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Association of Diet and Lifestyle with Blood Pressure in the Guangxi Hei Yi Zhuang and Han Populations

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Association of Diet and Lifestyle with Blood Pressure in the Guangxi Hei Yi Zhuang and Han Populations Public Health Nutrition: 12(4), 553–561 doi:10.1017/S1368980008002437 Association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations Yin Ruixing1,*, Li Hui2, Wu Jinzhen1, Lin Weixiong3, Yang Dezhai3, Pan Shangling4, Huang Jiandong5 and Long Xiuyan5 1Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, People’s Republic of China: 2Clinical Laboratory of the Affiliated Cancer Hospital, Guangxi Medical University, Nanning, People’s Republic of China: 3Department of Molecular Biology, Guangxi Medical Scientific Research Center, Nanning, People’s Republic of China: 4Department of Pathophysiology, School of Premedical Sciences, Guangxi Medical University, Nanning, People’s Republic of China: 5The Health Bureau of Napo County, Guangxi Zhuang Autonomous Region, Napo, Guangxi, People’s Republic of China Submitted 24 August 2007: Accepted 3 April 2008: First published online 19 May 2008 Abstract Objective: To detect the association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations. Design: A cross-sectional study of hypertension. Setting: Both populations were from seven to nine villages in Napo County, Guangxi Zhuang Autonomous Region, China. Subjects: A total of 1068 subjects of Hei Yi Zhuang and 933 participants of Han Chinese aged 20–89 years were surveyed by a stratified randomised cluster sampling. Results: The levels of systolic blood pressure and pulse pressure were higher in Hei Yi Zhuang than in Han (125?20 (SD 18?62) v. 121?88 (SD 15?99) mmHg and 48?64 (SD 14?75) v.44?98 (SD 11?12 ) mmHg, P , 0?001 for each, respectively). The prevalence of hypertension and isolated systolic hypertension was also higher in Hei Yi Zhuang than in Han (25?19 % v.17?26 % and 12?45 % v.3?86 %, P , 0?001 for each, respectively). Mean arterial pressure was positively correlated with gender, age, physical activity, TAG, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Hei Yi Zhuang (P , 0?05–0?001), whereas it was positively associated with gender, age, physical activity, BMI, waist circumference, total cholesterol, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre Keywords intake in Han (P , 0?05–0?001). Blood pressure Conclusions: The differences in blood pressure levels and the prevalence of Hypertension hypertension between the Hei Yi Zhuang and Han populations were associated Prevalence with different dietary habits, lifestyle choices, education level, as well as geo- Diet graphical surroundings. Lifestyle Hypertension is a principal cause of mortality and mor- the prevalence of hypertension in different races may bidity in China(1), and is also one of the most important also differ(11,12). cardiovascular risk factors all over the world(2). A recent There are fifty-six ethnic groups in China. Han is the cross-sectional study in China estimated that 129 million largest ethnic group and Zhuang is the largest minority. people aged 35–74 years have hypertension(3). Although There are also forty-three ethnic subgroups of the the exact causes and mechanisms of hypertension are Zhuang. Hei Yi Zhuang dwelling in Napo County (a not well known, it is generally believed that genetic county near Vietnam) of Guangxi is an isolated subgroup. factors(4) as well as environmental factors, such as more They worship black colour, and they like to wear black sodium intake(5,6), cigarette smoking(7,8) and mental garments and pants. Black colour has become the marking work(9,10), are involved in determining blood pressure of Hei Yi Zhuang. The population size is 51 655. Because of levels and the prevalence of hypertension. In addition, isolation from the other ethnic groups, the special customs *Corresponding author: Email [email protected] r The Authors 2008 Downloaded from https://www.cambridge.org/core. 29 Sep 2021 at 18:38:12, subject to the Cambridge Core terms of use. 554 Y Ruixing et al. and cultures including their clothing, intra-ethnic marriages, foods, beverages and supplements consumed during the dietary habits and lifestyle are still totally conserved to the 24 h period before the interview, including the quantity, present day(13). Little is known about the association of diet cooking method and brand names, were recorded by and lifestyle with blood pressure in this population. We a chief physician. Quantitative estimate of cumulative hypothesise that there may be significant differences in the nutrient intake per day in each food was based on food dietary patterns, lifestyle and blood pressure levels between tables derived from the 2002 Chinese Food Composition the two ethnic groups. Therefore, the present study was Tables(16). Overall physical activity was ascertained with undertaken to detect the association of diet and lifestyle the use of a modified version of the Harvard Alumni with blood pressure and the prevalence of hypertension in Physical Activity Questionnaire(17), which included the Guangxi Hei Yi Zhuang and Han populations. questions about the number of hours per day (mean of a regular weekday and a regular weekend day) spent sleeping and in sedentary, light, moderate and vigorous Methods activities; the interviewer ensured that the total time added up to 24 h. Current smoking was defined as more Populations than one cigarette per day. Consumption of alcohol A total of 1068 subjects of Hei Yi Zhuang from seven included questions about the number of liangs (about villages in Napo County, Guangxi Zhuang Autonomous 50 g) of rice wine, wine, beer or liquor consumed during Region, China, were surveyed by a stratified randomised the preceding 12 months. The physical examination cluster sampling. The ages of the subjects ranged from 20 included blood pressure, height, weight and waist cir- to 84 years, with an average age of 46?75 (SD 15?66) years. cumference. Blood pressure readings were taken with a There were 487 (45?6 %) males and 581 (54?4 %) females. standard mercury sphygmomanometer after at least 5 min All of them were peasants. The numbers of subjects of rest, while the subject was in a sitting position. The between the ages of 20–29, 30–39, 40–49, 50–59, 60–69 values used in the current analysis are means of three and $70 years were 156 (14?6 %), 255 (23?8 %), 177 measurements taken by the same investigator at about (16?6 %), 196 (18?4 %), 196 (18?4 %) and 88 (8?2 %), 5 min intervals. Systolic blood pressure (SBP) was deter- respectively. They accounted for 2?1 % of the total Hei Yi mined by the first Korotkoff sound, and diastolic blood Zhuang population. During the same period, a total of pressure (DBP) by the fifth Korotkoff sound. Pulse pres- 933 subjects of Han Chinese from nine villages in the sure (PP) was calculated as the difference between SBP same county were also surveyed by the same method. and DBP. Mean arterial pressure (MAP) was calculated The mean age of the subjects was 45?46 (SD 15?76) years as DBP plus one-third times PP(18). Body weight (to (range 20–89 years). There were 414 (44?4 %) men and the nearest 100 g on calibrated scales) and height (to the 519 (55?6 %) women. These subjects were also peasants. nearest 0?5 cm) were measured while the participants The numbers of subjects between the ages of 20–29, were wearing only light indoor clothing and no shoes. 30–39, 40–49, 50–59, 60–69 and $70 years were 183 BMI was calculated as weight (kg) divided by height (m) (19?6 %), 230 (24?7 %), 173 (18?5 %), 149 (16?0 %), 117 squared. Waist circumference was measured with a non- (12?5 %) and 81 (8?7 %), respectively. All study subjects stretchable measuring tape, at the level of the smallest were essentially healthy and had no evidence of any area of the waist, to the nearest 0?1 cm. chronic illness, including hepatic, renal, thyroid, cardiac dysfunction or diabetes mellitus. Some subjects were Measurements of lipids and apolipoproteins treated with antihypertensive drugs, such as nifedipine Blood samples were drawn from an antecubital vein in all (calcium channel blocker) and/or catopril (angiotensin subjects after an overnight fast. The blood was transferred converting enzyme inhibitor). The study was approved into glass tubes and allowed to clot at room temperature. by our institutional ethics committee, and the study Immediately following clotting, serum was separated by subjects gave informed consent to participate in the study. centrifugation for 15 min at 3000 rpm. The levels of total cholesterol, TAG, HDL cholesterol (HDL-C) and LDL Epidemiological survey cholesterol (LDL-C) in samples were determined enzy- The survey was carried out using internationally stan- matically using commercially available kits: Tcho-1, TG- dardised methods(14), following a common protocol. LH (RANDOX Laboratories Ltd, Crumlin, UK), Cholestest Information on demographics (age, gender, race/ethni- N HDL and Cholestest LDL (Daiichi Pure Chemicals Co., city and residential area), socio-economic status (educa- Ltd, Tokyo, Japan), respectively. Serum apo A1 and tion level achieved, marital status and annual household apo B levels were measured by an immunoturbidimetric income), health-related behaviour (alcohol consumption, assay (RANDOX Laboratories Ltd). All determinations cigarette smoking and physical activity) and dietary intake were performed with an autoanalyser (Type 7170A; was collected with standardised questionnaires. Dietary Hitachi Ltd, Tokyo, Japan) in the Clinical Science Experi- information of each subject was obtained using a 24 h ment Center of the First Affiliated Hospital, Guangxi dietary recall method(15). Detailed descriptions of all Medical University.
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