A nutrient-wide association study on blood pressure

Ioanna Tzoulaki, Chirag J. Patel, Tomonori Okamura, Queenie Chan, Ian J. Brown, Katsuyuki Miura, Hirotsugu Ueshima, Liancheng Zhao, Linda Van Horn, Martha L. Daviglus, Jeremiah Stamler, Atul J. Butte, John P.A. Ioannidis, Paul Elliott

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89 Citations (Scopus)

Abstract

BACKGROUND: A nutrient-wide approach may be useful to comprehensively test and validate associations between nutrients (derived from foods and supplements) and blood pressure (BP) in an unbiased manner. METHODS AND RESULTS: Data from 4680 participants aged 40 to 59 years in the cross-sectional International Study of Macro/Micronutrients and Blood Pressure (INTERMAP) were stratified randomly into training and testing sets. US National Health and Nutrition Examination Survey (NHANES) four cross-sectional cohorts (1999-2000, 2001-2002, 2003-2004, 2005-2006) were used for external validation. We performed multiple linear regression analyses associating each of 82 nutrients and 3 urine electrolytes with systolic and diastolic BP in the INTERMAP training set. Significant findings were validated in the INTERMAP testing set and further in the NHANES cohorts (false discovery rate <5% in training, P<0.05 for internal and external validation). Among the validated nutrients, alcohol and urinary sodium-to-potassium ratio were directly associated with systolic BP, and dietary phosphorus, magnesium, iron, thiamin, folacin, and riboflavin were inversely associated with systolic BP. In addition, dietary folacin and riboflavin were inversely associated with diastolic BP. The absolute effect sizes in the validation data (NHANES) ranged from 0.97 mm Hg lower systolic BP (phosphorus) to 0.39 mm Hg lower systolic BP (thiamin) per 1-SD difference in nutrient variable. Inclusion of nutrient intake from supplements in addition to foods gave similar results for some nutrients, though it attenuated the associations of folacin, thiamin, and riboflavin intake with BP. CONCLUSIONS: We identified significant inverse associations between B vitamins and BP, relationships hitherto poorly investigated. Our analyses represent a systematic unbiased approach to the evaluation and validation of nutrient-BP associations.

Original languageEnglish
Pages (from-to)2456-2464
Number of pages9
JournalCirculation
Volume126
Issue number21
DOIs
Publication statusPublished - 2012 Nov 20

Keywords

  • blood pressure
  • diet
  • epidemiology
  • nutrition assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Tzoulaki, I., Patel, C. J., Okamura, T., Chan, Q., Brown, I. J., Miura, K., Ueshima, H., Zhao, L., Van Horn, L., Daviglus, M. L., Stamler, J., Butte, A. J., Ioannidis, J. P. A., & Elliott, P. (2012). A nutrient-wide association study on blood pressure. Circulation, 126(21), 2456-2464. https://doi.org/10.1161/CIRCULATIONAHA.112.114058