J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China
Panpan He1, Huan Li1, Mengyi Liu1, Zhuxian Zhang1, Yuanyuan Zhang1, Chun Zhou1, Ziliang Ye1, Qimeng Wu1, Min Liang1, Jianping Jiang1, Guobao Wang1, Jing Nie1, Fan Fan Hou1, Chengzhang Liu2,3, Xianhui Qin1()
1. Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou 510515, China 2. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China 3. Institute of Biomedicine, Anhui Medical University, Hefei 230032, China
We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults. A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included. Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory. Participants with systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary zinc intake and new-onset hypertension followed a J-shape (P for non-linearity < 0.001). The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake (per mg/day: hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.88–0.98) in participants with zinc intake <10.9 mg/day, and increased with the increment of zinc intake (per mg/day: HR 1.14; 95% CI 1.11–1.16) in participants with zinc intake ≥ 10.9 mg/day. In conclusion, there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults, with an inflection point at about 10.9 mg/day.
. [J]. Frontiers of Medicine, 2023, 17(1): 156-164.
Panpan He, Huan Li, Mengyi Liu, Zhuxian Zhang, Yuanyuan Zhang, Chun Zhou, Ziliang Ye, Qimeng Wu, Min Liang, Jianping Jiang, Guobao Wang, Jing Nie, Fan Fan Hou, Chengzhang Liu, Xianhui Qin. J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China. Front. Med., 2023, 17(1): 156-164.
2017 Risk Factor Collaborators GBD. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1923–1994 https://doi.org/10.1016/S0140-6736(18)32225-6
pmid: 30496105
4
WHO. (2013) A global brief on hypertension. 2013. Available at WHO website
5
Y Li, L Yang, L Wang, M Zhang, Z Huang, Q Deng, M Zhou, Z Chen, L Wang. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol 2017; 227: 516–523 https://doi.org/10.1016/j.ijcard.2016.10.110
pmid: 27856040
6
J Lu, Y Lu, X Wang, X Li, GC Linderman, C Wu, X Cheng, L Mu, H Zhang, J Liu, M Su, H Zhao, ES Spatz, JA Spertus, FA Masoudi, HM Krumholz, L Jiang. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet 2017; 390(10112): 2549–2558 https://doi.org/10.1016/S0140-6736(17)32478-9
pmid: 29102084
7
N Mohammadifard, KH Humphries, C Gotay, G Mena-Sánchez, J Salas-Salvadó, A Esmaillzadeh, A Ignaszewski, N Sarrafzadegan. Trace minerals intake: risks and benefits for cardiovascular health. Crit Rev Food Sci Nutr 2019; 59(8): 1334–1346 https://doi.org/10.1080/10408398.2017.1406332
pmid: 29236516
8
M Bergomi, S Rovesti, M Vinceti, R Vivoli, E Caselgrandi, G Vivoli. Zinc and copper status and blood pressure. J Trace Elem Med Biol 1997; 11(3): 166–169 https://doi.org/10.1016/S0946-672X(97)80047-8
pmid: 9442464
9
Z Li, W Wang, H Liu, S Li, D Zhang. The association of serum zinc and copper with hypertension: a meta-analysis. J Trace Elem Med Biol 2019; 53: 41–48 https://doi.org/10.1016/j.jtemb.2019.01.018
pmid: 30910205
10
S Darroudi, M Saberi-Karimian, M Tayefi, B Tayefi, Z Khashyarmanesh, N Fereydouni, HM Haghighi, AA Mahmoudi, J Kharazmi-Khorassani, K Gonoodi, H Esmaeili, AH Mohammadpour, GA Ferns, M Ghayour-Mobarhan. Association between hypertension in healthy participants and zinc and copper status: a population-based study. Biol Trace Elem Res 2019; 190(1): 38–44 https://doi.org/10.1007/s12011-018-1518-4
pmid: 30267309
11
MM Bastola, C Locatis, R Maisiak, P Fontelo. Selenium, copper, zinc and hypertension: an analysis of the National Health and Nutrition Examination Survey (2011–2016). BMC Cardiovasc Disord 2020; 20(1): 45 https://doi.org/10.1186/s12872-020-01355-x
pmid: 32005161
12
W Wu, S Jiang, Q Zhao, K Zhang, X Wei, T Zhou, D Liu, H Zhou, Q Zeng, L Cheng, X Miao, Q Lu. Environmental exposure to metals and the risk of hypertension: a cross-sectional study in China. Environ Pollut 2018; 233: 670–678 https://doi.org/10.1016/j.envpol.2017.10.111
pmid: 29121602
13
B Yao, Y Wang, L Xu, X Lu, H Qu, H Zhou. Associations between copper and zinc and high blood pressure in children and adolescents aged 8–17 years: an exposure-response analysis of NHANES 2007–2016. Biol Trace Elem Res 2020; 198(2): 423–429 https://doi.org/10.1007/s12011-020-02095-x
pmid: 32219642
14
J Yao, P Hu, D Zhang. Associations between copper and zinc and risk of hypertension in US adults. Biol Trace Elem Res 2018; 186(2): 346–353 https://doi.org/10.1007/s12011-018-1320-3
pmid: 29594690
15
J Kim. Dietary zinc intake is inversely associated with systolic blood pressure in young obese women. Nutr Res Pract 2013; 7(5): 380–384 https://doi.org/10.4162/nrp.2013.7.5.380
pmid: 24133617
16
MH Kim, MK Choi. Seven dietary minerals (Ca, P, Mg, Fe, Zn, Cu, and Mn) and their relationship with blood pressure and blood lipids in healthy adults with self-selected diet. Biol Trace Elem Res 2013; 153(1–3): 69–75 https://doi.org/10.1007/s12011-013-9656-1
pmid: 23568713
17
Y Wang, XF Jia, B Zhang, ZH Wang, JG Zhang, FF Huang, C Su, YF Ouyang, J Zhao, WW Du, L Li, HR Jiang, J Zhang, HJ Wang. Dietary zinc intake and its association with metabolic syndrome indicators among Chinese adults: an analysis of the China nutritional transition cohort survey 2015. Nutrients 2018; 10(5): 572 https://doi.org/10.3390/nu10050572
pmid: 29738427
18
M Ho, LA Baur, CT Cowell, S Samman, SP Garnett. Zinc status, dietary zinc intake and metabolic risk in Australian children and adolescents; Nepean longitudinal study. Eur J Nutr 2017; 56(7): 2407–2414 https://doi.org/10.1007/s00394-016-1280-3
pmid: 27475431
19
SK Kunutsor, JA Laukkanen. Serum zinc concentrations and incident hypertension: new findings from a population-based cohort study. J Hypertens 2016; 34(6): 1055–1061 https://doi.org/10.1097/HJH.0000000000000923
pmid: 27032076
20
B Zhang, FY Zhai, SF Du, BM Popkin. The China health and nutrition survey, 1989–2011. Obes Rev 2014; 15(Suppl 1): 2–7 https://doi.org/10.1111/obr.12119
pmid: 24341753
21
M Liu, C Zhou, Z Zhang, Q Li, P He, Y Zhang, H Li, C Liu, X Qin. Inverse association between riboflavin intake and new-onset hypertension: a nationwide cohort study in China. Hypertension 2020; 76(6): 1709–1716 https://doi.org/10.1161/HYPERTENSIONAHA.120.16211
pmid: 33131313
22
C Zhou, C Liu, Z Zhang, M Liu, Y Zhang, H Li, P He, Q Li, X Qin. Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a nationwide cohort study in China. BMC Med 2022; 20(1): 6 https://doi.org/10.1186/s12916-021-02199-8
pmid: 35022027
23
Z Zhang, M Liu, C Zhou, P He, Y Zhang, H Li, Q Li, C Liu, X Qin. Evaluation of dietary niacin and new-onset hypertension among Chinese adults. JAMA Netw Open 2021; 4(1): e2031669 https://doi.org/10.1001/jamanetworkopen.2020.31669
pmid: 33404619
24
P He, H Li, M Liu, Z Zhang, Y Zhang, C Zhou, Q Li, C Liu, X Qin. U-shaped association between dietary zinc intake and new-onset diabetes: a nationwide cohort study in China. J Clin Endocrinol Metab 2022; 107(2): e815–e824 https://doi.org/10.1210/clinem/dgab636
pmid: 34448874
25
C Zhou, Z Zhang, M Liu, Y Zhang, H Li, P He, Q Li, C Liu, X Qin. Dietary carbohydrate intake and new-onset diabetes: a nationwide cohort study in China. Metabolism 2021; 123: 154865 https://doi.org/10.1016/j.metabol.2021.154865
pmid: 34391776
26
M Liu, C Liu, Z Zhang, C Zhou, Q Li, P He, Y Zhang, H Li, X Qin. Quantity and variety of food groups consumption and the risk of diabetes in adults: a prospective cohort study. Clin Nutr 2021; 40(12): 5710–5717 https://doi.org/10.1016/j.clnu.2021.10.003
pmid: 34743048
27
SB Seidelmann, B Claggett, S Cheng, M Henglin, A Shah, LM Steffen, AR Folsom, EB Rimm, WC Willett, SD Solomon. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018; 3(9): e419–e428 https://doi.org/10.1016/S2468-2667(18)30135-X
pmid: 30122560
28
Data Collection—China Health and Nutrition Survey (CHNS). 2022. Available from the website of Data Collection—China Health and Nutrition Survey (CHNS)
29
M Dehghan, A Mente, X Zhang, S Swaminathan, W Li, V Mohan, R Iqbal, R Kumar, E Wentzel-Viljoen, A Rosengren, LI Amma, A Avezum, J Chifamba, R Diaz, R Khatib, S Lear, P Lopez-Jaramillo, X Liu, R Gupta, N Mohammadifard, N Gao, A Oguz, AS Ramli, P Seron, Y Sun, A Szuba, L Tsolekile, A Wielgosz, R Yusuf, Yusufali A Hussein, KK Teo, S Rangarajan, G Dagenais, SI Bangdiwala, S Islam, SS Anand, S; Prospective Urban Rural Epidemiology (PURE) study investigators Yusuf. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390(10107): 2050–2062 https://doi.org/10.1016/S0140-6736(17)32252-3
pmid: 28864332
30
FB Hu, MJ Stampfer, E Rimm, A Ascherio, BA Rosner, D Spiegelman, WC Willett. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 1999; 149(6): 531–540 https://doi.org/10.1093/oxfordjournals.aje.a009849
pmid: 10084242
31
F Zhai, X Guo, BM Popkin, L Ma, Q Wang, WY Shuigao, JAK Ge. Evaluation of the 24-hour individual recall method in China. Food Nutr Bull 1996; 17(2): 1–7 https://doi.org/10.1177/156482659601700209
32
FY Zhai, SF Du, ZH Wang, JG Zhang, WW Du, BM Popkin. Dynamics of the Chinese diet and the role of urbanicity, 1991–2011. Obes Rev 2014; 15(Suppl 1): 16–26 https://doi.org/10.1111/obr.12124
pmid: 24341755
33
H Xue, M Yang, Y Liu, R Duan, G Cheng, X Zhang. Relative validity of a 2-day 24-hour dietary recall compared with a 2-day weighed dietary record among adults in South China. Nutr Diet 2017; 74(3): 298–307 https://doi.org/10.1111/1747-0080.12315
pmid: 28731610
Q Li, R Li, S Zhang, Y Zhang, P He, Z Zhang, M Liu, C Zhou, H Li, C Liu, X Qin. Occupational physical activity and new-onset hypertension: a nationwide cohort study in China. Hypertension 2021; 78(1): 220–229 https://doi.org/10.1161/HYPERTENSIONAHA.121.17281
pmid: 34058853
36
Y Zhang, M Liu, C Zhou, Z Zhang, P He, Q Li, C Liu, X Qin. Inverse association between dietary vitamin A intake and new-onset hypertension. Clin Nutr 2021; 40(5): 2868–2875 https://doi.org/10.1016/j.clnu.2021.04.004
pmid: 33940400
37
P He, H Li, C Liu, M Liu, Z Zhang, Y Zhang, C Zhou, Q Li, Z Ye, Q Wu, J Jiang, G Wang, M Liang, J Nie, FF Hou, X Qin. U-shaped association between dietary copper intake and new-onset hypertension. Clin Nutr 2022; 41(2): 536–542 https://doi.org/10.1016/j.clnu.2021.12.037
pmid: 35030528
JD Browning, PG Reeves, BL O’Dell. Zinc deficiency in rats reduces the vasodilation response to bradykinin and prostacyclin. J Nutr 1987; 117(3): 490–495 https://doi.org/10.1093/jn/117.3.490
pmid: 2883270
41
G Vezzoli, AA Elli, G Tripodi, G Bianchi, E Carafoli. Calcium ATPase in erythrocytes of spontaneously hypertensive rats of the Milan strain. J Hypertens 1985; 3(6): 645–648 https://doi.org/10.1097/00004872-198512000-00011
pmid: 2935571
CE O'NeilDR KeastVL FulgoniTA Nicklas. Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. Nutrients 2012; 19; 4(12): 2097–2120
44
G Ma, Y Li, Y Jin, F Zhai, FJ Kok, X Yang. Phytate intake and molar ratios of phytate to zinc, iron and calcium in the diets of people in China. Eur J Clin Nutr 2007; 61(3): 368–374 https://doi.org/10.1038/sj.ejcn.1602513
pmid: 16929240
45
W Gong, A Liu, Y Yao, Y Ma, C Ding, C Song, F Yuan, Y Zhang, G Feng, Z Chen, G Ding. Nutrient supplement use among the Chinese population: a cross-sectional study of the 2010–2012 China nutrition and health surveillance. Nutrients 2018; 10(11): 1733 https://doi.org/10.3390/nu10111733