王柳森, 王惠君, 王志宏, 姜红如, 李惟怡, 王邵顺子, 郝丽鑫, 张兵, 丁钢强. 我国成年人膳食镁摄入与高血压发病风险的相关性[J]. 环境与职业医学, 2022, 39(9): 974-980. DOI: 10.11836/JEOM22080
引用本文: 王柳森, 王惠君, 王志宏, 姜红如, 李惟怡, 王邵顺子, 郝丽鑫, 张兵, 丁钢强. 我国成年人膳食镁摄入与高血压发病风险的相关性[J]. 环境与职业医学, 2022, 39(9): 974-980. DOI: 10.11836/JEOM22080
WANG Liusen, WANG Huijun, WANG Zhihong, JIANG Hongru, LI Weiyi, WANG Shaoshunzi, HAO Lixin, ZHANG Bing, DING Gangqiang. Association between dietary magnesium intake and risk of hypertension in Chinese adults[J]. Journal of Environmental and Occupational Medicine, 2022, 39(9): 974-980. DOI: 10.11836/JEOM22080
Citation: WANG Liusen, WANG Huijun, WANG Zhihong, JIANG Hongru, LI Weiyi, WANG Shaoshunzi, HAO Lixin, ZHANG Bing, DING Gangqiang. Association between dietary magnesium intake and risk of hypertension in Chinese adults[J]. Journal of Environmental and Occupational Medicine, 2022, 39(9): 974-980. DOI: 10.11836/JEOM22080

我国成年人膳食镁摄入与高血压发病风险的相关性

Association between dietary magnesium intake and risk of hypertension in Chinese adults

  • 摘要: 背景

    镁有着重要的生理作用,膳食镁与高血压的发病风险关联性尚不明确,缺乏国内人群的剂量-反应关系研究。

    目的

    分析中国18~64岁成年人膳食镁摄入量与高血压发病风险的关联性,并探讨二者的剂量-反应关系。

    方法

    利用2000—2018年“中国健康与营养调查”的人口特征、膳食和体格测量数据,选择至少参加2轮调查的18~64岁13082名成年人作为研究对象。采用连续“3天24小时膳食回顾法”和“称重记账法”获得膳食数据,采用标准汞柱式血压计测量血压值;当收缩压≥140 mmHg和(或)舒张压≥90 mmHg,既往有高血压史,正在使用降压药物,将被诊断为高血压。采用被调查者全部调查年(不包括最后一次调查)膳食镁摄入量的均值作为该名研究对象的膳食镁摄入量,按平均摄入量水平将人群进行5等分。运用Cox比例风险模型,调整人口社会学因素、体重指数(BMI)、吸烟和饮酒的情况、睡眠时间、身体活动、膳食因素,分析膳食镁摄入量与高血压发病风险的关联性,并通过剔除基线患有糖尿病的人群和调整基线血压值进行敏感性分析;采用限制性立方样条模型校正上述混杂因素,分析镁摄入量与高血压发病风险的剂量-反应关系。

    结果

    研究人群中男性占比47.70%,18~44岁青年人占比72.47%,平均随访年数为12.56年,高血压患病率为13.86%。相比于第1五分位(中位数189.06 mg·d−1)人群,膳食镁摄入量在第4五分位(中位数333.56 mg·d−1)和第5五分位(中位数420.07 mg·d−1)时,与全人群高血压发病的风险呈负相关,风险比(HR)及其95%CI分别为0.81(0.67~0.97)和0.81(0.66~0.99)。剔除基线患有糖尿病的人群和调整基线血压值后,发现膳食镁摄入量与高血压发病风险仍呈负相关,与全人群 HR 值保持一致。进一步分析发现:膳食镁摄入量与全人群高血压发病风险的关联呈非线性关联(χ2=11.07,P=0.01);当膳食镁摄入量高于339 mg·d−1时,高血压的发病风险降低,且在375~418 mg·d−1HR最小(HR=0.65,95%CI:0.45~0.94);之后HR值逐渐趋于1,在467 mg·d−1及以上时,膳食镁摄入量与高血压发病风险的关联无统计学意义。

    结论

    我国成年居民镁摄入量在339~467 mg·d−1范围内与高血压的发病风险明显呈负相关,呈现“U”型的剂量-反应关系。

     

    Abstract: Background

    Magnesium plays an important physiological role in human, but the association between dietary magnesium intake and the risk of hypertension is unclear. Few studies have reported the dose-response relationship in Chinese population.

    Objective

    To analyze the relationship between dietary magnesium intake and the risk of hypertension in Chinese adults aged 18-64 years, and to explore the dose-response relationship.

    Methods

    A total of 13082 adults aged 18-64 years who participated in at least two rounds of the China Health and Nutrition Survey (CHNS) from 2000 to 2018 were selected. Dietary data were obtained by consecutive 3-day 24-hour dietary recall and weighting & bookkeeping method. Blood pressure was measured with a standard mercury sphygmomanometer. Hypertension was diagnosed when systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or self-reported hypertension history or using antihypertensive drugs. The mean of dietary magnesium intake in all survey years (excluding the last survey) was used as the dietary magnesium intake of the subject, and the mean of dietary magnesium intake was divided into 5 equal groups. Cox proportional risk model with adjustments for socio-demographic factors, body mass index (BMI), smoking and drinking, sleep time, physical activity, and dietary factors, was used to analyze the association between dietary magnesium intake and the risk of hypertension. A sensitivity analysis was conducted by excluding baseline diabetes patients and adjusting for baseline blood pressure. In addition, a restricted cubic spline model was used to analyze the dose-response relationship between them.

    Results

    In this study, male participants accounted for 47.70%, and those aged 18-44 years accounted for 72.47%. The mean follow-up time was 12.56 years and the prevalence of hypertension was 13.86%. Dietary magnesium intake was inversely associated with the risk of hypertension at the 4th quintile (median 333.56 mg·d−1) and the 5th quintile (median 420.07 mg·d−1) compared with the 1st quintile (median 189.06 mg·d–1), and the hazard risk (HR) values and associated 95%CIs were 0.81 (0.67-0.97) and 0.81 (0.66-0.99) respectively. After eliminating baseline diabetes and adjusting baseline blood pressure, dietary magnesium intake remained negatively associated with the risk of hypertension, which was consistent with the population-wide HR. The association between dietary magnesium intake and the risk of hypertension was non-linear (χ2=11.07, P=0.01). When dietary magnesium intake was higher than 339 mg·d−1, the risk of hypertension decreased, and the HR value was the lowest in 375-418 mg·d−1 (HR=0.65, 95%CI: 0.45-0.94), and then gradually tended to 1. There was no statistically significant association at 467 mg·d−1 and above.

    Conclusion

    Magnesium intake in the range of 339-467 mg·d−1 is negatively associated with the risk of hypertension in Chinese adults, presenting a U-shaped dose-response relationship.

     

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