude Griep
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
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Brown IJ, Stamler J, Van Horn L, Robertson CE, Chan Q, Dyer AR, Huang CC, Rodriguez BL, Zhao L, Daviglus ML, Ueshima H, Elliott P. Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure. Hypertension 2011; 57:695-701. [PMID: 21357284 PMCID: PMC3086758 DOI: 10.1161/hypertensionaha.110.165456] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.
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Affiliation(s)
- Ian J. Brown
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Claire E. Robertson
- Department of Human and Health Sciences, School of Biosciences, University of Westminster, London, UK
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Alan R. Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Chiang-Ching Huang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Liancheng Zhao
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Martha L. Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hirotsugu Ueshima
- Department of Health Science, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-HPA Centre for Environment and Health, Imperial College London, London, UK
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Dennis B, Stamler J, Buzzard M, Conway R, Elliott P, Moag-Stahlberg A, Okayama A, Okuda N, Robertson C, Robinson F, Schakel S, Stevens M, Van Heel N, Zhao L, Zhou BF. INTERMAP: the dietary data--process and quality control. J Hum Hypertens 2003; 17:609-22. [PMID: 13679951 PMCID: PMC6598198 DOI: 10.1038/sj.jhh.1001604] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this report is to describe INTERMAP standardized procedures for assessing dietary intake of 4680 individuals from 17 population samples in China, Japan, UK and USA: Based on a common Protocol and Manuals of Operations, standardized collection by centrally trained certified staff of four 24 h dietary recalls, two timed 24-h urines, two 7-day histories of daily alcohol intake per participant; tape recording of all dietary interviews, and use of multiple methods for ongoing quality control of dietary data collection and processing (local, national, and international); one central laboratory for urine analyses; review, update, expansion of available databases for four countries to produce comparable data on 76 nutrients for all reported foods; use of these databases at international coordinating centres to compute nutrient composition. Chinese participants reported 2257 foods; Japanese, 2931; and UK, 3963. In US, use was made of 17,000 food items in the online automated Nutrition Data System. Average time/recall ranged from 22 min for China to 31 min for UK. Among indicators of dietary data quality, coding error rates (from recoding 10% random samples of recalls) were 2.3% for China, 1.4% for Japan, and UK; an analogous US procedure (re-entry of recalls into computer from tape recordings) also yielded low discrepancy rates. Average scores on assessment of taped dietary interviews were high, 40.4 (Japan) to 45.3 (China) (highest possible score: 48); correlations between urinary and dietary nutrient values--similar for men and women--were, for all 4680 participants, 0.51 for total protein, range across countries 0.40-0.52; 0.55 for potassium, range 0.30-0.58; 0.42 for sodium, range 0.33-0.46. The updated dietary databases are valuable international resources. Dietary quality control procedures yielded data generally indicative of high quality performance in the four countries. These procedures were time consuming. Ongoing recoding of random samples of recalls is deemed essential. Use of tape recorded dietary interviews contributed to quality control, despite feasibility problems, deemed remediable by protocol modification. For quality assessment, use of correlation data on dietary and urinary nutrient values yielded meaningful findings, including evidence of special difficulties in assessing sodium intake by dietary methods.
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Affiliation(s)
- B Dennis
- Department of Biostatistics, Collaborative Studies Coordinating Centre, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Buzzard
- Medical College of Virginia at Virginia Commonwealth University, Richmond, VA, USA
| | - R Conway
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - P Elliott
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - A Moag-Stahlberg
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A Okayama
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - N Okuda
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - C Robertson
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - F Robinson
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - S Schakel
- Nutrition Coordinating Centre, University of Minnesota, Minneapolis, MN, USA
| | - M Stevens
- Nutrition Coordinating Centre, University of Minnesota, Minneapolis, MN, USA
| | - N Van Heel
- Nutrition Coordinating Centre, University of Minnesota, Minneapolis, MN, USA
| | - L Zhao
- Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - BF Zhou
- Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Zhou BF, Stamler J, Dennis B, Moag-Stahlberg A, Okuda N, Robertson C, Zhao L, Chan Q, Elliott P. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens 2003; 17:623-30. [PMID: 13679952 PMCID: PMC6561109 DOI: 10.1038/sj.jhh.1001605] [Citation(s) in RCA: 324] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of the study was to compare nutrient intakes among Chinese, Japanese, UK, and US INTERMAP samples, and assess possible relationships of dietary patterns to differential patterns of cardiovascular diseases between East Asian and Western countries. Based on a common Protocol and Manuals of Operations, high-quality dietary data were collected by four standardized 24-h dietary recalls and two 24-h urine collections from 17 population samples in China (three samples), Japan (four samples), UK (two samples), and USA (eight samples). There were about 260 men and women aged 40-59 years per sample--total N=4680. Quality of dietary interview and data entry were monitored and enhanced by extensive systematic ongoing quality control procedures at local, country, and international level. Four databases on nutrient composition of foods from the four countries were updated and enhanced (76 nutrients for all four countries) by the Nutrition Coordinating Center, University of Minnesota, in cooperation with Country Nutritionists. The mean body mass index was much higher for Western than East Asian samples. Macronutrient intakes differed markedly across these samples, with Western diet higher in total fat, saturated and trans fatty acids, and Keys dietary lipid score, lower in total carbohydrate and starch, higher in sugars. Based on extensive published data, it is a reasonable inference that this pattern relates to higher average levels of serum total cholesterol and higher mortality from coronary heart disease in Western than East Asian populations. The rural Chinese diet was lower in protein, especially animal protein, in calcium, phosphorus, selenium, and vitamin A. Dietary sodium was higher, potassium lower, hence Na/K ratio was higher in the Asian diet, especially for Chinese samples. This pattern is known to relate to risks of adverse blood pressure level and stroke. At the end of the 20th century, East Asian and Western diets remain significantly different in macro- and micronutrient composition. Both dietary patterns have aspects that can be regarded, respectively, as adverse and protective in relation to the major adult cardiovascular diseases. In both Asian and Western countries, public efforts should be targeted at overcoming adverse aspects and maintaining protective patterns for prevention and control of cardiovascular diseases.
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Affiliation(s)
- BF Zhou
- Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - J Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - B Dennis
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Moag-Stahlberg
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - N Okuda
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - C Robertson
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - L Zhao
- Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Q Chan
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
| | - P Elliott
- Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College, London, UK
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