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1.  Associations between dietary patterns and hypertension among Korean adults: the Korean National Health and Nutrition Examination Survey (2008-2010) 
Nutrition Research and Practice  2013;7(3):224-232.
The objective of this study is to identify the dietary patterns associated with the risk of hypertensions among Korean adults using data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2010). This study analyzes data from 11,883 subjects who participated in the health and nutrition survey, aging from 20 to 64 years. We performed factor analysis based on the weekly mean intake frequencies of 36 food groups to identify major dietary patterns. We identified three major dietary patterns in both sexes, namely "traditional", "western" and "dairy and carbohydrate" patterns. Participants in the highest quartile of western pattern scores had significantly higher blood pressure, serum total cholesterol, and triglyceride levels than those in the lowest quartile. Although not statistically significant, a trend (P for trend = 0.0732) toward a positive association between the western dietary pattern and hypertension risk was observed after adjustments for age, sex, education, income, body mass index (BMI), smoking, physical activity, and energy intake. The dairy and carbohydrate pattern was inversely related with BMI and blood pressures and positively associated with serum high-density lipoprotein (HDL)-cholesterol. After adjusting the age, sex, education, income, BMI, smoking, physical activity and energy intake, the dairy and carbohydrate pattern showed inverse associations with hypertension prevalence (OR = 0.64, 95% CI = 0.55-0.75; P for trend < 0.0001). Intakes of fiber, sodium, and antioxidant vitamins were significantly higher in the top quartile for the traditional pattern than in the lowest quartile for the traditional pattern (P for trend < 0.0001). Intakes of fiber (P for trend < 0.0001), calcium (P for trend < 0.0001), retinol (P for trend = 0.0164), vitamin B1 (P for trend = 0.001), vitamin B2 (P for trend < 0.0001), niacin (P for trend = 0.0025), and vitamin C (P for trend < 0.0001) were significantly increased across quartiles for the dairy and carbohydrate pattern whereas sodium (P for trend < 0.0001) intake was decreased for this pattern. In conclusion, the dairy and carbohydrate pattern may be associated with a reduced risk of hypertension whereas the western pattern may be associated with an increased risk of hypertension among Korean adults.
doi:10.4162/nrp.2013.7.3.224
PMCID: PMC3679332  PMID: 23766884
Dietary pattern; Korean adults; hypertension; nutrient intake; odd ratio
2.  Association between Dietary Patterns and the Indicators of Obesity among Chinese: A Cross-Sectional Study 
Nutrients  2015;7(9):7995-8009.
No previous study has investigated dietary pattern in association with obesity risk in a middle-aged Chinese population. The purpose of this study was to evaluate the associations between dietary patterns and the risk of obesity in the city of Hangzhou, the capital of Zhejiang Province, east China. In this cross-sectional study of 2560 subjects aged 45–60 years, dietary intakes were evaluated using a semi-quantitative food frequency questionnaire (FFQ). All anthropometric measurements were obtained using standardized procedures. The partial correlation analysis was performed to assess the associations between dietary patterns and body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR). Multivariate logistic regression analysis was used to examine the associations between dietary patterns and obesity, with adjustment for potential confounders. Four major dietary patterns were extracted by means of factor analysis: animal food, traditional Chinese, western fast-food, and high-salt patterns. The animal food pattern was positively associated with BMI (r = 0.082, 0.144, respectively, p < 0.05) and WC (r = 0.102, 0.132, respectively, p < 0.01), and the traditional Chinese pattern was inversely associated with BMI (r = −0.047, −0.116, respectively, p < 0.05) and WC (r = −0.067, −0.113, respectively, p < 0.05) in both genders. After controlling for potential confounders, subjects in the highest quartile of animal food pattern scores had a greater odds ratio for abdominal obesity (odds ratio (OR) = 1.67; 95% confidence interval (CI): 1.188–2.340; p < 0.01), in comparison to those from the lowest quartile. Compared with the lowest quartile of the traditional Chinese pattern, the highest quartile had a lower odds ratio for abdominal obesity (OR = 0.63; 95% CI: 0.441–0.901, p < 0.05). Conclusions: Our findings indicated that the animal food pattern was associated with a higher risk of abdominal obesity, while the traditional Chinese pattern was associated with a lower risk of abdominal obesity. Further prospective studies are warranted to confirm these findings.
doi:10.3390/nu7095376
PMCID: PMC4586571  PMID: 26393646
dietary patterns; obesity; China; cross-sectional study; factor analysis
3.  Association between Dietary Patterns and the Risk of Hypertension among Chinese: A Cross-Sectional Study 
Nutrients  2016;8(4):239.
Epidemiological studies of different dietary patterns and the risk of hypertension among a middle-aged Chinese population remain extremely scare. Thus, the aim of this study was to identify dietary patterns and investigate the relationship between dietary patterns and the risk of hypertension among Chinese adults aged 45–60 years. The present cross-sectional study includes 2560 participants who reported their dietary intake using a validated food frequency questionnaire (FFQ). Dietary patterns were identified using factor analysis. Anthropometric measurements were obtained using standardized procedures. We used log-binomial regression analysis to examine the associations between dietary patterns and hypertension risk. Four major dietary patterns were identified and labeled as traditional Chinese, animal food, western fast-food, and high-salt patterns. After adjusting for potential confounders, participants in the highest quartile of animal food pattern scores had a greater prevalence ratio (PR) for hypertension (PR = 1.26; 95% confidence interval (CI): 1.064–1.727; p < 0.05) in comparison to those from the lowest quartile. Compared with the lowest quartile of high-salt pattern, the highest quartile had a higher prevalence ratio for hypertension (PR = 1.12; 95% CI: 1.013–1.635; p < 0.05). Conclusions: Our findings indicated that animal food and high-salt patterns were associated with increased risk of hypertension, while traditional Chinese and western fast-food patterns were not associated with the risk of hypertension. Further prospective studies are warranted to confirm these findings.
doi:10.3390/nu8040239
PMCID: PMC4848707  PMID: 27120612
dietary patterns; hypertension; middle-aged population; factor analysis
4.  Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study 
BMC Public Health  2016;16:743.
Background
Few studies explored the effects of nutritional changes on body mass index (BMI), weight (Wt), waist circumference (WC) and hypertension, especially for the older Chinese population.
Methods
By using China Health and Nutrition Survey 2004-2011 waves, a total of 6348 observations aged ≥ 60 were involved in the study. The number of participants dropped from 2197 in 2004, to 1763 in 2006, 1303 in 2009, and 1085 in 2011. Dietary information was obtained from participants using 24 hour-recall over three consecutive days. Height, Wt, WC, systolic and diastolic blood pressure were also measured in each survey year.
The dietary pattern was derived by exploratory factor analysis using principal component analysis methods. Linear Mixed Models were used to investigate associations of dietary patterns with BMI, Wt and WC. Generalized Estimating Equation models were used to assess the associations between dietary patterns and hypertension.
Results
Over time, older people’s diets were shifting towards a modern dietary pattern (high intake of dairy, fruit, cakes and fast food). Traditional and modern dietary patterns had distinct associations with BMI, Wt and WC. Participants with a diet in the highest quartile for traditional composition had a β (difference in mean) of −0.23 (95 % CI: −0.44; −0.02) for BMI decrease, β of −0.90 (95 % CI: −1.42; −0.37) for Wt decrease; and β of −1.57 (95 % CI: −2.32; −0.83) for WC decrease. However, participants with a diet in the highest quartile for modern diet had a β of 0.29 (95 % CI: 0.12; 0.47) for BMI increase; β of 1.02 (95 % CI: 0.58; 1.46) for Wt increase; and β of 1.44 (95 % CI: 0.78; 2.10) for Wt increase. No significant associations were found between dietary patterns and hypertension.
Conclusions
We elucidate the associations between dietary pattern and change in BMI, Wt, WC and hypertension in a 7-year follow-up study. The strong association between favourable body composition and traditional diet, compared with an increase in BMI, WC and Wt with modern diet suggests that there is an urgent need to develop age-specific dietary guideline for older Chinese people.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-3425-y) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-016-3425-y
PMCID: PMC4977626  PMID: 27502827
Dietary pattern; Body mass index; Waist circumference; Hypertension; Older people
5.  THE ASSOCIATION OF NEIGHBORHOOD CHARACTERISTICS WITH OBESITY AND METABOLIC CONDITIONS IN OLDER WOMEN 
Objective
Previous studies exploring the relationship of neighborhood characteristics with metabolic conditions have focused on middle-aged adults but none have comprehensively investigated associations in older adults, a potentially vulnerable population. The aim was to explore the relationship of neighborhood characteristics with metabolic conditions in older women.
Design
Cross-sectional analysis.
Setting/Participants
We studied 384 women aged 70–79 years, representing the two-thirds least disabled women in the community, enrolled in the Women’s Health and Aging Study II at baseline. Neighborhood scores were calculated from census-derived data on median household income, median house value, percent earning interest income, percent completing high school, percent completing college, and percent with managerial or executive occupation. Participants were categorized by quartile of neighborhood score with a higher quartile representing relative neighborhood advantage. Logistic regression models were created to assess the association of neighborhood quartiles to outcomes, adjusting for key covariates.
Measurements
Primary outcomes included metabolic conditions: obesity, diabetes, hypertension, and hyperlipidemia. Secondary outcomes included BMI, HbA1c, blood pressure and lipids.
Results
Higher neighborhood quartile score was associated with a lower prevalence of obesity (highest quartile=13.5% versus lowest quartile=36.5%; p<0.001 for trend). A lower prevalence of diabetes was also observed in highest (6.3%) versus lowest (14.4%) neighborhood quartiles, but was not significantly different (p= 0.24 for trend). Highest versus lowest neighborhood quartile was associated with lower HbA1c (−0.31%, p=0.02) in unadjusted models. Women in the highest versus lowest neighborhood quartile had lower BMI (−2.01 kg/m2, p=0.001) and higher HDL-cholesterol (+6.09 mg/dL, p=0.01) after accounting for age, race, inflammation, and smoking.
Conclusion
Worse neighborhood characteristics are associated with adiposity, hyperglycemia, and low HDL. Further longitudinal studies are needed and can inform future interventions to improve metabolic status in older adults.
doi:10.1007/s12603-014-0477-5
PMCID: PMC4414394  PMID: 25389956
Neighborhood; elderly; obesity; diabetes; metabolic abnormalities
6.  Dietary Patterns Modulate the Risk of Non-Alcoholic Fatty Liver Disease in Chinese Adults 
Nutrients  2015;7(6):4778-4791.
Although previous studies reported the associations between the intakes of individual foods or nutrients and the risk of non-alcoholic fatty liver disease (NAFLD), the relationship between dietary patterns and NAFLD in the Chinese population has been rarely studied to date. This study aimed to investigate the associations between dietary patterns and the risk of NAFLD in a middle-aged Chinese population. The Study subjects were 999 Chinese adults aged 45–60 years in the Anhui province who participated in the Hefei Nutrition and Health Study. Dietary intake was collected by a semi-quantitative food frequency questionnaire. NAFLD was defined as the presence of moderate-severe hepatic steatosis (by B-ultrasonic examination); the absence of excessive alcohol use (>20 g day−1 in men and 10 g day−1 in women); no use of steatogenic medications within the past six months; no exposure to hepatotoxins; and no history of bariatric surgery. Log-binomial regression analysis was used to examine the association between dietary patterns and NAFLD with adjustment of potential confounding variables. Out of 999 participants, 345 (34.5%) were classified as having NAFLD. Four major dietary patterns were identified: “Traditional Chinese”, “Animal food”, “Grains-vegetables” and “High-salt” dietary patterns. After adjusting for potential confounders, subjects in the highest quartile of the “Animal food” pattern scores had greater prevalence ratio for NAFLD (prevalence ratio (PR) = 1.354; 95% confidence interval (CI): 1.063–1.724; p < 0.05) than did those in the lowest quartile. After adjustment for body mass index (BMI), compared with the lowest quartile of the “Grains-vegetables” pattern, the highest quartile had a lower prevalence ratio for NAFLD (PR = 0.777; 95% CI: 0.618–0.977, p < 0.05). However, the “traditional Chinese” and “high-salt” dietary patterns showed no association with the risk of NAFLD. Our findings indicated that the “Animal food” dietary pattern was associated with an increased risk of NAFLD.
doi:10.3390/nu7064778
PMCID: PMC4488813  PMID: 26083112
dietary patterns; factor analysis; non-alcoholic fatty liver disease; China
7.  Association of dietary pattern and body weight with blood pressure in Jiangsu Province, China 
BMC Public Health  2014;14:948.
Background
To identify risk factors, associations between dietary patterns, body mass index (BMI), and hypertension in a Chinese population.
Methods
Dietary intake was assessed in 2518 adults by a 3-day 24 h recall and a food frequency questionnaire. Salt and oil intake was assessed by weighing records. Four dietary patterns were identified using principal component analysis. Overweight and obesity was determined according to the Chinese cut-offs for BMI. High blood pressure was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Prevalence ratios (PR) were calculated using Poisson regression.
Results
Of the subjects, 26.7% had high blood pressure. Subjects with overweight and obesity were more likely to have high blood pressure than those with normal weight (PR, 95% CI: 1.60, 1.40-1.87; 2.45, 2.11-2.85, respectively). Subjects with a ‘traditional’ dietary pattern were more likely to have high blood pressure (P for trend = 0.001), whereas those with a ‘macho’ or ‘sweet tooth’ dietary pattern were less likely to have high blood pressure (P for trend = 0.004 and <0.001, respectively). More than half of the population had salt intakes > 9 g/d, and blood pressure increased with salt intake (P for trend <0.001). Subjects with a ‘traditional’ dietary pattern had the highest salt intake (12.3 g/d).
Conclusion
A traditional dietary pattern is associated with high blood pressure among the population of Jiangsu Province, which may be mainly due to high salt intake. Moreover, high BMI is an important determinant of high blood pressure. Both issues need to be addressed by lifestyle interventions.
doi:10.1186/1471-2458-14-948
PMCID: PMC4176575  PMID: 25216777
Dietary pattern; Body weight; Salt; Blood pressure; China
8.  Association of Dietary Patterns With Albuminuria and Kidney Function Decline in Older White Women: A Subgroup Analysis From the Nurses’ Health Study 
Background
Dietary patterns have been linked to chronic diseases such as cardiovascular disease, but sparse data are currently available on associations between dietary patterns and microalbuminuria or kidney function decline.
Study Design
Subgroup analysis from a prospective observational cohort study
Setting and Participants
Female participants in the Nurses’ Health Study who had dietary patterns data from food frequency questionnaires returned in 1984, 1986, 1990, 1994, and 1998 and urinary albumin-creatinine ratios (ACR) from the year 2000 (n=3121); estimated glomerular filtration rate (eGFR) change between 1989 and 2000 was available in 3071.
Predictor
Prudent (higher intake of fruits, vegetables, legumes, fish, poultry, and whole grains), Western (higher intake of red and processed meats, saturated fats, and sweets), and Dietary Approach to Stop Hypertension (DASH) style dietary patterns (also greater intake of vegetables, fruits, and whole grains).
Outcomes and Measurements
Microalbuminuria (albumin-to-creatinine ratio 25 to 354 mcg/mg) in 2000 and change in kidney function by eGFR between 1989 and 2000.
Results
After multivariable adjustment, the highest quartile of Western pattern score compared to the lowest quartile was directly associated with microalbuminuria (OR, 2.17; 95% CI, 1.18 to 3.66; p-for trend=0.01) and rapid eGFR decline of ≥3 ml/min/1.73 m2 per year (OR, 1.77; 95% CI, 1.03 to 3.03). Women in the top quartile of the DASH score had decreased risk for rapid eGFR decline (OR, 0.55; 95% CI, 0.38 to 0.80), but had no association with microalbuminuria. These associations did not vary with diabetes status. The prudent dietary pattern was not associated with microalbuminuria or eGFR decline.
Limitations
Study cohort included primarily older white women and generalizability of results would benefit from validation in non-whites and men.
Conclusions
A Western dietary pattern is associated with a significantly elevated risk for microalbuminuria and rapid kidney function decline whereas a DASH-style dietary pattern may be protective against rapid eGFR decline.
doi:10.1053/j.ajkd.2010.09.027
PMCID: PMC3026604  PMID: 21251540
9.  Dietary Patterns of Korean Adults and the Prevalence of Metabolic Syndrome: A Cross-Sectional Study 
PLoS ONE  2014;9(11):e111593.
The prevalence of metabolic syndrome has been increasing in Korea and has been associated with dietary habits. The aim of our study was to identify the relationship between dietary patterns and the prevalence of metabolic syndrome. Using a validated food frequency questionnaire, we employed a cross-sectional design to assess the dietary intake of 1257 Korean adults aged 31 to 70 years. To determine the participants’ dietary patterns, we considered 37 predefined food groups in principal components analysis. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III. The abdominal obesity criterion was modified using Asian guidelines. Prevalence ratios and 95% confidence intervals for the metabolic syndrome were calculated across the quartiles of dietary pattern scores using log binomial regression models. The covariates used in the model were age, sex, total energy intake, tobacco intake, alcohol consumption, and physical activity. The prevalence of metabolic syndrome was 19.8% in men and 14.1% in women. The PCA identified three distinct dietary patterns: the ‘traditional’ pattern, the ‘meat’ pattern, and the ‘snack’ pattern. There was an association of increasing waist circumference and body mass index with increasing score in the meat dietary pattern. The multivariate-adjusted prevalence ratio of metabolic syndrome for the highest quartile of the meat pattern in comparison with the lowest quartile was 1.47 (95% CI: 1.00–2.15, p for trend = 0.016). A positive association between the prevalence of metabolic syndrome and the dietary pattern score was found only for men with the meat dietary pattern (2.15, 95% CI: 1.10–4.21, p for trend = 0.005). The traditional pattern and the snack pattern were not associated with an increased prevalence of metabolic syndrome. The meat dietary pattern was associated with a higher prevalence of metabolic syndrome in Korean male adults.
doi:10.1371/journal.pone.0111593
PMCID: PMC4218781  PMID: 25365577
10.  Associations between dietary patterns and demographics, lifestyle, anthropometry and blood pressure in Chinese community-dwelling older men and women 
This cross-sectional study examined dietary patterns, and the associations of these patterns with demographics, lifestyle, anthropometry and blood pressure in 3707 Chinese people aged 65 years and above taking part in a population-based cohort study investigating the risk factors for osteoporosis. Baseline dietary data were collected using a validated FFQ. Dietary patterns were identified using factor analysis. Scores were calculated for each pattern. Demographics, lifestyle factors and self-reported hypertension history were collected through a questionnaire. BMI, waist circumference (WC), hip circumference (HC), waist-to-hip ratio, systolic blood pressure and diastolic blood pressure (DBP) were measured. Three dietary patterns were identified, namely ‘vegetables–fruit’, ‘snacks–drinks–milk products’ and ‘meat–fish’. Participants who were more physically active, more educated, non-smokers and non-drinkers were more likely to have higher ‘vegetables–fruit’ dietary pattern scores. Current smoking habit and alcohol use were associated with higher ‘snacks–drinks–milk products’ dietary pattern scores and ‘meat–fish’ dietary pattern scores. ‘Vegetables–fruit’ dietary pattern scores were inversely (unstandardised regression coefficient B = −0·60 mmHg, 95 % CI −1·04, −0·16) and ‘snacks–drinks–milk products’ dietary pattern scores were positively (B = 0·50 mmHg, 95 % CI 0·08, 0·92) associated with DBP in men in multiple regressions. Higher ‘meat–fish’ dietary pattern scores were associated with higher BMI (B = 0·19 kg/m2, 95 % CI 0·06, 0·33), waist-to-hip ratio (B = 0·004, 95 % CI 0·002, 0·007) and WC (B = 0·57 cm, 95 % CI 0·18, 0·97) in men, and higher BMI (B = 0·40 kg/m2, 95 % CI 0·22, 0·57), WC (B = 0·87 cm, 95 % CI 0·39, 1·36) and HC (B = 0·61 cm, 95 % CI 0·26, 0·96) in women in multiple regressions. The influence of demographic and lifestyle characteristics on dietary patterns and the health risks associated with dietary patterns provides insights for the provision of tangible dietary advice to this population.
doi:10.1017/jns.2012.19
PMCID: PMC4153085  PMID: 25191550
Dietary patterns; Factor analysis; Cross-sectional studies; Chinese elderly; DBP, diastolic blood pressure; PASE, Physical Activity Scale for the Elderly; SES, socio-economic status; WC, waist circumference
11.  Healthful dietary patterns and type 2 diabetes risk among women with a history of gestational diabetes 
Archives of internal medicine  2012;172(20):1566-1572.
Background
Type 2 diabetes (T2DM) has reached epidemic proportions. Women with gestational diabetes mellitus (GDM) are at high risk for T2DM after pregnancy. Adherence to healthful dietary patterns has been inversely associated with T2DM in the general population; however whether these dietary patterns are associated with progression to T2DM among a susceptible population is unknown.
Methods
4,413 participants from the Nurses’ Health Study II cohort with prior GDM were followed from 1991–2005. The alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary pattern adherence scores were derived from post-GDM validated food-frequency questionnaire, with cumulative average updating every 4 years. Multivariable Cox proportional hazards models estimated the relative risk (HR) and 95% confidence intervals [95% CI].
Results
491 cases of incident T2DM were observed over 52,743 person-years. All three patterns were inversely associated with T2DM risk adjusting for age, total calories, age at first birth, parity, ethnicity, parental diabetes, oral contraceptive use, menopause, and smoking. Comparing participants with highest adherence (quartile 4) versus lowest (quartile 1), the aMED pattern was associated with 40% lower risk of T2DM (HR=0.60 [95% CI: 0.44, 0.82] p-trend=0.0019), DASH with 46% lower risk (HR=0.54 [95% CI: 0.39, 0.73] p-trend=0.0002), and aHEI with 57% lower risk (HR=0.43 [95% CI: 0.31, 0.59] p-trend<0.0001). Adjustment for body mass index (BMI) moderately attenuated these findings.
Conclusions
Adherence to healthful dietary patterns is associated with lower T2DM risk among women with a history of GDM. The inverse associations were partly mediated by BMI.
doi:10.1001/archinternmed.2012.3747
PMCID: PMC3774782  PMID: 22987062
12.  Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young Black and White women 
Nutrition Journal  2008;7:35.
Background
The prevalence of hypertension and its contribution to cardiovascular disease risk makes it imperative to identify factors that may help prevent this disorder. Extensive biological and biochemical data suggest that plasma ascorbic acid may be such a factor. In this study we examined the association between plasma ascorbic acid concentration and blood pressure (BP) in young-adult women.
Methods
Participants were 242 Black and White women aged 18–21 yr from the Richmond, CA, cohort of the National Heart, Lung and Blood Institute Growth and Health Study. We examined the associations of plasma ascorbic acid with BP at follow-up year 10, and with change in BP during the previous year.
Results
In cross-sectional analysis, plasma ascorbic acid at year 10 was inversely associated with systolic BP and diastolic BP after adjusting for race, body mass index, education, and dietary intake of fat and sodium. Persons in the highest one-fourth of the plasma ascorbic acid distribution had 4.66 mmHg lower systolic BP (95% CI 1.10 to 8.22 mmHg, p = 0.005) and 6.04 mmHg lower diastolic BP (95% CI 2.70 to 9.38 mmHg, p = 0.0002) than those in the lowest one-fourth of the distribution. In analysis of the change in BP, plasma ascorbic acid was also inversely associated with change in systolic BP and diastolic BP during the previous year. While diastolic blood pressure among persons in the lowest quartile of plasma ascorbic acid increased by 5.97 mmHg (95% CI 3.82 to 8.13 mmHg) from year 9 to year 10, those in the highest quartile of plasma vitamin C increased by only 0.23 mmHg (95% CI -1.90 to +2.36 mmHg) (test for linear trend: p < 0.0001). A similar effect was seen for change in systolic BP, p = 0.005.
Conclusion
Plasma ascorbic acid was found to be inversely associated with BP and change in BP during the prior year. The findings suggest the possibility that vitamin C may influence BP in healthy young adults. Since lower BP in young adulthood may lead to lower BP and decreased incidence of age-associated vascular events in older adults, further investigation of treatment effects of vitamin C on BP regulation in young adults is warranted.
doi:10.1186/1475-2891-7-35
PMCID: PMC2621233  PMID: 19091068
13.  Association of Magnesium Intake with High Blood Pressure in Korean Adults: Korea National Health and Nutrition Examination Survey 2007–2009 
PLoS ONE  2015;10(6):e0130405.
Background
Magnesium is known to lower the risk of cardiovascular disease. However, studies on its relationship with hypertension, a single and common cause of various chronic diseases, are limited and their findings are not consistent. The purpose of the present study is to identify the relationship between magnesium intake and high blood pressure (HBP) risk in Koreans.
Methods
This research is a cross-sectional study based on the 2007~2009 Korean National Health and Nutritional Examination Survey data. This study investigated 11,685 adults aged over 20 to examine their general characteristics, anthropometry and blood pressure. Daily magnesium intake was analyzed using the 24-hour dietary recall method. To calculate the odds ratio (OR) of HBP risk (130/85 mmHg or over) according to the quartile of magnesium intake (mg/1000kcal) together with its 95% confidence interval (CI), multivariable logistic regression analysis was performed.
Results
No significant association between dietary magnesium intake and the risk of HBP was found. In obese women, particularly, after adjusting relevant factors, the adjusted odds ratio of HBP prevalence in the highest magnesium intake quartile was 0.40 compared with the lowest magnesium intake quartile (95% CI = 0.25~0.63, P for trend = 0.0014). Women, especially obese women, were found to have a negative relationship of magnesium intake with HBP.
Conclusions
The present results indicate that sufficient magnesium intake could be useful in decreasing the high blood pressure risk of obese women.
doi:10.1371/journal.pone.0130405
PMCID: PMC4468246  PMID: 26075385
14.  Dietary Patterns and Risk for Metabolic Syndrome in Korean Women 
Medicine  2015;94(34):e1424.
Abstract
Dietary patterns are a risk factor for metabolic syndrome (MetS). The prevalence of MetS has increased in Korea, and this condition has become a public health issue. Therefore, the present cross-sectional study aimed to identify the associations between dietary patterns and the risk of MetS among Korean women.
The data of 5189 participants were analyzed to determine dietary intake and lifestyle. A principal components analysis was employed to determine participant dietary patterns with regard to 106 food items. MetS was diagnosed using the National Cholesterol Education Program, Adult Treatment Panel III. Logistic regression analyses were applied to evaluate the associations between dietary pattern quintiles and MetS and to generate odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for potential confounders.
Three dietary patterns were identified: “traditional,” “western,” and “prudent.” The “prudent” dietary pattern consisted of a high intake of fruits and fruit products as well as nuts, dairy, and a low consumption of grains; this pattern was negatively associated with the risk of MetS. The highest quintile of the “prudent” dietary pattern was significantly less likely to develop MetS (OR: 0.5, 95% CI: 0.36–0.68, P for trend <0.001) compared with the lowest quintile. This pattern was also negatively associated with all of the MetS diagnostic criteria: abdominal obesity (OR: 0.52, 95% CI: 0.41–0.65), blood pressure (OR: 0.72, 95% CI: 0.59–0.87), triglycerides (OR: 0.67, 95% CI: 0.52–0.85), fasting glucose (OR: 0.64, 95% CI: 0.43–0.95), and high-density lipoprotein cholesterol (OR: 0.53, 95% CI: 0.42–0.68). However, the “traditional” and “western” dietary patterns were not associated with the risk of MetS.
The “prudent” dietary pattern was negatively associated with the risk of developing MetS among Korean women.
doi:10.1097/MD.0000000000001424
PMCID: PMC4602901  PMID: 26313795
15.  Serum Vitamin D Level and Prehypertension among Subjects Free of Hypertension 
Kidney & Blood Pressure Research  2011;35(2):106-113.
Background
Low serum vitamin D levels are associated with high blood pressure (BP). Prehypertension is a preclinical stage where primary prevention efforts have been recommended for delaying or preventing the onset of hypertension. However, the majority of studies examining the association between vitamin D and BP have not accounted for kidney function or systemic inflammation.
Methods
Participants of the 3rd National Health and Nutrition Examination Survey >20 years of age and free of hypertension (n = 9,215, 53.5% women) and clinical cardiovascular disease were examined. Serum vitamin D levels were analyzed as quartiles. Prehypertension (n = 3,712) was defined as systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg.
Results
Lower serum vitamin D levels were found to be associated with prehypertension independent of potential confounders including body mass index (BMI), serum cholesterol, C-reactive protein and estimated glomerular filtration rate. Compared to the highest quartile of serum vitamin D (referent), the odds ratio (95% confidence interval) of prehypertension associated with the lowest quartile was 1.48 (1.16–1.90; p trend <0.0001). This association persisted in subgroup analyses by gender, race-ethnicity and BMI.
Conclusion
Lower serum vitamin D levels are associated with prehypertension in a representative sample of US adults.
doi:10.1159/000330716
PMCID: PMC3221248  PMID: 21934326
Vitamin D; Blood pressure; Prehypertension
16.  Serum 25-Hydroxyvitamin D Levels and Prediabetes Among Subjects Free of Diabetes 
Diabetes Care  2011;34(5):1114-1119.
OBJECTIVE
Animal studies suggest that low serum 25-hydroxyvitamin D (25[OH]D) may impair insulin synthesis and secretion and be involved in the pathogenesis of diabetes. Results in studies in humans have not been consistent, however. Prediabetes is a stage earlier in the hyperglycemia/diabetes continuum where individuals are at increased risk of developing diabetes and where prevention efforts have been shown to be effective in delaying or preventing the onset of diabetes. However, previous studies have not examined the association between low serum 25(OH)D levels and prediabetes.
RESEARCH DESIGN AND METHODS
We examined the 12,719 participants (52.5% women) in the third National Health and Nutrition Examination Survey aged >20 years who were free of diabetes. Serum 25(OH)D levels were categorized into quartiles (≤17.7, 17.8–24.5, 24.6–32.4, >32.4 ng/mL). Prediabetes was defined as a 2-h glucose concentration of 140–199 mg/dL, or a fasting glucose concentration of 110–125 mg/dL, or an A1C value of 5.7–6.4%.
RESULTS
Lower serum 25(OH)D levels were associated with prediabetes after adjusting for age, sex, race/ethnicity, season, geographic region, smoking, alcohol intake, BMI, outdoor physical activity, milk consumption, dietary vitamin D, blood pressure, serum cholesterol, C-reactive protein, and glomerular filtration rate. Compared with quartile 4 of 25(OH)D (referent), the odds ratio of prediabetes associated with quartile 1 was 1.47 (95% CI 1.16–1.85; P = 0.001 for trend). Subgroup analyses examining the relation between 25(OH)D and prediabetes by sex, BMI, and hypertension categories also showed a consistent positive association.
CONCLUSIONS
Lower serum 25(OH)D levels are associated with prediabetes in a representative sample of U.S. adults.
doi:10.2337/dc10-1203
PMCID: PMC3114501  PMID: 21430085
17.  Major Dietary Patterns and Their Associations with Overweight and Obesity Among Iranian Children 
Background:
Increasing prevalence of obesity is a major health concern. Lifestyle behaviors and diet play an important role in developing childhood obesity. The aim of this study was to determine the association between major dietary patterns and overweight/obesity in a group of Iranian school-aged children.
Methods:
This cross-sectional study was conducted in Isfahan, Iran with 637 elementary school-aged children. A semi-quantitative food-frequency questionnaire was used to assess usual dietary intakes. Data on socio-demographic, physical activity and other lifestyle habits were collected using standard questionnaires. Obesity was determined based on national cut-offs. Factor analysis was used for identifying major dietary patterns.
Results:
Three major dietary patterns were extracted; “Healthy,” “Western,” and “Sweet-Dairy.” After adjusting for confounders, girls in the second quartile of healthy pattern, were more likely to be overweight (odds ratio [OR] =2.23, Confidence intervals [CI] =1.003, 4.96) compared to those in the highest quartile. Likelihood of being overweight was lower for girls in the second quartile of western dietary pattern versus the fourth quartile (OR = 0.46, CI = 0.21, 1.01). Accordingly, lower adherence to sweet and dairy pattern was associated with lower body mass index (BMI) among girls (OR = 0.42, CI = 0.21, 0.85). There was no significant relationship between western and sweet-dairy pattern with BMI among boys, however, significant association was observed between lowest and highest quartiles of healthy pattern (OR = 0.36, CI = 0.15, 0.84).
Conclusions:
We found significant associations between the three dietary patterns and obesity among girls. Only healthy pattern was related to weight status of schoolboys. Longitudinal studies will be needed to confirm these associations.
PMCID: PMC3650598  PMID: 23671778
Children; dietary patterns; factor analysis; obesity; overweight
18.  Association between dietary patterns and metabolic syndrome in Chinese adults: a propensity score-matched case-control study 
Scientific Reports  2016;6:34748.
Previous studies indicated that dietary patterns were associated with metabolic syndrome (MS), but little is known in Chinese. We design this case-control study to evaluate the associations between dietary patterns and MS in Chinese adults. In this study, 1492 participants with MS were matched with 1492 controls using the 1:1 ratio propensity score matching methods. Dietary intake was assessed using a valid self-administered food frequency questionnaire, and MS was defined in accordance with the criteria of the American Heart Association scientific statement of 2009. Higher scores for the high-protein/cholesterol pattern were associated with higher prevalence of MS. Compared with the participants in the lowest quartile, the odds ratio (OR) for the extreme quartile was 1.36 (95% confidence interval (CI), 1.10–1.68) and the P for trend <0.01 after adjusted for the other two dietary pattern scores. We also found a moderate consumption of the balanced pattern was associated with the lowest prevalence of MS. The ORs across quartiles of the balanced pattern were 1 (reference), 0.83 (95% CI, 0.68–1.02), 0.69 (95% CI, 0.56–0.85), and 0.84 (95% CI, 0.68–1.04) after adjustment. Our study demonstrates that there is a strong association between a diet rich in animal offal, animal blood, meat, and sausage and a higher prevalence of MS.
doi:10.1038/srep34748
PMCID: PMC5052517  PMID: 27708414
19.  Genome-Wide Association Study Identifies Eight Novel Loci Associated with Blood Pressure Responses to Interventions in Han Chinese 
Background
Blood pressure (BP) responses to dietary sodium and potassium intervention and cold pressor test (CPT) vary considerably among individuals. We aimed to identify novel genetic variants influencing individuals’ BP responses to dietary intervention and CPT.
Methods and Results
We conducted a genome-wide association study of BP responses in 1,881 Han Chinese and de novo genotyped top findings in 698 Han Chinese. Diet-feeding study included a 7-day low-sodium (51.3 mmol/day), a 7-day high-sodium (307.8 mmol/day), and a 7-day high-sodium plus potassium-supplementation (60 mmol/day). Nine BP measurements were obtained during baseline observation and each intervention period. The meta-analyses identified eight novel loci for BP phenotypes, which physically mapped in or near PRMT6 (P=7.29×10−9), CDCA7 (P=3.57×10−8), PIBF1 (P=1.78×10−9), ARL4C (P=1.86×10−8), IRAK1BP1 (P=1.44×10−10), SALL1 (P=7.01×10−13), TRPM8 (P=2.68×10−8), and FBXL13 (P=3.74×10−9). There was a strong dose-response relationship between the number of risk alleles of these independent SNPs and the risk of developing hypertension over 7.5-year follow-up in the study participants. Compared to those in the lowest quartile of risk alleles, odds ratios (95% confidence intervals) for those in the second, third and fourth quartiles were 1.39 (0.97, 1.99), 1.72 (1.19, 2.47), and 1.84 (1.29, 2.62), respectively (P=0.0003 for trend).
Conclusions
Our study identified 8 novel loci for BP responses to dietary sodium and potassium intervention and CPT. The effect size of these novel loci on BP phenotypes are much larger than those reported by the previously published studies. Furthermore, these variants predict the risk of developing hypertension among individuals with normal BP at baseline.
doi:10.1161/CIRCGENETICS.113.000307
PMCID: PMC3952335  PMID: 24165912
blood pressure; genomics; sodium; potassium
20.  A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India 
Nutrition Journal  2011;10:12.
Background
The role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.
Methods
The India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.
Results
Across the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); Ptrend = 0.008] and hypertension [2.20 (1.47-3.31); Ptrend < 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); Ptrend = 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); Ptrend = 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); Ptrend = 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.
Conclusions
Cardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.
doi:10.1186/1475-2891-10-12
PMCID: PMC3042918  PMID: 21276235
21.  Dietary glycemic index, glycemic load and incidence of type 2 diabetes in Japanese men and women: the Japan public health center-based prospective study 
Nutrition Journal  2013;12:165.
Background
Japanese diets contain a relatively high amount of carbohydrates, and its high dietary glycemic index and glycemic load may raise the risk of diabetes in the Japanese population. The current study evaluated the associations between the dietary glycemic index, glycemic load, and the risk of type 2 diabetes in a population based cohort in Japan.
Methods
We observed 27,769 men and 36,864 women (45–75 y) who participated in the second survey of the Japan Public Health Center-based Prospective Study. The dietary glycemic index and glycemic load were estimated using a food-frequency questionnaire. The development of diabetes was reported in a questionnaire administered five years later, and the associations were analyzed using logistic regression after controlling for age, area, total energy intake, smoking status, family history of diabetes, physical activity, hypertension, BMI, alcohol intake, magnesium, calcium, dietary fiber and coffee intake, and occupation.
Results
The dietary glycemic load was positively associated with the risk of diabetes among women: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.52 (95% CI, 1.13-2.04; P-trend = 0.01). The association was implied to be stronger among women with BMI < 25 than the women with BMI ≥ 25. The dietary glycemic index was positively associated with the risk of diabetes among men with a high intake of total fat: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.46 (95% CI, 0.94-2.28; P-trend = 0.04). Among women with a high total fat intake, those in the first and second quartiles of the dietary glycemic index had a significant reduced risk of diabetes, compared with those in the first quartile who had a lower total fat level (multivariable-adjusted odds ratio = 0.59 with 95% CI, 0.37-0.94, and odds ratio = 0.63 with 95% CI, 0.40-0.998 respectively).
Conclusions
The population-based cohort study in Japan indicated that diets with a high dietary glycemic load increase the risk of type 2 diabetes among women. Total fat intake may modify the association between the dietary glycemic index and the risk of type 2 diabetes among men and women.
doi:10.1186/1475-2891-12-165
PMCID: PMC4029149  PMID: 24370346
Dietary glycemic index; Dietary glycemic load; Diabetes Mellitus; Cohort study; Japanese
22.  Major Dietary Patterns in Relation to General and Central Obesity among Chinese Adults 
Nutrients  2015;7(7):5834-5849.
Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships.
doi:10.3390/nu7075253
PMCID: PMC4517030  PMID: 26184308
dietary pattern; general obesity; central obesity; body mass index; waist circumference; cross-sectional study
23.  Association between Dietary Sodium and Potassium Intake with Chronic Kidney Disease in U.S. Adults: A Cross-Sectional Study 
American journal of nephrology  2013;37(6):526-533.
Background/Aims
Clinical guidelines recommend a diet low in sodium and high in potassium to reduce blood pressure and cardiovascular events. Little is known about the relationship between dietary sodium and potassium intake and chronic kidney disease (CKD).
Methods
13,917 participants from the National Health and Nutrition Examination Survey (2001–2006) were examined. Sodium and potassium intake were calculated from 24-hour recall and evaluated in quartiles. CKD was defined as eGFR <60 mL/min, or eGFR ≥ 60mL/min with albuminuria (>30mg/g creatinine).
Results
The mean (SE) age and eGFR of participants was 45.0 ± 0.4 years and 88.0 ± 0.60 ml/min/1.73m2, respectively. 2333 (14.2%) had CKD: 1146 (7.3%) had an eGFR < 60 ml/min/1.73m2 and 1514 (8.4%) had an eGFR ≥ 60 ml/min/1.73 m2 and albuminuria. After adjustment for age, sex, race, body mass index, diabetes, hypertension, cardiovascular disease and congestive heart failure subjects in the highest quartile of sodium intake had a lower odds of CKD compared to subjects in the lowest quartile (adjusted OR 0.79, 95% CI, 0.66 to 0.96; p<0.016). Compared to the highest quartile, participants in the lowest quartile of potassium intake had a 44% increased odds of CKD (adjusted OR 1.44, 95% CI 1.16–1.79, p=0.0011).
Conclusions
Higher intake of sodium and potassium is associated with lower odds of CKD among US adults. These results should be corroborated through longitudinal studies and clinical trials designed specifically to examine the effects of dietary sodium and potassium intake on kidney disease and its progression.
doi:10.1159/000351178
PMCID: PMC3919025  PMID: 23689685
Chronic Kidney Disease; Dietary sodium intake; Dietary potassium intake
24.  High normal levels of albuminuria and risk of hypertension in Indo-Asian population 
Nephrology Dialysis Transplantation  2011;27(Suppl 3):iii58-iii64.
Background
Urine albumin excretion in the high normal range [urine albumin to creatinine ratio (UACR) 10–29 mg/g)] predicts hypertension in European-origin populations. However, the prognostic significance of UACR in the high normal range for incident hypertension is unclear in Indo-Asians. The objective of this study was to examine the relationship of normal to high normal levels of UACR and incident hypertension.
Methods
We conducted a nested cohort study within a cluster randomized controlled trial in Pakistan on 1272 normotensive non-diabetic adults aged ≥40 years with UACR <30 mg/g. Incident hypertension was defined as new onset of systolic blood pressure (SBP) ≥140 mmHg or diastolic ≥ 90 mmHg or initiation of antihypertensive therapy.
Results
A total of 920 (72.3%) participants completed the 2-year final follow-up. During this time, 105 (11.4%) developed incident hypertension. In the multivariable model, the odds [95% confidence interval (CI)] for incident hypertension were 2.45(1.21–4.98) for those in the fourth (top) quartile (≥6.1 mg/g) and 2.12 (1.04–4.35) in the third quartile (3.8–6.1 mg/g) compared to those in the lowest quartile (<2.8 mg/g). In addition, a significant interaction between UACR and baseline SBP was observed suggesting that the odds (95% CI) of incident hypertension with UACR were greater at lower baseline SBP (interaction P = 0.044).
Conclusions
High normal levels of albuminuria as measured by UACR predict hypertension in non-diabetic Indo-Asians, and this relationship may be enhanced in individuals with low baseline SBP. Further research is needed to assess the clinical applicability of these findings.
doi:10.1093/ndt/gfr200
PMCID: PMC3634393  PMID: 21592974
albuminuria; ethnicity; hypertension
25.  Relationship between Blood Mercury Level and Risk of Cardiovascular Diseases: Results from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2008–2009 
Limited epidemiologic data is available regarding the cardiovascular effects of mercury exposure. The purpose of this study was to determine the relationship between mercury exposure from fish consumption and cardiovascular disease in a nationally representative sample of Korean adults using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV 2008~2009). Survey logistic regression models accounting for the complex sampling were used to estimate the odds ratios (OR) adjusted for fish consumption frequency, age, education, individual annual income, household annual income, body mass index (BMI), waist circumference (WC), alcohol consumption status, and smoking status. The mean blood mercury level in the population was 5.44 μg/L. Trends toward increased blood mercury levels were seen for increased education level (P=0.0011), BMI (P<0.0001), WC (P<0.0001), and fish (i.e., anchovy) consumption frequency (P=0.0007). The unadjusted OR for hypertension in the highest blood mercury quartile was 1.450 [95% confidential interval (CI): 1.106~1.901] times higher than that of the lowest quartile. The fish consumption-adjusted OR for hypertension in the highest blood mercury quartile was 1.550 (95% CI: 1.131~2.123) times higher than that of the lowest quartile, and the OR for myocardial infarction or angina in the highest blood mercury quartile was 3.334 (95% CI: 1.338~8.308) times higher than that of the lowest quartile. No associations were observed between blood mercury levels and stroke. These findings suggest that mercury in the blood may be associated with an increased risk of hypertension and myocardial infarction or angina in the general Korean population.
doi:10.3746/pnf.2014.19.4.333
PMCID: PMC4287327  PMID: 25580399
blood mercury levels; cardiovascular disease; KNHANES; fish consumption

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