J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China

Abstract

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.

Keywords

dietary zinc intake / new-onset hypertension / general population / CHNS

References

[1] Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol 2020; 16(4): 223–237

[2] Qin X, Huo Y. H-Type hypertension, stroke and diabetes in China: opportunities for primary prevention. J Diabetes 2016; 8(1): 38–40

[3] GBD 2017 Risk Factor Collaborators. 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

[4] WHO. (2013) A global brief on hypertension. 2013. Available at WHO website

[5] Li Y, Yang L, Wang L, Zhang M, Huang Z, Deng Q, Zhou M, Chen Z, Wang L. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol 2017; 227: 516–523

[6] Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, Cheng X, Mu L, Zhang H, Liu J, Su M, Zhao H, Spatz ES, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. 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

[7] Mohammadifard N, Humphries KH, Gotay C, Mena-Sánchez G, Salas-Salvadó J, Esmaillzadeh A, Ignaszewski A, Sarrafzadegan N. Trace minerals intake: risks and benefits for cardiovascular health. Crit Rev Food Sci Nutr 2019; 59(8): 1334–1346

[8] Bergomi M, Rovesti S, Vinceti M, Vivoli R, Caselgrandi E, Vivoli G. Zinc and copper status and blood pressure. J Trace Elem Med Biol 1997; 11(3): 166–169

[9] Li Z, Wang W, Liu H, Li S, Zhang D. The association of serum zinc and copper with hypertension: a meta-analysis. J Trace Elem Med Biol 2019; 53: 41–48

[10] Darroudi S, Saberi-Karimian M, Tayefi M, Tayefi B, Khashyarmanesh Z, Fereydouni N, Haghighi HM, Mahmoudi AA, Kharazmi-Khorassani J, Gonoodi K, Esmaeili H, Mohammadpour AH, Ferns GA, Ghayour-Mobarhan M. Association between hypertension in healthy participants and zinc and copper status: a population-based study. Biol Trace Elem Res 2019; 190(1): 38–44

[11] Bastola MM, Locatis C, Maisiak R, Fontelo P. Selenium, copper, zinc and hypertension: an analysis of the National Health and Nutrition Examination Survey (2011–2016). BMC Cardiovasc Disord 2020; 20(1): 45

[12] Wu W, Jiang S, Zhao Q, Zhang K, Wei X, Zhou T, Liu D, Zhou H, Zeng Q, Cheng L, Miao X, Lu Q. Environmental exposure to metals and the risk of hypertension: a cross-sectional study in China. Environ Pollut 2018; 233: 670–678

[13] Yao B, Wang Y, Xu L, Lu X, Qu H, Zhou H. 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

[14] Yao J, Hu P, Zhang D. Associations between copper and zinc and risk of hypertension in US adults. Biol Trace Elem Res 2018; 186(2): 346–353

[15] Kim J. Dietary zinc intake is inversely associated with systolic blood pressure in young obese women. Nutr Res Pract 2013; 7(5): 380–384

[16] Kim MH, Choi MK. 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

[17] Wang Y, Jia XF, Zhang B, Wang ZH, Zhang JG, Huang FF, Su C, Ouyang YF, Zhao J, Du WW, Li L, Jiang HR, Zhang J, Wang HJ. 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

[18] Ho M, Baur LA, Cowell CT, Samman S, Garnett SP. Zinc status, dietary zinc intake and metabolic risk in Australian children and adolescents; Nepean longitudinal study. Eur J Nutr 2017; 56(7): 2407–2414

[19] Kunutsor SK, Laukkanen JA. Serum zinc concentrations and incident hypertension: new findings from a population-based cohort study. J Hypertens 2016; 34(6): 1055–1061

[20] Zhang B, Zhai FY, Du SF, Popkin BM. The China health and nutrition survey, 1989–2011. Obes Rev 2014; 15(Suppl 1): 2–7

[21] Liu M, Zhou C, Zhang Z, Li Q, He P, Zhang Y, Li H, Liu C, Qin X. Inverse association between riboflavin intake and new-onset hypertension: a nationwide cohort study in China. Hypertension 2020; 76(6): 1709–1716

[22] Zhou C, Liu C, Zhang Z, Liu M, Zhang Y, Li H, He P, Li Q, Qin X. 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

[23] Zhang Z, Liu M, Zhou C, He P, Zhang Y, Li H, Li Q, Liu C, Qin X. Evaluation of dietary niacin and new-onset hypertension among Chinese adults. JAMA Netw Open 2021; 4(1): e2031669

[24] He P, Li H, Liu M, Zhang Z, Zhang Y, Zhou C, Li Q, Liu C, Qin X. 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

[25] Zhou C, Zhang Z, Liu M, Zhang Y, Li H, He P, Li Q, Liu C, Qin X. Dietary carbohydrate intake and new-onset diabetes: a nationwide cohort study in China. Metabolism 2021; 123: 154865

[26] Liu M, Liu C, Zhang Z, Zhou C, Li Q, He P, Zhang Y, Li H, Qin X. 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

[27] Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, Folsom AR, Rimm EB, Willett WC, Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018; 3(9): e419–e428

[28] Data Collection—China Health and Nutrition Survey (CHNS). 2022. Available from the website of Data Collection—China Health and Nutrition Survey (CHNS)

[29] Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, Iqbal R, Kumar R, Wentzel-Viljoen E, Rosengren A, Amma LI, Avezum A, Chifamba J, Diaz R, Khatib R, Lear S, Lopez-Jaramillo P, Liu X, Gupta R, Mohammadifard N, Gao N, Oguz A, Ramli AS, Seron P, Sun Y, Szuba A, Tsolekile L, Wielgosz A, Yusuf R, Hussein Yusufali A, Teo KK, Rangarajan S, Dagenais G, Bangdiwala SI, Islam S, Anand SS, Yusuf S; Prospective Urban Rural Epidemiology (PURE) study investigators. 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

[30] Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, Willett WC. 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

[31] Zhai F, Guo X, Popkin BM, Ma L, Wang Q, Shuigao WY, Ge JAK. Evaluation of the 24-hour individual recall method in China. Food Nutr Bull 1996; 17(2): 1–7

[32] Zhai FY, Du SF, Wang ZH, Zhang JG, Du WW, Popkin BM. Dynamics of the Chinese diet and the role of urbanicity, 1991–2011. Obes Rev 2014; 15(Suppl 1): 16–26

[33] Xue H, Yang M, Liu Y, Duan R, Cheng G, Zhang X. 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

[34] Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986; 124(1): 17–27

[35] Li Q, Li R, Zhang S, Zhang Y, He P, Zhang Z, Liu M, Zhou C, Li H, Liu C, Qin X. Occupational physical activity and new-onset hypertension: a nationwide cohort study in China. Hypertension 2021; 78(1): 220–229

[36] Zhang Y, Liu M, Zhou C, Zhang Z, He P, Li Q, Liu C, Qin X. Inverse association between dietary vitamin A intake and new-onset hypertension. Clin Nutr 2021; 40(5): 2868–2875

[37] He P, Li H, Liu C, Liu M, Zhang Z, Zhang Y, Zhou C, Li Q, Ye Z, Wu Q, Jiang J, Wang G, Liang M, Nie J, Hou FF, Qin X. U-shaped association between dietary copper intake and new-onset hypertension. Clin Nutr 2022; 41(2): 536–542

[38] Li H, Förstermann U. Nitric oxide in the pathogenesis of vascular disease. J Pathol 2000; 190(3): 244–254

[39] Moncada S. Nitric oxide in the vasculature: physiology and pathophysiology. Ann N Y Acad Sci 1997; 811(1 Atheroscleros): 60–69

[40] Browning JD, Reeves PG, O’Dell BL. Zinc deficiency in rats reduces the vasodilation response to bradykinin and prostacyclin. J Nutr 1987; 117(3): 490–495

[41] Vezzoli G, Elli AA, Tripodi G, Bianchi G, Carafoli E. Calcium ATPase in erythrocytes of spontaneously hypertensive rats of the Milan strain. J Hypertens 1985; 3(6): 645–648

[42] Berridge MJ. Regulation of ion channels by inositol trisphosphate and diacylglycerol. J Exp Biol 1986; 124(1): 323–335

[43] O'NeilCEKeast DRFulgoniVLNicklasTA. Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. Nutrients 2012; 19; 4(12): 2097–2120

[44] Ma G, Li Y, Jin Y, Zhai F, Kok FJ, Yang X. 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

[45] Gong W, Liu A, Yao Y, Ma Y, Ding C, Song C, Yuan F, Zhang Y, Feng G, Chen Z, Ding G. 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

Acknowledgements

This research uses data from the China Health and Nutrition Survey (CHNS). We thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center (P2C HD050924 and T32 HD007168), the University of North Carolina at Chapel Hill, the National Institutes of Health (NIH; R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077 and D43 TW007709) for financial support for the CHNS data collection and analysis files from 1989 to 2015 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011. The study was supported by the National Key Research and Development Program (Nos. 2022YFC2009600 and 2022YFC2009605), the National Natural Science Foundation of China (Nos. 81973133 and 81730019). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-022-0932-3 and is accessible for authorized users.

Compliance with ethics guidelines

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, and Xianhui Qin declare no conflict of interest. The Institutional Review Boards of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, and the Chinese Center for Disease Control and Prevention, approved the study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

RIGHTS & PERMISSIONS

2022 Higher Education Press