膳食纤维摄入量与高血压的关系：基于2015—2016年美国国家健康与营养调查数据库（NHANES）的分析

摘要:

方法

采用美国国家健康与营养调查数据库（National Health and Nutrition Examination Survey, NHANES）2015—2016年的数据，将24 h膳食回顾法收集的饮食数据与美国农业部食品和营养数据库相结合计算膳食纤维摄入量；通过问卷调查和移动中心检测的血压数值定义高血压。采用logistic回归模型分析年龄≥18岁人群的膳食纤维摄入量与高血压的关系，采用广义相加模型（generalized additive model, GAM）、平滑曲线拟合分析两者间的剂量-反应关系。

结果

与低膳食纤维摄入者（膳食纤维摄入量＜11.75 g/d）相比，在总人群中，高膳食纤维摄入者（膳食纤维摄入量≥18.85 g/d）高血压的患病风险下降18%（OR＝0.82，95%CI 0.68～0.98)。男性人群中，高膳食纤维摄入者高血压的患病风险下降23%（OR＝0.77，95%CI 0.60～0.98)；女性人群中，当膳食纤维摄入量＞28.05 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94，95%CI 0.89～0.99)。年龄＞60岁人群中，高膳食纤维摄入者高血压的患病风险下降31%（OR＝0.69，95%CI 0.48～0.99)；年龄≤45岁人群中，膳食纤维摄入＞34.5 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94，95%CI 0.88～0.99)。

结论

高膳食纤维摄入与高血压患病风险下降有关，合理增加膳食纤维摄入有助于降低高血压的发生。

Abstract:

Objective

To explore the relationship between dietary fiber intake and hypertension in different populations.

Methods

Dietary fiber intake was calculated using the data from 2015—2016 National Health and Nutrition Examination Survey (NHANES) database by combining dietary data collected by the 24-hour dietary recall method with the USDA Food and Nutritional Database. Hypertension was defined based on blood pressure values obtained through questionnaires and mobile center measurements. Logistic regression models were used to analyze the relationship between dietary fiber intake and hypertension in individuals aged ≥18 years. Generalized additive model (GAM) and smoothed curve fitting were used to analyze the dose-response relationship between them.

Results

Compared with the low dietary fiber intake (＜17.75 g/d) group , in the total population, the prevalence risk of hypertension was 18% lower in the high dietary fiber intake (≥18.85 g/d) group (OR＝0.82, 95%CI 0.68-0.98). In the male population, the risk of hypertension in the high dietary fiber intake group decreased by 23% (OR＝0.77, 95%CI 0.60-0.98). In the female population, when dietary fiber intake was ＞28.05 g/d, the risk of hypertension decreased by 6% (OR＝0.94, 95%CI 0.89-0.99) for 1 g/d increase in dietary fiber intake. In the population aged ＞60 years, the risk of hypertension decreased by 31% in the high dietary fiber intake group (OR＝0.69, 95%CI 0.48-0.99). In the population aged ≤45 years, the risk of hypertension decreased by 6% (OR＝0.94, 95%CI 0.88-0.99) for 1 g/d increase when dietary fiber intake ＞34.5 g/d.

Conclusions

High dietary fiber intake is associated with a decreased risk of developing hypertension, and a reasonable increase in dietary fiber intake can help reduce the incidence of hypertension.

图  1   膳食纤维摄入量与高血压之间的剂量-反应关系

Figure  1.   Dose-response relationship between dietary fiber intake and hypertension

A: In total population. The solid line and dashed line represent the estimated ORs and the corresponding 95% confidence intervals, respectively. B: In different sex group. C: In different age group. Adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable.

表  1   调查对象的基本特征

Table  1   Basic characteristics of the subjects of study

　Characteristic Non-hypertension group（n＝2 135） Hypertension group（n＝2 432） χ2/t/u P Age/years 38.85±16.24 56.71±16.04 37.318 ＜0.001 TG/(mg•dL−1) 80.00(15.00-770.00) 100.00(18.00-1 761.00) −8.060 ＜0.001 TC/(mg•dL−1) 184.34±38.90 192.61±43.10 6.656 0.001 HDL-C/(mg•dL−1) 54.59±16.51 53.18±18.06 −2.699 0.007 LDL-C/(mg•dL−1) 109.36±33.27 113.36±37.49 2.478 0.013 FBG/(mg•dL−1) 101.34±23.41 120.27±48.65 11.493 ＜0.001 Dietary fiber intake/(g•d−1) 15.25(0.30-86.80) 14.70(0.40-89.55) −2.236 0.025 Sedentary time/(min•d−1) 360.00(1.00-1 200.00) 360.00(0-1 380.00) −0.024 0.981 Sex n(%) 11.802 0.001 　Male 1 000(46.84) 1 263(51.93) 　Female 1 135(53.16) 1 169(48.07) Race n(%) 34.089 ＜0.001 　Mexican American 411(19.25) 399(16.41) 　Other Hispanic 275(12.88) 303(12.46) 　Non-Hispanic White 743(34.80) 859(35.32) 　Non-Hispanic Black 378(17.71) 577(23.72) 　Other Race 328(15.36) 294(12.09) Education n(%) −4.207 ＜0.001 　Below high school 419(19.63) 616(25.33) 　High school 505(23.65) 559(22.99) 　Above high school 1 211(56.72) 1 257(51.68) Household income n(%) −7.131 ＜0.001 　＜20 000 dollars 418(19.57) 674(27.72) 　20 000-44 999 dollars 656(30.73) 760(31.25) 　45 000-64 999 dollars 336(15.74) 350(14.39) 　≥65 000 dollars 725(33.96) 648(26.64) Diabetes n(%) 124(5.81) 528(21.71) 234.935 ＜0.001 Smoking history n(%) 752(35.22) 1 169(48.07) 76.973 ＜0.001 Drinking history n(%) 1 448(67.82) 1 649(67.80) ＜0.001 0.990 BMI n(%) −14.800 ＜0.001 　≤24.9 kg/m2 795(37.24) 467(19.20) 　＞24.9-29.9 kg/m2 676(31.66) 769(31.62) 　＞29.9 kg/m2 664(31.10) [20]

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