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Dietary intake, blood pressure and osteoporosis

Abstract

Both hypertension and osteoporosis have common underlying nutritional aetiology, with regards to dietary cations intake. We tested the hypothesis that sodium intake reflected in urinary Na/Cr and blood pressure would be negatively associated with bone mineral density (BMD), whereas other cations may have opposite associations. Subjects were part of a study of bone health in 4000 men and women aged 65 years and over. A total of 1098 subjects who were not on antihypertensive drugs or calcium supplements and who provided urine samples were available for analysis. Logistic regression was used to examine associations between total hip and lumbar spine BMD, age, gender, body mass index (BMI), urinary Na/Cr, K/Cr, calcium and magnesium intake, systolic blood pressure and diastolic blood pressure. Total hip BMD was inversely associated with age, being female and urinary Na/Cr, and positively associated with BMI, urine K/Cr and dietary calcium intake. Lumbar spine BMD was inversely associated with being female and urinary Na/Cr, and positively associated with BMI, dietary calcium intake and SBP. We conclude that sodium intake, reflected by urinary Na/Cr, is the major factor linking blood pressure and osteoporosis as shown by the inverse relationship with BMD. The findings lend further emphasis to the health benefits of salt reduction in our population both in terms of hypertension and osteoporosis.

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References

  1. Suter PM, Sierro C, Vetter W . Nutritional Factors in the control of blood pressure and hypertension. Nutr Clin Care 2002; 5: 9–19.

    Article  Google Scholar 

  2. Hajjar I, Kotchen T . Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: the NHANES-III data. J Nutr 2003; 133: 211–214.

    Article  CAS  Google Scholar 

  3. Van Leer EM, Seidell JC, Kromhout D . Dietary calcium, potassium, magnesium and blood pressure in the Netherlands. Int J Epidemiol 1995; 24: 1117–1123.

    Article  CAS  Google Scholar 

  4. Sacks FM, Brown LE, Appel L, Borhani NO, Evans D, Whelton P . Combinations of potassium, calcium, and magnesium supplements in hypertension. Hypertension 1995; 26: 950–956.

    Article  CAS  Google Scholar 

  5. Yang CY, Chiu HF . Calcium and magnesium in drinking water and the risk of death from hypertension. Am J Hypertens 1999; 12: 894–899.

    Article  CAS  Google Scholar 

  6. INTERSALT. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ 1988; 297: 319–328.

    Article  Google Scholar 

  7. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. Effects on blood pressure of reduced dietary sodium and to Dietary Approaches to Stop Hypertension (DASH) diet. DASH-sodium Collaborative Research Groups. N Engl J Med 2001; 344: 3–10.

    Article  CAS  Google Scholar 

  8. Akita S, Sacks FM, Svetkey LP, Conlin PR, Kimura G . Effects of the dietary approaches to stop hypertension (DASH) diet on the pressure-natriuresis relationship. Hypertension 2003; 42: 8–13.

    Article  CAS  Google Scholar 

  9. Ho SC, Chen YM, Woo JL, Leung SS, Lam TH, Janus ED . Sodium is the leading dietary factor associated with urinary calcium excretion in Hong Kong Chinese adults. Osteoporosis Int 2001; 12: 723–731.

    Article  CAS  Google Scholar 

  10. Resnick LM . The role of calcium in hypertension. A hierarchal overview. Am J Hypertens 1999; 12: 99–112.

    Article  CAS  Google Scholar 

  11. Judd SE, Nanes MS, Ziegler TR, Wilson PW, Tangpricha V . Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey. Am J Clin Nutr 2008; 87: 136–141.

    Article  CAS  Google Scholar 

  12. Jorde R, Sundsfjord J, Haug E, Bonaa KH . Relation between low calcium intake, parathyroid hormone, and blood pressure. Hypertension 2000; 35: 1154–1159.

    Article  CAS  Google Scholar 

  13. Jorde R, Bonaa KH . Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study. Am J Clin Nutr 2000; 71: 1530–1535.

    Article  CAS  Google Scholar 

  14. Schroder H, Schmelz E, Marrugat T . Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr 2002; 41: 161–167.

    Article  CAS  Google Scholar 

  15. Majjar IM, Grim CE, Kotchen TA . Dietary calcium lowers the age-related rise in blood pressure in the United States: the NHANES III survey. J Clin Hypertension 2003; 5: 122–126.

    Article  Google Scholar 

  16. Reid IR, Horne A, Mason B, Ames R, Bava U, Gamble GD . Effect of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. J Clin Endocrinol Metab 2005; 90: 3824–3829.

    Article  CAS  Google Scholar 

  17. Nowson C, Morgan T . Effect of calcium carbonate on blood pressure in normotensive and hypertensive people. Hypertension 1989; 13: 630–639.

    Article  CAS  Google Scholar 

  18. Dickinson HO, Nicolson DJ, Cook JV, Campbell F, Beyer FR, Ford GA et al. Calcium supplementation for the management of primary hypertension in adults. The Cochrane Database of Systematic Reviews 2008; 4. AN:00075320-100000000-03558.

  19. Woo J, Lau E, Chan A, Cockram C, Swaminathan R . Blood pressure and urinary cations in a Chinese population. J Hum Hypertens 1992; 6: 299–304.

    CAS  PubMed  Google Scholar 

  20. Kwok TC, Chan TY, Woo J . Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians. Eur J Clin Nutr 2003; 57: 299–304.

    Article  CAS  Google Scholar 

  21. Paul AA, Southgate DAT . McCance & Widdowson's: The Composition of Foods, 4th edn, HM SO: London, UK, 1978.

    Google Scholar 

  22. Yang Y, Wang G, Pan G (eds). Institute of Nutrition & Food Safety, China CDC, In: China Food Composition 2002. University Medical Press: Peking, China, 2002.

    Google Scholar 

  23. Woo J, Leung SSF, Ho SC, Lam TH, Janus ED . A food frequency questionnaire for use in the Chinese population in Hong Kong: description and examination of validity. Nutr Res 1997; 17: 1633–1641.

    Article  CAS  Google Scholar 

  24. Woo J . Nutrition and health issues in the general Hong Kong population. HK Med J 1998; 4: 383–388.

    CAS  Google Scholar 

  25. INTERSALT Cooperative Research Group. INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Br Med J 1988; 297: 319–328.

    Article  Google Scholar 

  26. Kesteloot H, Huang DX, Li YL, Geboers J, Joossens JV . The relationship between cations and blood pressure in the People's Republic of China. Hypertension 1987; 9: 654–659.

    Article  CAS  Google Scholar 

  27. Bruce NG, Cook DG, Shaper AG, Radcliffe JG . Casual urine concentrations of sodium, potassium and creatinine in populations studies of blood pressure. J Hum Hypertens 1990; 4: 597–602.

    CAS  PubMed  Google Scholar 

  28. Khaw KT . Blood pressure and casual urine electrolytes in 93 London workers. Clin Sci 1983; 65: 243–245.

    Article  CAS  Google Scholar 

  29. Khaw KT, Rose GA . A population study of blood pressure and associated factors in St Lucia, West Indies. Int J Epidemiol 1982; 11: 372–377.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study received support from the Jockey Club Charities Trust, the Research Grants Council of Hong Kong CUHK 4101/02M.

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Correspondence to J Woo.

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Woo, J., Kwok, T., Leung, J. et al. Dietary intake, blood pressure and osteoporosis. J Hum Hypertens 23, 451–455 (2009). https://doi.org/10.1038/jhh.2008.156

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