Association of fructose consumption and components of metabolic syndrome in human studies: A systematic review and meta-analysis

ObjectiveThe aim of this study was to review the current corpus of human studies to determine the association of various doses and durations of fructose consumption on metabolic syndrome.MethodsWe searched human studies in PubMed, Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases. We searched for the following keywords in each paper: metabolic syndrome x, insulin resistance, blood glucose, blood sugar, fasting blood sugar, triglycerides, lipoproteins, HDL, cholesterol, LDL, blood pressure, mean arterial pressure, systolic blood pressure, diastolic blood pressure, hypertens*, waist circumference, and fructose, sucrose, high-fructose corn syrup, or sugar.ResultsOverall, 3102 articles were gathered. We excluded studies on natural fructose content of foods, non-clinical trials, and trials in which fructose was recommended exclusively as sucrose or high-fructose corn syrup. Overall, 3069 articles were excluded. After review by independent reviewers, 15 studies were included in the meta-analysis. Fructose consumption was positively associated with increased fasting blood sugar (FBS; summary mean difference, 0.307; 95% confidence interval [CI], 0.149–0.465; P = 0.002), elevated triglycerides (TG; 0.275; 95% CI, 0.014–0.408; P = 0.002); and elevated systolic blood pressure (SBP; 0.297; 95% CI, 0.144–0.451; P = 0.002). The corresponding figure was inverse for high-density lipoprotein (HDL) cholesterol (−0.267; 95% CI, −0.406 to −0.128; P = 0.001). Significant heterogeneity existed between studies, except for FBS. After excluding studies that led to the highest effect on the heterogeneity test, the association between fructose consumption and TG, SBP, and HDL became non-significant. The results did not show any evidence of publication bias. No missing studies were identified with the trim-and-fill method.ConclusionFructose consumption from industrialized foods has significant effects on most components of metabolic syndrome.     

中老年人群中吸烟与血压关联的前瞻性队列研究

目的 吸烟是重要的心血管事件危险因素,但部分研究却发现吸烟与高血压无关,甚至吸烟者血压水平更低。吸烟与血压的关联还需要更多纵向研究证据。本研究基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Survey,CHARLS）数据探索45～80岁中老年人群中吸烟对血压的影响。方法 研究对象来源于CHARLS研究中完成2011年基线和2013、2015年随访的人群。纳入完成3次调查的研究对象,采用多水平线性回归分析吸烟对血压的影响,采用含时依变量的Cox回归分析吸烟对高血压发生风险的影响,同时调整性别、年龄、文化程度、婚姻状况、BMI和饮酒。结果 本研究共纳入6 667名无心血管疾病的研究对象,平均年龄58.8岁,男性占46.3%。多水平线性回归分析显示,在调整协变量后,相对于不吸烟者,吸烟者的SBP高1.81 mmHg（95% CI：0.55～3.07 mmHg,P<0.05）,DBP高0.85 mmHg（95% CI：0.10～1.60 mmHg,P<0.05）。Cox回归分析显示,吸烟与高血压发生风险的关联无统计学意义（HR=1.11,95% CI：0.89～1.38,P>0.05）。结论 在中老年人群中,吸烟与血压水平升高相关联。吸烟与高血压发生风险的关系有待进一步研究证实。     

Dietary Calcium and Blood Pressure in a Native American Population

Objective: To assess the relationship between dietary calcium and blood pressure.

Methods: Cross-sectional study of 404 adult Pima Indians of Arizona. Dietary variables were assessed by the 24-hour recall. Hypertension (HTN) was defined as systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg or drug treatment.

Results: Controlled for age and sex, dietary calcium intake was higher in subjects with HTN than in those without (p<0.01), and higher dietary calcium was associated with a higher prevalence of HTN (odds ratio comparing highest with lowest tertile group of calcium=2.6, 95% CI 1.4–4.8). Age-sex-adjusted mean DBP in low, middle and high tertiles of calcium was 74, 76, and 79 mmHg, respectively (p<0.001). SBP was not significantly different in the three tertiles (p=0.07). Multiple regression analyses that controlled for age, sex, body mass index, sodium, potassium and alcohol also suggested a positive association between DBP and dietary calcium (p<0.01), an association which was stronger at higher glucose concentrations (p<0.01 for the calcium-glucose interaction).

Conclusion: In Pima Indians, a population with a high incidence of diabetes, the inverse association between dietary calcium and blood pressure reported in other populations was not found.     

Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS)

(1) Background. Visceral adiposity index (VAI) has been recently identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidaemia. The aim of the present paper was to evaluate the relationship between VAI, daily energy intake and metabolic syndrome (MetS) in a cohort of obese Caucasian children and adolescents, aged 8 to 15 years. (2) Methods. Consecutive Italian children and adolescents with obesity, according to World Health Organization were enrolled. Anthropometric parameters and blood pressure were measured. Fasting blood samples have been analyzed for lipids, insulin and glucose levels. MetS was diagnosed using identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) or International Diabetes Federation (IDF) criteria according to age. Homeostatic model assessment index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), A body shape index (ABSI) and VAI were calculated. Multivariable logistic regression analyses with sex, age and each anthropometric parameter (body mass index (BMI) z-score, ABSI, waist-to-height ratio (WHR)) or VAI was performed to predict MetS. Receiver operation curve (ROC) analysis was used to define the optimal VAI cut-off to identify MetS. Multiple regression was performed to predict the BMI z-score and VAI from daily energy intake after adjusting for age and sex. (3) Results. Six hundred and thirty-seven (313 boys and 324 girls) children and adolescents with obesity with median age 11 (interquartile range 10–13) years were included in the analysis. MetS was diagnosed in 79 patients. VAI correlated with BMI, WHR, ABSI, HOMA-IR, QUICKI, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides and triglycerides-to-HDL ratio (p < 0.050). Optimal VAI cut-off (AUC) values to identify MetS were 1.775 (0.774), 1.685 (0.776) and 1.875 (0.797) in the whole population, boys and girls, respectively. Energy intake was positively associated with BMI z-score but no association was found with VAI. (4) Conclusion. VAI is a promising tool to identify MetS in children and adolescents with obesity and should be used in the management of abdominal obesity together with dietary assessment.     

Orthostatic blood pressure regulation correlates with cognitive function in Hispanic American Head Start children

The postural shift from lying to standing may provide a challenge for maintaining adequate blood flow to the brain. Cerebral perfusion in response to the shift to upright posture is affected by a variety of factors including the health of the cardiovascular system and a slight increase in orthostatic systolic blood pressure (SBP). In this study, cognitive functioning was examined in Hispanic American preschoolers in relation to systolic orthostatic blood pressure regulation (OBPR). The extent to which SBP increases in response to standing provides an index for predicting cognitive functioning. Developmental cognitive screening tests (Speed-DIAL-III) were administered individually. At a separate time, blood pressure regulation was assessed in response to an orthostatic challenge. After controlling for age and gender, adequate effective SBP regulation was found to predict performance on measures of concept skills and language competency. Findings support previous research and suggest an association between effective blood pressure regulation and cognitive performance among 3–5-year-old children.     

Longitudinal profiles of neighborhood socioeconomic vulnerability influence blood pressure changes across the female midlife period

PurposeTo examine whether longitudinal exposure to neighborhood socioeconomic vulnerability influences blood pressure changes throughout midlife in a racially, ethnically, and geographically-diverse cohort of women transitioning through menopause.MethodsWe used longitudinal data on 2738 women (age 42–52 at baseline) living in six United States cities from The Study of Women's Health Across the Nation. Residential histories, systolic blood pressures (SBP), and diastolic blood pressures (DBP) were collected annually for ten years. We used longitudinal latent profile analysis to identify patterns of neighborhood socioeconomic vulnerability occurring from 1996 to 2007 in participant neighborhoods. We used linear mixed-effect models to determine if a woman's neighborhood profile throughout midlife was associated with blood pressure changes.ResultsWe identified four unique profiles of neighborhood socioeconomic vulnerability – differentiated by residential socioeconomic status, population density, and vacant housing conditions – which remained stable across time. Women residing in the most socioeconomically vulnerable neighborhoods experienced the steepest increase in annual SBP growth by 0.93 mmHg/year (95% CI: 0.65–1.21) across ten-year follow-up.ConclusionsNeighborhood socioeconomic vulnerability was significantly associated with accelerated SBP increases throughout midlife among women.     

Effect of fruits and vegetables on metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials

Abstract

Evidence regarding the effect of fruit and vegetable consumption on metabolic syndrome remains inconclusive. Using MEDLINE, EMBASE, and Cochrane, we searched for relevant studies published before 10 December 2013. Of the 383 articles identified, eight randomized controlled trials with 396 participants (205 in intervention groups and 191 in control groups) were included in the final analyses. Fruit and vegetable intake was associated with a reduction in diastolic blood pressure (standardized mean difference: ?0.29; 95% confidence interval: ?0.57 to ?0.02; p?=?0.04); however, such intake did not affect waist circumference, systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, and triglyceride levels in metabolic syndrome patients. In a subgroup analysis, there were no statistically significant differences found according to the intervention period and provision type. Our results suggest an inverse association between fruit and vegetable consumption and diastolic blood pressure in metabolic syndrome patients.     

Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis

ObjectivesOrthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls.DesignSystematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134).Setting and participantsA literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers.MeasuresUnadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale.ResultsOut of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method.Conclusions and implicationsOrthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.     

Evidence supporting a combined movement behavior approach for children and youth's mental health – A scoping review and environmental scan

IntroductionAssociations between physical activity (PA), sedentary behavior (SED), and sleep – 24-h movement behaviors (MBs) – and children/youth's mental health (MH) is well-established though often only examined separately.MethodsThis scoping review sought to answer the question: What evidence is there on the association between 24-h movement behaviors and children/youth's mental health and what integrated knowledge mobilization applications/tools exist? Included articles examined all three MBs and MH among children/youth. The electronic search was conducted in June 2022 on PsycINFO, MEDLINE, CINAHL, Scopus. An environmental was conducted to search for MB and MH integrated knowledge mobilization applications/tools.ResultsA total of 55 articles were included, where 42 reported on combined MB and MH; 27/42 (64%) examined MB and mental wellness; 27/42 (64%) examined MB and indicators of mental illness; an overlap of 12/42 (29%) articles examined MB in relation to both mental wellness and illness. In total, 21/27 (78%) articles reported a positive and 6/27 (22%) reported no association between combined MB and mental wellness. Additionally, 23/27 (85%) reported a negative association between combined MB and indicators of mental illness and 4/27 (15%) reported no association. The environmental scan revealed one tool that examined how integrated MBs are associated with MH outcomes.DiscussionThere is a wealth of knowledge on the association between combined MB and MH though only one tool examined how combined MB and MH are associated. Efforts are warranted to better track and intervene on population and individual-level 24-h MB for MH promotion and disease prevention.     

The Efficacy and Safety of Tube Feeding in Advanced Dementia Patients: A Systemic Review and Meta-Analysis Study

ObjectivesThe current study aimed to conduct a systematic review and meta-analysis to explore the efficacy and safety of tube feeding in patients with advanced dementia.DesignSystematic review and meta-analysis.Setting and ParticipantsPubMed, Medline, Embase, and Cochrane Library were searched from inception until March 7, 2020, to obtain relevant studies.InterventionFeeding with nasogastric tube or percutaneous endoscopic gastrostomy (PEG).MeasuresWe evaluated the associations of tube feeding and the risk of mortality, period of survival days, tube-related complications, and nutritional status. Data from original studies were synthesized by using a random-effects model. Each selected article was assessed for bias using the Newcastle-Ottawa Scale. A narrative synthesis and pooled analyses are reported.ResultsTwelve trials were eligible, involving 1805 patients with tube feeding (mean age: 82.8 years; 71.3% female) and 3861 without tube feeding (mean age: 82.7; 68.7% female). For mortality rate, patients with advanced dementia with tube feeding are associated with significantly higher mortality rate [k = 8; odds ratio (OR) 1.79; 95% confidence interval (CI) 1.04–3.07; P = .03]. Initially, no association was found for the risk of pneumonia and pressure sore between groups. However, sensitivity analysis showed patients with advanced dementia with PEG tube feeding have significantly higher risk of pneumonia (OR 3.56; 95% CI 2.32–5.44; P < .001) and pressure sore (OR 2.25; 95% CI 1.92–2.63; P < .001). Finally, no association was found for the survival period and nutritional status between groups.Conclusions and ImplicationsThis meta-analysis indicates that tube feeding is associated with increased mortality rate and possible tube-related complications, but not improves with prolonging survival days and nutritional status. Shared decision-making routinely before insertion of a tube between caregivers and physicians is recommended.     

Association between blood levels of lead, blood pressure and risk of diabetes and heart disease in workers

Background: Previous studies have supported the association between high levels of blood lead levels (BLL) and elevated blood pressure. In addition, significant correlations between BLL and a variety of risk factors for blood pressure and diabetes mellitus have been well-established. Objective: To examine the relationship between BLL, blood pressure and diabetes as well as other selected social and biochemical factors, among workers in the United Arab Emirates (UAE). Methods: This comparative study included 110 industrial workers (exposed to lead in the workplace) and 110 non-industrial workers (not exposed); all were recruited in the city of Al-Ain, Abu-Dhabi Emirate, UAE and the groups were evenly matched for age, gender and nationality. Results: The industrial workers had a significantly higher mean of BLL (median 81 and geometric mean (GM) 62 μg/dl) than did non-industrial workers (median 11 and GM 13 μg/dl). In the present study, the lead-exposed group also had significantly higher blood lead levels, body-mass index (BMI), systolic and diastolic blood pressures, fasting blood glucose and plasma levels of total cholesterol, lactate dehydrogenase and uric acid than did the non-exposed group. Furthermore a significant correlation between BLL and systolic blood pressure was observed. Conclusion: The study supports the hypothesis of a positive association between lead exposure, high blood pressure and risk of diabetes and heart disease. Received: 11 July 2000 / Accepted: 5 January 2001     

Revisión de la medicación en ancianos polimedicados en riesgo vascular: ensayo aleatorizado y controlado

ObjectiveTo analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease.DesignA randomised controlled trial with blind evaluation.SettingFourteen Primary Health Care centres in AndalusiaParticipantsA total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease.InterventionA pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care.Main measurementsPercentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA_1c, and quality of life scores.ResultsA total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051).ConclusionClinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.     

The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study

BackgroundThe association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature.ObjectiveThis study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP).MethodsPatients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO₂, particulate matter with a diameter of <10 µm, particulate matter with a diameter of <2.5 µm, and SO₂) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP).ResultsA total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP.ConclusionsShort-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease.     

Vasculitis as an adverse event following immunization – Systematic literature review

BackgroundSeveral types of vasculitis have been observed and reported in temporal association with the administration of various vaccines. A systematic review of current evidence is lacking.ObjectiveThis systematic literature review aimed to assess available evidence and current reporting practice of vasculitides as adverse events following immunization (AEFI).MethodsWe reviewed the literature from 1st January 1994 to 30th June 2014. This review comprises randomized controlled trials, observational studies, case series, case reports, reviews and comments regardless of vaccine and target population.ResultsThe initial search resulted in the identification of 6656 articles. Of these, 157 articles were assessed for eligibility and 75 studies were considered for analysis, including 6 retrospective/observational studies, 2 randomized controlled trials, 7 reviews, 11 case series, 46 case reports and 3 comments. Most of the larger, higher quality studies found no causal association between vaccination and subsequent development of vasculitis, including several studies on Kawasaki disease and Henoch-Schönlein purpura (IgA vasculitis). Smaller case series reported a few cases of vasculitis following BCG and vaccines against influenza and hepatitis. Only 24% of the articles reported using a case definition of vasculitis.ConclusionsExisting literature does not allow establishing a causative link between vaccination and vasculitides. Further investigations were strengthened by the use of standardized case definitions and methods for data collection, analysis and presentation to improve data comparability and interpretation of vasculitis cases following immunization.     

中国2014年7~18岁儿童青少年血压偏高流行的区域分析

目的 分析2014年我国7~18岁儿童青少年血压偏高流行的地域分布特点,为制定儿童高血压防控策略和措施提供依据。方法 收集2014年"全国学生体质与健康调研"资料中31个省、自治区和直辖市（除我国香港、澳门、台弯地区外）的数据,选择血压数据记录完整的7~18岁216 299名学生作为研究对象。以血压偏高检出率<4%为低流行区,4%~7%为中等流行区,>7%为高流行区,分析儿童青少年血压偏高流行的地域分布特点。收集2014年全国31个省会城市的环境数据,分析儿童青少年血压Z评分与环境指标的相关性。结果 2014年全国7~18岁儿童青少年血压偏高平均检出率为6.4%（1.5%~14.2%）,血压偏高的高流行区主要分布在东部和沿海地区,尤其是环渤海地区,低流行区主要分布在中西部地区以及东部部分省份。关联性分析显示,2014年年均气温、年均气湿以及当地的海拔高度与血压（SBP和DBP）Z评分均呈负相关,男女生呈现相同趋势;年均日照时间、年均PM_2.5和PM₁₀浓度以及SO₂含量与血压Z评分均呈正相关,男女生呈现相同趋势。结论 2014年全国7~18岁儿童青少年血压偏高检出率存在较大差异,应重视高流行区域,并了解影响其血压的环境因素。     

Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review

ObjectiveThis study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years.DesignThis systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Setting and ParticipantsPubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: “Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety,” “under-nutrition or stunting or wasting or underweight or nutritional status,” and “children or infants.” Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles.Main Outcome Measures, Analysis, and ResultsTotally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight.Conclusions and ImplicationsThe findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.     

天津市1989 ～ 1998 年伤害死亡状况分析

探明不同地区、不同时期、不同年龄的伤害类型和严重性 ,有助于政府及全社会对伤害的控制和预防。为此我们对天津市 1989～ 1998年的伤害死亡水平及其年龄分布特征进行分析。1.伤害总死亡状况及主要死因分析 :1989～ 1998年伤害一直是天津市居民主要死亡原因中的第五位 ,年平均死亡率为 31.2 8/ 10万 ,年均死亡人数为 2 75 7.3人 ,低于全国伤害死亡的平均水平[1] 。 10年资料的分析显示 ,除“意外的机械性窒息”从未列入过前十位死因外 ,其他死因均在不同年份中进入前十位。其中机动车交通事故、自杀、意外中毒这 3种死因始终位居前三位 ;“…     

北京社区人群血压与颈动脉内中膜厚度的相关性探讨

目的探讨颈动脉内中膜厚度增厚与否对血压与颈动脉内中膜厚度相关性的影响。方法研究人群来自北京大学第一医院心内科于2011年12月至2012年4月在北京市石景山区横断面调查的动脉粥样硬化研究队列。纳入标准为问卷调查资料完整并完成颈动脉超声图像的采集且未应用过任何降压药物,研究人群(n=2 569)以最大颈动脉内中膜厚度0.9 mm为分界点分为颈动脉内中膜厚度增厚组(n=1 597)及非增厚组(n=972),分析血压与颈动脉内中膜厚度的关系。结果多重线性回归分析显示,在调整了性别、年龄、BMI、目前吸烟饮酒状况、血肌酐、空腹血糖、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、降糖降脂药物使用、心血管疾病患病情况等因素后,总体人群各项血压指标(收缩压、舒张压、脉压及平均动脉压)均与颈动脉内中膜厚度平均值呈显著正相关(收缩压:β=0.009,P0.000 1;舒张压:β=0.002,P0.000 1;脉压:β=0.007,P0.000 1;平均动脉压:β=0.009,P0.000 1);在颈动脉内中膜厚度≥0.9 mm组各项血压指标依然与颈动脉内中膜厚度平均值呈显著正相关(收缩压:β=0.006,P=0.000 1;舒张压:β=0.001,P=0.000 1;脉压:β=0.005,P0.0001;平均动脉压:β=0.005,P=0.023 8),而非增厚组中各项血压指标与颈动脉内中膜厚度平均值均无明显相关。结论本研究发现在颈动脉内中膜厚度增厚的人群中血压指标与颈动脉内中膜厚度显著相关,非增厚人群中无显著相关。提示血管壁增厚影响血压的作用机制在二者相关性机制方面可能占据更重要的地位。     

Urinary Sodium and Potassium Levels and Blood Pressure in Population with High Sodium Intake

The purpose of this study was to examine the association of urinary sodium-to-creatinine ratio and potassium-to-creatinine ratio with blood pressure in a cross-sectional study comprising Korean adults who participated in the Healthy Twin Study. The participants consisted of 2653 men and women in the Healthy Twin Study aged ≥19 years. Participants’ urinary excretion of sodium, potassium, and creatinine was measured from overnight half-day urine samples. Food intake was assessed using a validated food frequency questionnaire. We examined systolic and diastolic blood pressures according to sodium- or potassium-to-creatinine ratios using the generalized linear model. We determined food groups explaining high urinary sodium- or potassium-to-creatinine ratio using the reduced rank regression and calculated sodium- or potassium-contributing food score. We observed that systolic blood pressure was higher among men and women in the highest quintile of urinary sodium-to-creatinine ratio or sodium-to-potassium ratio than it was in the lowest quintile. Geometric means (95% CIs) of the lowest and the highest quintiles of systolic blood pressure (mmHg) were 113.4 (111.8–115.0) and 115.6 (114.1–117.2; P for trend = 0.02), respectively, for sodium-to-creatinine ratio. The association between urinary sodium-to-creatinine and systolic blood pressure was more pronounced among individuals whose body mass index (BMI) was less than 25 kg/m² (P for interaction = 0.03). We found that vegetables, kimchi and seaweed intake contributed to high sodium intake and a sodium-contributing food score were associated with increased blood pressure. In our study, we identified the food groups contributing to high sodium intake and found that high urinary sodium levels were associated with increasing blood pressure among Korean adults.     

Multimorbidity patterns: a systematic review

ObjectivesThe aim of this review was to identify studies on patterns of associative multimorbidity, defined as the nonrandom association between diseases, focusing on the main methodological features of the studies and the similarities among the detected patterns.Study Design and SettingStudies were identified through MEDLINE and EMBASE electronic database searches from their inception to June 2012 and bibliographies.ResultsThe final 14 articles exhibited methodological heterogeneity in terms of the sample size, age and recruitment of study participants, the data source, the number of baseline diseases considered, and the statistical procedure used. A total of 97 patterns composed of two or more diseases were identified. Among these, 63 patterns were composed of three or more diseases. Despite the methodological variability among studies, this review demonstrated relevant similarities for three groups of patterns. The first one comprised a combination of cardiovascular and metabolic diseases, the second one was related with mental health problems, and the third one with musculoskeletal disorders.ConclusionThe existence of associations beyond chance among the different diseases that comprise these patterns should be considered with the aim of directing future lines of research that measure their intensity, clarify their nature, and highlight the possible causal underlying mechanisms.