Intake of fruits, vegetables, and dairy products in early childhood and subsequent blood pressure change

BACKGROUND: Diets characterized by high intakes of fruits and vegetables and low-fat dairy products (for example, the DASH diet) have been shown to reduce blood pressure in adults. The effects of similar diets on children's blood pressure are unknown. METHODS: We used 8 years of follow-up data from 95 children, initially 3 to 6 years of age at enrollment in the prospective Framingham Children's Study in 1986. The yearly clinic visits included 5 measures of blood pressure obtained with an automated device. Diet was assessed by means of replicate sets of 3-day food diaries during each year. RESULTS: Children who consumed more fruits and vegetables (4 or more servings per day) or more dairy products (2 or more servings per day) during the preschool years had smaller yearly gains in systolic blood pressure throughout childhood. By the time of early adolescence, children with higher intakes of fruits and vegetables and dairy products had an adjusted mean (+/- standard deviation) systolic blood pressure of 106 +/- 2.9 mm Hg, whereas those with lower intakes in both food groups had a mean systolic blood pressure of 113 +/-1.5 mm Hg. Those with higher intakes of fruits and vegetables alone or dairy alone had intermediate levels of systolic blood pressure in adolescence. The effects on diastolic blood pressure were weaker. CONCLUSION: These results suggest that a diet rich in fruits, vegetables, and dairy products may have beneficial effects on blood pressure during childhood.     

Hypotensive peptides from milk proteins

Hypertension is the major controllable risk factor associated with cardiovascular disease (CVD) events such as myocardial infarction, stroke, heart failure, and end-stage diabetes. A 5 mm Hg decrease in blood pressure has been equated with approximately 16% decrease in CVD. In the U.S. alone current annual antihypertensive drug costs are approximately dollars 15 billion. The renin-angiotensin-aldosterone system is a target for blood pressure control. Cleavage of angiotensinogen by renin produces angiotensin I which is subsequently hydrolyzed by angiotensin-I-converting enzyme (ACE) to angiotensin II (a potent vasoconstrictor). Various side effects are associated with the use of ACE inhibitory drugs in the control of blood pressure including hypotension, increased potassium levels, reduced renal function, cough, angioedema, skin rashes, and fetal abnormalities. Milk proteins, both caseins and whey proteins, are a rich source of ACE inhibitory peptides. Several studies in spontaneously hypertensive rats show that these casokinins and lactokinins can significantly reduce blood pressure. Furthermore, a limited number of human studies have associated milk protein-derived peptides with statistically significant hypotensive effects (i.e., lower systolic and diastolic pressures). The advent of effective milk protein based functional food ingredients/nutraceuticals for the prevention/control of blood pressure therefore has the potential to significantly reduce global healthcare cost.     

The effect of dietary interventions to reduce blood pressure in normal humans.

Changes in electrolyte intake have been advocated to lower the prevalence of hypertension in the normal population. To elucidate the potential impact of such strategies, we conducted a comprehensive analysis of data from three interventions, namely, salt (NaCl) restriction, calcium (Ca) supplementation, and potassium (K) supplementation in normal volunteers. Eighty-two adults lowered their Na intake from 157 +/? 6 S.E. to 68 +/? 3 mEq/day for 12 weeks. Population mean systolic and diastolic blood pressure decreased less than or equal to 2 mm Hg. Ca supplementation, 1.5 g daily for 12 weeks in 37 men, decreased blood pressure compared to 38 men receiving placebo. Ca supplementation, 1 g daily for 8 weeks in an older group of 44 normal subjects, decreased supine diastolic and standing systolic blood pressure. K supplementation with a nonchloride salt in 64 normal adults for 4 weeks had no effect on systolic or diastolic blood pressure even though urinary excretion was increased by 20 mmol/day. The responses to all interventions were Gaussian in distribution. A potentially adverse effect on blood pressure in some normal individuals cannot be excluded on the basis of the currently available data. Although all three interventions may benefit some hypertensive and some normal individuals, the data from these relatively short-term cross-sectional studies are insufficient to warrant generalized dietary recommendations for the normal population.     

The effect of dietary interventions to reduce blood pressure in normal humans

Changes in electrolyte intake have been advocated to lower the prevalence of hypertension in the normal population. To elucidate the potential impact of such strategies, we conducted a comprehensive analysis of data from three interventions, namely, salt (NaCl) restriction, calcium (Ca) supplementation, and potassium (K) supplementation in normal volunteers. Eighty-two adults lowered their Na intake from 157 +/- 6 S.E. to 68 +/- 3 mEq/day for 12 weeks. Population mean systolic and diastolic blood pressure decreased less than or equal to 2 mm Hg. Ca supplementation, 1.5 g daily for 12 weeks in 37 men, decreased blood pressure compared to 38 men receiving placebo. Ca supplementation, 1 g daily for 8 weeks in an older group of 44 normal subjects, decreased supine diastolic and standing systolic blood pressure. K supplementation with a nonchloride salt in 64 normal adults for 4 weeks had no effect on systolic or diastolic blood pressure even though urinary excretion was increased by 20 mmol/day. The responses to all interventions were Gaussian in distribution. A potentially adverse effect on blood pressure in some normal individuals cannot be excluded on the basis of the currently available data. Although all three interventions may benefit some hypertensive and some normal individuals, the data from these relatively short-term cross-sectional studies are insufficient to warrant generalized dietary recommendations for the normal population.     

Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials.

OBJECTIVES: This study evaluated the effectiveness of dietary advice in primary prevention of chronic disease. METHODS: A meta-analysis was conducted of 17 randomized controlled trials of dietary behavior interventions of at least 3 months' duration. Results were analyzed as changes in reported dietary fat intakes and biomedical measures (serum cholesterol, urinary sodium, systolic and diastolic blood pressure) in the intervention group minus changes in the control group at 3 to 6 months and 9 to 18 months of follow-up. RESULTS: After 3 to 6 months, mean net changes in each of the five outcomes favored intervention. For dietary fat as a percentage of food energy, the change was -2.5% (95% confidence interval [CI] = -3.9%, -1.1%). Mean net changes over 9 to 18 months were as follows: serum cholesterol, -0.22 (95% CI = -0.39, -0.05) mmol/L; urinary sodium, -45.0 (95% CI = -57.1, -32.8) mmol/24 hours; systolic blood pressure, -1.9 (95% CI = -3.0, 0.8) mm Hg; and diastolic blood pressure, -1.2 (95% CI = -2.6, 0.2) mm Hg. CONCLUSIONS: Individual dietary interventions in primary prevention can achieve modest improvements in diet and cardiovascular disease risk status that are maintained for 9 to 18 months.     

脉压分布与脑卒中和心肌梗死患病率的关系

目的　探讨脉压在我国人群中的分布特征及与主要心血管疾病的关系。方法　对1991年全国第三次高血压抽样调查中年龄≥ 18岁的 882 6 81人的资料进行再分析。统计分析采用t检验、χ2 检验 ,多因素分析使用logistic回归模型。结果　 (1)人群的脉压均值为 (44 6 1± 13 5 9)mmHg(1mmHg =0 133kPa) ,其中男性为 (44 92± 12 72 )mmHg,女性为 (44 34± 14 32 )mmHg。随年龄的增长脉压逐渐增宽 ,5 0岁以后脉压增宽的幅度加速且女性高于男性。在≥ 6 0岁人群中 ,脉压≥ 6 0mmHg的比例高于 <6 0岁组人群。 (2 )随脉压增宽 ,脑卒中和心肌梗死的患病率也呈增加趋势。 (3)多因素logistic回归模型分析显示 ,调整了性别、年龄、体重指数、吸烟及饮酒后 ,以脉压 <4 5mmHg的人群为基线组 ,脉压为 4 5～ 5 9、6 0～ 74和≥ 75mmHg组人群 ,脑卒中的患病危险分别是基线组的 1 9、3 5和 5倍。同样 ,心肌梗死的患病危险是基线组的 1 2、1 5和 1 7倍。将收缩压和舒张压纳入影响因素中再分析 ,仍显示脑卒中和心肌梗死的患病危险随脉压的增宽而增加。结论脑卒中和心肌梗死的患病率随脉压的增宽而增高 ,脉压增宽是脑卒中和心肌梗死患病的危险因素之一 ,尤其在老年人群中更为明显。     

上海市脑卒中社区人群计划防治研究

目的了解已证明有效的干预措施在社区实施的效果以及需要的人力和费用如何,从而总结出符合中国国情的脑卒中防治方案。方法对上海8个社区383万人口进行以社区为基础的脑卒中综合防治研究,干预措施包括高血压控制、糖尿病控制和合理营养。结果通过2年的干预,全人群高血压知晓率为80.6%;高血压病人管理率达66%,血压值<160/95mmHg的控制率为61%,血压值<140/90mmHg的控制率为31%;2年里高血压人群收缩压下降39mmHg,舒张压下降18mmHg.干预人群脑卒中标化发病率较干预前下降42.24/10万。以5个设有对照的社区来分析,扣除了对照的基数后,2年来脑卒中发病减少70例,平均每年脑卒中发病减少25.41/10万。经济学分析表明8个干预点用于高血压防治预防脑卒中所花费用平均为38.0元/人·年,平均每位卫生工作人员应管高血压病人数为459人。研究也发现在高血压和脑卒中的第一级预防、对三级高血压病人的管理和对上班人员高血压的防治方面仍是薄弱环节。结论脑卒中的社区综合防治是有效的,但需要进一步加强高血压的第一级预防和对轻度高血压尤其是上班族高血压的管理,研究提出了脑卒中社区防治4要素的方案。     

The effects of a reduced-sodium, high-potassium salt substitute on food taste and acceptability in rural northern China

A potassium chloride-containing salt substitute lowers blood pressure levels, but its overall acceptability has been of concern due to its potential adverse effects on food taste. In a large-scale, blinded randomised trial evaluating the comparative effects of a salt substitute (65 % sodium chloride, 25 % potassium chloride and 10 % magnesium sulphate) and a normal salt (100 % sodium chloride) on blood pressure, we collected data on the saltiness, flavour and overall acceptability of food. We performed this at baseline, 1, 6 and 12 months post-randomisation using 100 mm visual analogue scales for assessments of both home-cooked foods and a standard salty soup. The mean age of the 608 participants from rural northern China was 60 years and 56 % of them were females. In the primary analyses, the changes in the saltiness, flavour and overall acceptability of both home-cooked foods and a standard salty soup were not different between the randomised groups (all P>0.08). In the secondary analyses, weighting each of the data points according to the lengths of the respective follow-up intervals, the flavour of both home-cooked foods (mean difference = - 1.8 mm, P = 0.045) and a standard salty soup (mean difference = - 1.9 mm, P = 0.03) was slightly weaker in the salt substitute group. We conclude that salt substitution is both an effective and an acceptable means of blood pressure control. Possible small differences in flavour did not importantly deter the use of the salt substitute in this study group, although the acceptability of the salt substitute by a more general population group would need to be confirmed.     

我国四城市中小学教师高盐食品消费状况及影响因素分析

了解沈阳、武汉、成都、广州4座城市中小学教师高盐食品的消费状况及其影响因素,为进一步开展减盐干预策略措施提供基础资料和科学依据.方法 采用分层随机整群抽样的方法,从沈阳、广州、武汉、成都4座城市抽取2 518名中小学教师进行高盐食品消费状况问卷调查.结果 过去3个月,教师食用薯条/薯片、方便面、加工肉制品、盐焗坚果、果脯≥1次/周的比例分别为11.2%,9.5%,18.0%,26.8%,13.4%.多因素Logistic回归分析显示,相对于对照组(40岁以下、家庭经济水平低、不知道盐的推荐摄人量、不使用营养标签、沈阳),40岁及以上、家庭经济水平高、知道盐的推荐摄入量、使用营养标签、广州/成都/武汉的教师消费高盐食品的OR(95%CI)值分别为0.687(0.577~0.819),2.988(1.786~4.999),0.760(0.635~ 0.910),0.720(0.578~ 0.896),0.500(0.393~0.636),0.689(0.538~ 0.883),0.561(0.442~0.711),均是影响教师消费高盐食品的主要因素(P值均<0.05).结论 四城市中小学教师存在消费高盐食品频次较高的现象.应加强中小学教师盐与健康相关知识的营养教育,引导其减少盐的摄入量,预防和控制高血压的发生.     

The inverse relation of average population blood pressure and stroke mortality rates in the seven countries study: A paradox

This study attempts to explain the unexpected finding of an inverse population (ecological) relationship between mean systolic blood pressure levels and stroke death rates in 25 years follow-up of the Seven Countries Study, a cross-cultural study of cardiovascolar disease. Sixteen cohorts of all men aged 40–59 in seven countries (one cohort in the USA, two in Finland, one in the Netherlands, three in Italy, two in Croatia (former Yugoslavia), three in Serbia (former Yugoslavia), two in Greece, two in Japan) were surveyed from 1958 to 1964. Risk factors and personal characteristics were measured and follow-up for vital status and cause of death was then carried out over 25 years. Analyses were based on comparisons of mean levels of risk factors and death rates within and among the 16 cohorts. Mean entry population levels of systolic blood pressure among the cohorts were strongly and inversely related with their 25-year stroke death rates (R –0.55; CI –0.81 and –0.06; p = 0.0276). Within cohorts in contrast, the individual relation of blood pressure and stroke was strongly positive and significant in 14 of the 16 cohorts. Mean population levels of serum cholesterol were inversely and strongly related to stroke death rates (R –0.79; CI –0.92 and –0.46; p = 0.0003), while the partial correlation coefficient of systolic blood pressure, computed in models including serum cholesterol, became small and not significant (– 0.05; CI –0.55 and +0.48; p = 0.8537). Age at death for stroke (average 68.9 ± 7.1 years) was significantly higher than age at death from myocardial infarction and sudden death (average 65.8 ± 7.8 years) suggesting a competition effect between the conditions. Multivariate models including population average systolic blood pressure and serum cholesterol provided no added explanation for the lack of direct and significant relationship of population blood pressure with stroke death rates. They were base on these variables: age at stroke death, age at myocardial infarction death or and sudden death, death rates from myocardial infarction and sudden death, the interaction term of systolic blood pressure with serum cholesterol and the multivariate coefficients for systolic blood pressure from Cox models run in individuals. Similar findings were obtained using diastolic instead of systolic blood pressure and excluding the Japanese cohorts. The paradox of the inverse ecologic relation of population blood pressure and stroke mortality and a direct relation for individual is only partly explained by the cofounding effect of population mean serum cholesterol levels. An effect of low cholesterol levels on excess stroke mortality cannot be excluded. A major limitation of the study was our inability to segregate thrombotic from heamorrhagic strokes.     

The efficacy of indapamide in different cardiovascular outcome--meta-analysis

BACKGROUND: First line antihypertensive treatment's drugs have to be able to decrease the cardiovascular morbidity and mortality. This kind of efficacy of thiazides type diuretics were published earlier in several studies. The efficacy of indapamide was investigated in several studies, but there is no analysis which is including all of the indapamide-studies. OBJECTIVE: We conducted a meta-analysis of all relevant randomized-controlled-trials with indapamide. Efficacy of indapamide was analyzed in different cardiovascular and safety outcomes. METHODS: We searched the MEDLINE database 1995-2005 for indapamide-trials. Only double-blind, parallel-group design trials were involved. Both the fixed effect model and the random effect model were used for data synthesis, results were probed with Mantel-Hanzel test and inverse variance test. RESULTS: Data were combined from 9 trials that included 10 108 patients. Indapamide treatment of 48 patients with a history of stroke prevents another stroke (NNT = 47.8 95% CI 29.6-126.6). Data from 5 trials including 7085 patients show that indapamide is superior to placebo in reducing blood pressure, the differences are: 7.28 mm Hg (95% CI: 6.37-8.19) in systolic blood pressure and 3.50 mm Hg (95% CI 2.99-4.01) in diastolic blood pressure. Data from 5 trials including 2856 patients show that indapamide is superior to active controls in reducing systolic blood pressure, the difference is significant: 1.30 mm Hg (95% CI 0.28-2.31). The difference in diastolic blood pressure was not significant. Data of 505 patients show that indapamide reduced left ventricular mass index significantly more than enalapril 20 mg, the difference is 6.50 g/m(2) (95%CI: 0.81-12.19). Data of 6206 patients show that frequency of adverse drug reaction is similar in the indapamide and placebo groups (rr = 0.97 95%CI 0.76-1.22). CONCLUSIONS: Indapamide is efficacious in prevention of further stroke, reduces effectively the blood pressure and the left ventricular mass index. Indapamide treatment is well tolerated.     

Infant nutrition and blood pressure in early adulthood: the Barry Caerphilly Growth study

BACKGROUND: Evidence suggests that environmental factors acting early in life may affect blood pressure in adulthood. OBJECTIVE: The objective was to test the hypothesis that dried formula milk (derived from cow milk) intake in infancy is positively associated with blood pressure in early adulthood. DESIGN: We conducted a long-term follow-up (1997-1999) of the Barry Caerphilly Growth study cohort (1972-1974) into which mothers and their offspring had originally been randomly assigned to receive a milk supplement or usual care. Participants were the offspring, who were aged 23-27 y at follow-up. The main outcome measures were systolic and diastolic blood pressure. RESULTS: The social and demographic characteristics of the subjects who were (n = 679) and were not (n = 272) followed up were similar. For each increase in quartile of dried milk consumption (in oz) at 3 mo of age, there was a 1.28-mm Hg (95% CI: 0.46, 2.10 mm Hg) increase in systolic and a 0.63-mm Hg (95% CI: 0.04, 1.22 mm Hg) increase in diastolic blood pressure after adjustment for sex, intervention group, birth weight z scores, social class in childhood, age at follow-up, alcohol consumption, and pack-years of smoking. These coefficients were attenuated when adult body mass index and height were included in the models, but the association of dried milk consumption at 3 mo of age with systolic pressure remained significant (1.07 mm Hg; 95% CI: 0.27, 1.87 mm Hg). CONCLUSIONS: Our findings are consistent with the hypothesis that high blood pressure in later life is influenced by early postnatal nutrition. Thus, interventions to optimize infant nutrition may have important long-term health benefits.     

中国九省居民膳食、体力活动与血压水平关系的纵向分析研究

目的 通过构建多水平模型,对中国九省居民饮食、体力活动与血压水平之间的关系进行纵向分析.方法 以"中国健康与营养调查"追踪调查项目中参加1997、2000、2004和2006年四轮调查中至少一次调查的18岁及以上成年人(男性6706名,女性7140名)为研究对象,分性别拟合包括个体和调查时间两个水平的发展模型,分析膳食中盐、蔬菜、水果、脂肪和蛋白质摄入量以及中重度体力活动时间对SBP和DBP的影响.结果 在调整年龄、教育程度、BMI、饮酒和能量摄入量等因素之后,四轮调查女性个体平均盐摄入量与SBP呈正相关(β=0.0481,s-x=0.0178,P＜0.01);男女性个体平均蔬菜摄入量与SBP呈负相关(P＜0.01),其回归系数估计值分别为-0.0063、-0.0068,即个体四次调查日均蔬菜摄入量每增加100 g,其SBP会降低0.6mm Hg(1 mm Hg=0.133kPa)以上,另外,男女性个体平均蔬菜摄入量同DBP亦呈负相关(P＜0.01).对同一调查时间的不同个体或不同调查时间的同一个体来说,男女性水果摄入量和SBP呈负相关,其回归系数估计值分别为-0.0029、-0.0031.中重度体力活动时间与男女性SBP和女性DBP均呈负相关(P＜0.05).不过,膳食总脂肪和蛋白质摄入量与血压水平之间并无关联.结论 膳食中盐、蔬菜和水果摄入量以及中重度体力活动时间与血压水平有关.限盐、增加蔬菜和水果摄入量、提高各项体力活动水平、积极控制体重等生活方式的转变是控制血压水平的重要方法.     

On the ability of blood pressure effects to explain the relation between oral contraceptives and cardiovascular disease

The use of combined oral contraceptives is associated with average blood pressure increases of 5 mmHg systolic and 2 mmHg diastolic. Increases of this low magnitude hardly seem capable of generating the twofold or larger relative risks for myocardial infarction and stroke seen among users of oral contraceptives. However, relative risks at young ages depend more strongly on blood pressure levels than do those at older ages; secondly, blood pressure elevations corresponding to oral contraceptive use are undoubtedly heterogenous across individuals; and thirdly, blood pressure readings possess substantial measurement error. Blood pressure elevations of 5 mmHG systolic and 2 hemorrhage, cerebral infarction, and coronary heart disease respectively, but only if the measured blood pressure were the true blood pressure. If the recorded elevations are added to the corrected blood pressure, the relative risks for cerebral hemorrhage, cerebral infarction, and coronary heart disease increase to 1.7, 1.5, and 1.2 respectively. An example of the heterogeneity among oral contraceptive-induced blood pressure effects is shown in the Walnut Creek study, where despite small average blood pressure elevations, 3 times as many oral contraceptive users as controls had blood pressure levels of 140/90 mmHg. Moreover, disease levels presumably reflect blood pressure levels in effect over years, not merely at the time of measurement. The mechanisms by which elevated blood pressure contributes to cardiovascular disease and stroke include mechanical distension of small arteries, platelet aggregation, changes in the coagulation and fibrinolytic mechanisms, and changes in the level of blood lipids and high-and low-density lipoproteins. It can thus be seen how the moderate average elevation in blood pressure seen in oral contraceptive users is consistent with their increased relative risk of cardiovascular diseases and stroke.     

上海市社区老年高血压患者血压水平影响因素的多水平分析

目的 应用多水平分析模型分析社区老年高血压患者血压水平的影响因素.方法 通过多阶段随机抽样,抽取上海市23个社区的927例老年高血压患者作为研究对象,采用两水平线性多层模型分别分析社区老年高血压患者收缩压(SBP)和舒张压(DBP)的影响因素.结果 研究对象的平均血压水平为SBP(139.2±11.7)mm Hg、DBP(85.6±8.6)mm Hg(I mm Hg=0.133 kPa).在社区水平上,辖区高血压患者/站点医师数(医患比)"高"的社区较医患比"低"的社区患者的SBP低3.86 mm Hg、DBP低2.51 mm Hg.在个体水平上,年龄、性别、超重/肥胖是血压升高的危险因素;规律服药、限盐、疾病管理自我效能的提高可降低血压,特别是在控制其他影响因素后仅限盐1项就可降低SBP 2.44 mm Hg、DBP 2.03 mm Hg.结论 多水平分析模型可以灵活有效地处理具有层次结构的数据,社区因素和个体因素对老年高血压患者的血压水平均有影响.     

山东省40岁以上人群心脑血管病死亡事件影响因素的队列研究

目的探讨各因素对心脑血管病死亡的影响和作用强度及各因素在不同年龄段作用的差异。方法对11 008名人群进行基线调查,随访8年,应用Cox回归分析各因素对心脑血管病死亡的预测价值。结果心脑血管病死亡事件的发生与脑卒中史、吸烟、收缩压(SBP)、舒张压(DBP)、年龄有关。40～59岁人群主要危险因素相对危险度分别为:脑卒中史(4.903)、DBP每增加10 mm Hg (1.366,1 mm Hg=0.133 kPa)、吸烟(1.157)、年龄每增加1岁(1.098);60-74岁人群分别为:脑卒中史(2.405)、吸烟(1.231)、SBP每增加10 mm Hg(1.201)、体重指数每增加1(1.141)、年龄每增加1岁(1.095);≥75岁人群:仅年龄每增加1岁(1.068)有统计学意义。结论各因素对心脑血管病死亡的预测价值在不同年龄段是不同的,不同年龄段的人群应侧重于不同的危险因素的预防与控制。     

Case in Point

Abstract

Epidemiologic and clinical trial data suggest that blood pressure in patients with hypertension who are at high risk for cardiovascular events because of coronary artery disease, diabetes, chronic kidney disease, stroke, or heart failure should be reduced to < 140/90 mm Hg in patients aged < 80 years, and that systolic blood pressure should be reduced to 140 to 145 mm Hg, if tolerated, in patients aged ≥ 80 years. Studies on patients with coronary artery disease, diabetes, chronic kidney disease, stroke, and heart failure are discussed, supporting a blood pressure goal of < 140/90 mm Hg in patients aged < 80 years who are at high risk for cardiovascular events.     

An Economic Evaluation of Salt Reduction Policies to Reduce Coronary Heart Disease in England: A Policy Modeling Study

ObjectivesDietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD).MethodsThe validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a “do nothing” baseline.ResultsAll policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million.ConclusionsAll policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease.     

中老年人血压水平与脑卒中患病率及患病风险的相关性研究

目的 研究中老年人群中血压水平与脑卒中患病率及患病风险之间的关系。方法 采用分层整群抽样方法,对扬州市广陵区40岁及以上常住居民开展问卷调查、体格检查和实验室检查。通过对年龄分层,采用单因素和多因素logistic回归分析不同年龄组血压与脑卒中患病率及患病风险的关系。结果 3 999例有效样本中,男性1 904例（47.61%）,女性2 095例（52.39%）;其中脑卒中243例（6.08%）,高血压1 900例（47.51%）,糖尿病929例（23.23%）,血脂异常943例（23.58%）,高血压患者中脑卒中211例（86.83%）。男性（χ2 = 9.539,P = 0.002）、高龄（t = - 13.683,P＜0.001）、缺乏运动（χ2 = 15.568,P＜0.001）、吸烟史（χ2 = 40.799,P＜0.001）、高血压（t = - 9.149,P＜0.001）、高血糖（t = - 6.832,P＜0.001）、低高密度脂蛋白胆固醇（t = 3.509,P＜0.001）、肥胖（t = - 4.964,P＜0.001）均是脑卒中重要危险因素。随着年龄和血压的增加,脑卒中的患病率增加。对年龄进行分层,并对危险因素进行校正,60岁以下人群中脑卒中患病风险随血压升高而显著增加;收缩压≥160 mm Hg脑卒中患病风险是收缩压＜130 mm Hg的8.13倍;舒张压≥110 mm Hg脑卒中患病风险是舒张压＜80 mm Hg的28.54倍。60岁及以上人群中收缩压≥150 mm Hg脑卒中患病风险开始增加;收缩压≥160 mm Hg脑卒中患病风险是收缩压＜130 mm Hg的2.12倍;舒张压与脑卒中患病风险之间无显著相关性。结论 高血压是脑卒中的重要危险因素,根据不同的年龄,设定相应的降压目标是有效预防脑卒中的重要途径。     

Effect of flavor enhancers on the nutritional status of older persons

Objectives

This study on flavor enhancers aims to: 1) compare food intake of older persons, 2) determine changes in body weight, blood pressure and serum sodium and 3) determine tolerance/intolerance to the flavor enhancers.

Design

The project is a cross-over, double blind study design.

Setting

A nursing home for the aged, Golden Acres Institution located in Quezon City, Philippines.

Participants

Sixty eligible subjects (31 males and 29 females), aged 60 years and over.

Intervention

Subjects were initially given: pouch A (0.5gram monosodium glutamate) or pouch B (0.5gram iodized salt) for lunch and supper for 2 months. The intervention was switched after one week wash period.

Measurements

Before the start and during intervention, 24 hour food intake of subjects was recorded and anthropometric and clinical data were measured. Tolerance/intolerance to the flavor enhancer and data on the quality of life were evaluated using a pre-tested structured questionnaire. Paired t-test was used to determine significant changes among each period of dietary intervention between different groups.

Results

Energy intake and almost all nutrients increased for males and females for both interventions. Body weight and body mass index increased significantly for both gender with MSG usage but not with iodized salt. The diastolic blood pressure of all subjects was normal while the systolic blood pressure remained at pre-hypertension level before and after both interventions. The sodium serum was within normal levels for both groups for both interventions. It was also observed that systolic blood pressure increased in both groups while sodium levels did not. It was further observed that both MSG and iodized salt interventions were well tolerated by majority of the participants.

Conclusion

The use of flavor enhancers have increased food intake and were well-tolerated among older persons. No difference in blood pressure and sodium serum was noted in both MSG and iodized salt intake.

Recommendation

People with less appetite, especially among older persons can use flavor enhancers to improve their food intake and body weight. Sodium containing flavor enhancers can be part of a healthy diet for older persons when used in moderation.