Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

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Vascular effects of sodium and potassium intake
Gijsbers, Lieke - \ 2017
Wageningen University. Promotor(en): Marianne Geleijnse; Pieter van 't Veer. - Wageningen : Wageningen University - ISBN 9789463436267 - 161
sodium - potassium - vascular system - hypertension - blood pressure - mineral supplements - endothelium - blood vessels - heart rate - osmoregulation - human nutrition research - randomized controlled trials - cardiovascular diseases - natrium - kalium - vaatsysteem - hypertensie - bloeddruk - minerale supplementen - endotheel - bloedvaten - hartfrequentie - osmoregulatie - voedingsonderzoek bij de mens - gestuurd experiment met verloting - hart- en vaatziekten

Cardiovascular diseases (CVD) are the main cause of death worldwide. Annually, about 17.5 million people die from CVD, accounting for ~30% of deaths worldwide. Elevated blood pressure (BP) is a major risk factor for CVD and the largest single contributor to global mortality. BP is a modifiable risk factor that is largely determined by lifestyle factors, including diet. Dietary minerals, in particular sodium and potassium, play an important role in BP regulation. While adverse effects of sodium and beneficial effects of potassium on BP have repeatedly been shown in human intervention studies, evidence on other vascular effects of these dietary minerals is still scarce. Therefore, we investigated the BP effects of sodium and potassium intake in healthy humans in a broader (patho)physiological context, focusing also on endothelial function, arterial stiffness, fluid regulation and heart rate.

In Chapter 2, the effects of sodium and potassium supplementation on BP and arterial stiffness were examined by means of a randomized placebo-controlled crossover trial. Thirty-six untreated Dutch individuals with mildly elevated BP on a fully controlled diet that was relatively low in sodium (2-3 g/d) and potassium (2-3 g/d) received capsules with sodium (3 g/d), potassium (3 g/d) or placebo, for 4 weeks each, in random order. After each intervention, fasting office BP, 24-h ambulatory BP and measures of arterial stiffness were assessed. The results of this study showed that increased sodium intake strongly raised office and ambulatory systolic BP (7-8 mmHg) whereas increased potassium intake lowered systolic BP (3-4 mmHg). Potassium supplementation increased ambulatory HR, but office HR was not affected. Measures of arterial stiffness were not materially affected by increased sodium or potassium intake, possibly due to the relatively short intervention period.

In the same study we investigated the effects of increased sodium and potassium intake on the functional measure of endothelial function (flow-mediated dilation), and on a comprehensive set of biomarkers of endothelial dysfunction and low-grade inflammation (Chapter 3). Four weeks of supplemental sodium had no effect on brachial flow-mediated dilation, or on the blood biomarkers of endothelial dysfunction and low-grade inflammation, except for an increase in serum endothelin-1 (a biomarker of endothelial dysfunction). Potassium supplementation improved flow-mediated dilation by 1.2% and tended to lower the low-grade inflammation marker interleukin-8. This suggests that potassium may beneficially influence vascular health by improving endothelial function.

In a post-hoc analysis of the same study in 35 untreated individuals, the humoral effects of supplemental sodium and potassium were assessed using a panel of markers that are involved in osmoregulation and volume regulation (Chapter 4). Results showed that supplemental sodium increased plasma natriuretic peptides and plasma copeptin, and suppressed the renin-angiotensin system. Supplemental potassium decreased plasma MR-pro-ANP, increased plasma copeptin, and stimulated the renin-angiotensin system. These findings suggest that the mineral-induced changes in BP elicit several counter regulatory mechanisms to maintain volume homeostasis.

In Chapter 5, the effect of potassium supplementation on heart rate was assessed in a meta-analysis of 22 randomized, placebo-controlled trials in healthy adults. Overall, increasing potassium intake by 2-3 g/d for at least two weeks did not affect resting heart rate. 24-h Ambulatory heart rate was not significantly affected in subgroup analysis of 4 RCTs, including ours. Other subgroup analyses for characteristics of the study and study population also showed no significant effects, and there was no evidence for a dose-response relationship. These results suggest that increasing potassium intake is not expected to adversely affect heart rate in apparently healthy adults.

In Chapter 6, BP associations for sodium and potassium intake using different dietary assessment methods were examined. Data of 993 healthy Dutch adults not on antihypertensive medication were analyzed using a cross-sectional approach. Sodium and potassium intake were estimated from two non-consecutive 24-h urinary samples (considered as the gold standard), two non-consecutive web-based 24-h recalls, and a validated 180-item food frequency questionnaire (FFQ). This study showed no significant associations of sodium intake with BP, regardless of the dietary assessment method used. Potassium intake estimated from 24-h urine and FFQ was inversely associated with BP (~1.5 mmHg reduction per 1 g/d increment). This suggests that dietary assessment methods in cross-sectional studies may be inadequate for estimating the association of sodium intake with BP, but may yield reliable results for potassium intake.

As discussed in Chapter 7, the studies presented in this thesis indicate that increasing sodium intake from a recommended level to a level that is common in Western societies for four weeks strongly raises BP in individuals with an untreated mildly elevated BP. The results for endothelial function and arterial stiffness are inconclusive, and hence more (longer-term) studies are warranted. Increasing the intake of potassium lowers BP and improves endothelial function, even in individuals on a relatively low-sodium diet. Both sodium and potassium intake affected fluid parameters, likely indicating that compensatory responses are stimulated to maintain body fluid balance. Although in our RCT ambulatory heart rate was increased after supplemental potassium, the meta-analysis showed that increasing potassium intake is unlikely to affect heart rate in apparently healthy adults. When evaluating the effectiveness of sodium and potassium intake on cardiovascular health, results obtained from observational studies should be interpreted with caution, particularly for sodium intake.

Around the world people consume on average 9-12 g of salt and 2-4 g of potassium on a daily basis. A more optimal intake of sodium and potassium can be achieved through adherence to dietary guidelines and product reformulation by food industry. This could reduce BP by more than 10 mmHg and lower the number of cardiovascular deaths by at least one-quarter in Western populations.

Dietary protein, blood pressure and mortality : the value of repeated measurements
Tielemans, S.M.A.J. - \ 2016
Wageningen University. Promotor(en): Marianne Geleijnse; Daan Kromhout, co-promotor(en): Hendriek Boshuizen. - Wageningen : Wageningen University - ISBN 9789462577916 - 169 p.
cardiovascular diseases - blood pressure - dietary protein - mortality - cardiovascular disorders - hypertension - urea - meta-analysis - antihypertensive agents - plant protein - animal protein - hart- en vaatziekten - bloeddruk - voedingseiwit - mortaliteit - hart- en vaatstoornissen - hypertensie - ureum - meta-analyse - antihypertensiva - plantaardig eiwit - dierlijk eiwit

Cardiovascular diseases (CVD) are the main cause of death worldwide. In 2012, about 17.5 million people died from CVD, accounting for 30% of all deaths. High blood pressure (BP) is a major cardiovascular risk factor, which was responsible for 10.4 million deaths in 2013. Diet and lifestyle play an important role in the etiology of hypertension. Maintenance of a desirable body weight, physical activity, and low intake of alcohol and salt are well-known measures to avoid high BP. Whether dietary protein, or more specifically plant and animal protein, could contribute to maintaining a healthy BP is less clear. The association between BP and CVD mortality has been extensively investigated. BP in prospective studies can be analyzed using different approaches, such as single BP (measured at one moment in time), single BP adjusted for regression dilution, average BP, and trajectories of BP. It is not yet clear which of these approaches is to be preferred for CVD risk prediction.

This thesis is centered on BP as a major cardiovascular risk factor. In the first part (Chapter 2, 3 and 4), the relation of dietary protein intake with BP level and change was examined. In the second part (Chapter 5 and 6), various approaches for analyzing repeated BP measurements were compared in relation to CVD and all‑cause mortality risk. The final chapter discusses the main findings and their implications.

Chapter 2 describes the association of 24-h urinary urea excretion, as a biomarker of total protein intake, with 9-year incidence of hypertension. We analyzed data of ~4000 men and women aged 28–75 years, who participated in the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, a prospective cohort study. BP was measured four times during 1997–2009 and participants were followed for hypertension incidence, defined as BP ≥140/90mmHg or use of antihypertensive medication. Urea excretion was assessed in two consecutive 24-h urine collections at baseline and approximately 4 years later, from which total protein intake was estimated. Protein intake based on 24-h urinary urea excretion was not associated with incident hypertension.

Chapter 3 presents findings for long-term total, animal and plant protein intake in relation to 5‑year BP change. Analyses were based on 702 observations of 272 men who participated in the Zutphen Elderly Study. Participants did not use antihypertensive medication and were initially free of CVD. Physical and dietary examinations were performed in 1985, 1990, 1995, and 2000. BP was measured twice at each examination and protein intake was assessed using the cross-check dietary history method. The upper tertiles of plant protein intake were associated with a mean 5‑year change in systolic BP of ‑2.9 mmHg (95% CI: ‑5.6, ‑0.2), compared with the bottom tertile. Total and animal protein intake was not associated with BP.

Chapter 4 describes a meta‑analysis of 12 observational studies and 17 randomized controlled trials (RCTs) of dietary protein, including animal and plant protein, in relation to BP. Protein intake in prospective cohort studies was not associated with incident hypertension. For RCTs that used carbohydrate as a control treatment, the pooled BP effect was ‑2.1 mmHg systolic (95% CI: ‑2.9, ‑1.4) for a weighted mean contrast in protein intake of 41 grams per day. There was no differential effect of animal and plant protein on BP.

Chapter 5 describes repeated BP measures and their association with CVD and all‑cause mortality and life years lost in two prospective and nearly extinct cohorts of middle-aged men, the Minnesota Business and Professional Men Study (n=261) and the Zutphen Study (n=632). BP was measured annually during 1947–1957 in Minnesota and 1960–1970 in Zutphen. After 10 years of BP measurements, men were followed until death on average 20 years later. Each 25-mmHg increase in average SBP was associated with a 49% to 72% greater CVD mortality risk, 34% to 46% greater all-cause mortality risk and 3 to 4 life years lost. Four systolic BP trajectories were identified, in which mean systolic BP increased by 5 to 49 mmHg in Minnesota and 5 to 20 mmHg in Zutphen between age 50 and 60. In Zutphen, a 2-times greater CVD and all-cause mortality risk and 4 life years lost were observed when comparing trajectories. In Minnesota, associations were twice as strong. BP trajectories were the strongest predictors of CVD mortality and life years lost in Minnesota men, whereas in Zutphen men, the average BP was superior to other measures.

Chapter 6 presents findings for average BP and BP trajectories in relation to CVD and all-cause mortality, taking into account antihypertensive medication. A total of 762 participants aged ≥50 years of the Rancho Bernardo Study were examined five times from 1984 to 2002 and monitored for cause‑specific mortality from 2002 to 2013. Each 20‑mmHg increment in average systolic BP was associated with 35% greater CVD mortality and 25% greater all-cause mortality risk. We identified four trajectories for systolic BP for which BP increases ranged from 5 to 12 mmHg between age 60 and 70. In individuals who belonged to the higher trajectories, 2‑3 times greater CVD mortality and 1.5-times greater all-cause mortality risks were observed, compared to those who belonged to the lowest trajectory. Long-term systolic BP trajectories and average systolic BP were both significant predictors of CVD and all-cause mortality. The associations were not modified by antihypertensive medication.

As described in Chapter 7, various approaches were used to study the relation between protein intake and BP. Findings from individual studies and a meta-analysis suggest that dietary protein per se does not affect BP within the range of intake generally consumed in the Netherlands. Replacing carbohydrates by protein, however, has a beneficial effect on BP.

Moreover, this thesis showed that BP trajectories are not superior to average BP in predicting CVD and all-cause mortality. A few repeated BP measurements, e.g. three or four, are likely to be sufficient for obtaining a reliable average BP and had a similar predictive value for mortality compared to BP trajectories. Therefore, average BP can be considered the most practical tool for estimating mortality risk.

Public health impact of salt reduction
Hendriksen, M.A.H. - \ 2015
Wageningen University. Promotor(en): Hendriek Boshuizen, co-promotor(en): Joop van Raaij; Marianne Geleijnse. - Wageningen - ISBN 9789462575462 - 223
zout - jodiumhoudend zout - opname (intake) - reductie - gezondheid - voeding en gezondheid - modelleren - hart- en vaatziekten - hypertensie - europa - salt - iodized salt - intake - reduction - health - nutrition and health - modeling - cardiovascular diseases - hypertension - europe

The health and economic burden related to cardiovascular diseases is substantial and prevention of these diseases remains a challenge. There is convincing evidence that high salt intake affects blood pressure and the risk of cardiovascular diseases. As salt intake is far above the recommended maximum level of intake, salt reduction may help to reduce cardiovascular disease incidence. However, the effect of salt reduction initiatives on intake levels and long-term health is largely unknown. The main aim of the research described in this thesis is to assess salt intake and the potential health impact of salt reduction in the Netherlands and in Europe. This is addressed by estimating the potential effect of salt reduction strategies on salt intake, by monitoring the effect of the ongoing salt reduction initiatives in the Netherlands between 2006 and 2010 on daily salt intake and by projecting the expected long-term health benefits of salt reduction in the Netherlands and Europe.

Firstly, we used data from the Dutch National Food Consumption Survey 2007-2010 and the Dutch Food Composition Database 2010 to study the effect of two potential salt reduction scenarios on salt intake from processed foods. In the first scenario, sodium levels in processed foods were reduced towards their minimum feasible sodium level. In the second scenario, foods were substituted by a low-salt alternative within the same food category. This study demonstrated that daily salt intake from foods could be reduced below the recommended maximum intake of 6 g/d, provided these strategies are successfully implemented.

Secondly, the effect of the ongoing salt reduction initiatives in the Netherlands between 2006 and 2010 was evaluated. Dutch adults in two cross-sectional studies (n=317 in 2006 and n=342 in 2010) collected a single 24h urine sample. Despite the initiatives of the food industry to reduce sodium levels in processed foods, no statistically significant difference in daily salt intake was observed between 2006 (8.7 g/d) and 2010 (8.5 g/d).

Thirdly, the long-term health impact of salt reduction was assessed for the Netherlands using the RIVM Chronic Disease Model and for Europe using the Dynamic Model for Health Impact Assessment (DYNAMO-HIA). A two-step approach was used: the effect of salt reduction on blood pressure was estimated, which was subsequently translated into occurrence of cardiovascular diseases. Substantial changes in incident stroke (6.0%) and acute myocardial infarction (4.4%) can be expected in the Netherlands if sodium contents in processed foods were reduced to the minimum feasible level. The potential health impact of population-wide adherence to the salt intake guideline of the World Health Organization (maximum of 5 g/d) ranged for nine European countries between 10.1% in Finland to 23.1% in Poland for stroke, and between 6.6% in Finland to 15.5% in Poland for ischemic heart diseases.

Finally, a methodological comparison of seven population health models on salt reduction revealed that these models vary in underlying assumptions. We demonstrated that these differences in assumptions may substantially affect the health impact estimates.

In conclusion, technologically feasible salt reductions in processed foods or changes in dietary behaviour may, if implemented successfully, lead to a substantial lowering of daily salt intake, and thereby contribute to considerable health gain. Cross-country comparisons of health impact of salt reduction strategies might benefit from more transparency on the necessary assumptions in the various population health impact models for salt reduction used worldwide.

Hypertension in Vietnam: prevalence, risk groups and effects of salt substitution
Do, H.T.P. - \ 2014
Wageningen University. Promotor(en): Edith Feskens; Frans Kok, co-promotor(en): Marianne Geleijnse. - Wageningen : Wageningen University - ISBN 9789462571372 - 159
hypertensie - risicogroepen - risico - gezondheid - zout - vervangmiddelen - voeding - levensstijl - vietnam - hypertension - risk groups - risk - health - salt - substitutes - nutrition - lifestyle

ABSTRACT

Background: Over the past decades, the morbidity and mortality patterns have changed rapidly in Vietnam, with a reduction in infectious diseases in parallel with a rapid increase in non-communicable diseases (NCDs), leading to the so-called double burden. It was estimated that in 2008 NCDs accounted for 75% of all deaths in Vietnam, and cardiovascular diseases were the leading cause accounting for 40% of total mortality. Hypertension is one of the major risk factors for cardiovascular disease, but information on the nationwide prevalence and main determinants is lacking. There is an urgent need for appropriate population-based interventions for hypertension control and prevention in Vietnam.

Methods and Results: Data of 17,213 adults aged 25-64 years from the nationally representative 2005 National Adult Obesity Survey were used to study the prevalence of hypertension and prehypertension and their determinants. The overall prevalence of hypertension was 20.7% and the prevalence of prehypertension was 41.8%. Hypertension and prehypertension were more prevalent in men than in women (25.2% vs. 15.9%). Determinants of raised blood pressure including advancing age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher levels of physical activity and education were inversely associated. Age, body mass index (BMI), and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, only 25.9% were aware of having hypertension and 12.2% were treated. Among the treated hypertensives, 32.4% had their blood pressure controlled.

Overweight and obesity, important risk factors for hypertension, were investigated using data of 14,452 Vietnamese adults aged 25-64 years from the nationally representative 2000 National Nutrition Survey and data of 17,213 adults aged 25-64 years from the nationally representative 2005 National Adult Obesity Survey. The results showed that the distribution of BMI across the population and in population subgroups indicated a shift towards higher levels in 2005 as compared to 2000. The nationwide prevalences of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were 6.6% and 0.4% respectively in 2005, almost twice the rates of 2000 (3.5% and 0.2%). Using the Asian BMI cut-off of 23 kg/m2 the overweight prevalence was 16.3% in 2005 and 11.7% in 2000. Women were more likely to be both underweight and overweight than men in both 2000 and 2005. Urban residents were more likely to be overweight and less likely to be underweight as compared to rural residents in both years. The shifts from underweight to overweight were more pronounced in those with higher food expenditure levels.

A survey on sodium intake among a rural community near Hanoi (n=121) showed that mean 24-hour sodium excretion was 188.6 ± 57.5 mmol (4.3g), which corresponds to an intake of salt (sodium chloride) of 10.8 ± 3.3 g/day. Men had a higher mean sodium excretion (196.8 ± 56.9 mmol/day or 4.5g/day) than women (181.1 ± 57.4 mmol/day or 4.2g/day); 97.5% of the men and women had a salt intake higher than the World Health Organization’s recommendation of < 5g/day. Subjects with complete urine collection had a salt excretion of 11.7 g/day. Sodium in condiments added during cooking or eating at the table accounted for 81% of sodium intake. Processed foods contributed 11.6% and natural foods 7.4%. Regarding the condiments, the largest source was the mixed seasoning (35.1% of total); 31.6% of total dietary sodium was provided by fish sauce, 7.4% by monosodium glutamate and 6.1% by table salt.

Sodium-reduced and potassium-enriched salt and ‘bot canh’, a traditional seasoning, were experimentally produced and underwent organoleptic testing, which showed high acceptance. An 8-week randomized double-blind trial was carried out in 173 men and women between 45 and 64 years of age with untreated (pre)hypertension in a rural Vietnamese community. The intervention group that received sodium-reduced and potassium-enriched condiments (salt and bot canh) experienced a median 24-hour sodium excretion decrease of 28.5 mmol/d (1.6 g/d salt) compared to the control group that received regular condiments for home food preparation and dining. The mean change in BP in the intervention compared to the control group was -2.6 mmHg (95% CI: -4.6 to -0.5, p = 0.013) for systolic BP and -1.6 mmHg (95% CI: -3.0 to -0.2, p= 0.024) for diastolic BP. The prevalence of iodine deficiency was significantly reduced in both groups (from 66% to 41% in the intervention group and from 72% to 36% in the controls).

Conclusion: Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. Lifestyle modifications, including the prevention of overweight, and the promotion of physical activity, particularly in urban areas, and the reduction of high alcohol consumption in men, may help to prevent hypertension in Vietnam. Between 2000 and 2005, BMI in the population shifted towards higher levels, especially in those with higher food expenditure levels, but under nutrition was also still prevalent in 2005. Most dietary sodium (81%) comes from adding salty condiments during food preparation or at the table. Therefore, limiting condiments added during cooking and at the table should be given priority. Alternatively, regular condiments may be replaced with sodium-reduced and potassium-enriched salt and ‘bot canh’ to lower BP in (pre)hypertensive Vietnamese adults. Salt iodization should be reconsidered to ensure adequate iodine intake of the population.


TABLE OF CONTENTS

Chapter 1

General introduction

1 - 24

Chapter 2

National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults.

American Journal of Hypertension, Epub ahead of print 2014/05/28

25 - 44

Chapter 3

Nationwide shifts in the double burden of overweight and underweight in Vietnamese adults in 2000 and 2005: two national nutrition surveys.

BMC Public Health 2011, 11:62

45 - 66

Chapter 4

Sodium intake and its dietary sources in Vietnamese rural adults

Submitted

67 - 80

Chapter 5

Sodium-reduced and potassium-enriched condiments reduce sodium intake and blood pressure in Vietnamese adults: a randomized controlled trial.

Submitted

81 - 100

Chapter 6

General discussion

101 - 120

Summary

Summary in Dutch

Summary in Vietnamese

Acknowledgment

About the author


Zinc intake and dietary pattern in Jiangsu Province, China: consequences of nutrition transition
Qin, Y. - \ 2012
Wageningen University. Promotor(en): Frans Kok; Michael Zimmermann, co-promotor(en): Alida Melse-Boonstra; J.K. Zhao. - S.l. : s.n. - ISBN 9789461733740 - 133
zink - voedingstoestand - fortificatie - dieet - hypertensie - obesitas - china - zinc - nutritional state - fortification - diet - hypertension - obesity

Background: Jiangsu Province is an economically booming area in East China, where soil zinc concentrations are low. Nutrition transition to a dietary pattern with more animal source foods may have improved zinc intake in this area. However, such a transition may also have increased the burden of non-communicable diseases (NCDs), such as hypertension and obesity. Investigation of dietary patterns in relation to undernutrition and overnutrition could help to better address both problems.

Objectives: The first aim of this thesis was to assess zinc status in Jiangsu Province using dietary zinc intake, serum zinc and stunting as indicators, as well to investigate the potential of biofortified rice to improve zinc intake. The second aim was to investigate the association between dietary patterns and high blood pressure, taking obesity into account.

Methods:Data from the 2002 National Nutrition and Health Survey in Jiangsu Province were used to assess zinc intake in the population aged 4-89 years (n=3,867). Primary school children (n=2,268) were selected from three counties in the Province with relatively low soil zinc for assessment of stunting. Serum zinc was measured among children in the county where stunting was highest (n=297). Thirteen women were recruited in the same county for three test rounds with rice meals (zinc biofortified rice, zinc extruded fortified rice and control rice). Fractional zinc absorption (FAZ) was measured with the use of the double isotope tracer ratio method. Effect of biofortified rice with zinc, at a level of 2.7 and 3.8 mg/100g, on zinc intake was simulated in adults (n=2.819). For adults, four distinct dietary patterns were identified, named “traditional”, “Macho”, “sweet tooth” and “healthy” pattern. Associations were assessed between the four dietary patterns and blood pressure in adults (n=2,518) by using Poisson regression analysis.

Results:The overall prevalence of insufficient intake of zinc was 22.9%, with a higher prevalence in children (64.6%) and adolescents (64.9%), and in those with low socio-economic status (27.3%). Around 4% of the primary school children were stunted, and the prevalence of zinc deficiency measured by serum and hair zinc was 0.7%, and 15.2%, respectively. Biofortified 70Zn enriched rice with an intrinsic label was found to have higher fractional zinc absorption (FAZ) than extrinsically labeled fortified extruded rice. However, FAZ could not be accurately quantified because we could not determine the exact amount of isotope infused to subjects due to adhesion of zinc to the vial. When simulating zinc intake by replacing normal rice with zinc biofortified rice with either 2.7 and 3.8 mg/100g of zinc, the prevalence of insufficient zinc intake decreased from 15.4% to 6.5% and 4.4%, respectively. The “traditional” dietary pattern in Jiangsu Province was most strongly associated with high blood pressure (P for trend = 0.005). This pattern is characterized primarily by consumption of rice and fresh vegetable; secondary of pork and fish; and lastly of root vegetable and wheat flour, but also by high salt intake. Subjects with overweight and obesity were more likely to have high blood pressure than those with normal weight.

Conclusion: Children and adolescents had low dietary zinc intake, in Jiangsu Province, where the soil is also deficient in zinc. However, these findings did not match with the low prevalence of stunting and zinc deficiency based on serum zinc concentrations in primary school children from three rural areas of the Province. Zinc appears to be better absorbed from biofortified rice than from control rice or from extruded fortified rice, which needs further investigation. Simulated zinc intake from biofortified rice with zinc at a level of 2.7 mg/kg has the potential to significantly improve zinc intake, especially in the “traditional” dietary pattern. However, this pattern is also related to high blood pressure, which may be due to high salt intake. High blood pressure is also positively and independently related to obesity. Nutrition education is required to improve knowledge and awareness of healthy diets in Jiangsu Province.

Zout, bloeddruk en hart- en vaatziekten
Geleijnse, J.M. - \ 2011
In: Hart- en vaatziekten in Nederland 2011 / Vaartjes, I., van Dis, I., Visseren, F.L.J., Bots, M.L., Den Haag : Hartstichting - ISBN 9789075131703 - p. 73 - 90.
zout - reductie - hart- en vaatziekten - bloeddruk - hypertensie - natriumchloride - zoutgehalte - ziektepreventie - gezondheidsbevordering - salt - reduction - cardiovascular diseases - blood pressure - hypertension - sodium chloride - salinity - disease prevention - health promotion
Dit hoofdstuk richt zich op het belang van zoutreductie in de Nederlandse bevolking, waarbij achtereenvolgens het verband met bloeddruk en hart- en vaatziekten, de dagelijkse zoutinname en bronnen van zout, de potentiële gezondheidswinst door zoutreductie en lopende initiatieven op het gebied van zoutreductie in de bevolking besproken worden.
Nutritional interventions and blood pressure : role of specific micronutrients and other food components
Mierlo, L.A.J. van - \ 2010
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Marianne Geleijnse; P.L. Zock. - [S.l.] : S.n. - ISBN 9789085856900 - 187
bloeddruk - dieet - ziektepreventie - maatregel op voedingsgebied - sporenelementen - hypertensie - mineralen - blood pressure - diet - disease prevention - nutritional intervention - trace elements - hypertension - minerals
Background
Elevated blood pressure is an important risk factor for cardiovascular diseases (CVD). Modest reductions in blood pressure at the population level, as can be achieved by dietary and lifestyle changes, have a large impact on the burden of CVD. Blood pressure is regulated by several physiological mechanisms, including vascular endothelial function.

This thesis
The studies described in this thesis examined the potential effects of various micronutrients and other food components on blood pressure and endothelial function. The first aim was to assess the importance of selected minerals on population blood pressure levels and the second was to investigate the vascular effects of food components other than minerals that have recently attracted attention in the field of nutrition and blood pressure.
A review of 21 national surveys showed that current dietary potassium intakes are suboptimal (1.7-3.7 gram per day). We estimated that increasing intakes to the recommended level of 4.7 gram per day can reduce population systolic blood pressure by 2-3 mmHg in Western countries, this effect being similar to that which can be achieved by reducing current sodium intakes to recommended levels. Our meta-analysis of 40 randomized controlled intervention studies showed that increasing calcium intake by ~1200 mg per day significantly lowers systolic blood pressure by 2 mmHg and diastolic blood pressure by 1 mmHg. This effect tended to be stronger in populations with lower intakes (<800 mg per day). In an 8-week placebo controlled parallel study in 124 subjects with elevated blood pressure, we found no significant blood pressure lowering effects of skimmed milk enriched in potassium (1500 or 750 mg per daily serving) combined with calcium, magnesium, selenium, vitamin C and vitamin E. However, this study was not designed to detect reductions in systolic blood pressure of 2-3 mmHg, which are still relevant at the population level.
In two 4-week placebo controlled cross-over studies, in 162 subjects with untreated elevated blood pressure, we could not demonstrate an antihypertensive effect of a yogurt drink with lactotripeptides obtained by enzymatic hydrolysis (study 1: 10.2 mg per day; study 2: 4.6 mg per day plus 350 mg added potassium). In another 2-week placebo controlled cross-over study in 35 healthy males we found no consistent effect on endothelial function and blood pressure of ~800 mg polyphenols per day from either a wine-grape mix or grape seeds. Finally, a meta-analysis of 14 randomized controlled intervention studies showed that folic acid at a high dose (≥5000 g per day), which can not be attained with a regular diet, significantly improved flow-mediated dilation by 8%.

Conclusion
Adequate potassium and calcium intakes can play an important role in the prevention of hypertension at the population level. Lactotripeptides have no relevant effect on blood pressure in Caucasian populations. The potential of grape polyphenols and folic acid to improve endothelial function is limited.
Multiple actions are needed to lower blood pressure at the population level and reduce the burden of CVD. To improve intakes of potassium and calcium, public health measures should re-emphasize the intake of fruits, vegetables, and low-fat dairy products. Further optimization of mineral intakes, in particular reduction of sodium intake, requires collaborative actions of government and food industry.

Cacao, flavanolen, en hart- en vaatziekten: Stand van de wetenschap
Buijsse, B. ; Kromhout, D. - \ 2010
Voeding Nu 12 (2010)3. - ISSN 1389-7608 - p. 15 - 17.
chocolade - flavanoïden - hart- en vaatziekten - hypertensie - ziektepreventie - gezondheidsvoedsel - onderzoek - voeding en gezondheid - chocolate - flavanoids - cardiovascular diseases - hypertension - disease prevention - health foods - research - nutrition and health
De gedachte dat cacao gezondheidseffecten bezit is niet nieuw. Al in de 18e eeuw werd verondersteld dat cacao een veelvoud aan kwalen kon verlichten, alleen ontbrak hiervoor lange tijd de wetenschappelijke onderbouwing. Nadat halverwege de jaren negentig van de vorige eeuw werd ontdekt dat cacao rijk is aan flavanolen werd het een populair onderzoeksonderwerp. Vooral de effecten op hart en bloedvaten staan hierbij in de belangstelling. Wat is de stand van de wetenschap?
Zuivelconsumptie, bloeddruk en hypertensie : observationele studies en interventieonderzoek
Engberink, M.F. - \ 2009
Wageningen University. Promotor(en): Evert Schouten; Frans Kok, co-promotor(en): Marianne Geleijnse. - [S.l. : S.n. - ISBN 9789085853619 - 143
melkproducten - bloeddruk - hypertensie - gestuurd experiment met verloting - epidemiologische onderzoeken - maatregel op voedingsgebied - voedselopname - dieetrichtlijnen - nederland - milk products - blood pressure - hypertension - randomized controlled trials - epidemiological surveys - nutritional intervention - food intake - dietary guidelines - netherlands
Diet and lifestyle play an important role in maintaining a healthy blood pressure. Whether intake of dairy products could reduce population blood pressure remains to be established. We examined the association of (specific types of) dairy food intake with blood pressure and risk of hypertension using data from two Dutch population-based cohort studies; i.e. the MORGEN study and the Rotterdam study. Blood pressure level was not consistently associated with overall dairy intake or intake of specific dairy foods in 21,553 Dutch adults from the MORGEN study. However, both in the MORGEN study and in the Rotterdam study, the risk of hypertension was reduced by ~20% in subjects who consumed more than 150 mL of low-fat dairy per day. Other dairy foods, i.e. fermented dairy, high-fat dairy, milk and milk products, and cheese, were not consistently associated with risk of hypertension. In addition, we assessed the effect of two dairy components on human blood pressure, i.e. lactotripeptides and cis-9, trans-11 conjugated linoleic acid, in controlled intervention studies. These dairy components did not affect blood pressure.
Het belang van voeding en leefstijl : hypertensie, een volksgezondheidprobleem
Geleijnse, J.M. - \ 2005
Voeding Nu 7 (2005)11. - ISSN 1389-7608 - p. 12 - 14.
humane voeding - gezondheidsgevaren - levensstijl - hypertensie - obesitas - gewichtsvermindering - ziektepreventie - volksgezondheidsbevordering - lichamelijke activiteit - human feeding - health hazards - lifestyle - hypertension - obesity - weight reduction - disease prevention - sanitation - physical activity
Voeding en leefstijl hebben effect op de bloeddruk en daarmee invloed op de prevalentie van hypertensie in Nederland. Ook overgewicht veroorzaakt een stijging van de bloeddruk, waardoor het aantal gevallen van hart- en vaatziekten kan toenemen. Voor de preventie van hart- en vaatziekten zijn dalingen in de gemiddelde bloeddruk van de bevolking van enkele millimeters kwik al relevant. Een gezondere leefomgeving, waarbij het aanbod van gezonde voeding en maatregelen ter verhoging van de lichamelijke activiteit centraal staan, kan dit tij keren
Pulmonary Hypertension Syndrome in Chicken: Peeking Under QTL Peaks
Rabie, T. - \ 2004
Wageningen University. Promotor(en): Martien Groenen, co-promotor(en): Richard Crooijmans. - Wageningen : S.n. - ISBN 9085041325 - 147
vleeskuikens - kippen - ascites - hypertensie - kwantitatieve kenmerken - genkartering - genen - genetica - broilers - fowls - hypertension - quantitative traits - gene mapping - genes - genetics
Voeding en gezondheid - hypertensie
Geleijnse, J.M. ; Grobbee, D.E. - \ 2003
Nederlands Tijdschrift voor Geneeskunde 147 (2003)21. - ISSN 0028-2162 - p. 996 - 1000.
voeding - gezondheid - hypertensie - dieetadvisering - zout - ziektepreventie - kalium - magnesium - bloeddruk - nutrition - health - hypertension - diet counseling - salt - disease prevention - potassium - blood pressure
A healthy diet plays an important role in both the prevention and treatment of hypertension. Very good results have been obtained with the "Dietary approaches to stop hypertension (Dash)" combination diet. Salt reduction has a favourable effect; simultaneous increases in potassium and magnesium intake could have an additional beneficial effect. The use of low-sodium high-potassium mineral salt could make a useful contribution to prevention and treatment. These dietary measures, combined with weight loss and physical exercise, may prevent drug treatment
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