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Food and health

Dietary phytochemical index is inversely associated with the occurrence of hypertension in adults: a 3-year follow-up (the Tehran Lipid and Glucose Study)

European Journal of Clinical Nutrition volume 69, pages 392–398 (2015)Cite this article

Subjects

Abstract

Background/Objective:

The epidemiological association of phytochemical-rich foods with the risk of hypertension is unclear. This study aimed to determine the association of dietary phytochemical index (PI) with the occurrence of hypertension (HTN) after 3 years of follow-up in Tehranian adults.

Subjects/Methods:

This prospective study was conducted on 1546 nonhypertensive subjects, aged 20–70 years. Dietary intake was collected by validated semiquantitative food frequency questionnaire (FFQ). Dietary PI was calculated as (dietary energy derived from phytochemical-rich foods (kcal)/total daily energy intake (kcal)) × 100. Blood pressure was measured at baseline and after 3 years of follow-up and HTN was defined by Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. The odds of HTN after 3 years in each quartile category of dietary PI were estimated by logistic regression model and adjusted for potential variables.

Results:

The mean age of participants was 38.0±12.0 years and 43% were male. The mean dietary PI was 29.1±11.8. After 3 years of follow-up, 265 (17.1%) new cases of HTN were identified. No significant changes were observed in the systolic and diastolic blood pressure across quartile categories of dietary PI. After adjustment for confounders, the odds (95% confidence interval) of HTN across quartiles of dietary PI were 1.00, 0.97 (0.62–1.38), 0.69 (0.45–1.07) and 0.52 (0.32–0.84) (P for trend=0.004).

Conclusions:

Consumption of phytochemical-rich foods may prevent the development of HTN. Further investigations are, however, recommended.

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References

  • Kearney PM, Whelton M, Reynolds K, Whelton PK, He J . Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22: 11–19.

    Article  CAS  Google Scholar 

  • World Health Organization. A global brief on hypertension : silent killer, global public health crisis: World Health Day 2013 2013. 039 p.

  • Esteghamati A, Abbasi M, Alikhani S, Gouya MM, Delavari A, Shishehbor MH et al. Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran. Am J Hypertens 2008; 21: 620–626.

    Article  Google Scholar 

  • Vasdev S, Stuckless J . Antihypertensive effects of dietary protein and its mechanism. Int J Angiol 2010; 19: e7–e20.

    Article  Google Scholar 

  • Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open 2013; 3: e003423.

    Article  Google Scholar 

  • Slimko ML, Mensah GA . The role of diets, food, and nutrients in the prevention and control of hypertension and prehypertension. Cardiol Clin 2010; 28: 665–674.

    Article  Google Scholar 

  • Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM . Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006; 47: 296–308.

  • Bazzano LA, Green T, Harrison TN, Reynolds K . Dietary approaches to prevent hypertension. Curr Hypertens Rep 2013; 15: 694–702.

    Article  CAS  Google Scholar 

  • Craddick SR, Elmer PJ, Obarzanek E, Vollmer WM, Svetkey LP, Swain MC . The DASH diet and blood pressure. Curr Atheroscler Rep 2003; 5: 484–491.

    Article  Google Scholar 

  • Conlin PR, Chow D, Miller ER 3rd, Svetkey LP, Lin PH, Harsha DW et al. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Am J Hypertens 2000; 13: 949–955.

    Article  CAS  Google Scholar 

  • Moore TJ, Conlin PR, Ard J, Svetkey LP . DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage 1 isolated systolic hypertension. Hypertension2001; 38: 155–158.

  • Doyle L, Cashman KD . The effect of nutrient profiles of the Dietary Approaches to Stop Hypertension (DASH) diets on blood pressure and bone metabolism and composition in normotensive and hypertensive rats. Br J Nutr 2003; 89: 713–724.

    Article  CAS  Google Scholar 

  • Seymour EM, Singer AA, Bennink MR, Parikh RV, Kirakosyan A, Kaufman PB et al. Chronic intake of a phytochemical-enriched diet reduces cardiac fibrosis and diastolic dysfunction caused by prolonged salt-sensitive hypertension. J Gerontol A Biol Sci Med Sci 2008; 63: 1034–1042.

    Article  CAS  Google Scholar 

  • Dreosti IE . Recommended dietary intake levels for phytochemicals: Feasible or fanciful? Asia Pac J Clin Nutr 2000; 9: S119–S122.

    Article  Google Scholar 

  • Holst B, Williamson G . Nutrients and phytochemicals: from bioavailability to bioefficacy beyond antioxidants. Curr Opin Biotechnol 2008; 19: 73–82.

    Article  CAS  Google Scholar 

  • McCarty MF . Proposal for a dietary ‘phytochemical index’. Med Hypotheses 2004; 63: 813–817.

    Article  CAS  Google Scholar 

  • Bahadoran Z, Golzarand M, Mirmiran P, Saadati N, Azizi F . The association of dietary phytochemical index and cardiometabolic risk factors in adults: Tehran Lipid and Glucose Study. J Hum Nutr Diet 2013; 26: 145–153.

    Article  Google Scholar 

  • Vincent HK, Bourguignon CM, Taylor AG . Relationship of the dietary phytochemical index to weight gain, oxidative stress and inflammation in overweight young adults. J Hum Nutr Diet 2010; 23: 20–29.

    Article  CAS  Google Scholar 

  • Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M et al. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed 2002; 47: 408–426.

    Article  Google Scholar 

  • Fung TT, Hu FB, Pereira MA, Liu S, Stampfer MJ, Colditz GA et al. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 2002; 76: 535–540.

    Article  CAS  Google Scholar 

  • Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN et al. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 1990; 13: 401–411.

    Article  CAS  Google Scholar 

  • Esfahani FH, Asghari G, Mirmiran P, Azizi F . Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 2010; 20: 150–158.

    Article  Google Scholar 

  • Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr. et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  • Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser 2000; 894: 1–253

  • WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation, Part 1: Diagnosis and classification of diabetes mellitus 1999: World Health Organization, Geneva, Switzerland. WHO/NCD/NCS/99.2. p 59.

  • Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–1357.

    Article  CAS  Google Scholar 

  • Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H . Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004; 159: 572–580.

    Article  Google Scholar 

  • Utsugi MT, Ohkubo T, Kikuya M, Kurimoto A, Sato RI, Suzuki K et al. Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study. Hypertens Res 2008; 31: 1435–1443.

    Article  Google Scholar 

  • Hosseinpour-Niazi S, Mirmiran P, Amiri Z, Hosseini-Esfahani F, Shakeri N, Azizi F . Legume intake is inversely associated with metabolic syndrome in adults. Arch Iran Med 2012; 15: 538–544.

    CAS  PubMed  Google Scholar 

  • Jayalath VH, de Souza RJ, Sievenpiper JL, Ha V, Chiavaroli L, Mirrahimi A et al. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens 2014; 27: 56–64.

    Article  Google Scholar 

  • Djousse L, Rudich T, Gaziano JM . Nut consumption and risk of hypertension in US male physicians. Clin Nutr 2009; 28: 10–14.

    Article  CAS  Google Scholar 

  • Weng LC, Steffen LM, Szklo M, Nettleton J, Chambless L, Folsom AR . A diet pattern with more dairy and nuts, but less meat is related to lower risk of developing hypertension in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Nutrients 2013; 5: 1719–1733.

    Article  Google Scholar 

  • Flint AJ, Hu FB, Glynn RJ, Jensen MK, Franz M, Sampson L et al. Whole grains and incident hypertension in men. Am J Clin Nutr 2009; 90: 493–498.

    Article  CAS  Google Scholar 

  • Wang L, Gaziano JM, Liu S, Manson JE, Buring JE, Sesso HD . Whole- and refined-grain intakes and the risk of hypertension in women. Am J Clin Nutr 2007; 86: 472–479.

    Article  CAS  Google Scholar 

  • Heidemann C, Scheidt-Nave C, Richter A, Mensink GB . Dietary patterns are associated with cardiometabolic risk factors in a representative study population of German adults. Br J Nutr 2011; 106: 1253–1262.

    Article  CAS  Google Scholar 

  • Huang WY, Davidge ST, Wu J . Bioactive natural constituents from food sources-potential use in hypertension prevention and treatment. Crit Rev Food Sci Nutr 2013; 53: 615–630.

    Article  CAS  Google Scholar 

  • Pounis G, Costanzo S, di Giuseppe R, de Lucia F, Santimone I, Sciarretta A et al. Consumption of healthy foods at different content of antioxidant vitamins and phytochemicals and metabolic risk factors for cardiovascular disease in men and women of the Moli-sani study. Eur J Clin Nutr 2013; 67: 207–213.

    Article  CAS  Google Scholar 

  • Most MM . Estimated phytochemical content of the dietary approaches to stop hypertension (DASH) diet is higher than in the Control Study Diet. J Am Diet Assoc 2004; 104: 1725–1727.

    Article  Google Scholar 

  • Medina-Remon A, Vallverdu-Queralt A, Arranz S, Ros E, Martinez-Gonzalez MA, Sacanella E et al. Gazpacho consumption is associated with lower blood pressure and reduced hypertension in a high cardiovascular risk cohort. Cross-sectional study of the PREDIMED trial. Nutrition, metabolism, and cardiovascular diseases: NMCD 2013; 23: 944–952.

    Article  CAS  Google Scholar 

  • Bouchenak M, Lamri-Senhadji M . Nutritional quality of legumes, and their role in cardiometabolic risk prevention: a review. J Med Food 2013; 16: 185–198.

    Article  CAS  Google Scholar 

  • Perez-Vizcaino F, Duarte J, Jimenez R, Santos-Buelga C, Osuna A . Antihypertensive effects of the flavonoid quercetin. Pharmacol Rep 2009; 61: 67–75.

    Article  CAS  Google Scholar 

  • Moline J, Bukharovich IF, Wolff MS, Phillips R . Dietary flavonoids and hypertension: is there a link? Med Hypotheses 2000; 55: 306–309.

    Article  CAS  Google Scholar 

  • Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A et al. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 2012; 51: 637–663.

    Article  CAS  Google Scholar 

  • Loke WM, Hodgson JM, Proudfoot JM, McKinley AJ, Puddey IB, Croft KD . Pure dietary flavonoids quercetin and (-)-epicatechin augment nitric oxide products and reduce endothelin-1 acutely in healthy men. Am J Clin Nutr 2008; 88: 1018–1025.

    Article  CAS  Google Scholar 

  • Olszanecki R, Gebska A, Kozlovski VI, Gryglewski RJ . Flavonoids and nitric oxide synthase. J Physiol Pharmacol 2002; 53: 571–584.

    CAS  PubMed  Google Scholar 

  • Steffen Y, Gruber C, Schewe T, Sies H . Mono-O-methylated flavanols and other flavonoids as inhibitors of endothelial NADPH oxidase. Arch Biochem Biophys 2008; 469: 209–219.

    Article  CAS  Google Scholar 

  • Steffen Y, Schewe T, Sies H . (-)-Epicatechin elevates nitric oxide in endothelial cells via inhibition of NADPH oxidase. Biochem Biophys Res Commun 2007; 359: 828–833.

    Article  CAS  Google Scholar 

  • Cassidy A, O'Reilly EJ, Kay C, Sampson L, Franz M, Forman JP et al. Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr 2011; 93: 338–347.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the Tehran Lipid and Glucose Study participants and the field investigators of the Tehran Lipid and Glucose Study for their cooperation and assistance in physical examinations, biochemical and nutritional evaluation and database management. This study was supported by grant no. 121 from the National Research Council of the Islamic Republic of Iran and the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences. We thank Ms N Shiva for critical editing of the English language of the manuscript.

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Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    M Golzarand, Z Bahadoran & S Sadeghian-Sharif

  2. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    M Golzarand & Z Bahadoran

  3. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    P Mirmiran

  4. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    F Azizi

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Correspondence to P Mirmiran.

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Golzarand, M., Bahadoran, Z., Mirmiran, P. et al. Dietary phytochemical index is inversely associated with the occurrence of hypertension in adults: a 3-year follow-up (the Tehran Lipid and Glucose Study). Eur J Clin Nutr 69, 392–398 (2015). https://doi.org/10.1038/ejcn.2014.233

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