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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.

Perinatal inhibition of NF-KappaB has long-term antihypertensive and renoprotective effects in fawn-hooded hypertensive rats
Koeners, Maarten P. ; Wesseling, Sebas ; Sánchez, Manuel ; Braam, Branko ; Joles, Jaap A. - \ 2016
American Journal of Hypertension 29 (2016)1. - ISSN 0895-7061 - p. 123 - 131.
blood pressure - developmental plasticity - glomerulosclerosis - hypertension - nuclear factor-kappa B - renal hemodynamics

BACKGROUND Inhibition of transcription factor nuclear factor-kappa B (NFκB) is beneficial in various models of hypertension and renal disease. We hypothesized first that NFκB inhibition during renal development ameliorates hereditary hypertensive renal disease and next whether this was mediated via suppression of peroxisome proliferator-activated receptor (PPAR)γ coactivator 1α (PGC-1α). METHODS AND RESULTS Prior to the development of renal injury in fawn-hooded hypertensive (FHH) rats, a model of hypertension, glomerular hyperfiltration, and progressive renal injury, NFkB activity, measured by nuclear protein expression of NFkB subunit p65, was enhanced twofold in 2-day-old male and female FHH kidneys as compared to normotensive Wistar-Kyoto (WKY) rats (P <0.05). Treating FHH dams with pyrrolidine di thio carbamate (PDTC), an NFκB inhibitor, from 2 weeks before birth to 4 weeks after birth diminished NFkB activity in 2-day-FHH offspring to 2-day-WKY levels (P <0.01). Perinatal PDTC reduced systolic blood pressure from 20 weeks onwards by on average 25mm Hg (P <0.001) and ameliorated proteinuria (P <0.05) and glomerulosclerosis (P <0.05). In kidneys of 2-day-, 2-week-, and adult offspring of PDTC-treated FHH dams, PGC-1α was induced on average by 67% (quantitative polymerase chain reaction (qPCR)) suggesting that suppression of this factor by NFkB could be involved in renal damage. Follow-up experiments with perinatal pioglitazone (Pio), a PPARγ agonist, failed to confer persistent antihypertensive or renoprotective effects. CONCLUSIONS Perinatal inhibition of enhanced active renal NFκB in 2-day FHH had persistent antihypertensive and renoprotective effects. However, this was not the case for PPARγ stimulation. NFkB stimulation is therefore involved in renal damage in the FHH model of proteinuric renal disease by pathways other than via PPARγ.

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.

Effect of a high-protein diet on maintenance of blood pressure levels achieved after initial weight loss: the DiOGenes randomized study
Engberink, M.F. ; Geleijnse, J.M. ; Bakker, S.J.L. ; Larsen, T. - \ 2015
Journal of Human Hypertension 29 (2015). - ISSN 0950-9240 - p. 58 - 63.
risk-factors - controlled-trial - glycemic index - obese women - supplementation - hypertension - overweight - markers - fat
Randomized trials have shown significant blood pressure (BP) reductions after increased protein compared with carbohydrate intake, but the effect on BP maintenance after initial weight loss is unclear. We examined the effect of a high-protein diet on the maintenance of reduced BP after weight loss in 420 overweight adults from the Diet, Obesity and Genes study. After an 8-week weight-loss period (>8% BW), subjects (42±6 years) were randomized to either a high-protein diet (23–28 en% protein) or a lower-protein control diet (10–15 en% protein) for 26 weeks. BMI after weight loss was 30.3±4.3¿kg¿m-2, BP was 118/73¿mm¿Hg and 28 subjects (6.5%) used antihypertensive agents. Systolic BP during 26 weeks of weight maintenance dietary intervention increased in both treatment groups, but it was 2.2¿mm¿Hg less (95% CI: -4.6 to 0.2¿mm¿Hg, P=0.08) in the high-protein group than in the lower-protein control group. In 191 (pre)hypertensive subjects (baseline systolic BP120¿mm¿Hg), a larger difference was observed (-4.2¿mm¿Hg (-7.7, -0.7), P=0.02). The effect was attenuated after adjustment for initial BP (-3.4¿mm¿Hg (-6.9, -0.03), P=0.048), and after additional adjustment for weight change (-2.7¿mm¿Hg (-6.1, 0.4), P=0.11). Adjustment for 24-h urinary excretion of sodium and potassium did not change the results. Diastolic BP yielded similar results. These findings suggest that a BP reduction after weight loss is better maintained when the intake of protein is increased at the expense of carbohydrates. This effect is partly mediated by body weight.
Non-linear associations between serum 25-OH vitamin D and indices of arterial stiffness and arteriosclerosis in an older population
Dijk, S.C. van; Sohl, E. ; Oudshoorn, C. ; Enneman, A.W. ; Ham, A.C. ; Swart, K.M.A. ; Wijngaarden, J.P. van; Brouwer, E.M. ; Zwaluw, N.L. van der; Uitterlinden, A.G. ; Groot, C.P.G.M. de; Dhonukshe-Rutten, R.A.M. ; Lips, P. ; Schoor, N.M. van; Blom, H.J. ; Geleijnse, J.M. ; Feskens, E.J.M. - \ 2015
Age and Ageing 44 (2015)1. - ISSN 0002-0729 - p. 136 - 142.
nutrition examination survey - 3rd national-health - cardiovascular-disease - blood-pressure - d deficiency - risk - 25-hydroxyvitamin-d - hypertension - mortality - system
Background: several studies have been pointing towards a non-linear relationship between serum 25(OH)D and cardiovascular disease. Next to vitamin D deficiency, also higher levels of 25(OH)D have been reported to be associated with increased cardiovascular risk. We aimed to investigate the nature of the relationship between serum 25(OH)D and measures of arterial stiffness and arteriosclerosis in an elderly population. Design: cross-sectional. Setting/subjects: a subgroup of the B-PROOF study was included to determine associations between serum 25(OH)D and arterial stiffness and atherosclerosis (n = 567, 57% male, age 72.6 ± 5.6 years, mean serum 25(OH)D 54.6 ± 24.1 nmol/l). Methods: carotid intima media thickness (IMT) was assessed using ultrasonography and pulse wave velocity (PWV) was determined with applanation tonometry. Associations were tested using multivariable restricted cubic spline functions and stratified linear regression analysis. Results: the associations between serum 25(OH)D and carotid IMT or PWV were non-linear. Spline functions demonstrated a difference between 25(OH)D deficient and sufficient individuals. In serum 25(OH)D sufficient participants (=50 nmol/l; n = 287), a positive association with IMT and serum 25(OH)D was present (ß 1.24; 95%CI [0.002; 2.473]). PWV levels were slightly lower in vitamin D deficient individuals, but the association with 25(OH)D was not significant. Conclusion: our study demonstrates that associations of serum 25(OH)D and PWV and IMT in an elderly population are not linear. In particular from serum 25(OH)D levels of 50 nmol/l and up, there is a slight increase of IMT with increasing 25(OH)D levels.
Higher dietary salt intake is associated with microalbuminuria, but not with retinopathy in individuals with type 1 diabetes: the EURODIAB Prospective Complications Study
Engelen, L. ; Soedamah-Muthu, S.S. ; Geleijnse, J.M. ; Toeller, M. ; Chaturvedi, N. ; Fuller, J.H. ; Schalkwijk, C.G. ; Stehouwer, C.D. - \ 2014
Diabetologia 57 (2014)11. - ISSN 0012-186X - p. 2315 - 2323.
urinary albumin excretion - blood-pressure - risk-factors - sodium-excretion - hypertension - mellitus - disease - system - iddm - aldosterone
Aims/hypothesis High dietary salt intake has been associated with elevated BP and may also have a deleterious effect on microvascular complications. We studied the cross-sectional associations between dietary salt intake (estimated from 24 h urinary sodium excretion) and urinary potassium excretion on the one hand, and the prevalence of microvascular complications on the other, in individuals with type 1 diabetes. Methods We measured sodium and potassium concentrations in two 24 h urine samples in 1,212 individuals with type 1 diabetes (40¿±¿10 years old, 51% men) who participated in the EURODIAB Prospective Complications Study. We used multiple logistic regression analyses to investigate associations between dietary salt intake and microvascular complications adjusted for age and sex, and additionally for BMI, smoking, urinary potassium excretion, antihypertensive medication and physical activity, and total energy, protein, alcohol, saturated fat and fibre intake. Results After full adjustment, 1 g/day higher dietary salt intake was positively associated with the presence of microalbuminuria (OR 1.06 [95% CI 1.01, 1.10]), but not macroalbuminuria (OR 0.99 [95% CI 0.94, 1.05]), non-proliferative retinopathy (OR 1.00 (95% CI 0.96, 1.04]) or proliferative retinopathy (OR 1.02 (95% CI 0.95, 1.08]). After excluding individuals with cardiovascular disease and/or antihypertensive medication (n¿=¿418), we found a non-significant association with microalbuminuria (OR 1.04 [95% CI 0.99, 1.10]) and macroalbuminuria (OR 1.05 [95% CI 0.96, 1.16]). The association between dietary salt intake and microalbuminuria was stronger in individuals with a BMI above 25 kg/m2 (OR 1.11 [95% CI 1.04, 1.18]) than in those with BMI below 25 kg/m2 (OR 1.03 [95% CI 0.97, 1.09]). No significant associations were found between urinary potassium excretion and microvascular complications. Conclusions/interpretation In individuals with type 1 diabetes, higher dietary salt intake, as determined by 24 h urinary sodium excretion, may be positively associated with microalbuminuria, particularly in overweight individuals.
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


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.


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


67 - 80

Chapter 5

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


81 - 100

Chapter 6

General discussion

101 - 120


Summary in Dutch

Summary in Vietnamese


About the author

Association of dietary pattern and body weight with blood pressure in Jiangsu Province, China
Qin, Y. ; Boonstra, A. ; Pan, X. ; Zhao, J. ; Yuan, B. ; Dai, Yue ; Zhou, M. ; Geleijnse, J.M. ; Kok, F.J. ; Shi, Z. - \ 2014
BMC Public Health 14 (2014). - ISSN 1471-2458 - 16 p.
randomized controlled-trials - public-health - global burden - risk-factors - meat intake - mass index - hypertension - sodium - adults - metaanalysis
Background To identify risk factors, associations between dietary patterns, body mass index (BMI), and hypertension in a Chinese population. Methods Dietary intake was assessed in 2518 adults by a 3-day 24 h recall and a food frequency questionnaire. Salt and oil intake was assessed by weighing records. Four dietary patterns were identified using principal component analysis. Overweight and obesity was determined according to the Chinese cut-offs for BMI. High blood pressure was defined as systolic blood pressure¿=¿140 mmHg and/or diastolic blood pressure¿=¿90 mmHg. Prevalence ratios (PR) were calculated using Poisson regression. Results Of the subjects, 26.7% had high blood pressure. Subjects with overweight and obesity were more likely to have high blood pressure than those with normal weight (PR, 95% CI: 1.60, 1.40-1.87; 2.45, 2.11-2.85, respectively). Subjects with a ‘traditional’ dietary pattern were more likely to have high blood pressure (P for trend¿=¿0.001), whereas those with a ‘macho’ or ‘sweet tooth’ dietary pattern were less likely to have high blood pressure (P for trend¿=¿0.004 and ¿9 g/d, and blood pressure increased with salt intake (P for trend
Potential effect of salt reduction in processed foods on health
Hendriksen, M.A.H. ; Hoogenveen, R.T. ; Hoekstra, J. ; Geleijnse, J.M. ; Boshuizen, H.C. ; Raaij, J.M.A. van - \ 2014
American Journal of Clinical Nutrition 99 (2014)3. - ISSN 0002-9165 - p. 446 - 453.
cardiovascular-disease - blood-pressure - sodium restriction - cost-effectiveness - dietary-sodium - iodine intake - hypertension - metaanalysis - mortality - interventions
Background: Excessive salt intake has been associated with hypertension and increased cardiovascular disease morbidity and mortality. Reducing salt intake is considered an important public health strategy in the Netherlands. Objective: The objective was to evaluate the health benefits of salt-reduction strategies related to processed foods for the Dutch population. Design: Three salt-reduction scenarios were developed: 1) substitution of high-salt foods with low-salt foods, 2) a reduction in the sodium content of processed foods, and 3) adherence to the recommended maximum salt intake of 6 g/d. Health outcomes were obtained in 2 steps: after salt intake was modeled into blood pressure levels, the Chronic Disease Model was used to translate modeled blood pressures into incidences of cardiovascular diseases, disability-adjusted life years (DALYs), and life expectancies. Health outcomes of the scenarios were compared with health outcomes obtained with current salt intake. Results: In total, 4.8% of acute myocardial infarction cases, 1.7% of congestive heart failure cases, and 5.8% of stroke cases might be prevented if salt intake meets the recommended maximum intake. The burden of disease might be reduced by 56,400 DALYs, and life expectancy might increase by 0.15 y for a 40-y-old individual. Substitution of foods with comparable low-salt alternatives would lead to slightly higher salt intake reductions and thus to more health gain. The estimates for sodium reduction in processed foods would be slightly lower. Conclusion: Substantial health benefits might be achieved when added salt is removed from processed foods and when consumers choose more low-salt food alternatives.
Associations of plant and animal protein intake with 5-year changes in blood pressure: The Zutphen Elderly Study
Tielemans, S.M.A.J. ; Kromhout, D. ; Altorf-van der Kuil, W. ; Geleijnse, J.M. - \ 2014
Nutrition, Metabolism & Cardiovascular Diseases 24 (2014)11. - ISSN 0939-4753 - p. 1228 - 1233.
hypertension - prevention - intermap - health - risk - life
Background and aim The aim of the present study was to investigate the association of plant and animal protein intake with 5-year changes in blood pressure (BP) level. Methods and results Analyses were based on 702 observations of 272 men participating in the Zutphen Elderly Study. Men did not use antihypertensive medication and were initially free of cardiovascular disease, diabetes mellitus and cancer. Physical and dietary examinations were performed in 1985, 1990, 1995, and 2000. Diet was assessed using the cross-check dietary history method. Men were categorised into tertiles according to their plant and animal protein intake. BP was measured twice at each examination. The associations of plant and animal protein intake with 5-year changes in BP level were investigated by a random intercept model with first-order autoregressive (AR [1]) serial correlation and a nugget effect. Adjustments were made for age, examination year, BMI, socioeconomic status, smoking, physical activity, prescribed diet, alcohol consumption and intake of energy and nutrients. In 1985, men were 70.1 ± 4.6 years old and had a mean BP of 147/84 mmHg. Mean protein intake was 15 en%, of which one-third consisted of plant protein. The higher-intake tertiles of plant protein intake were associated with a mean 5-year change of -2.9 mmHg (95% CI: -5.6, -0.2) systolic and -1.7 mmHg (95% CI: -3.2, -0.2) diastolic, compared with the lowest-intake tertile. No associations were observed for animal protein intake. Conclusion Intake of plant protein, but not animal protein, was inversely associated with 5-year changes in BP level in elderly men.
Joint Association of Dietary Pattern and Physical Activity Level with Cardiovascular Disease Risk Factors among Chinese Men: A Cross-Sectional Study
Wang, D. ; He, Y. ; Li, Y.P. ; Luan, D.C. ; Zhai, F.Y. ; Yang, X.G. ; Ma, G.S. - \ 2013
PLoS ONE 8 (2013)6. - ISSN 1932-6203
diabetes prevention program - impaired glucose-tolerance - life-style - metabolic syndrome - blood-pressure - attributable risk - plasma biomarkers - us adults - population - hypertension
The purpose of this cross-sectional study was to investigate the joint associations of physical activity level (PAL) and dietary patterns in relation to cardiovascular disease (CVD) risk factors among Chinese men. The study population consisted of 13 511 Chinese males aged 18-59 years from the 2002 China National Nutrition and Health Survey. Based on dietary data collected by a food frequency questionnaire, four dietary patterns were identified and labeled as "Green Water'' (high consumption of rice, vegetables, seafood, pork, and poultry), "Yellow Earth'' (high consumption of wheat flour products and starchy tubers), "New Affluent'' (high consumption of animal sourced foods and soybean products), and "Western Adopter'' (high consumption of animal sourced foods, cakes, and soft drinks). From the information collected by a 1-year physical activity questionnaire, PAL was calculated and classified into 4 categories: sedentary, low active, active, and very active. As compared with their counterparts from the New Affluent pattern, participants who followed the Green Water pattern had a lower likelihood of abdominal obesity (AO; 50.2%), hypertension (HT; 37.9%), hyperglycemia (HG; 41.5%), elevated triglyceride (ETG; 14.5%), low HDL (LHDL; 39.8%), and metabolic syndrome (MS; 51.9%). When compared to sedentary participants, the odds ratio of participants with very active PAL was 0.62 for AO, 0.85 for HT, 0.71 for HG, 0.76 for ETG, 0.74 for LHDL, and 0.58 for MS. Individuals who followed both very active PAL and the Green Water pattern had a lower likelihood of CVD risk factors (AO: 65.8%, HT: 39.1%, HG: 57.4%, ETG: 35.4%, LHDL: 56.1%, and MS: 75.0%), compared to their counterparts who followed both sedentary PAL and the New Affluent pattern. In addition, adherence to both healthy dietary pattern and very active PAL presented a remarkable potential for CVD risk factor prevention.
Dietary protein, blood pressure and renal function in renal transplant recipients
Berg, E. van den; Engberink, M.F. ; Brink, E.J. ; Baak, M.A. van; Gans, R.O.B. ; Navis, G. ; Bakker, S.J.L. - \ 2013
The British journal of nutrition 109 (2013)8. - ISSN 0007-1145 - p. 1463 - 1470.
kidney-transplantation - cardiovascular-disease - sodium-intake - follow-up - hypertension - restriction - association - progression - failure - inhibition
Hypertension is highly prevalent among renal transplant recipients (RTR) and a risk factor for graft failure and cardiovascular events. Protein intake has been claimed to affect blood pressure (BP) in the general population and may affect renal function. We examined the association of dietary protein with BP and renal function in RTR. We included 625 RTR (age 53 (SD 13) years; 57% male). Protein intake was assessed with a FFQ, differentiating between animal and plant protein. BP was measured according to a strict protocol. Creatinine clearance and albuminuria were measured as renal parameters. Protein intake was 83 (SD 12) g/d, of which 63% derived from animal sources. BP was 136 (SD 17) mmHg systolic (SBP) and 83 (SD 11) mmHg diastolic (DBP). Creatinine clearance was 66 (SD 26) ml/min; albuminuria 41 (10-178) mg/24 h. An inverse, though statistically insignificant, association was found between the total protein intake and both SBP (beta = -2.22 mmHg per SD, P=0.07) and DBP (beta = -0.48 mmHg per SD, P=0.5). Protein intake was not associated with creatinine clearance. Although albuminuria was slightly higher in the highest tertile of animal protein intake compared with the lowest tertile (66 v. 33 mg/d, respectively, P=0.03), linear regression analyses did not reveal significant associations between dietary protein and albuminuria. Protein intake exceeded the current recommendations. Nevertheless, within the range of protein intake in our RTR population, we found no evidence for an association of dietary protein with BP and renal function. Intervention studies focusing on different protein types are warranted to clarify their effect on BP and renal function in RTR.
Biomarkers of Dairy Fatty Acids and Risk of Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis
Oliveira Otto, M.C. de; Nettleton, J.A. ; Lemaitre, R.N. ; Steffen, L.M. ; Kromhout, D. ; Rich, R.L. ; Tsai, M.Y. ; Jacobs, D.R. ; Mozaffarian, D. - \ 2013
Journal of the American Heart Association 2 (2013). - ISSN 2047-9980 - 11 p.
intima-media thickness - physical-activity - dietary patterns - plasma-lipids - milk-fat - hypertension - women - association - calcium - mesa
Background Evidence regarding the role of dairy fat intake in cardiovascular disease (CVD) has been mixed and inconclusive. Most earlier studies have used self-reported measures of dietary intake and focused on relatively racially homogeneous populations. Circulating biomarkers of dairy fat in a multiethnic cohort provide objective measures of dairy fat intake and facilitate conclusions relevant to populations with different diets and susceptibility to CVD. Methods and Results In a multiethnic cohort of 2837 US adults aged 45 to 84 years at baseline (2000–2002), phospholipid fatty acids including 15:0, 14:0, and trans-16:1n7 were measured using standardized methods, and the incidence of CVD prospectively adjudicated. Self-reported whole-fat dairy and butter intakes had strongest associations with 15:0, rather than 14:0 or trans-16:1n7. In multivariate models including demographics and lifestyle and dietary habits, each SD-unit of 15:0 was associated with 19% lower CVD risk (hazard ratio [95% CI] 0.81 [0.68 to 0.98]) and 26% lower coronary heart disease (CHD) risk (0.74 [0.60 to 0.92]). Associations were strengthened after mutual adjustment for 14:0 and trans-16:1n-7 and were similar after adjustment for potential mediators. Plasma phospholipid 14:0 and trans-16:1n-7 were not significantly associated with incident CVD or CHD. All findings were similar in white, black, Hispanic, and Chinese American participants. Conclusion Plasma phospholipid 15:0, a biomarker of dairy fat, was inversely associated with incident CVD and CHD, while no association was found with phospholipid 14:0 and trans-16:1n-7. These findings support the need for further investigation of CVD effects of dairy fat, dairy-specific fatty acids, and dairy products in general
Intake of total protein, plant protein and animal protein in relation to blood pressure: a meta-analysis of observatinoal and intervention studies
Tielemans, S.M.A.J. ; Altorf-van der Kuil, W. ; Engberink, M.F. ; Brink, E.J. ; Baak, M.A. van; Bakker, S.J. ; Geleijnse, J.M. - \ 2013
Journal of Human Hypertension 27 (2013). - ISSN 0950-9240 - p. 564 - 571.
low-fat diet - randomized-trial - weight-loss - carbohydrate intake - obese women - hypertension - risk - overweight - supplementation - macronutrients
There is growing evidence from epidemiological studies that dietary protein may beneficially influence blood pressure (BP), but findings are inconclusive. We performed a meta-analysis of 29 observational studies and randomized controlled trials (RCTs) of dietary protein and types of protein in relation to BP or incident hypertension, published until January 2012. The analysis included eight cross-sectional studies (n=48¿985), four prospective studies (n=11¿761) and 17 RCTs (n=1449). A modest inverse association between total protein intake and BP (-0.20¿mm¿Hg systolic (95% CI: -0.39, -0.01) per 25¿g (~1¿s.d.)) was found in cross-sectional studies, but not in prospective studies (relative risk of 0.99 (95% CI: 0.96, 1.02)). For RCTs that used carbohydrate as a control treatment, the pooled BP effect was -2.11¿mm¿Hg systolic (95% CI: -2.86, -1.37) for a weighed mean contrast in protein intake of 41¿g per day. A non-significant inverse association of -0.52¿mm¿Hg systolic (95% CI: -1.10, +0.05) per 11¿g (~1¿s.d.) was found for plant protein in cross-sectional studies, whereas animal protein was not associated with BP. In prospective studies and RCTs, however, the associations of plant protein and animal protein with BP were broadly similar. These findings suggest that increasing the intake of protein at the expense of carbohydrates may have a beneficial effect on BP. The BP effect of specific types of protein remains to be established.
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.

Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis
Oliveira Otto, M.C. de; Mozaffarian, D. ; Kromhout, D. ; Bertoni, A.G. ; Sibley, C.T. ; Jacobs, D.R. ; Nettleton, J.A. - \ 2012
American Journal of Clinical Nutrition 96 (2012)2. - ISSN 0002-9165 - p. 397 - 404.
coronary-heart-disease - blood-pressure - risk-factors - womens health - cholesterol - consumption - mesa - hypertension - metaanalysis - patterns
Background: Although dietary recommendations have focused on restricting saturated fat (SF) consumption to reduce cardiovascular disease (CVD) risk, evidence from prospective studies has not supported a strong link between total SF intake and CVD events. An understanding of whether food sources of SF influence these relations may provide new insights. Objective: We investigated the association of SF consumption from different food sources and the incidence of CVD events in a multi-ethnic population. Design: Participants who were 45-84 y old at baseline (n = 5209) were followed from 2000 to 2010. Diet was assessed by using a 120-item food-frequency questionnaire. CVD incidence (316 cases) was assessed during follow-up visits. Results: After adjustment for demographics, lifestyle, and dietary confounders, a higher intake of dairy SF was associated with lower CVD risk [HR (95% CI) for +5 g/d and +5% of energy from dairy SF: 0.79 (0.68, 0.92) and 0.62 (0.47, 0.82), respectively]. In contrast, a higher intake of meat SF was associated with greater CVD risk [HR (95% CI) for +5 g/d and a +5% of energy from meat SF: 1.26 (1.02, 1.54) and 1.48 (0.98, 2.23), respectively]. The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk [HR (95% CI): 0.75 (0.63, 0.91)]. No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow. Conclusion: Associations of SF with health may depend on food-specific fatty acids or other nutrient constituents in foods that contain SF, in addition to SF. Am J Clin Nutr 2012;96:397-404.
Sources of dietary protein in relation to blood pressure in a general Dutch population
Altorf-van der Kuil, W. ; Engberink, M.F. ; Vedder, M.M. ; Boer, J.M.A. ; Verschuren, W.M.M. ; Geleijnse, J.M. - \ 2012
PLoS ONE 7 (2012)2. - ISSN 1932-6203 - 8 p.
disease risk-factors - controlled-trial - men - hypertension - women - association - prevention - nutrition - intermap - cancer
Background - Little is known about the relation of different dietary protein types with blood pressure (BP). We examined whether intake of total, plant, animal, dairy, meat, and grain protein was related to BP in a cross sectional cohort of 20,820 Dutch adults, aged 20–65 y and not using antihypertensive medication. Design - Mean BP levels were calculated in quintiles of energy-adjusted protein with adjustment for age, sex, BMI, education, smoking, and intake of energy, alcohol, and other nutrients including protein from other sources. In addition, mean BP difference after substitution of 3 en% carbohydrates or MUFA with protein was calculated. Results - Total protein and animal protein were not associated with BP (ptrend = 0.62 and 0.71 respectively), both at the expense of carbohydrates and MUFA. Systolic BP was 1.8 mmHg lower (ptrend36 g/d) than in the lowest (
Protein supplementation lowers blood pressure in overweight adults: effect of dietary proteins on blood pressure (PROPRES), a randomized trail
Teunissen-Beekman, K.F.M. ; Dopheide, J. ; Geleijnse, J.M. ; Bakker, S.J.L. ; Brink, E.J. ; Leeuw, P.W. de; Baak, M.A. van - \ 2012
American Journal of Clinical Nutrition 95 (2012)4. - ISSN 0002-9165 - p. 966 - 971.
carbohydrate intake - hypertension - excretion - markers - women - fat
Background: Dietary protein intake may help to manage blood pressure (BP) and prevent complications associated with elevated BP. Objective: The objective of this study was to determine whether 4 wk of increased protein intake (~25% compared with ~15% of energy intake that isoenergetically replaces carbohydrate intake) lowers office and daytime BP compared with increased carbohydrate intake. Design: A randomized, double-blind, parallel study compared consumption of 3 × 20 g protein/d (20% pea, 20% soy, 30% egg, and 30% milk-protein isolate) with 3 × 20 g maltodextrin/d. Protein or maltodextrin were isoenergetically substituted for a sugar-sweetened drink. Primary outcomes were office and daytime BP. A total of 99 men and women [age range: 20–70 y; BMI (in kg/m2): 25–35] with untreated elevated BP (BP =130/85 and
The effect of conjugated linoneic acid, a natural trans fat from milk and meat, on human blood pressure: results from a randomized crossover feeding study
Engberink, M.F. ; Geleijnse, J.M. ; Wanders, A.J. ; Brouwer, I.A. - \ 2012
Journal of Human Hypertension 26 (2012). - ISSN 0950-9240 - p. 127 - 132.
body-composition - vaccenic acid - hypertension - rats - esters - lipids - men
Cis-9, trans-11 conjugated linoleic acid (CLA) is a natural trans fatty acid that is largely restricted to ruminant fats and consumed in foods and supplements. Its role in blood pressure (BP) regulation is still unclear. We examined the effect of cis-9, trans-11 CLA on BP compared with oleic acid. A total of 61 healthy volunteers were sequentially fed each of 3 diets for 3 weeks, in random order, for a total of 9 weeks. The diets were identical except for 7% of energy (18.9¿g in a diet of 10¿MJ¿day–1) that was provided either by oleic acid, by industrial trans fatty acids or by cis-9, trans-11 CLA. We measured BP on two separate days at the end of each intervention period. At baseline, mean BP was 113.8±14.4¿mm¿Hg systolic and 66.3±9.6¿mm¿Hg diastolic. The effect of the CLA diet compared with the oleic acid diet was 0.11¿mm¿Hg (95% confidence interval: -1.27, 1.49) systolic and -0.45¿mm¿Hg (-1.63, 0.73) diastolic. After the industrial trans fatty acid diet, the effect was 1.13¿mm¿Hg (-0.25, 2.51) systolic and -0.44¿mm¿Hg (-1.62, 0.73) diastolic compared with the oleic acid diet. Our study suggests that short-term high intakes of cis-9,trans-11 CLA do not affect BP in healthy volunteers
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