摘要:

方法

采用美國(guó)國(guó)家健康與營(yíng)養(yǎng)調(diào)查數(shù)據(jù)庫(kù)（National Health and Nutrition Examination Survey, NHANES）2015—2016年的數(shù)據(jù)，將24 h膳食回顧法收集的飲食數(shù)據(jù)與美國(guó)農(nóng)業(yè)部食品和營(yíng)養(yǎng)數(shù)據(jù)庫(kù)相結(jié)合計(jì)算膳食纖維攝入量；通過(guò)問(wèn)卷調(diào)查和移動(dòng)中心檢測(cè)的血壓數(shù)值定義高血壓。采用logistic回歸模型分析年齡≥18歲人群的膳食纖維攝入量與高血壓的關(guān)系，采用廣義相加模型（generalized additive model, GAM）、平滑曲線(xiàn)擬合分析兩者間的劑量-反應(yīng)關(guān)系。

結(jié)果

與低膳食纖維攝入者（膳食纖維攝入量＜11.75 g/d）相比，在總?cè)巳褐?，高膳食纖維攝入者（膳食纖維攝入量≥18.85 g/d）高血壓的患病風(fēng)險(xiǎn)下降18%（OR＝0.82，95%CI 0.68～0.98)。男性人群中，高膳食纖維攝入者高血壓的患病風(fēng)險(xiǎn)下降23%（OR＝0.77，95%CI 0.60～0.98)；女性人群中，當(dāng)膳食纖維攝入量＞28.05 g/d時(shí)，膳食纖維攝入量每增加1 g/d，高血壓的患病風(fēng)險(xiǎn)下降6%（OR＝0.94，95%CI 0.89～0.99)。年齡＞60歲人群中，高膳食纖維攝入者高血壓的患病風(fēng)險(xiǎn)下降31%（OR＝0.69，95%CI 0.48～0.99)；年齡≤45歲人群中，膳食纖維攝入＞34.5 g/d時(shí)，膳食纖維攝入量每增加1 g/d，高血壓的患病風(fēng)險(xiǎn)下降6%（OR＝0.94，95%CI 0.88～0.99)。

結(jié)論

高膳食纖維攝入與高血壓患病風(fēng)險(xiǎn)下降有關(guān)，合理增加膳食纖維攝入有助于降低高血壓的發(fā)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.

圖  1   膳食纖維攝入量與高血壓之間的劑量-反應(yīng)關(guān)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   調(diào)查對(duì)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 ?。?0 000 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) ?。?9.9 kg/m2 664(31.10) [20]

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