Abstract
Blood pressure (BP) above optimal (⩽120/⩽80 mmHg) is established as a major cardiovascular disease (CVD) risk factor. Prevalence of adverse BP is high in most adult populations; until recently research has been sparse on reasons for this. Since the 1980s, epidemiologic studies confirmed that salt, alcohol intake, and body mass relate directly to BP; dietary potassium, inversely. Several other nutrients also probably influence BP. The DASH feeding trials demonstrated that with the multiple modifications in the DASH combination diet, SBP/DBP (SBP: systolic blood pressure, DBP: diastolic blood pressure) was sizably reduced, independent of calorie balance, alcohol intake, and BP reduction with decreased dietary salt. A key challenge for research is to elucidate specific nutrients accounting for this effect. The general aim of the study was to clarify influences of multiple nutrients on SBP/DBP of individuals over and above effects of Na, K, alcohol, and body mass. Specific aims were, in a cross-sectional epidemiologic study of 4680 men and women aged 40–59 years from 17 diverse population samples in China, Japan, UK, and USA, test 10 prior hypotheses on relations of macronutrients to SBP/DBP and on role of dietary factors in inverse associations of education with BP; test four related subgroup hypotheses; explore associations with SBP/DBP of multiple other nutrients, urinary metabolites, and foods. For these purposes, for all 4680 participants, with standardized high-quality methods, assess individual intake of 76 nutrients from four 24-h dietary recalls/person; measure in two timed 24-h urine collections/person 24-h excretion of Na, K, Ca, Mg, creatinine, amino acids; microalbuminuria; multiple nutrients and metabolites by nuclear magnetic resonance and high-pressure liquid chromatography. Based on eight SBP/DBP measurements/person, and data on multiple possible confounders, utilize mainly multiple linear regression and quantile analyses to test prior hypotheses and explore relations of multiple dietary and urinary variables to SBP/DBP of individuals.
The 4680 INTERMAP participants are equally divided across four age/gender strata: diverse in ethnicity, education, occupation, physical activity; use of cigarettes, alcohol; diagnosed high BP, CVD, diabetes; CVD family history; women vary in parity, use of contraceptive medication and hormone replacement therapy.
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Acknowledgements
This research was supported by Grant 2-RO1-HL50490 from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; by the Chicago Health Research Foundation; and by national agencies in China, Japan (the Ministry of Education, Science, Sports, and Culture, Grant-in-Aid for Scientific Research [A], No. 090357003), and the UK.
We are grateful to Rand McNally & Company, Skokie, IL, USA for permission to reproduce here as Figure 1 three maps from its publication The Rand McNally Classroom Atlas.
The INTERMAP Study has been accomplished through the fine work of the staff at the local, national, and international centres. A partial listing of colleagues follows:
Japan
Shiga, Country Coordinating Center Management Committee
Hirotsugu Ueshima, Principal Investigator and Chair
Akira Okayama, Co-Principal Investigator
Sohel R Choudhury, Co-Principal Investigator
Yoshikuni Kita, Co-Principal Investigator
Nagako Okuda, Country Nutritionist
Aito Town Local Center
Akira Okayama, Principal Investigator
Sohel R Choudhury, Co-Principal Investigator
Yoshikuni Kita, Co-Principal Investigator
Harumi Fuse, Research Associate
Takashi Kadowaki, Research Associate
Atsuko Morino, Research Associate and Site Nutritionist
Yoko Sekiya, Research Associate and Site Nutritionist
Makoto Watanabe, Research Associate
Kazuyo Yamamoto, Research Associate
Masako Yoshioka, Research Associate
Sapporo Local Center
Shigeyuki Saitoh, Principal Investigator
Kazuaki Shimamoto, Co-Principal Investigator
Shigeyuki Tanaka, Co-Principal Investigator
Koko Ishishita, Site Nutritionist
Toshio Isomatsu, Research Associate
Toshiyuki Takahashi, Research Associate
Toyama Local Center
Hideaki Nakagawa, Principal Investigator
Katsuyuki Miura, Co-Principal Investigator
Katsushi Yoshita, Co-Principal Investigator and Site Nutritionist
Masako Higashiyama, Research Associate
Sadanobu Kagamimori, Research Associate
Yuchi Naruse, Research Associate
Wakayama Local Center
Tsutomu Hashimoto, Principal Investigator
Seiji Morioka, Co-Principal Investigator
Kiyomi Sakata, Co-Principal Investigator
Fujihisa Kinoshita, Research Associate
Osamu Mohara, Research Associate
Masanori Ohta, Research Associate
Kayoko Oki, Research Associate and Site Nutritionist
Yoshimi Shibe, Research Associate and Site Nutritionist
People's Republic of China
Beijing, Country Coordinating Center
Beifan Zhou, Principal Investigator and Country Nutritionist
Liancheng Zhao, Country Nutritionist
Yangfeng Wu, Co-Principal Investigator
Beijing Local Center
Yangfeng Wu, Principal Investigator and Coordinator
The two other above listed colleagues, plus:
Jun Yang, Dietary Interviewer
Donghai Lu, Technician for Urine Collection
Yao Li, Data Entry Technician
Jun Xing, Dietary Interviewer
Guangxi Local Center
Shuxiong Zhu, Principal Investigator
Liguang Zhu, Coordinator and Site Nutritionist
Xingsan Li, Quality Control Technician, Non-Dietary Data Collection
Xiufan Li, Assistant Coordinator
Mengsheng Mo, Dietary Interviewer
Shanxi Local Center
Ruixiang Yang, Principal Investigator
Dongshuang Guo, Coordinator
Jinglan Gong, Site Nutritionist
Shengying Liang, Assistant Coordinator
Peizhu Wang, Quality Control Technician, Non-Dietary Data Collection
Xiuming Li, Data Entry Technician
UK
London, INTERMAP International and Country Coordinating Center
Paul Elliott, Principal Investigator
Queenie Chan, Data Coordinator and Statistician
Deborah Chee, Coordinator
Rana Conway, Country Nutritionist
Judith Diamond, Data Coordinator and Statistician
Valerie McCormack, Data Coordinator
Rob Nichols, Data Coordinator and Statistician
Yui Rerkpatima, Dietary Coder
Claire Robertson, Country Nutritionist
Frankie Robinson, Country Nutritionist
Nina Seres, Nutritionist
Simon Sheffield, Administrator
Caroline Terrill, Data Coordinator and Statistician
Michael Tumilty, Nutritionist
Jennifer Wells, Special Assistant
London, Metabonomics Laboratory
Jeremy Nicholson, Co-Principal Investigator
Elaine Holmes, Co-Principal Investigator
Claire James, PhD Candidate
Elaine Taylor, Research Associate
Belfast Local Center
Alun Evans, Principal Investigator
John Yarnell, Co-Principal Investigator
Claire Robertson, Coordinator and Site Nutritionist
Jackie Bates, Dietary Interviewer
Mary Crawford, Dietary Interviewer
Elaine Duffy, Interviewer, BP Technician
Sally Johnson, Interviewer, BP Technician
Julie Laird, Dietary Interviewer
Annette McAnnulla, Dietary Interviewer
Gillian McGeough, Site Nutritionist
Collette Ryan, Dietary Interviewer
Margaret Ward, Interviewer, BP Technician
West Bromwich Local Center
Gareth Beevers, Principal Investigator
Gregory Lip, Co-Principal Investigator
Koon-Lan Chan, Coordinator
Georgina Alderslade, Site Nutritionist
Ada Conteh, Dietary Interviewer
Melanie Farron, Dietary Coder
Anne Gowing, Dietary Interviewer
Tina Howe, Dietary Coder
Karen Hubbard, Dietary Coder
Baljit Sanghera, Site Nutritionist
USA
Chicago, INTERMAP International and Country Coordinating Center
Jeremiah Stamler, Principal Investigator
Alan R Dyer, Co-Principal Investigator
Kiang Liu, Co-Principal Investigator
Rose Stamler (deceased), Co-Principal Investigator
Martha Daviglus, Principal Investigator, Study on Urinary Amino Acids
Philip Greenland, Co-Investigator
Linda Van Horn, Consultant Nutritionist
Sujata Archer, Nutritionist
Alicia Moag-Stahlberg, US Coordinator and Country Nutritionist
Dan Garside, Chief, Computer Systems
Niki Gernhofer, Nutritionist
Colleen De Luca, Administrator
Joseph Shayka, Chief, Computer Systems for INTERMAP USA
Harold Wexler, Secretary
Chapel Hill, INTERMAP International Nutrition Coordinating Center
Barbara Dennis, International Nutrition Coordinator
Susan Blackwell Marshall, Research Associate
Minneapolis, Nutrition Coordinating Center
Nancy Van Heel, Project Coordinator
Marilyn Buzzard, Principal Investigator
Lisa Harnack, Principal Investigator
Gloria Ray, Dietary Interview Quality Control
Sally Schakel, Chief Database Nutritionist
Susan Seftick, Dietary Interview Quality Control
Alice Shapiro, Project Coordinator
Mary Stevens, Dietary Interview and Quality Control Training Coordinator
Christine Wold, Database Nutritionist
Roberta Zeug, Database Nutritionist
Richmond
Marilyn Buzzard, Senior Consultant, Dietary Data Collection and Analysis
Rhonda Stout, Graduate Assistant, Dietary Interview Quality Control
Bethesda, National Heart, Lung, and Blood Institute
Eva Obarzanek, Project Officer
Jeffrey Cutler, Program Director
Baltimore Local Center
Paul Whelton, original Principal Investigator
Lawrence Appel, Principal Investigator
Jeanne Charleston, Director of Research Operations
Phyllis McCarron, Site Nutritionist
Vicki Shank, Coordinator
Sharon Cappelli, Nutritionist
Ellen Gold, Nutritionist
Charles Harris, Data Technician
Dolores Kaidy, Recruiter
Shirley Kritt, Recruiter
Estelle Levitas, Data Technician
Bonnie Peterson, Nutritionist
LeeLana Thomas, Nutritionist
Letitia Thomas, Nutritionist
Bobbie Weiss, Data Technician
Chicago Local Center
Linda Van Horn, Principal Investigator
Philip Greenland, Co-Principal Investigator
Alan R. Dyer, Co-Investigator
Kiang Liu, Co-Investigator
Judy Gerber, Coordinator and Nutritionist
Niki Gernhofer, Site Nutritionist
Cindy Buettgan, Nutritionist
Colleen De Luca, Department Administrator
Penelope Garrett, Nutritionist
Natalie Lopez, Site Administrator
Frances Oppenheimer, Nutritionist
Corpus Christi Local Center
Darwin R Labarthe, Principal Investigator
Milton Nichaman, Principal Investigator
Deanna Montgomery Hoelscher, Co-Investigator
Lyn Steffen, Project Coordinator
Mark Canales, BP Technician
Pam Folsom, BP Technician and original Clinic Manager
Sarita Garcia, Dietary Interviewer
Mimi Guajardo, Administrative Assistant
Luanna Ortiz, BP Technician
Rose Ramirez, BP Technician
Melissa Taylor, BP and Lab Technician
Gina Valdez, BP Technician, Dietary Interviewer, Clinic Manager
Laurita Yuras, Dietary Interviewer
Honolulu Local Center
Beatriz L Rodriguez, Principal Investigator
J David Curb, Co-Principal Investigator
Kamal Masaki, Co-Principal Investigator
Helen Petrovitch, Co-Investigator
Joane Moylan, Site Nutritionist
Jackson Local Center
Daniel Jones, Principal Investigator
Margaret E Miller, Co-Investigator
Mary Whitten, Research Administrator
Teresa Caruthers, Site Nutritionist
Cathy Adair, Research Nurse
Mary Cameron, Dietary Interviewer
Gertie Carr, Dietary Interviewer
Nancy King, Research Assistant
Diane Willoughby, Research Nurse
Minneapolis Local Center
Patricia J Elmer, Principal Investigator
David R Jacobs Jr, Co-Principal Investigator
Terri Tharp, Project Coordinator and Site Nutritionist
Mary Dahlberg Johnson, Dietary Interviewer
Kari Elfstrom, Dietary Interviewer
Pittsburgh Local Center
Arlene Caggiula, Principal Investigator
Monica Yamamoto, Co-Principal Investigator and Site Manager
Lewis H Kuller, Co-Investigator
Lisa Atkins, Site Administrative Assistant and Data Clerk
Nancy Epler, Recruiter
Karen Givner, Site Administrative Assistant and Data Clerk
Refaat Hegasi, Clinical Assessor
Deborah Larsen, Dietary Interviewer
Alysia Mason Feuer, Dietary Interviewer
Rebecca M Meehan, Dietary Interviewer
Blanca Nieves, Dietary Interviewer
Tony O'Dea, Summer Intern
Heather Strickland, Clinical Assesssor
Charlene Walter, Dietary Interviewer
Belgium—Leuven, INTERMAP Central Laboratory
Hugo Kesteloot, Principal Investigator
Peter Declercq, Co-Principal Investigator
George Claeys, Co-Principal Investigator
Norbert Blanckaert, Head, Central Clinical Laboratory
Wim Blom, Adviser
Lene Koolen, Technician, INTERMAP Laboratory
Kristine Lauwereys, Head Programmer
Nadia Vangeel, Technician, INTERMAP Laboratory
INTERMAP International Steering and Editorial Committee
Jeremiah Stamler, Co-Chair
Paul Elliott, Co-Chair
Barbara Dennis
Alan R Dyer
Hugo Kesteloot
Kiang Liu
Rose Stamler (deceased)
Hirotsugu Ueshima
Beifan Zhou
INTERMAP International Advisory Committee
John Chalmers
Scott Grundy
Mark Hegsted
Lisheng Liu
Michael Marmot
Teruo Omae
Kalevi Pyorala
Neil Stone
INTERMAP International Nutrition Advisory Committee
Anna Ferro-Luzzi
Daan Kromhout
Wen Harn Pan
Pirjo Pietinen
Wija J van Steveren
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Stamler, J., Elliott, P., Dennis, B. et al. INTERMAP: background, aims, design, methods, and descriptive statistics (nondietary). J Hum Hypertens 17, 591–608 (2003). https://doi.org/10.1038/sj.jhh.1001603
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DOI: https://doi.org/10.1038/sj.jhh.1001603
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