Association between the ratio of dietary vitamin A to body weight and hypertension in children
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摘要:
目的 探讨膳食维生素A(VitA)和体重的比值与儿童高血压的相关性，为通过膳食营养干预改善儿童血压水平与降低儿童期高血压的患病风险提供参考。 方法 利用2014—2019年在重庆城乡地区建立的健康儿童队列研究基线调查与随访样本资料，采用结构式定量膳食问卷和自行设计的调查表调查15 279名儿童膳食摄入量与社会经济学指标，测量血压、身高与体重等检测指标。儿童膳食VitA与体重的比值按照四分位数分为≤P25(Q1)，＞P25~P50(Q2)，＞P50~P75(Q3)，＞P75(Q4)4组。采用广义线性回归模型与Logistic回归模型分析膳食VitA和体重的比值与血压水平及高血压患病率的相关性。 结果 2014年基线调查结果表明，在校正人口统计学指标及营养摄入指标等混杂因素后，不同儿童膳食VitA摄入与体重比值组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)的差异均有统计学意义(F值分别为157.57，44.71，95.92，P值均 < 0.05)。2014年儿童膳食VitA和体重的比值与SBP[β值(95%CI)=-0.65(-0.89~-0.42) ]、DBP[β值(95%CI))=-0.22(-0.42~-0.01) ]和MAP[β值(95%CI))=-0.36(-0.56~-0.16) ]均呈负相关(P值均＜0.05)；与Q1组比较，Q4组中儿童高血压的患病风险降低[OR值(95%CI)=0.63(0.49~0.81)，P＜0.01 ]。2014年儿童基线膳食VitA和体重的比值与2019年随访SBP、DBP、MAP均呈负相关[β值分别为-0.77(-1.34~-0.19)，-0.62(-1.21~-0.02)，-0.77(-1.34~-0.19)，P值均＜0.05 ]；与Q1组相比，Q4组中的2019年儿童高血压患病风险也降低[OR值(95%CI)=0.18(0.08~0.42)，P＜0.01 ]。 结论 膳食VitA和体重的比值与儿童血压水平呈负相关，膳食VitA缺乏为儿童高血压的独立危险因素。应采取措施积极调整儿童膳食营养，降低儿童期高血压的患病风险。 Abstract:Objective To explore the relationship between the ratio of dietary vitamin A (VitA) to body weight and hypertension among children, so as to provide a reference for blood pressure control through dietary nutritional interventions and childhood hypertension prevention. Methods Utilizing the baseline survey and follow-up sample data from the Healthy Children Cohort established in urban and rural areas of Chongqing from 2014 to 2019, structured quantitative dietary questionnaire and self-designed questionnaire were used to investigate the information of dietary intake and socioeconomic characteristics of 15 279 children, as well as blood pressure, height, weight measurement. The ratio of dietary VitA to body weight was divided into four groups based on quartiles [≤P25(Q1), >P25~P50(Q2), >P50~P75(Q3), >P75(Q4)]. Generalized linear regression models and Logistic regression models were used to analyze the correlation between ratio of dietary VitA to body weight with blood pressure levels and prevalence of hypertension. Results The results of the 2014 baseline survey indicated that, after adjusting for confounding factors such as demographic indicators and nutritional intake, significant differences were observed in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) among different groups categorized by the ratio of dietary VitA to body weight (F=157.57, 44.71, 95.92, P < 0.01). The baseline ratio of dietary VitA to body weight in children exhibited a negative correlation with DBP, SBP and MAP at baseline and in 2019. Compared to Q1 group, the risk of hypertension decreased among children in Q4 at baseline and follow-up in 2019.[baseline: β(95%CI)=-0.65(-0.89--0.42), -0.22(-0.42--0.01), -0.36(-0.56--0.16); 2019: β(95%CI)=-0.77(-1.34--0.19), -0.62(-1.21--0.02), -0.77(-1.34--0.19), P < 0.05 ]. Compared to Q1 group, the risk of hypertension decreased among children in Q4 at baseline and follow-up in 2019 [OR(95%CI)=0.63(0.49-0.81), 0.18(0.08-0.42), P < 0.01 ]. Conclusions The ratio of dietary VitA to body weight is significantly negatively correlated with blood pressure levels among children, and dietary VitA deficiency is an independent risk factor for hypertension among children. Measures should be taken to actively adjust children's dietary nutrition and reduce the risk of childhood hypertension. -
Key words:
- Diet /
- Vitamin A /
- Body weight /
- Hypertension /
- Regression analysis /
- Child
1) 利益冲突声明 所有作者声明无利益冲突。2) 程平与任艳玲为共同第一作者。 -
表 1 2014年不同膳食VitA与体重比值组儿童体格检查、膳食摄入指标及VitA、VitA/体重值比较(x±s)
Table 1. Comparison of physical examination, dietary intake indicators, and VitA and VitA/weight values of children in different ratio groups of dietary VitA to body weight from 2014 (x±s)
组别 人数 年龄/岁 身高/cm 体重/kg BMI/(kg·m-2) 腰围/cm SBP/mmHg DBP/mmHg MAP/mmHg 心率/(次·min-1) Q1 3 820 9.21±1.74 138.50±11.63 36.32±11.04 18.57±3.72 61.57±9.76 105.41±10.51 64.06±7.83 77.84±7.99 94.76±12.90 Q2 3 819 8.82±1.78 135.57±11.36 32.89±9.34 17.58±2.98 58.92±8.40 103.68±9.91 63.44±7.58 76.86±7.65 94.46±12.48 Q3 3 821 8.63±1.75 133.58±11.03 30.96±8.61 17.06±2.74 57.40±7.70 102.43±9.51 62.78±7.47 76.00±7.43 94.66±12.50 Q4 3 819 8.43±1.70 131.01±10.36 28.34±6.87 16.29±2.14 55.39±6.47 100.86±9.24 62.42±7.61 75.23±7.49 94.77±12.22 F值 202.92 371.67 615.11 460.52 429.25 157.57 44.71 95.92 0.07 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 0.67 组别 人数 谷类/g 蔬菜/g 水果/g 猪牛羊肉/g 鸡、鸭及其他禽肉/g 各种鱼虾贝类/g 鸡蛋、鸭蛋等蛋类/g 牛奶、酸奶等制品/g 豆类及豆制品/g Q1 3 820 159.40±131.30 96.33±95.24 110.68±111.80 65.62±63.80 27.13±46.06 16.76±36.07 35.84±42.58 241.15±146.70 33.01±60.61 Q2 3 819 191.69±150.40 180.24±169.80 164.26±155.20 100.04±93.58 45.21±68.39 31.41±65.45 57.80±61.67 260.50±153.20 47.89±77.56 Q3 3 821 222.01±165.40 251.72±190.10 211.45±180.50 126.57±109.50 63.83±80.67 43.02±80.92 75.00±77.37 263.20±163.00 64.91±98.88 Q4 3 819 253.64±188.80 361.25±201.40 271.42±214.70 172.41±135.20 96.76±106.60 58.51±96.39 99.77±96.02 271.80±162.40 85.71±109.10 F/Z值 100.20 715.18 456.07 1 180.38 974.13 312.94 830.72 698.03 292.99 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 组别 人数 各种坚果/g 菌藻类食物/g 营养补充剂/g 饮料(可乐、雪碧等)/g 食用油/g 咸菜/g VitA/(μmol·L-1) VitA与体重比值[μmol·(L·kg)-1] Q1 3 820 16.50±34.91 10.94±27.29 11.48±44.88 45.60±96.46 64.03±54.83 13.57±28.37 507.74±211.50 4.13±4.33 Q2 3 819 26.31±51.77 20.28±44.16 13.96±50.12 41.04±85.04 70.91±58.68 15.75±31.82 824.81±247.20 25.13±2.83 Q3 3 821 35.31±65.18 33.47±73.60 20.88±72.31 48.90±105.80 76.02±61.68 19.45±35.94 1 126.20±326.50 36.47±3.93 Q4 3 819 47.61±71.60 50.05±81.13 27.72±81.50 54.11±111.50 83.22±66.99 24.94±41.45 1 744.20±505.90 62.58±16.91 F/Z值 180.90 283.73 43.91 47.93 54.56 37.50 4 790.12 8 398.90 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 注：1 mmHg=0.133 kPa；以上儿童食物指标为每天摄入量。 
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表 2 2014年各种模型下不同VitA膳食摄入量与体重比值组血压水平比较/[mmHg, x(95%CI)]
Table 2. Comparison of blood pressure levels among different ratio groups of dietary VitA to body weight among children for various models from 2014/[mmHg, x(95%CI)]
模型 组别 统计值 SBP DBP MAP 模型1 Q1 105.41(105.10~105.70) 64.06(63.82~64.30) 77.84(77.60~78.08) Q2 103.68(103.40~104.00)* 63.44(63.20~63.69)* 76.86(76.61~77.10)* Q3 102.43(102.10~102.70)* 62.78(62.54~63.03)* 76.00(75.76~76.24)* Q4 100.86(100.50~101.20)* 62.42(62.18~62.66)* 75.23(74.99~75.48)* H值 455.20 124.90 273.50 P值 ＜0.01 ＜0.01 ＜0.01 模型2 Q1 103.99(103.70~104.30) 63.61(63.37~63.85) 77.07(76.83~77.30) Q2 103.32(103.00~103.60)* 63.33(63.10~63.57) 76.66(76.43~76.90)* Q3 102.84(102.60~103.10)* 62.91(62.67~63.15)* 76.22(75.99~76.45)* Q4 102.23(101.90~102.50)* 62.86(62.61~63.10)* 75.98(75.75~76.22)* H值 542.13 127.40 294.16 P值 ＜0.01 ＜0.01 ＜0.01 模型3 Q1 103.97(103.60~104.40) 63.45(63.10~63.79) 76.95(76.62~77.28) Q2 103.48(103.20~103.80)* 63.36(63.11~63.62) 76.74(76.49~76.98) Q3 102.69(102.40~103.00)* 62.82(62.56~63.07)* 76.11(75.86~76.35)* Q4 101.97(101.50~102.40)* 62.95(62.56~63.35)* 75.96(75.58~76.34)* H值 512.47 118.08 273.95 P值 ＜0.01 0.02 ＜0.01 注：1 mmHg=0.133 kPa；*表示与Q1组相比，P＜0.05。
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表 3 2014年儿童膳食VitA和体重的比值与血压的线性回归分析(n=15 279)
Table 3. Linear regression analysis of the relationship between the ratio of dietary VitA to body weight and blood pressure among children from 2014 (n=15 279)
模型 SBP DBP MAP β值(95%CI) F值 P值 β值(95%CI) F值 P值 β值(95%CI) F值 P值 1 -1.49(-1.63~-1.35) 440.57 ＜0.01 -0.56(-0.67~-0.45) 102.13 ＜0.01 -0.87(-0.98~-0.76) 246.14 ＜0.01 2 -0.58(-0.71~-0.45) 75.56 ＜0.01 -0.27(-0.38~-0.16) 22.64 ＜0.01 -0.37(-0.48~-0.26) 46.08 ＜0.01 3 -0.65(-0.89~-0.42) 28.99 ＜0.01 -0.22(-0.42~-0.01) 4.23 0.04 -0.36(-0.56~-0.16) 12.78 ＜0.01
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表 4 2014年儿童膳食VitA和体重的比值与2019年血压的线性回归分析(n=4 140)
Table 4. Linear regression analysis of the relationship between the ratio of dietary VitA to body weight from 2014 and blood pressure among children from 2019(n=4 140)
模型 SBP DBP MAP β值(95%CI) F值 P值 β值(95%CI) F值 P值 β值(95%CI) F值 P值 1 -2.29(-2.80~-1.77) 76.25 ＜0.01 -0.89(-1.26~-0.51) 21.47 ＜0.01 -1.35(-1.74~-0.97) 48.18 ＜0.01 2 -1.39(-1.87~-0.91) 79.92 ＜0.01 -0.64(-1.02~-0.25) 13.87 ＜0.01 -0.89(-1.27~-0.51) 38.11 ＜0.01 3 -0.77(-1.34~-0.19) 32.09 ＜0.01 -0.62(-1.21~-0.02) 8.36 0.04 -0.77(-1.34~-0.19) 18.06 ＜0.01
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表 5 2014年不同膳食VitA和体重的比值与儿童高血压患病风险的Logistic回归分析(n=15 279)
Table 5. Logistic regression analysis of the relationship between different ratios of dietary VitA to body weight and the risk of hypertension in 2014 (n=15 279)
自变量 模型1 模型2 模型3 β值 标准误 OR值(95%CI) P值 β值 标准误 OR值(95%CI) P值 β值 标准误 OR值(95%CI) P值 Q2 -0.03 0.04 0.86(0.75~0.97) ＜0.01 -0.04 0.04 0.84(0.74~0.96) ＜0.01 -0.08 0.05 0.84(0.73~0.98) ＜0.01 Q3 -0.11 0.04 0.74(0.65~0.85) 0.01 -0.11 0.04 0.72(0.63~0.83) 0.01 -0.11 0.05 0.70(0.58~0.84) 0.02 Q4 -0.13 0.04 0.72(0.63~0.83) ＜0.01 -0.14 0.04 0.70(0.61~0.80) ＜0.01 -0.22 0.07 0.63(0.49~0.81) ＜0.01 注：自变量以Q1为参照。
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表 6 2014年不同膳食VitA和体重的比值与2019年儿童高血压患病风险的Logistic回归分析(n=4 140)
Table 6. Logistic regression analysis of the relationship between different ratios of dietary VitA to body weight from 2014 and the risk of hypertension from 2019 (n=4 140)
自变量 模型1 模型2 模型3 β值 标准误 OR值(95%CI) P值 β值 标准误 OR值(95%CI) P值 β值 标准误 OR值(95%CI) P值 Q2 -1.72 0.08 0.18(0.15~0.21) ＜0.01 -0.23 0.11 0.79(0.63~0.99) 0.04 -1.18 0.37 0.31(0.15~0.64) ＜0.01 Q3 -1.52 0.07 0.22(0.19~0.25) ＜0.01 -0.03 0.10 0.97(0.79~1.18) 0.75 -1.40 0.39 0.25(0.11~0.53) ＜0.01 Q4 -1.66 0.08 0.19(0.16~0.22) ＜0.01 -0.28 0.12 0.76(0.60~0.96) 0.02 -1.71 0.43 0.18(0.08~0.42) ＜0.01 注：自变量以Q1为参照。
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