The relationship between dietary fiber intake and hypertension: an analysis based on the NHANES data from 2015—2016 in the United States
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摘要:目的
探讨不同人群膳食纤维摄入量与高血压的关系。
方法采用美国国家健康与营养调查数据库（National Health and Nutrition Examination Survey, NHANES）2015—2016年的数据，将24 h膳食回顾法收集的饮食数据与美国农业部食品和营养数据库相结合计算膳食纤维摄入量；通过问卷调查和移动中心检测的血压数值定义高血压。采用logistic回归模型分析年龄≥18岁人群的膳食纤维摄入量与高血压的关系，采用广义相加模型（generalized additive model, GAM）、平滑曲线拟合分析两者间的剂量-反应关系。
结果与低膳食纤维摄入者（膳食纤维摄入量＜11.75 g/d）相比，在总人群中，高膳食纤维摄入者（膳食纤维摄入量≥18.85 g/d）高血压的患病风险下降18%（OR＝0.82，95%CI 0.68～0.98)。男性人群中，高膳食纤维摄入者高血压的患病风险下降23%（OR＝0.77，95%CI 0.60～0.98)；女性人群中，当膳食纤维摄入量＞28.05 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94，95%CI 0.89～0.99)。年龄＞60岁人群中，高膳食纤维摄入者高血压的患病风险下降31%（OR＝0.69，95%CI 0.48～0.99)；年龄≤45岁人群中，膳食纤维摄入＞34.5 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94，95%CI 0.88～0.99)。
结论高膳食纤维摄入与高血压患病风险下降有关，合理增加膳食纤维摄入有助于降低高血压的发生。
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关键词:
- 膳食纤维 /
- 高血压 /
- logistic回归 /
- 剂量-反应关系
Abstract:ObjectiveTo explore the relationship between dietary fiber intake and hypertension in different populations.
MethodsDietary fiber intake was calculated using the data from 2015—2016 National Health and Nutrition Examination Survey (NHANES) database by combining dietary data collected by the 24-hour dietary recall method with the USDA Food and Nutritional Database. Hypertension was defined based on blood pressure values obtained through questionnaires and mobile center measurements. Logistic regression models were used to analyze the relationship between dietary fiber intake and hypertension in individuals aged ≥18 years. Generalized additive model (GAM) and smoothed curve fitting were used to analyze the dose-response relationship between them.
ResultsCompared with the low dietary fiber intake (＜17.75 g/d) group , in the total population, the prevalence risk of hypertension was 18% lower in the high dietary fiber intake (≥18.85 g/d) group (OR＝0.82, 95%CI 0.68-0.98). In the male population, the risk of hypertension in the high dietary fiber intake group decreased by 23% (OR＝0.77, 95%CI 0.60-0.98). In the female population, when dietary fiber intake was ＞28.05 g/d, the risk of hypertension decreased by 6% (OR＝0.94, 95%CI 0.89-0.99) for 1 g/d increase in dietary fiber intake. In the population aged ＞60 years, the risk of hypertension decreased by 31% in the high dietary fiber intake group (OR＝0.69, 95%CI 0.48-0.99). In the population aged ≤45 years, the risk of hypertension decreased by 6% (OR＝0.94, 95%CI 0.88-0.99) for 1 g/d increase when dietary fiber intake ＞34.5 g/d.
ConclusionsHigh dietary fiber intake is associated with a decreased risk of developing hypertension, and a reasonable increase in dietary fiber intake can help reduce the incidence of hypertension.
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Keywords:
- dietary fiber /
- hypertension /
- logistic regression /
- dose-response relationship
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高血压是多种疾病的主要可改变危险因素[1]，全球近1/3的人口患有高血压[2]。膳食纤维对心血管系统是有益的，缺乏膳食纤维不仅加速心血管事件的发生，也会引起胃肠道和其他代谢疾病[3-4]。膳食纤维和高血压的关系已有报道，但研究结果并不完全一致。研究[5-7]指出，增加膳食纤维摄入量可以减少高血压的发病风险或者降低血压；也有研究[8]发现，不同来源种类和数量的不溶性膳食纤维与高血压的关系并不确定；还有研究[9-11]报道膳食纤维的摄入量与高血压无显著关联。然而，这些研究存在一定局限性，例如多数针对总人群而缺乏分层分析，缺少对种族、其他生活方式、经济收入等混杂因素的调整，血压值基于自述或测量次数不足[9]，以及采用140/90 mmHg作为高血压的诊断标准。本研究采用2017年美国心脏病学会更新的高血压标准（130/80 mmHg）[12]，使用logistic回归和广义相加模型（generalized additive model, GAM），并进行年龄、性别的分层分析，全面分析膳食纤维摄入量与高血压的关系。
1. 资料与方法
1.1 研究对象
本研究对象来自2015—2016年美国国家健康与营养调查（National Health and Nutrition Examination Survey, NHANES）数据库。NHANES数据库收集美国全国代表性人群的人口学、社会经济学、饮食和健康相关数据，使用复杂的多阶段概率抽样评估成人和儿童的健康和营养状况。数据库每2年发布1次，所有参与对象都接受结构化的问卷调查，并在移动中心进行检查[13]。本研究为横断面调查，共9 971人参与了该项调查。排除标准：（1）年龄＜18岁；（2）妊娠女性；（3）问卷调查高血压病史及血压检测数据缺失；（4）体质量指数（body mass index, BMI）数据缺失；（5）膳食纤维摄入量数据缺失；（6）重要协变量（种族、教育水平、高脂血症、糖尿病、吸烟史、饮酒史、家庭经济收入、久坐时间）缺失。最终纳入4 567名调查对象，所有调查对象都提供了书面同意。
1.2 膳食纤维摄入量
膳食纤维摄入量由2名营养师通过2次24 h膳食回顾法获得。第1次访谈在移动中心收集，第2次在3～10 d后通过电话访谈进行。将2次收集的饮食数据与美国农业部食品和营养数据库中的数据相结合，计算得到调查对象膳食纤维的每日摄入量[14]。如果同时收集2天的数据，则计算2天数据的平均值。
1.3 高血压定义
高血压的定义采用以下3种方式：（1）在问卷访谈中，由专业人员询问调查对象：“您是否被医务人员告知过有高血压？”，回答“是”的个体被定义为高血压人群。（2）正在服用降压药的调查对象。（3）遵循 2017年美国心脏病学会更新的成年人高血压临床实践指南[12]，在移动中心检查血压收缩压（SBP）≥130 mmHg和（或）舒张压（SBP）≥80 mmHg。血压值为调查对象坐位安静休息5 min后，通过袖带充气法测量得出。获得3个连续的血压读数，如果血压测量中断或不完整，则进行第4次测量，取3次或4次的平均测量值作为最终血压数值。
1.4 协变量定义
协变量包括年龄、性别、种族、教育水平、BMI、吸烟饮酒状况、久坐时间、家庭收入及钠盐摄入情况。结合世界卫生组织标准[15]，成人体型根据BMI分为3组：（1）偏瘦或正常，BMI≤24.9 kg/m2；（2）超重，BMI 大于24.9 kg/m2且≤29.9 kg/m2；（3）肥胖，BMI＞29.9 kg/m2。调查对象一生中吸烟超过100支，则被视为吸烟者。在调查前1年饮用超过12种酒精饮料，则被视为饮酒者。根据问卷调查：“你通常一天坐多少时间？”评估久坐时间。根据问卷“你昨天餐桌上加盐（包括盐替代品）了吗？”评估钠盐摄入情况。
1.5 统计学处理
采用R语言软件（4.2.0版本）进行统计学分析。符合正态分布的计量资料以$ \bar{{x}}\pm{s} $表示，采用独立样本t检验进行比较，偏态分布的计量资料用中位数（范围）表示，采用秩和检验进行比较。计数资料以n（%）表示，无序分类变量采用χ2检验进行比较，等级变量采用秩和检验进行比较。采用二分类logistic回归模型评估膳食纤维摄入量与高血压的关系。采用GAM和平滑曲线拟合以进一步分析膳食纤维摄入量与高血压的剂量-反应关系。在阈值饱和效应分析中，对数似然比＜0.05提示非线性关联。非线性关系的拐点采用分段线性回归模型进行计算。统计学检验采用双侧检验，检验水准（α）为0.05。
2. 结 果
2.1 调查对象一般资料
共纳入美国4 567名调查对象，平均年龄（47.64±17.46）岁，49.55%为男性，53.25%患高血压，54.04%为高中以上学历。高血压组和非高血压组基本特征比较结果（表1）显示：与非高血压组相比，高血压组的年龄、三酰甘油、总胆固醇、低密度脂蛋白、空腹血糖水平更高，糖尿病患病率、肥胖和吸烟比例更高（P＜0.05）；高血压组的膳食纤维摄入量、高密度脂蛋白水平更低（P＜0.05）。此外，两组的性别、种族、教育水平、家庭收入差异也有统计学意义（P＜0.05）。
表 1 调查对象的基本特征Table 1. Basic characteristics of the subjects of studyCharacteristic Non-hypertension group（n＝2 135） Hypertension group（n＝2 432） χ2/t/u P Age/years 38.85±16.24 56.71±16.04 37.318 ＜0.001 TG/(mg•dL−1) 80.00(15.00-770.00) 100.00(18.00-1 761.00) −8.060 ＜0.001 TC/(mg•dL−1) 184.34±38.90 192.61±43.10 6.656 0.001 HDL-C/(mg•dL−1) 54.59±16.51 53.18±18.06 −2.699 0.007 LDL-C/(mg•dL−1) 109.36±33.27 113.36±37.49 2.478 0.013 FBG/(mg•dL−1) 101.34±23.41 120.27±48.65 11.493 ＜0.001 Dietary fiber intake/(g•d−1) 15.25(0.30-86.80) 14.70(0.40-89.55) −2.236 0.025 Sedentary time/(min•d−1) 360.00(1.00-1 200.00) 360.00(0-1 380.00) −0.024 0.981 Sex n(%) 11.802 0.001 Male 1 000(46.84) 1 263(51.93) Female 1 135(53.16) 1 169(48.07) Race n(%) 34.089 ＜0.001 Mexican American 411(19.25) 399(16.41) Other Hispanic 275(12.88) 303(12.46) Non-Hispanic White 743(34.80) 859(35.32) Non-Hispanic Black 378(17.71) 577(23.72) Other Race 328(15.36) 294(12.09) Education n(%) −4.207 ＜0.001 Below high school 419(19.63) 616(25.33) High school 505(23.65) 559(22.99) Above high school 1 211(56.72) 1 257(51.68) Household income n(%) −7.131 ＜0.001 ＜20 000 dollars 418(19.57) 674(27.72) 20 000-44 999 dollars 656(30.73) 760(31.25) 45 000-64 999 dollars 336(15.74) 350(14.39) ≥65 000 dollars 725(33.96) 648(26.64) Diabetes n(%) 124(5.81) 528(21.71) 234.935 ＜0.001 Smoking history n(%) 752(35.22) 1 169(48.07) 76.973 ＜0.001 Drinking history n(%) 1 448(67.82) 1 649(67.80) ＜0.001 0.990 BMI n(%) −14.800 ＜0.001 ≤24.9 kg/m2 795(37.24) 467(19.20) ＞24.9-29.9 kg/m2 676(31.66) 769(31.62) ＞29.9 kg/m2 664(31.10) 1196 (49.18)TG: triglyceride; TC: total cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FBG: fasting blood glucose; BMI: body mass index. 2.2 膳食纤维摄入量与高血压的logistic回归分析
2.2.1 总体人群
根据三分位数将膳食纤维摄入量分为高、中和低3个等级。结果（表2）显示：与低膳食纤维摄入相比，在调整了年龄、性别、种族、教育水平后，高膳食纤维摄入者高血压的患病风险下降24%（OR＝0.76, 95%CI 0.64～0.90）；进一步调整高脂血症史、糖尿病史、吸烟史、饮酒史、BMI、久坐时间、家庭收入、钠盐摄入情况后，高膳食纤维摄入者高血压的患病风险下降18%（OR＝0.82, 95%CI 0.68～0.98）。
表 2 总体人群膳食纤维摄入量与高血压的logistic回归分析Table 2. The logistic regression analysis of dietary fiber intake and hypertension in the total populationDietary fiber intakea Crude Model 1 Model 2 OR(95%CI) P OR(95%CI) P OR(95%CI) P ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.90(0.78-1.04) 0.149 0.88(0.74-1.04) 0.128 0.93(0.78-1.11) 0.404 ≥18.85 g/d 0.85(0.74-0.98) 0.025 0.76(0.64-0.90) 0.002 0.82(0.68-0.98) 0.031 aDietary fiber intake is categorized into tertiles. Model 1 adjusted for age, sex, race, education; Model 2 adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. OR: odds ratio; CI: confidence interval. 2.2.2 按性别、年龄分层
结果（表3）显示：与低膳食纤维摄入相比，在男性人群中，调整了年龄、种族、教育水平、高脂血症史、糖尿病史、吸烟史、饮酒史、BMI、久坐时间、家庭收入以及钠盐摄入情况（模型2）后，高膳食纤维摄入者高血压的患病风险下降23%（OR＝0.77, 95%CI 0.60～0.98）；女性人群中，高膳食纤维摄入对高血压的保护作用无统计学意义。
表 3 按性别、年龄分层的膳食纤维摄入量与高血压的logistic回归分析Table 3. The logistic regression analysis of dietary fiber intake and hypertension stratified by sex and ageDietary fiber intakea Crude Model 1 Model 2 OR(95%CI) P OR(95%CI) P OR(95%CI) P Male ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.83(0.67-1.03) 0.086 0.89(0.70-1.13) 0.347 0.88(0.68-1.13) 0.312 ≥18.85 g/d 0.77(0.63-0.94) 0.011 0.75(0.59-0.95) 0.017 0.77(0.60-0.98) 0.035 Female ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.95(0.79-1.15) 0.607 0.83(0.66-1.06) 0.132 0.95(0.74-1.22) 0.696 ≥18.85 g/d 0.87(0.70-1.06) 0.171 0.75(0.58-0.97) 0.029 0.86(0.65-1.13) 0.285 Age≤45 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.85(0.67-1.07) 0.156 0.85(0.67-1.07) 0.172 0.91(0.70-1.18) 0.470 ≥18.85 g/d 0.92(0.73-1.16) 0.477 0.92(0.72-1.17) 0.480 1.02(0.78-1.33) 0.875 Age 46-60 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.87(0.64-1.18) 0.369 0.92(0.67-1.26) 0.586 0.95(0.68-1.33) 0.775 ≥18.85 g/d 0.66(0.49-0.89) 0.007 0.71(0.52-0.98) 0.037 0.78(0.55-1.09) 0.149 Age＞60 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.83(0.59-1.18) 0.297 0.86(0.61-1.23) 0.420 0.94(0.65-1.36) 0.725 ≥18.85 g/d 0.61(0.44-0.85) 0.004 0.65(0.46-0.92) 0.015 0.69(0.48-0.99) 0.046 aDietary fiber intake is categorized into tertiles. Model 1 adjusted for age, sex, race, education; Model 2 adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable. OR: odds ratio; CI: confidence interval. 年龄分层中，在年龄≤45岁、46～60岁人群中，与低膳食纤维摄入相比，高膳食纤维摄入对高血压的影响无统计学意义。在年龄＞60岁人群中，与低膳食纤维摄入相比，在完全调整的模型2中，高膳食纤维摄入者高血压的患病风险下降31%（OR＝0.69, 95%CI 0.48～0.99）。
2.3 膳食纤维摄入量与高血压的剂量-反应关系
为进一步验证膳食纤维摄入量与高血压的关系，采用GAM，将膳食纤维摄入量作为连续变量，采取平滑曲线拟合来分析其与高血压的关系，结果（图1）显示：总人群中膳食纤维摄入量与高血压的患病率线性相关（P＝0.005；图1A）；男性人群中，膳食纤维摄入量与高血压的患病率线性相关（P＝0.027；图1B）；年龄＞60岁人群中，膳食纤维摄入量与高血压的患病率线性相关（P＝0.014；图1C）。
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图 1 膳食纤维摄入量与高血压之间的剂量-反应关系Figure 1. Dose-response relationship between dietary fiber intake and hypertensionA: In total population. The solid line and dashed line represent the estimated ORs and the corresponding 95% confidence intervals, respectively. B: In different sex group. C: In different age group. Adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable.2.4 基于性别、年龄分层的非线性关系分析
进一步采用阈值饱和效应分析，使用分段线性回归模型，计算女性人群和年龄≤45岁人群膳食纤维摄入量拐点，结果（表4）显示：在女性人群中，膳食纤维摄入量＞28.05 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94, 95%CI 0.89～0.99）。在年龄≤45岁人群中，膳食纤维摄入量＞34.5 g/d时，膳食纤维摄入量每增加1 g/d，高血压的患病风险下降6%（OR＝0.94, 95%CI 0.88～0.99）。
表 4 女性及年龄≤45岁人群的阈值饱和效应分析Table 4. Analysis of threshold saturation effects in women and individuals aged ≤ 45 years oldSegmented linear regression Adjusted OR (95%CI) P Female Inflection point of dietary fiber intake 28.05 ≤28.05 g/d 1.00(0.98-1.02) 0.916 ＞28.05 g/d 0.94(0.89-0.99) 0.015 Log-likelihood ratio test 0.027 Age≤45 years Inflection point of dietary fiber intake 34.5 ≤34.5 g/d 1.01(0.99-1.02) 0.318 ＞34.5 g/d 0.94(0.88-0.99) 0.021 Log-likelihood ratio test 0.007 The log-likelihood ratio ＜ 0.05 represents nonlinear relationship. Model adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable. 3. 讨 论
本研究采用logistic回归模型和GAM阐述了膳食纤维摄入量与高血压的关系，并在性别和不同年龄段中进行分层分析。结果显示，在总人群中，高膳食纤维摄入与高血压患病风险下降有关；而在性别和年龄分层后，高膳食纤维摄入对高血压的保护作用仅在男性人群和年龄＞60岁的人群中显现出来。在女性人群中，当膳食纤维摄入＞28.05 g/d时，膳食纤维摄入量增加与高血压患病率降低有关。在年龄≤45岁人群中，当膳食纤维摄入＞34.5 g/d时，膳食纤维摄入量增加与高血压患病率降低有关。
膳食纤维降低高血压患病风险有以下几种可能的机制。首先，膳食纤维摄入可以改善血糖和胰岛素抵抗[16-17]。胰岛素抵抗与高血压的进展有关[18]，据报道，可溶性纤维可能通过调节胰岛素代谢来影响血压[19-20]。其次，富含纤维的食物通常能量、胆固醇含量较低，血浆胆固醇水平的降低也与内皮介导的血管舒张和血压降低有关[21]。再次，增加膳食纤维摄入可以调节饱腹感，改善胰腺功能[22-23]。膳食纤维导致的体质量减轻也被认为是降低高血压水平的潜在机制[23-24]。最后，肠道微生物菌群与高血压之间存在相关性，高血压是一种轻度炎症性疾病，膳食纤维改善肠道菌群减少炎症而被认为有降低血压的作用[25-26]。
本研究观察到膳食纤维与高血压的关系在不同性别、年龄中是有差异的，关于该差异的研究及解释非常有限。多项研究[27-28]证实雌激素具有心脏保护和血管舒张作用。不同膳食纤维对于女性体内雌激素水平的作用不同[29-30]，膳食纤维与高血压关系的性别差异可能与雌激素的介导有关。Streppel等[31]基于24项针对膳食纤维影响血压研究的meta分析表明，老年人和高血压人群的血压降低程度常大于年轻人和血压正常人群，差异的机制尚不清楚。本研究发现在46～60岁人群中，膳食纤维对于血压的保护作用不再显著，可能与不同年龄人群的饮食、生活方式、压力、合并疾病等多种因素有关，亦或与膳食纤维摄入水平、人口统计学特征和研究方法的差异有关。
本研究存在许多优势：（1）分析了从NHANES数据库中获得的大量样本，具有代表性，涉及多个种族，结果外推性较高。（2）采用logistic回归模型分析膳食纤维摄入量分组与高血压的关系，并进一步采用GAM来探索两者间的剂量-反应关系。GAM在处理非线性关系方面具有明显的优势，可以处理非参数平滑，对数据拟合回归样条，可以更好地发现暴露和结果之间的真实关系[32]。（3）在女性和年龄≤45岁人群中发现了有意义的拐点，对特定人群中膳食纤维的摄入量有了具体的参考值。然而，本研究也存在一定局限性：（1）为横断面研究，膳食纤维摄入量与高血压之间的因果关系尚不确定。（2）膳食纤维摄入量采用的是膳食回顾法，参与者通过自我回忆获得饮食数据，存在回忆偏倚。（3）部分协变量是从问卷调查中自我报告的，不是客观测量的。
综上所述，高膳食纤维摄入与高血压患病风险下降有关。膳食纤维摄入量与高血压的关系在男性和年龄＞60岁人群线性负相关。在女性和年龄≤45岁人群中非线性相关。
致谢 本研究使用了美国国家健康与营养调查（NHANES）的数据。非常感谢美国疾病控制和预防中心（CDC）、美国国家卫生统计中心（NCHS）以及其他合作方在数据收集和分析方面提供的支持。
伦理声明 无。
利益冲突 所有作者声明不存在利益冲突。
作者贡献 李林娟：选题，文献回顾，图表制作，文章撰写，文章修订；李佼彦：设计文章框架，文章审阅；罗小琴：设计文章框架，文章审阅，文章修订。
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图 1 膳食纤维摄入量与高血压之间的剂量-反应关系
Figure 1. Dose-response relationship between dietary fiber intake and hypertension
A: In total population. The solid line and dashed line represent the estimated ORs and the corresponding 95% confidence intervals, respectively. B: In different sex group. C: In different age group. Adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable.
表 1 调查对象的基本特征
Table 1 Basic characteristics of the subjects of study
Characteristic Non-hypertension group（n＝2 135） Hypertension group（n＝2 432） χ2/t/u P Age/years 38.85±16.24 56.71±16.04 37.318 ＜0.001 TG/(mg•dL−1) 80.00(15.00-770.00) 100.00(18.00-1 761.00) −8.060 ＜0.001 TC/(mg•dL−1) 184.34±38.90 192.61±43.10 6.656 0.001 HDL-C/(mg•dL−1) 54.59±16.51 53.18±18.06 −2.699 0.007 LDL-C/(mg•dL−1) 109.36±33.27 113.36±37.49 2.478 0.013 FBG/(mg•dL−1) 101.34±23.41 120.27±48.65 11.493 ＜0.001 Dietary fiber intake/(g•d−1) 15.25(0.30-86.80) 14.70(0.40-89.55) −2.236 0.025 Sedentary time/(min•d−1) 360.00(1.00-1 200.00) 360.00(0-1 380.00) −0.024 0.981 Sex n(%) 11.802 0.001 Male 1 000(46.84) 1 263(51.93) Female 1 135(53.16) 1 169(48.07) Race n(%) 34.089 ＜0.001 Mexican American 411(19.25) 399(16.41) Other Hispanic 275(12.88) 303(12.46) Non-Hispanic White 743(34.80) 859(35.32) Non-Hispanic Black 378(17.71) 577(23.72) Other Race 328(15.36) 294(12.09) Education n(%) −4.207 ＜0.001 Below high school 419(19.63) 616(25.33) High school 505(23.65) 559(22.99) Above high school 1 211(56.72) 1 257(51.68) Household income n(%) −7.131 ＜0.001 ＜20 000 dollars 418(19.57) 674(27.72) 20 000-44 999 dollars 656(30.73) 760(31.25) 45 000-64 999 dollars 336(15.74) 350(14.39) ≥65 000 dollars 725(33.96) 648(26.64) Diabetes n(%) 124(5.81) 528(21.71) 234.935 ＜0.001 Smoking history n(%) 752(35.22) 1 169(48.07) 76.973 ＜0.001 Drinking history n(%) 1 448(67.82) 1 649(67.80) ＜0.001 0.990 BMI n(%) −14.800 ＜0.001 ≤24.9 kg/m2 795(37.24) 467(19.20) ＞24.9-29.9 kg/m2 676(31.66) 769(31.62) ＞29.9 kg/m2 664(31.10) 1196 (49.18)TG: triglyceride; TC: total cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FBG: fasting blood glucose; BMI: body mass index. 
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表 2 总体人群膳食纤维摄入量与高血压的logistic回归分析
Table 2 The logistic regression analysis of dietary fiber intake and hypertension in the total population
Dietary fiber intakea Crude Model 1 Model 2 OR(95%CI) P OR(95%CI) P OR(95%CI) P ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.90(0.78-1.04) 0.149 0.88(0.74-1.04) 0.128 0.93(0.78-1.11) 0.404 ≥18.85 g/d 0.85(0.74-0.98) 0.025 0.76(0.64-0.90) 0.002 0.82(0.68-0.98) 0.031 aDietary fiber intake is categorized into tertiles. Model 1 adjusted for age, sex, race, education; Model 2 adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. OR: odds ratio; CI: confidence interval.
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表 3 按性别、年龄分层的膳食纤维摄入量与高血压的logistic回归分析
Table 3 The logistic regression analysis of dietary fiber intake and hypertension stratified by sex and age
Dietary fiber intakea Crude Model 1 Model 2 OR(95%CI) P OR(95%CI) P OR(95%CI) P Male ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.83(0.67-1.03) 0.086 0.89(0.70-1.13) 0.347 0.88(0.68-1.13) 0.312 ≥18.85 g/d 0.77(0.63-0.94) 0.011 0.75(0.59-0.95) 0.017 0.77(0.60-0.98) 0.035 Female ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.95(0.79-1.15) 0.607 0.83(0.66-1.06) 0.132 0.95(0.74-1.22) 0.696 ≥18.85 g/d 0.87(0.70-1.06) 0.171 0.75(0.58-0.97) 0.029 0.86(0.65-1.13) 0.285 Age≤45 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.85(0.67-1.07) 0.156 0.85(0.67-1.07) 0.172 0.91(0.70-1.18) 0.470 ≥18.85 g/d 0.92(0.73-1.16) 0.477 0.92(0.72-1.17) 0.480 1.02(0.78-1.33) 0.875 Age 46-60 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.87(0.64-1.18) 0.369 0.92(0.67-1.26) 0.586 0.95(0.68-1.33) 0.775 ≥18.85 g/d 0.66(0.49-0.89) 0.007 0.71(0.52-0.98) 0.037 0.78(0.55-1.09) 0.149 Age＞60 years ＜11.75 g/d 1.00(Ref.) 1.00(Ref.) 1.00(Ref.) 11.75-18.84 g/d 0.83(0.59-1.18) 0.297 0.86(0.61-1.23) 0.420 0.94(0.65-1.36) 0.725 ≥18.85 g/d 0.61(0.44-0.85) 0.004 0.65(0.46-0.92) 0.015 0.69(0.48-0.99) 0.046 aDietary fiber intake is categorized into tertiles. Model 1 adjusted for age, sex, race, education; Model 2 adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable. OR: odds ratio; CI: confidence interval.
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表 4 女性及年龄≤45岁人群的阈值饱和效应分析
Table 4 Analysis of threshold saturation effects in women and individuals aged ≤ 45 years old
Segmented linear regression Adjusted OR (95%CI) P Female Inflection point of dietary fiber intake 28.05 ≤28.05 g/d 1.00(0.98-1.02) 0.916 ＞28.05 g/d 0.94(0.89-0.99) 0.015 Log-likelihood ratio test 0.027 Age≤45 years Inflection point of dietary fiber intake 34.5 ≤34.5 g/d 1.01(0.99-1.02) 0.318 ＞34.5 g/d 0.94(0.88-0.99) 0.021 Log-likelihood ratio test 0.007 The log-likelihood ratio ＜ 0.05 represents nonlinear relationship. Model adjusted for age, sex, race, education, hyperlipidemia, diabetes, smoking history, drinking history, body mass index, sedentary time, household income, sodium intake. In each stratification analysis, the model did not repeat to adjust for that stratification variable.
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