中国农村地区高血压患者果蔬摄入对血压进展的影响研究

贺枝; 刘芳超; 李建新; 曹杰; 陈纪春; 胡东生; 沈冲; 顾淑君; 赵颖馨; 黄建凤; 陈恕凤; 鲁向锋; 顾东风

doi:10.16462/j.cnki.zhjbkz.2021.03.006

中国农村地区高血压患者果蔬摄入对血压进展的影响研究

doi: 10.16462/j.cnki.zhjbkz.2021.03.006

贺枝¹,
刘芳超¹,
李建新¹,
曹杰¹,
陈纪春¹,
胡东生^{2, 3},
沈冲⁴,
顾淑君⁵,
赵颖馨⁶,
黄建凤¹,
陈恕凤^1, ,,
鲁向锋¹,
顾东风¹

1.
100037 北京，北京协和医学院，国家心血管病中心，中国医学科学院阜外医院，流行病研究部，中国医学科学院心血管流行病学重点实验室
2.
450001 郑州，郑州大学公共卫生学院
3.
518060 深圳，深圳大学公共卫生学院
4.
211166 南京，南京医科大学公共卫生学院
5.
215500 常熟，江苏省常熟市疾病预防控制中心
6.
250062 济南，山东第一医科大学(山东省医学科学院)

基金项目:

国家重点研发计划 2018YFC1311703

国家重点研发计划 2017YFC0211703

中国医学科学院医学与健康科技创新工程 2019-I2M-2-003

中国医学科学院医学与健康科技创新工程 2017-I2M-1-004

详细信息

通讯作者:
陈恕凤，E-mail: chenshufeng@fuwai.cams.cn

中图分类号: R544.1
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出版历程
- 收稿日期: 2021-01-01
- 修回日期: 2021-02-20
- 刊出日期: 2021-03-10

Influence of fruit and vegetable consumption on blood pressure progression among hypertensive patients in rural China

1.
Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
2.
School of Public Health, Zhengzhou University, Zhengzhou 450001, China
3.
School of Public Health, Shenzhen University, Shenzhen 518060, China
4.
School of Public Health, Nanjing Medical University, Nanjing 211166, China
5.
Changshu Center for Disease Control and Prevention, Changshu 215500, China
6.
Shandong First Medical University (Shandong Academy of Medicine Sciences), Jinan, 250062, China

Funds:

National Key Research and Development Program of China 2018YFC1311703

National Key Research and Development Program of China 2017YFC0211703

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2019-I2M-2-003

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2017-I2M-1-004

More Information

Corresponding author: CHEN Shu-feng, E-mail: chenshufeng@fuwai.cams.cn

摘要

摘要: 目的基于前瞻性队列研究探讨我国农村地区高血压患者果蔬摄入与血压进展的关系。方法中国代谢综合征社区干预研究暨中国家庭健康研究于2007-2008年开展基线调查，收集膳食、体力活动和血压等信息，并于2012-2015年进行随访调查。膳食资料采用食物频率问卷获取，按照研究对象总果蔬、水果和蔬菜摄入量是否达到推荐摄入水平和摄入量的四分位数分别进行分组。根据血压水平将高血压分为1级、2级和3级，随访期间高血压分级升高1级及以上则定义为血压进展。采用Logistic回归模型分析果蔬摄入与血压进展的关系。结果本研究纳入25 080例基线高血压患者，平均随访5.8年，共有4 112例高血压患者发生血压进展，进展率为16.4%。总果蔬摄入达标者较未达标者血压进展风险降低17%(OR=0.83，95% CI：0.77~0.90)，蔬菜分析结果类似。以总果蔬摄入最低组(Q1)为参照，摄入量位于Q2~Q4组的ORs(95% CIs)值分别为0.86(0.78~0.95)、0.77(0.69~0.86)和0.69(0.61~0.77)(χ²_趋势=43.02, P < 0.001)，水果和蔬菜分析结果相似。总果蔬和蔬菜摄入量每增加100 g/d血压进展风险分别下降4%(OR=0.96，95%CI：0.94~0.98)和5%(OR=0.95，95% CI：0.93~0.97)，而水果与血压进展风险的关联无统计学意义(OR=0.97，95% CI：0.93~1.01)。结论增加果蔬摄入能够有效降低血压进展的风险，对高血压患者的健康管理具有积极作用。
- 水果 /
- 蔬菜 /
- 血压进展 /
- 高血压 /
- 队列研究
Abstract: Objective To evaluate the relationship of fruit and vegetable consumption with blood pressure (BP) progression among hypertensive patients in rural China, using a prospective cohort study. Methods Baseline examination of the Community Intervention of Metabolic Syndrome in China & Chinese Family Health Study (CIMIC) was conducted in 2007-2008 to collect information on diet consumption, physical activity, BP, and so on. Participants were followed up during 2012-2015. Diet consumption was calculated from food frequency questionnaires. Participants were divided into two groups by whether meeting the recommended intake of total fruit and vegetable (total F&V), fruit, or vegetable consumption (Yes or No), and were also classified into four groups according to their quartiles (Q1-Q4), respectively. Three stages of hypertension were ascertained according to BP levels, and BP progression was defined as an increment of ≥1 stage of hypertension from baseline to the follow-up visit. Logistic regression models were used to estimate the odds ratios (ORs) and their corresponding confidence intervals (CIs) for the relationship of fruit and vegetable intake with the risk of BP progression. Results Among 25 080 participants with hypertension at baseline, 4 112 patients had BP progression during the average follow-up of 5.8 years, with the progression rate of 16.4%. Participants who met the recommended total F&V intake had a 17% (OR=0.83, 95% CI: 0.77-0.90) reduction in the risk of BP progression compared with those who did not. Compared with the lowest group of total F&V consumption (Q1), the ORs (95% CIs) of BP progression were 0.86 (0.78-0.95), 0.77 (0.69-0.86) and 0.69 (0.61-0.77) for the Q2, Q3 and Q4 group, respectively (χ²_trend=43.02, P < 0.001). Analyses of vegetable and fruit consumption showed similar results. Furthermore, each increment of 100 g/d in total F&V and vegetable intake was associated with a 4% (OR=0.96, 95% CI: 0.94-0.98) and 5% (OR=0.95, 95% CI: 0.93-0.97) lower risk of BP progression, respectively. The association of fruit with BP progression was not significant (OR=0.97, 95% CI: 0.93-1.01). Conclusions Increasing the intake of fruit and vegetable could reduce the risk of BP progression and is beneficial for the management of hypertension patients.
- Fruit /
- Vegetable /
- Blood pressure progression /
- Hypertension /
- Cohort study

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图 1 高血压患者中总果蔬摄入量与血压进展关联关系的亚组分析

Figure 1. Subgroup analyses for the association of total F&V consumption with blood pressure progression among hypertensive patients

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表 1 依据总果蔬摄入量分组的高血压患者基线特征[n(%)]

Table 1. Baseline characteristics of hypertensive patients according to total F&V consumption [n(%)]

项目	Q1(< 266.7 g/d)	Q2(266.7~435.6 g/d)	Q3(435.7~549.9 g/d)	Q4(≥550.0 g/d)	χ²/F值	P值
人数	6 169(24.6)	6 158(24.6)	6 423(25.6)	6 330(25.2)	—	—
水果摄入占比(%)	13.3	15.4	15.8	23.0	—	—
年龄[(x±s), 岁]^a	58.5±10.6	57.0±10.5	57.1±10.3	55.8±10.4	69.68	< 0.001
男性^b	2 251(36.5)	2 292(37.2)	2 455(38.2)	2 517(39.8)	15.58	< 0.001
南方^b	4 802(77.8)	2 285(37.1)	1 628(25.4)	1 065(16.8)	4 970.15	< 0.001
文化程度高中及以上^b	267(4.4)	388(6.3)	391(6.1)	511(8.1)	64.45	< 0.001
BMI [(x±s), kg/m²]^a	24.5±3.6	25.3±3.7	25.3±3.7	25.5±3.7	91.01	< 0.001
吸烟^b	1 500(24.3)	1 303(21.2)	1 207(18.8)	1 189(18.8)	68.22	< 0.001
饮酒^b	1 201(19.5)	1 188(19.3)	1 247(19.4)	1 185(18.7)	0.91	0.341
体力活动达到推荐水平者^b	3 350(54.3)	4 029(65.4)	4 513(70.3)	4 509(71.2)	425.93	< 0.001
高血压家族史^b	2 240(36.3)	1 997(32.4)	1 734(27.0)	1 798(28.4)	123.98	< 0.001
糖尿病^b	644(10.9)	633(10.6)	588(9.5)	569(9.2)	11.97	< 0.001
高胆固醇血症^b	180(3.0)	280(4.7)	346(5.6)	297(4.8)	26.94	< 0.001
SBP [(x±s), mm Hg)]^a	147.3±17.4	150.2±18.8	151.8±19.6	151.9±19.1	82.56	< 0.001
DBP [(x±s), mm Hg)]^a	87.3±10.2	89.3±10.5	89.5±10.8	90.5±10.6	99.73	< 0.001
红肉摄入≥75 g/d^b	400(6.5)	586(9.5)	655(10.2)	393(6.2)	0.02	0.896
豆类摄入≥125 g/d^b	175(2.8)	245(4.0)	226(3.5)	479(7.6)	137.86	< 0.001
鱼肉摄入≥200 g/周^b	1 799(29.2)	1 684(27.4)	1 426(22.2)	1 207(19.1)	213.04	< 0.001
注：^a连续变量用(x±s)表示，采用方差分析检验，统计量为F值；^b分类变量用例数(%)表示，采用χ²检验，统计量为χ²值。水果摄入占比(%)=水果摄入量/总果蔬摄入量×100。

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表 2 高血压患者中果蔬摄入量达标与血压进展的关联关系

Table 2. Associations of meeting the recommended level of fruit and vegetable consumption with blood pressure progression among hypertensive patients

变量	摄入量(g/d)	进展例数/暴露例数	进展率(%)	OR (95% CI)值
变量	摄入量(g/d)	进展例数/暴露例数	进展率(%)	模型1	模型2	模型3
总果蔬
未达标	< 500	2 664/14 296	18.6	1.00	1.00	1.00
达标	≥500	1 448/10 784	13.4	0.84(0.78~0.90)	0.83(0.77~0.90)	0.83(0.77~0.90)
水果
未达标	< 200	3 703/21 885	16.9	1.00	1.00	1.00 ^a
达标	≥200	409/3 195	12.8	0.92(0.82~1.03)	0.92(0.82~1.04)	0.94(0.83~1.06) ^a
蔬菜
未达标	< 300	2 097/10 323	20.3	1.00	1.00	1.00 ^b
达标	≥300	2 015/14 757	13.7	0.79(0.74~0.85)	0.80(0.74~0.87)	0.81(0.75~0.87) ^b
注：模型1：调整年龄、性别、南北、教育水平、随访时长；模型2：模型1+调整BMI、糖尿病、高胆固醇血症、高血压家族史、基线SBP；模型3：模型2+调整红肉、豆类、鱼类、吸烟、饮酒、体力活动水平；^a模型3+调整蔬菜；^b模型3+调整水果。

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表 3 高血压患者中果蔬摄入量与血压进展的关联关系

Table 3. Associations of fruit and vegetable consumption with blood pressure progression among hypertensive patients

项目	Q1	Q2	Q3	Q4	χ_趋势²值	P值	摄入每增加100 g/d
总果蔬
摄入量(g/d)	< 266.7	266.7~435.6	435.7~549.9	≥550.0	—	—	—
进展例数/暴露例数	1 413/6 169	1 024/6 158	908/6 423	767/6 330	—	—	—
进展率(%)	22.9	16.6	14.1	12.1	—	—	—
OR (95% CI)值
模型1	1.00	0.86(0.78~0.95)	0.76(0.69~0.84)	0.68(0.61~0.76)	53.99	< 0.001	0.96(0.94~0.97)
模型2	1.00	0.84(0.76~0.93)	0.76(0.68~0.84)	0.68(0.61~0.76)	47.99	< 0.001	0.95(0.94~0.97)
模型3	1.00	0.86(0.78~0.95)	0.77(0.69~0.86)	0.69(0.61~0.77)	43.02	< 0.001	0.96(0.94~0.98)
水果
摄入量(g/d)	< 16.7	16.7~42.8	42.9~99.9	≥100.0	—	—	—
进展例数/暴露例数	1 324/5 827	1 135/6 647	667/5 304	986/7 302	—	—	—
进展率(%)	22.7	17.1	12.6	13.5	—	—	—
OR (95% CI)值
模型1	1.00	0.87(0.79~0.96)	0.68(0.61~0.76)	0.80(0.72~0.88)	16.78	< 0.001	0.96(0.92~1.00)
模型2	1.00	0.88(0.79~0.97)	0.69(0.61~0.77)	0.80(0.72~0.89)	13.66	< 0.001	0.96(0.92~1.00)
模型3^a	1.00	0.90(0.82~1.00)	0.72(0.64~0.81)	0.84(0.76~0.94)	7.51	0.006	0.97(0.93~1.01)
蔬菜
摄入量(g/d)	< 250.0	250.0~349.9	350.0~499.9	≥500.0	—	—	—
进展例数/暴露例数	1 211/5 370	1 168/6 841	751/6 070	982/6 799	—	—	—
进展率(%)	22.6	17.1	12.4	14.4	—	—	—
OR (95% CI)值
模型1	1.00	0.90(0.82~0.99)	0.73(0.65~0.81)	0.77(0.70~0.86)	33.96	< 0.001	0.95(0.93~0.97)
模型2	1.00	0.88(0.80~0.98)	0.75(0.66~0.84)	0.76(0.68~0.84)	31.76	< 0.001	0.95(0.93~0.97)
模型3^b	1.00	0.90(0.81~0.99)	0.77(0.68~0.87)	0.76(0.68~0.85)	28.58	< 0.001	0.95(0.93~0.97)
注：模型1：调整年龄、性别、南北、教育水平、随访时长；模型2：模型1+调整BMI、糖尿病、高胆固醇血症、高血压家族史、基线SBP；模型3：模型2+调整红肉、豆类、鱼类、吸烟、饮酒、体力活动水平；^a模型3+调整蔬菜；^b模型3+调整水果。

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表 4 未服降压药高血压患者中果蔬摄入量与血压进展关联关系的敏感性分析

Table 4. Sensitivity analyses for the associations of fruit and vegetable consumption with blood pressure progression among hypertensive patients without taking anti-hypertensive medications

项目	Q1	Q2	Q3	Q4	χ_趋势²值	P值	摄入每增加100 g/d
总果蔬
摄入量(g/d)	< 266.7	266.7~435.6	435.7~549.9	≥550.0	—	—	—
进展例数/暴露例数	184/1 661	198/2 129	188/2 469	183/2 475	—	—	—
进展率(%)	11.1	9.3	7.6	7.4	—	—	—
OR (95% CI)值
模型1	1.00	0.81 (0.64~1.02)	0.65 (0.51~0.82)	0.63 (0.49~0.80)	16.89	< 0.001	0.93 (0.89~0.98)
模型2	1.00	0.81 (0.64~1.02)	0.66 (0.52~0.85)	0.62 (0.49~0.80)	16.09	< 0.001	0.94 (0.89~0.98)
模型3	1.00	0.87 (0.69~1.11)	0.74 (0.58~0.95)	0.68 (0.53~0.88)	10.40	0.001	0.95 (0.91~0.99)
水果
摄入量(g/d)	< 16.7	16.7~42.8	42.9~99.9	≥100.0	—	—	—
进展例数/暴露例数	176/1 607	194/2 192	143/1 955	240/2 980	—	—	—
进展率(%)	11.0	8.9	7.3	8.1	—	—	—
OR (95% CI)值
模型1	1.00	0.80 (0.64~1.00)	0.66 (0.51~0.85)	0.70 (0.56~0.88)	6.22	0.013	0.92 (0.84~1.02)
模型2	1.00	0.80 (0.64~1.01)	0.66 (0.52~0.85)	0.72 (0.57~0.91)	4.77	0.029	0.94 (0.85~1.03)
模型3^a	1.00	0.84 (0.67~1.06)	0.71 (0.55~0.92)	0.81 (0.63~1.03)	1.46	0.228	0.97 (0.89~1.06)
蔬菜
摄入量(g/d)	< 250.0	250.0~349.9	350.0~499.9	≥500.0	—	—	—
进展例数/暴露例数	171/1 464	205/2 386	201/2 567	176/2 317	—	—	—
进展率(%)	11.7	8.6	7.8	7.6	—	—	—
OR (95% CI)值
模型1	1.00	0.69 (0.55~0.87)	0.61 (0.48~0.78)	0.63 (0.49~0.80)	11.36	< 0.001	0.93 (0.88~0.98)
模型2	1.00	0.70 (0.56~0.89)	0.61 (0.48~0.79)	0.63 (0.49~0.80)	11.90	< 0.001	0.93 (0.88~0.98)
模型3^b	1.00	0.75 (0.59~0.95)	0.69 (0.53~0.89)	0.66 (0.52~0.85)	8.51	0.004	0.94 (0.89~0.99)
注：模型1：调整年龄、性别、南北、教育水平、随访时长；模型2：模型1+调整BMI、糖尿病、高胆固醇血症、高血压家族史和基线SBP；模型3：模型2+调整红肉、豆类、鱼类、吸烟、饮酒和体力活动水平；^a模型3+调整蔬菜；^b模型3+调整水果。

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