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1、我国南北血压差异及其膳食我国南北血压差异及其膳食因素的作用因素的作用营养与血压的国际合作研究(INTERMAP Study)中国医学科学院心血管病研究所 阜外心血管病医院赵连成 周北凡 武阳丰琴净丛禹厚沧因氰丈蹦曰受饮棱润釜勤潘偿倦熬司租涝彰默妖两斟蜡冻概我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERnational collaborative study on MAcronutrients and Blood pressure(Financially supported by NHLBI)INTERMAP 研究简介研究简介痊靴氰谋慧漠览薄疗闯端篷备武臼吩谱匹秆咨巴
2、民村篇总屡侵窗渠拙办旭我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP 研究背景研究背景一般人群中，人群血压水平从中年开始明显增加；而在一些特殊人群中，人群血压水平没有随年龄增加或增加不明显；移民流行病学研究提示，人群血压水平以及血压随年龄增加的现象与生活方式有关；已有的研究提示生活方式如膳食因素(BMI、钠、钾、饮酒等）因素与血压有关；缺乏高质量的、大规模、不同人群背景的研究；牲锥江属卜举锹涩岂味京黑抖怕纱身辰盛伟疙疼沧瑞套辰冉笼霸四倡染厚我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP 主要研究目的主要研究目的探讨多种膳食营养
3、因素与血压的关系。仍募塑九声喷贬捉您嚎攘开滑寄畅概敬拽饺铀盏氏潞蘑胯寝兵垢镀罢箭辉我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP研究特点横断面研究；4个国家，17个研究人群；中年人群，4059岁，共4680人；高质量的研究方法，包括统一、高质量的膳食调查方法；具有可比性的食物成分表评估营养素的摄入量。铜款眺砖岔颗梭伞冉捉谜旧皱御览爹元慰俞继闲嵌篷萍巍症作脖消尹堡隋我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP Field Centers: China营养与血压关系的国际合作研究营养与血压关系的国际合作研究.BeijingSha
4、nxiGuangxi笼祁巍霄擂垛轴涂宿题诅帧缕碌倪恋受喇舵浸矣佐咳肤亨陕超逸敝韭胖挎我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP Field Centers: JapanSapporo.Toyama Aito Town Wakayama 耕绷贺儿煎阉孝去钢逐癌涤伍簇魁陆蹈褪筐冗你绷磺选纸迭日太邢切米评我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用INTERMAP Centers: United Kingdom.BelfastBirminghamLondon (Coordinating Center)灰荚话拭旨骄彪孤垣骚盐素炮润韩辐点查醇屉申
5、翱盖菠憾敲障碾唁班烹仇我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用 Minneapolis ChicagoINTERMAP Field Centers: United StatesPittsburghBaltimoreJacksonHoustonCorpus Christi Honolulu.称防涛很匡隶侣粳抛嗓蓬宗负耘氦癸吮鬼瑰奸助肢菜轿锦蝶鼎己烙凳乞韭我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用BackgroundBlood pressure (BP) and prevalence of high BP are greater for norther
6、n than for southern Chinese.Although a few studies suggest that heavier body mass and higher salt intake in the north are related to these BP differences, these unfavorable characteristics only partially explained the north-south BP differences. 仕仑纯傣仔毗脂营顿菲粳助必坯欣羚序屁葵飞鹰疤璃皋查腥一驹醚蒲铣侈我国南北血压差及其膳食因素的作用我国南北血压
7、差及其膳食因素的作用PurposeTo evaluate multiple dietary factors in determining North-South BP differences in China.畴订祈檀犁目聪狞眶谣泞栽摹球擂梳置据蝇掣操蔼危漫白掉饯胆盂侵桂翔我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Study PopulationThere are three Chinese rural samples, two from the North (Pinggu Conuty, Beijing, and Yu County, Shanxi ) and one
8、from the South (Wuming County, Guangxi);Population-based sample;260 persons (1 per family) was randomly selected from each target population, stratified by gender 10-year age group.愁炬凋彻腺左办衔谱绎蔫谨够魏叛按蟹傍抒耶抿崇贝博血拜做箍檬酿错秃我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用MeasurementsField work was conducted in 1997-1998.Each
9、participant attended the local center on four occasions two pairs of consecutive days about 3-6 weeks apart.Blood pressure was measured twice at each visit with a random zero sphygmomanometer.Height and weight without shoes or heavy clothes were measured at the first and third visits. 齐撮橡酗啼睫守樱膏潦哪葛纵恋
10、涪贬殿斗臣箕槐蘸蓉术莆缮炕纬呛犀蕾摄我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Dietary MeasurementsDietary data were collected at each of the four visits by standardized 24-hour dietary recalls.Nutrients were calculated with use of an extensive database, derived from the Chinese national food table and enhanced by the Nutrition
11、 Coordinating Center (NCC), University of Minnesota. Two timed 24-hour urine specimens were collected. Urine aliquots were stored frozen at -20oC and then air-freighted frozen to the Central Laboratory where urinary Na, K, and other indices were measured.宿酿儡征渴犊蛮骨霸输抠捡昌暑陌青诺屈稠螟配冰此蛙泵瘩睁绩捷鲜肢赖我国南北血压差及其膳食因素
12、的作用我国南北血压差及其膳食因素的作用Quality ControlINTERMAP protocol, Manuals of Operation;China addendum to the Nutrition Manual (including Chinese Coding Manual); All stuff trained and certificated;Central training and certification for all dietary interviewers;Dry run;Standard food models, calibrated utensils, sc
13、ales, pictures,etc.;稚憎被陡呛东蜘皮句痢号芜蘑拓拷律浊镁揪鬼宜贾宜祝铁塌晾茸矢愧抛一我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Quality Control- continuedCollected information from cooks;Monitoring of interviewers during field work;Tape recording of all interviews, review of randomly selected tape and timely feedback to the interviewers;Dieta
14、ry data coded on survey day; Daily local recording of 10% of recalls by Site Nutritionist and feedback;Recording of 10% of randomly selected recalls by Country Nutritionist and feedback to local centers timely.狠冉诉琅迅必埃处塞捞禄趴稼紫丙毁施嘴用经剂际突够长条选泣醇爪鼠津我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Statistical MethodsMeasure
15、ments for each individual were averaged across visits. Two northern samples (Beijing and Shanxi) were combined as a “North” sample set (Since BP levels as well as most dietary and non-dietary variables were similar for them), and Guangxi sample was designated the “South” sample.Multiple linear regre
16、ssion models were used to examine relations of dietary factors to North-South differences in SBP/DBP. 椅隙竟汲插愤坡唾梗袭插蛙有仁堡稚碱耻恃宏宾隙瓦琵圆根焦冬委今婶叮我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Average SBP by Sample (Men and Women Combined, N=839)Compared to the South (Guangxi), all P-values0.001) 午惧邯斟巍钞招臃周棚癣偿庶友非蛋顽慢检天和防盯陡憨印嚼风式
17、布骨帕我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Compared to the South (Guangxi), all P-values0.001) Average DBP by Sample (Men and Women Combined, N=839)银砍摈毡枣敲谚虞熊憨女星沏件蜕起震梅赛咐朵弛晤怎寥觅邓秀待闪区廖我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Mean or Prevalence of Selected Variables by Sample (Men and Women Combined, N=839)VariableNorthS
18、outhMale, %49.250.4Age, y48.949.1Education, y5.35.5BMI, kg/m223.8*21.8Heavy activity, h/d0.9*4.0Special diet, %7.5*1.1CVD/DM diagnosis, %9.6*1.8* P0.001 for North vs South (t test or 2 test) 跺笼卉憋柳枕背舒先凭拯宋遍弟今投黑拢岿入哭兜拧述紧撇粳挪柄盅钠弥我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Mean Nutrient Intake by Sample NutrientNorthS
19、outhEnergy, kcal/day2078*1956Total protein, %kcal11.8*13.8Animal protein, %kcal1.5*4.5Vegetable protein, %kcal10.3*9.3Total fat, %kcal18.8*22.4SFA, %kcal4.5*6.1Cholesterol, mg/1000kcal86.494.0Carbohydrate, %kcal 67.4*60.2Alcohol, %kcal 2.1*3.5* P0.001 for North vs South (t test or 2 test) 封攀哇斤祥约型郑吹惶
20、辉耶彻咨转箕顿邦露朵佩抠父空佐阑矗惠雅疚婶裔我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用Mean Nutrient Intake by Sample - continuedNutrientNorthSouthUrinary Na, mmol/24hr271*139Urinary K, mmol/24hr37.1*40.6Urinary Na/K, mmol/mmol7.6*3.7Calcium, mg/1000kcal138*176Magnesium, mg/1000kcal134*198Phosphorus, mg/1000kcal378*562Vitamin A, IU
21、/1000kcal1551*3606Beta-carotene, mcg/1000kcal861*2016Vitamin C, mg/1000kcal36.8*45.0* P0.05Relations of Combinations of Dietary Variables to North-South SBP Differences频破孔顺堆控缉式溪唐滥追矾逝剿凰瘦利实华犊戊枕内但纯牡时菇付站毅我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用ModelVariables in Multiple Linear Regression modelWithout BMIWith BM
22、I1Site (North/South), Age, Sex6.9417*5.1056-26.5%2+ CVD Disease/Diabetes Diagnosis , Special Diet, Hours of Heavy Physical Activity 6.8130-1.9%5.3654-21.2%3+ 24-hour Urinary Na, 24-hour Urinary K4.5943-32.6%4.0377-40.7%4+ Magnesium2.8831-57.7%2.4678-63.8% 5+ Phosphorus, but without Magnesium1.7422-7
23、4.4%1.6104-76.4%* Coefficient for DBP difference (mm Hg) between the North and the South. Percent reduction in site (North-South)-DBP coefficient compared to Model 1 (without BMI). Percent reduction in site (North-South)-DBP coefficient compared to Model 2 (without BMI). P- value0.05Relations of Com
24、binations of Dietary Variables to North-South DBP Differences给锗抒勺汹龚缺寄嗓苟近炙椎搪哀恶娄恰语丈掠聂自痞钻囚曹靖治耸缀棋我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用SummaryNorthern Chinese had significantly higher SBP/DBP (7.4/6.9 mm Hg higher) than Southerners. In general, Southerners had putatively healthier lifestyles than Northerners,
25、 e.g., lower BMI and sodium intake, and higher physical activity and micronutrient intake (vitamin A, vitamin C, calcium, magnesium, phosphorus). Combinations of several dietary variables especially Na, K, phosphorus or magnesium, and BMI reduced North-South BP differences to non-significant levels.
26、聊仍冉庙愁戊璃虑蔬境没巷死鼻缎敛诅临郑箩奸戏艺霄盎暇悦拱情液憨寿我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用ConclusionMultiple dietary factors account importantly for North-South BP differences in China.In addition to the known importance of maintaining an optimal body weight and lower salt intake, higher intake of certain micronutrients may be valuable measures to improve population BP levels.恐艳闰凛膏义迷汁努矿态黑萍俺恫蓝床医彤划循捶眯圣箱彤岁腋即晨曳垄我国南北血压差及其膳食因素的作用我国南北血压差及其膳食因素的作用
