Nutrient Intake, Lifestyle Factors and Prevalent Hypertension in Korean Adults: Results from 2007-2008 Korean National Health and Nutrition Examination Survey

Article information

Korean J Community Nutr. 2012;17(3):329-340

Publication date (electronic) : 2012 June 30

doi : https://doi.org/10.5720/kjcn.2012.17.3.329

Sle Koo , Youngok Kim ¹, Mi Kyung Kim ², Jin-Sook Yoon ³, Kyong Park

Department of Food and Nutrition, Yeungnam University, Gyeongsan, Gyeongbuk, Korea.

¹Department of Food and Nutrition, Dongduk Women's University, Seoul, Korea.

²Division of Carcinogenesis, National Cancer Center, Goyang, Korea.

³Department of Food and Nutrition, Keimyung University, Daegu, Korea.

Corresponding author: Kyong Park, Department of Food & Nutrition, Yeungnam University, 214-1 Dae-dong, Gyeongsan, Gyeongbuk 712-749, Korea. Tel: (053) 810-2879, Fax: (053) 810-4768, kypark@ynu.ac.kr

Received 2012 April 24; Revised 2012 May 31; Accepted 2012 June 15.

Abstract

Hypertension is a well-known risk factor for cardiovascular disease. Previous studies have shown that changes in diet and lifestyle factors can prevent the development of hypertension, but the combined effects of these modifiable factors on hypertension are not well established. The objective of this study is to investigate associations of diet and lifestyle factors, evaluated both individually and in combination, with prevalent hypertension among Korean adults. We analyzed data obtained from the 2007-2008 Korean National Health and Nutritional Examination Survey, a nationwide cross-sectional study using a stratified, multistage probability sampling design. The associations of 12 nutrient intakes and lifestyle factors with risk of hypertension were explored using restricted cubic spline regression and logistic regression models among 6,351 adults. Total energy and several nutrients and minerals, including, calcium, vitamin A, vitamin C, and sodium, showed non-linear relationships with the risk of prevalent hypertension. In multivariate logistic regression models, dietary score, obesity and alcohol intake were independently associated with the risk of prevalent hypertension, but smoking and physical activity were not. Overall, participants whose dietary habits and lifestyle factors were all in the low-risk group had 68% lower prevalence of hypertension (OR: 0.32, 95 CI: 0.14-0.74) compared to those who were at least one in the high-risk group of any dietary or lifestyle factors. The result suggests that combined optimal lifestyle habits are strongly associated with lower prevalence of hypertension among Korean adults.

Keywords: hypertension; lifestyle factors; Korean adults

Notes

This research was supported by grants from Korea Centers for Disease Control & Prevention (2011E3500900).

References

1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003. 289(16)2083–2093.

2. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005. 294(19)2455–2464.

3. Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, Sacks F, Stampfer MJ. A prospective study of nutritional factors and hypertension among US men. Circulation 1992. 86(5)1475–1484.

4. Azadbakht L, Fard NR, Karimi M, Baghaei MH, Surkan PJ, Rahimi M, Esmaillzadeh A, Willett WC. Effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial. Diabetes Care 2011. 34(1)55–57.

5. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 2010. 170(2)126–135.

6. Cackett P, Wong TY, Aung T, Saw SM, Tay WT, Rochtchina E, Mitchell P, Wang JJ. Smoking, cardiovascular risk factors, and age-related macular degeneration in Asians: the Singapore Malay Eye Study. Am J Ophthalmol 2008. 146(6)960–967.e1.

7. Chen J, Gu D, Huang J, Rao DC, Jaquish CE, Hixson JE, Chen CS, Lu F, Hu D, Rice T, Kelly TN, Hamm LL, Whelton PK, He J. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet 2009. 373(9666)829–835.

8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003. 289(19)2560–2572.

9. Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009. 54(25)2396–2406.

10. Fogari R, Zoppi A, Corradi L, Preti P, Mugellini A, Lazzari P, Derosa G. Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension. Hypertens Res 2010. 33(3)236–242.

11. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009. 302(4)401–411.

12. Govindarajulu US, Malloy EJ, Ganguli B, Spiegelman D, Eisen EA. The comparison of alternative smoothing methods for fitting non-linear exposure-response relationships with cox models in a simulation study. Int J Biostat 2009. 5(1)Article 2.

13. Guthrie HA, Scheer JC. Validity of a dietary score for assessing nutrient adequacy. J Am Diet Assoc 1981. 78(3)240–245.

14. Houston MC, Harper KJ. Potassium, magnesium, and calcium: their role in both the cause and treatment of hypertension. J Clin Hypertens (Greenwich) 2008. 107 Suppl 2. 3–11.

15. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001. 345(11)790–797.

16. Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE, Colditz GA. Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998. 128(2)81–88.

17. Kim KR, Hong SA, Kim MK. Nutritional status and food insufficiency of Korean population through the life-course by education level based on 2005 National Health and Nutrition Survey. Korean J Nutr 2008. 41(7)667–681.

18. Lee HJ, Lee HS, Lee YN, Jang YA, Moon JJ, Kim CI. Nutritional environment influences hypertension in the middle-aged Korean adults: based on 1998 & 2001 National Health and Nutrition Survey. Korean J Community Nutr 2007. 12(3)272–283.

19. Lee LL, Watson MC, Mulvaney CA, Tsai CC, Lo SF. The effect of walking intervention on blood pressure control: a systematic review. Int J Nurs Stud 2010. 47(12)1545–1561.

20. Lee YP, Puddey IB, Hodgson JM. Protein, fibre and blood pressure: potential benefit of legumes. Clin Exp Pharmacol Physiol 2008. 35(4)473–476.

21. Leigh JP, Du J. Are low wages risk factors for hypertension? Eur J Public Health 2012. 22(3)1–5.

22. Li H, Tong W, Wang A, Lin Z, Zhang Y. Effects of cigarette smoking on blood pressure stratified by BMI in Mongolian population, China. Blood Press 2010. 19(2)92–97.

23. Marrie RA, Dawson NV, Garland A. Quantile regression and restricted cubic splines are useful for exploring relationships between continuous variables. J Clin Epidemiol 2009. 62(5)511–517.e1.

24. Ministry of Health and Welfare & Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3) 2010.

25. Miura K, Okuda N, Turin TC, Takashima N, Nakagawa H, Nakamura K, Yoshita K, Okayama A, Ueshima H. Dietary salt intake and blood pressure in a representative Japanese population: baseline analyses of NIPPON DATA80. J Epidemiol 2010. 20Suppl 3. S524–S530.

26. Mozaffarian D, Kamineni A, Carnethon M, Djousse L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med 2009. 169(8)798–807.

27. Nakanishi N, Suzuki K. Daily life activity and the risk of developing hypertension in middle-aged Japanese men. Arch Intern Med 2005. 165(2)214–220.

28. Narkiewicz K, Kjeldsen SE, Hedner T. Is smoking a causative factor of hypertension? Blood Press 2005. 14(2)69–71.

29. National Statistical Office. Annual report of the cause of death statistics 2005 2006.

30. Niskanen L, Laaksonen DE, Nyyssonen K, Punnonen K, Valkonen VP, Fuentes R, Tuomainen TP, Salonen R, Salonen JT. Inflammation, abdominal obesity, and smoking as predictors of hypertension. Hypertension 2004. 44(6)859–865.

31. Psaty BM, Heckbert SR, Koepsell TD, Siscovick DS, Raghunathan TE, Weiss NS, Rosendaal FR, Lemaitre RN, Smith NL, Wahl PW, Wagner EH, Furberg CD. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995. 274(8)620–625.

32. Ries CP, Daehler JL. Evaluation of the nutrient guide as a dietary assessment tool. J Am Diet Assoc 1986. 86(2)228–233.

33. Rocchini AP. Obesity hypertension. Am J Hypertens 2002. 152 Pt 2. 50S–52S.

34. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001. 344(1)3–10.

35. Sesso HD, Cook NR, Buring JE, Manson JE, Gaziano JM. Alcohol consumption and the risk of hypertension in women and men. Hypertension 2008. 51(4)1080–1087.

36. Siegel M, Luengen M, Stock S. On age-specific variations in income-related inequalities in diabetes, hypertension and obesity. Int J Public Health 2012. DOI 10.1007/S00038-012-0368-7.

37. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med 1993. 153(5)598–615.

38. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000. 343(1)16–22.

39. Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith West D, Milas NC, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Raczynski J, Brewer A, Singh B, Cohen J. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med 2001. 134(1)1–11.

40. Thadhani R, Camargo CA, Stampfer MJ Jr, Curhan GC, Willett WC, Rimm EB. Prospective study of moderate alcohol consumption and risk of hypertension in young women. Arch Intern Med 2002. 162(5)569–574.

41. van Rossum CT, van de Mheen H, Witteman JC, Hofman A, Mackenbach JP, Grobbee DE. Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly. Hypertension 2000. 35(3)814–821.

42. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH, Kostis JB, Kumanyika S, Lacy CR, Johnson KC, Folmar S, Cutler JA. TONE Collaborative Research Group. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA 1998. 279(11)839–846.

43. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, Roccella EJ, Stout R, Vallbona C, Winston MC, Karimbakas J. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA 2002. 288(15)1882–1888.

44. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, Klag MJ. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997. 277(20)1624–1632.

45. Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens 2005. 23(3)475–481.

46. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004. 363(9403)157–163.

47. Willett W. Nutritional epidemiology 1998. New York: Oxford University Press; 3–32.

48. Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Sacks FM, Speizer FE, Rosner B, Hennekens CH. A prospective study of nutritional factors and hypertension among US women. Circulation 1989. 80(5)1320–1327.

49. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2001. 38(5)1112–1117.

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Fig. 1

Flowchart for the subjects of present analysis.

1) Implausible estimates of total energy intake; age and sex specific total energy intake less than 25% of estimated energy requirements (EER) or more than 300% of EER.

Fig. 2

Odds ratios (95% CI) for the non-linear relationships between nutrient intakes (NAR) and the risk of prevalent hypertension, evaluated using restricted cubic spline regression, adjusting for age, sex and total energy intakes.

Table 1

Demographic and lifestyle characteristics among 6,351 Korean adults

1) Data are Means ± SD or N (%)

Table 2

The optimal range of nutrient intakes for the lower risk of prevalent hypertension (N = 6,351)

NAR_en: Estimated Energy Requirements (EER)

NAR: Nutrient Adequacy Ratio

Table 3

Comparisons of Individual Nutrient Score between hypertension and normal groups (N = 6,351)

1) Values are means of Individual Nutrient Scores (INS), adjusting for age, sex and total energy intake (INS of energy was adjusted for age and sex only)

Table 4

Individual lifestyle factors and the risk of prevalent hypertension

1) Adjusted for age, sex, and household income.

2) Additionally adjusted for each of the other lifestyle risk factors in the table

Table 5

The risk of prevalent hypertension according to the number of low-risk lifestyle factors

All models were adjusted for age, sex, and household income