膳食胆固醇摄入量对我国成人血压值和高血压发病影响的多水平纵向研究

Longitudinal association between dietary cholesterol and blood pressure,risk of incident hypertension among Chinese adults

目的分析我国成年人膳食胆固醇摄入量对血压值及高血压发病的影响。方法利用中国健康与营养调查数据,研究对象为1993-2011年至少参加两轮调查且在进入队列时血压值正常年龄18~60岁的成人,共7754(男性3756、女性3998)人。应用三水平混合效应模型进行分析:模型1,只纳入膳食胆固醇摄入量;模型2,在模型1的基础上,纳入个人水平变量;模型3,在模型2的基础上,纳入社区变量。结果与不摄入膳食胆固醇的男女性相比,膳食胆固醇摄入量最高组收缩压增加了1.87(男性,95%CI 1.01~2.73,P<0.05)、1.44mm Hg(女性,95%CI0.54~2.35,P<0.05);舒张压升高了2.04(男性,95%CI 1.40~2.67,P<0.05)、0.82mm Hg(女性,95%CI0.21~1.44,P<0.05);男性和女性发生高血压的相对危险分别是1.78(95%CI 1.29~2.45,P<0.05)和1.23(95%CI0.87~1.74,P=0.25)。在调整了个体水平、社区水平、基线血压值和基线年龄后,与不摄入膳食胆固醇组相比,胆固醇摄入量与男性收缩压和舒张压呈正相关,与女性收缩压和舒张压呈负相关,男性和女性的膳食胆固醇摄入水平最高组发生高血压的相对危险分别增加,但都无统计学意义。结论无论男性还是女性,膳食胆固醇摄入对血压值和高血压发病风险可能没有影响。

Objective To examine the longitudinal association between dietary cholesterol and blood pressure, risk of incident hypertension among Chinese adults. Methods We used data from the China Health and Nutrition Sur- vey collected in years of 1993, 1997, 2000, 2004, 2006, 2009 and 2011. A total of 7754 participants （3756 males and 3998 females） aged from 18 to 60 years old with at least twice data collection and with normal basal blood pres- sure were included. Separate sex-stratified multilevel mixed model was applied to investigate the effect of dietary cholesterol consumption on blood pressure and hypertension risk. Model 1 included dietary cholesterol only. Model 2 included component of model 1 plus variables at individual level. Model 3 included all components of model 2 plus the urbanization index. Results Compared to non-consumers of dietary cholesterol, men and women in the highest quartile of dietary cholesterol intake showed an increase of 1.87 mm Hg （95% CI 1.01-2.73, P〈0.05） and 1.44 mm Hg （95% CI 0. 54-2.35, P〈0.05） on systolic blood pressure, and 2.04 mm Hg （95% CI 1.40- 2.67, P〈0.05） and 0.82 mm Hg （95 % CI 0.21-1.44, P〈0.05） on diastolic blood pressure, respectively. The odds ratios of developing hypertension in males and females who were in the highest quartile of dietary cholesterol in- take were 1.78（95% CI 1.29-2.45, P〈0.05） and 1.23（95% CI0. 87-1.74, P=0.25} in comparison with non- consumers of dietary cholesterol respectively. After adjusted for individual level, community level, baseline SBP and DBP, and baseline age, dietary cholesterol showed a positive association with blood pressure in male and a nega- tive association in female; after the adjustments, above odds ratio increased, however, none was statistical signifi- cance anymore compared to non-consumers of dietary cholesterol. Conclusion Effect of dietary cholesterol intake on hypertension was probably insignificant in Chinese adults.