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Variety and quantity of dietary insoluble fiber intake from different sources and risk of new-onset hypertension

BMC Medicine volume 21, Article number: 61 (2023) Cite this article

Abstract

Background

The relations of the variety and quantity of different sources of dietary insoluble fibers and hypertension remain uncertain. We aimed to investigate the associations between the variety and quantity of insoluble fibers intake from six major food sources and new-onset hypertension, using data from the China Health and Nutrition Survey (CHNS).

Methods

Twelve thousand one hundred thirty-one participants without hypertension at baseline from CHNS were included. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of insoluble fiber sources was defined as the number of insoluble fiber sources consumed at the appropriate level, accounting for both types and quantities of insoluble fibers. The study outcome was new-onset hypertension, defined as blood pressure ≥ 140/90 mmHg, or physician-diagnosed hypertension or receiving antihypertensive treatments during the follow-up.

Results

During a median follow-up of 6.1 years, 4252 participants developed hypertension. There were L-shaped associations of dietary insoluble fibers derived from vegetables, beans, tubers, and fruits with new-onset hypertension; a reversed J-shaped association of whole grain-derived insoluble fiber with new-onset hypertension; and no obvious association of refined grain-derived insoluble fiber with new-onset hypertension. Therefore, refined grain was not included in the insoluble fiber variety score calculation. More importantly, a higher insoluble fiber variety score was significantly associated with lower risks of new-onset hypertension (per score increment, hazard ratio, 0.50; 95% CI, 0.45–0.55).

Conclusions

There was an inverse association between the variety of insoluble fibers with appropriate quantity from different food sources and new-onset hypertension.

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Background

Hypertension is a major cause of the cardiovascular disease (CVD) and all-cause mortality worldwide [1]. The prevalence of hypertension is still rising rapidly in low and middle-income countries [2]. An estimated 626 million women and 652 million men aged 30–79 years were living with hypertension globally in 2019 [3]. Therefore, it is of great clinical significance to identify more modifiable factors for the primary prevention of hypertension.

Recently, there has been growing interest in studies of nutrients and the risk of hypertension [4, 5]. Dietary fiber, composed of indigestible and non-absorbable carbohydrate polymers, is found primarily in plant material in the diet. Previous studies have reported that the amount and composition of dietary fibers differ from food to food [6]. Consistently, studies have shown that the beneficial effect of dietary fibers on CVD varied significantly with its water solubility and food sources [7, 8]. However, although a previous meta-analysis of randomized control trials (RCTs) found that higher consumption of beta-glucan fiber (soluble fiber) was associated with lower blood pressure (BP) levels [9], none of the previous studies have examined the relation of total dietary insoluble fiber, or insoluble fibers from specific food sources, with the risk of new-onset hypertension. Furthermore, a previous cross-sectional study showed that dietary fiber from different food sources had different associations with the prevalence of hypertension [10]. Nevertheless, to date, the relation of the variety of insoluble fiber sources with new-onset hypertension has not yet been examined.

To address these essential knowledge gaps, the current study aimed to evaluate the prospective associations between the variety and quantity of insoluble fibers intake from six major food sources (whole and refined grains, vegetables, beans, tubers, and fruits) and new-onset hypertension in general Chinese adults., using data from the China Health and Nutrition Survey (CHNS), a national health and nutrition survey in China.

Methods

Study design and participants

The study design and major results of the CHNS have been reported elsewhere [11,12,13,14,15]. In brief, CHNS is an ongoing nationwide multipurpose longitudinal open cohort study established in 1989 and has been followed up every 2 to 4 years with a sum of 10 rounds already completed (1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, and 2015). The study participants were sampled from 9 provinces (Heilongjiang [enrolled in 1997], Liaoning, Shandong, Henan, Jiangsu, Hubei, Hunan, Guizhou, and Guangxi) and 3 of China’s largest autonomous cities (Beijing, Shanghai, and Chongqing [all enrolled in 2011]) with a multistage, random cluster approach. In the 2009 round of CHNS, blood samples were collected. All samples were analyzed with strict quality control at a national central lab in Beijing (medical laboratory accreditation certificate ISO 15189:2007). By 2011, the survey included 12 provinces/autonomous cities and 288 communities, which covered 47% of China’s population [11].

A prospective open cohort study design was employed in our current study based on 7 rounds of CHNS data from 1997 to 2015. As shown in Additional file 1: Figure S1, we first excluded participants who were pregnant (360 person-waves) or < 18 years old (17,672 person-waves). Among the remaining 76,500 person-waves, the participants with BP data measurements (69,852 person-waves) did not differ in most of the baseline characteristics from those with missing BP data (6648 person-waves; Additional file 1: Table S1). The remaining participants who were surveyed at least two rounds were included, and the first round is termed as the baseline. In addition, participants who had hypertension (defined as having systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg, previously diagnosed by physicians, or currently receiving antihypertensive therapy) and self-reported physician-diagnosed cardiovascular diseases at baseline, missing cumulative average dietary insoluble fiber data, or implausible cumulative average dietary energy data (male: > 4200 or < 600 kcal/day; female, > 3600 or < 500 kcal/day) [16] were also excluded. Finally, a total of 12,131 participants were included in the final analyses (Additional file 1: Figure S1).

Data and study materials that support the findings of this study can be found on the CHNS official website (http://www.cpc.unc.edu/projects/china). The study was approved by the institutional review boards of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety and Chinese Center for Disease Control and Prevention. Each participant provided written informed consent.

Dietary nutrient intakes

In each survey round of CHNS, trained nutritionists collected dietary data through face-to-face interviews. Individual diet assessment was repeatedly assessed with 3 consecutive 24-h dietary recalls at an individual level in combination with weighing inventory over the same 3 days at the household level. The 3 consecutive days were randomly allocated from Monday to Sunday and were almost equally balanced across the 7 days of the week for each sampling unit. The China food composition tables (FCTs) were used to calculate nutrient intakes of each participant. It has been validated that 24-h dietary recall could accurately assess energy and nutrient intake [17,18,19]. The amount of dietary insoluble fiber for each food, which was measured with the neutral detergent method, was available from the Chinese FCTs.

We calculated 3-day average intakes of dietary macro- and micro-nutrients in each round in the analyses. To represent long-term dietary intake and minimize within-person variation, all values of each nutrient in the analyses, if not specified, were presented as the cumulative averages, using all results from baseline to the last visit before the date of new-onset hypertension, or using all results during the follow-up among participants without new-onset hypertension. Moreover, in our current study, total insoluble fiber was divided into specific sourced fibers. Food sources constituting these subtypes are presented in Additional file 1: Table S2. The variety score of insoluble fiber sources was the sum of the total numbers of the major food sources of insoluble fibers consumed at the appropriate quantity during the study period [20, 21]. The appropriate quantity for each major food source of insoluble fiber was determined by assessing insoluble fiber intakes from different food sources as categorical variables (quartiles or tertiles) and choosing the corresponding insoluble fiber categories with the relatively lowest risk of new-onset hypertension.

Assessment of blood pressure and covariates

Seated BP was measured by trained research staff using a mercury manometer and an appropriate-sized cuff, following a standard method at each study survey after the participants had rested for 5 min. The BP of the same arm was measured three times in a quiet and bright room. The mean SBP and DBP of all measurements were used in the analysis.

Demographic and lifestyle information was available through questionnaires, including age, sex, smoking status, occupations, education levels, and living regions. Calibrated equipment was used to measure body height and weight following a standard operation procedure. Body mass index (BMI) was calculated as weight (kg) divided by height squared (m2).

Assessment of outcomes

The study outcome was new-onset hypertension, defined as an SBP ≥ 140 mmHg or a DBP ≥ 90 mmHg, or physician-diagnosed hypertension, or receiving antihypertensive treatments during the follow-up [22, 23].

The year of each participant's first entry into the survey was considered as the baseline. The follow-up person-time for each participant was calculated from the baseline date until the first hypertension diagnosis (the middle date between the survey of the first diagnosis and the nearest survey before), the last survey round before the participant’s departure from the survey, or the end of the latest survey (2015), whichever came first.

Statistical analysis

Population characteristics were presented as mean (standardized deviation [SD]) or proportions for continuous and categorical variables, respectively. Differences in population characteristics by the quartile of dietary total insoluble fiber intake were compared using ANONA tests or \({\chi }^{2}\) tests, accordingly.

Age-stratified Cox proportional-hazards models were used to estimate the association of variety score of insoluble fiber sources, intake of total insoluble fiber, and insoluble fibers from different food sources (refined and whole grains, vegetables, beans, tubers, and fruits) with new-onset hypertension, without and with adjustments for sex, BMI, SBP, DBP, smoking, alcohol drinking, urban or rural residents, regions, education levels, occupations, physical activity levels, self-reported physician-diagnosed diabetes, dietary intakes of sodium, potassium, protein, fat, and carbohydrate. Moreover, mutual adjustments for intakes of other sources of insoluble fiber were further included for the association between insoluble fibers from different food sources and new-onset hypertension. The Schoenfeld residual test was used to test the proportional hazards assumption, and no clear evidence of violation was detected. We also used restricted cubic splines with 3 knots (25%, 50%, 75% of intake of insoluble fibers) to investigate the potential nonlinear relationship of total dietary insoluble fiber and insoluble fibers from different food sources with new-onset hypertension with the adjustments for the covariates mentioned before.

A series of sensitivity analyses were conducted. First, dietary intakes of vitamin A, vitamin B2, niacin, copper, and zinc were further adjusted. Second, dietary intakes of refined and whole grains, vegetables, beans, tubers, and fruits were further adjusted. Third, BMI trajectory classes, which were estimated by the R package lcmm, were further adjusted. Fourth, total insoluble fiber intake was estimated by multiple source methods (MSM) [24]. Fifth, those with physician-diagnosed hypertension or receiving antihypertensive treatments were further excluded to account for the effect of possible dietary changes due to diagnosis on the results. Moreover, possible modifications of the association between variety score of insoluble fiber source and new-onset hypertension were evaluated by stratified analyses and interaction testing.

A 2-side P value < 0.05 was considered statistically significant. All statistical analyses were conducted using R software (version 4.0.2, https://www.R-project.org/).

Results

Study participants and baseline characteristics

Of the included 12,131 participants (Additional file 1: Figure S1), the mean (SD) of dietary total insoluble fiber intake was 10.8 (6.4) g/day. Refined grains followed by vegetables, beans, whole grains, tuber, and fruit are the major sources of insoluble fiber, constituting more than 90% of dietary insoluble fiber intake (Additional file 1: Table S2). The mean (SD) age was 41.1 (14.1) years, and 6459 (53.2%) of the participants were female.

The baseline characteristics of study participants were presented according to dietary insoluble fiber intake quartiles in Table 1. Participants with higher dietary insoluble fiber intake were more likely to be male, physically active, smokers, alcohol drinkers, and less likely to be urban residents, unemployed; had lower education levels, higher intakes of protein, fat, carbohydrate, sodium, and potassium; and had lower intake ratio of sodium-to-potassium.

Table 1 Participants characteristics by quartiles of total dietary insoluble fiber intake
Full size table

Relations of dietary total insoluble fiber and insoluble fibers from different foods with new-onset hypertension

During a median follow-up duration of 6.1 years (25th–75th: 3.7–11.4 years, 94,918 person-years in total), a total of 4252 (35.1%) participants developed new-onset hypertension.

Overall, there was an L-shaped relation of dietary total insoluble fiber with new-onset hypertension (Additional file 1: Figure S2). Accordingly, when dietary total insoluble fiber intake was assessed as quartiles, the adjusted HRs (95% CIs) of new-onset hypertension were 1.00 (reference), 0.78 (0.60, 1.01), 0.62 (0.47, 0.83), and 0.61 (0.44, 0.85) across the quartiles of total insoluble fiber intake, respectively. The risk of new hypertension seemed to reach a plateau when the dietary total insoluble fiber intake was greater than 9.6 g/day (quartile 3) (Table 2). Further adjustments for dietary intakes of vitamin A, vitamin B2, niacin, copper, and zinc (model 2); dietary intakes of refined and whole grains, vegetables, beans, tubers, and fruits (model 3); or BMI trajectory (model 4) did not substantially change the results (Additional file 1: Table S3). Similar results were also observed when dietary total insoluble fiber intake was estimated by MSM (Additional file 1: Figure S3) or exclusion of those with physician-diagnosed hypertension or receiving antihypertensive treatments (Additional file 1: Figure S4). Moreover, we further investigated the relation of changes in dietary total insoluble fiber intake in the first two waves with new-onset hypertension that occurred in subsequent follow-up waves. As expected, although not statistically significant, participants who consumed dietary total insoluble fiber ≥ 9.6 g/day in both waves had the lowest risk of new hypertension compared with those who consumed total insoluble fiber < 9.6 g/day in both diets (HR, 0.68; 95% CI: 0.43–1.06) (Additional file 1: Table S4).

Table 2 The association of total dietary insoluble fiber with new-onset hypertension
Full size table

Figure 1 showed the associations between dietary insoluble fibers derived from different food sources and new-onset hypertension. There were L-shaped associations of insoluble fibers derived from vegetables, beans, tubers, and fruits with new-onset hypertension and a reversed J-shaped association of whole grain-derived insoluble fiber with new-onset hypertension (all P values for nonlinearity < 0.05). That is, for each above insoluble fiber, there is a window of consumption (appropriate level) where the risk of new-onset hypertension was lowest. However, there was no obvious association between refined grain-derived insoluble fiber and new-onset hypertension.

Fig. 1
figure 1

The associations between intakes of specific-sourced insoluble fiber with new-onset hypertension. Adjusted for sex, body mass index, systolic blood pressure, diastolic blood pressure, smoking, alcohol drinking, urban/rural residents, regions, education levels, occupations, diabetes, physical activity levels, dietary intakes of sodium, potassium, protein, fat, and carbohydrate, as well as mutual adjustments for intake from other specific dietary insoluble fiber source. DIF, dietary insoluble fiber

Full size image

Similar trends were found when assessing different sources of insoluble fiber intakes as categorical variables. Accordingly, the appropriate levels (g/day) of specific sourced insoluble fiber associated with the lowest risk of new-onset hypertension were \(\ge\) 1.9 (the 2–4 quartiles) for vegetable-derived insoluble fiber, \(\ge\) 0.4 (the 2–4 quartiles) for bean-derived insoluble fiber, 0– < 1.7 (the 1–2 tertiles among consumers) for whole grain-derived insoluble fiber, > 0 (consumers) for tuber-derived insoluble fiber, and > 0 (consumers) for fruit-derived insoluble fiber (Additional file 1: Figure S5).

Relation of variety score of insoluble fiber sources with new-onset hypertension

Since there was no obvious relation of refined grain-derived insoluble fiber with new-onset hypertension, the refined grain was not included in the calculation of variety score of insoluble fiber sources. As such, if a participant consumed one of the 5 major food sources (vegetables, beans, tubers, fruits, and whole grain) of insoluble fiber at an appropriate quantity during the entire study period, he/she will get one point, with a maximal score of 5.

Overall, there was an inverse relation of the variety score of insoluble fiber sources with new-onset hypertension (per score increment, HR, 0.50; 95% CI, 0.45–0.55) (Fig. 2). Further adjustments for variety score of dietary protein sources (model 2); dietary intakes of vitamin A, vitamin B2, niacin, copper, and zinc (model 3); dietary intakes of refined and whole grains, vegetables, beans, tubers, and fruits (model 4); or BMI trajectory classes (model 5) did not substantially change the results (Additional file 1: Table S5). Similar trends were also observed after the removal of any one kind of insoluble fiber from the variety score of insoluble fiber (Additional file 1: Table S6). Moreover, among participants with blood sample measurements, further adjustments for creatinine concentrations also did not materially alter the results (Additional file 1: Figure S5).

Fig. 2
figure 2

The association between variety score of dietary insoluble fiber sources and new-onset hypertension. Adjusted for sex, body mass index, systolic blood pressure, diastolic blood pressure, smoking, alcohol drinking, urban/rural residents, regions, education levels, occupations, diabetes, physical activity levels, dietary intakes of sodium, potassium, protein, fat, and carbohydrate, as well as total insoluble fiber

Full size image

In the stratified analyses, the inverse associations between variety score of insoluble fiber sources (per score increment) and the risk of new-onset hypertension were found in all the subgroups. Although the P value of the interaction for fat intake was < 0.05, because of multiple testing and similar directionality of the associations in different subgroups, the clinical implications of these interactions still should be further investigated (Additional file 1: Table S6).

Discussion

In this large, prospective cohort study among general Chinese adults, we reported an L-shaped association between dietary total insoluble fiber and new-onset hypertension. In addition, there was no obvious association of refined grain-derived insoluble fiber with new-onset hypertension, while a reversed J-shaped association of whole grain-derived insoluble fiber and L-shaped associations for insoluble fibers from vegetables, beans, tubers, and fruits, with new-onset hypertension. Moreover, a higher variety score of insoluble fibers was significantly associated with a lower risk of new-onset hypertension.

A previous meta-analysis of 18 RCTs reported that an increase in total fiber intake had no significant impact on BP [9]. Another meta-analysis of 15 RCTs with the moderate quality found that higher intakes of total dietary fiber were associated with lower SBP levels (mean difference: − 1.27 mmHg; 95% CI: − 2.50 to − 0.04) [25]. However, among these RCTs, limited data were available for fiber described as soluble or insoluble. The potential effect and the underlying mechanisms of soluble fiber on BP have been relatively thoroughly investigated [9, 26]. Nevertheless, to date, only two cross-sectional studies have evaluated the relation of insoluble fiber intake and the prevalence of hypertension and reported inconsistent findings [10, 27]. As such, to date, the prospective relations of the variety and quantity of different sources of dietary insoluble fibers intake and hypertension remain uncertain. Our current study, with a prospective design and a relatively large sample size, provided an opportunity to assess the dose–response associations between the variety and quantity of insoluble fibers intake from different food sources and new-onset hypertension in the general population.

Our study provides some new insights. First, there were non-linear relations of dietary total insoluble fiber and dietary insoluble fibers from different food sources with new-onset hypertension, including a reversed J-shaped association for the whole grain-derived insoluble fiber, and L-shaped associations for the total insoluble fiber, and insoluble fibers from vegetables, beans, tubers, and fruits. That is, when these foods-derived insoluble fiber intakes were relatively low, there were negative correlations between intakes of foods-derived insoluble fiber and hypertension risk; however, when intake exceeded certain thresholds, the risks of new-onset hypertension will increase or reach a plateau. More importantly, we found that there was no obvious association between refined grain-derived insoluble fiber and hypertension. The potential mechanisms by which insoluble fiber lowers blood pressure may include reduced inflammation levels [28, 29] and improved endothelial function [30]. Moreover, cellulose could inhibit starch digestion by binding α- amylase [31], thereby reducing glucose absorption and improving insulin resistance, and lowering the risk of hypertension [32]. However, the reversed J-shaped association of whole grain-derived insoluble fiber with new-onset hypertension and the no obvious association of refined grain-derived insoluble fiber with new-onset hypertension indicated that too high intakes of grain-derived insoluble fibers, especially refined grain-derived insoluble fiber, may have no benefit on BP. Consistently, the smooth curve of the association between grain fiber intake and SBP levels also showed a U-shape in the Study of Women’s Health Across the Nation (SWAN) [33]. And the Tehran Lipid and Glucose Study found that there were positive relations of grain fiber with CVD risk score at baseline and increased insulin resistance index during the study follow-up [34]. It has been reported that the fiber of refined grain derived from cell walls in the starchy endosperm is nutrient-poor, as it does not include the biochemicals found in the nutrient-rich bran and germ [35]. Moreover, a recent study showed plasma trimethylamine N-oxide (TMAO) directly correlated with the intake of whole-grain products [36]. Overall, more studies are needed to confirm our findings and further examine the underlying mechanisms involved in the associations between the intake of different insoluble fibers and hypertension.

Second, we first found that there was a significant inverse association between the variety score of insoluble fiber sources and new-onset hypertension. More importantly, the removal of any one kind of fiber from the insoluble variety scores could not substantially change our findings. The possible explanation may be that the role of dietary fiber not only depends on the amount of intake but also its food sources. Since not all fibers from different food sources behave in the same way, fibers from a diverse range of sources, with differences in fiber structure and activities, may offer diverse functional characteristics and thus provide better health benefits. However, the detailed mechanisms still need to be further investigated in future studies.

There are some limitations needed to be mentioned. First, although a broad array of covariates had been adjusted in the regression models, the possibility of residual confounding cannot be excluded. For example, CHNS only collected information about self-reported physician-diagnosed hypertension, diabetes, asthma, and CVD but not kidney diseases at baseline. Therefore, we could not examine whether baseline kidney diseases may affect our findings. However, among those with blood sample measurements, further adjustments for creatinine concentrations did not substantially change our findings. Second, the neutral detergent fiber method is a reliable analytical tool for measuring insoluble fiber. We could not calculate the amount of soluble fiber intake. Third, our study only included insoluble fibers from 6 major food sources in Chinese adults. Fourth, since the detailed sampling information was not provided by CHNS, summary statistics like prevalence and incidence should be treated with caution. Finally, our study was conducted in the Chinese population, whether the findings can be extrapolated to other populations needs further investigation. Therefore, the results need further confirmation.

Conclusions

In summary, our study suggested that there was an inverse relation of the variety of insoluble fibers with appropriate quantity from different food sources (whole grain, vegetable, bean, tuber, and fruit) and new-onset hypertension in general Chinese adults. If our results are further confirmed, these findings support that the intake of an appropriate quantity of insoluble fibers from various food sources plays an important role in the primary prevention of hypertension.

Availability of data and materials

The datasets generated and analyzed during the current study are available the CHNS official website (http://www.cpc.unc.edu/projects/china).

Abbreviations

BP:

Blood pressure

BMI:

Body mass index

CVD:

Cardiovascular disease

CHNS:

China health and nutrition survey

DBP:

Diastolic blood pressure

FCTs:

Food composition tables

MSM:

Multiple source methods

RCTs:

Randomized control trials

SD:

Standardized deviation

SBP:

Systolic blood pressure

TMAO:

Trimethylamine n-oxide

References

  1. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2:634–47.

    Article  Google Scholar 

  2. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Li Q, Liu C, Zhang S, Li R, Zhang Y, He P, et al. Dietary carbohydrate intake and new-onset hypertension: a nationwide cohort study in China. Hypertension. 2021;78(2):422–30 HYPERTENSIONAHA12016751.

    Article  CAS  PubMed  Google Scholar 

  5. Liu M, Zhou C, Zhang Z, Li Q, He P, Zhang Y, et al. Inverse association between riboflavin intake and new-onset hypertension: a nationwide cohort study in China. Hypertension. 2020;76:1709–16.

    Article  CAS  PubMed  Google Scholar 

  6. Dhingra D, Michael M, Rajput H, Patil RT. Dietary fibre in foods: a review. J Food Sci Technol. 2012;49:255–66.

    Article  CAS  PubMed  Google Scholar 

  7. Threapleton DE, Greenwood DC, Evans CEL, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 2013;347:f6879.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hosseinpour-Niazi S, Mirmiran P, Sohrab G, Hosseini-Esfahani F, Azizi F. Inverse association between fruit, legume, and cereal fiber and the risk of metabolic syndrome: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract. 2011;94:276–83.

    Article  PubMed  Google Scholar 

  9. Evans CEL, Greenwood DC, Threapleton DE, Cleghorn CL, Nykjaer C, Woodhead CE, et al. Effects of dietary fibre type on blood pressure: a systematic review and meta-analysis of randomized controlled trials of healthy individuals. J Hypertens. 2015;33:897–911.

    Article  CAS  PubMed  Google Scholar 

  10. Lairon D, Arnault N, Bertrais S, Planells R, Clero E, Hercberg S, et al. Dietary fiber intake and risk factors for cardiovascular disease in French adults. Am J Clin Nutr. 2005;82:1185–94.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang B, Zhai FY, Du SF, Popkin BM. The China Health and Nutrition Survey, 1989–2011. Obes Rev. 2014;15(Suppl 1):2–7 (http://www.cpc.unc.edu/projects/china).

    Article  PubMed  Google Scholar 

  12. He P, Li H, Liu M, Zhang Z, Zhang Y, Zhou C, et al. U-shaped Association Between Dietary Zinc Intake and New-onset Diabetes: A Nationwide Cohort Study in China. J Clin Endocrinol Metab. 2022;107:e815–24.

  13. Zhou C, Zhang Z, Liu M, Zhang Y, Li H, He P, et al. Dietary carbohydrate intake and new-onset diabetes: a nationwide cohort study in China. Metabolism. 2021;123:154865.

    Article  CAS  PubMed  Google Scholar 

  14. Li Q, Li R, Zhang S, Zhang Y, He P, Zhang Z, et al. Occupational physical activity and new-onset hypertension: a nationwide cohort study in China. Hypertension. 2021;78:220–9.

    Article  CAS  PubMed  Google Scholar 

  15. Liu M, Liu C, Zhang Z, Zhou C, Li Q, He P, et al. Quantity and variety of food groups consumption and the risk of diabetes in adults: a prospective cohort study. Clin Nutr. 2021;40:5710–7.

    Article  CAS  PubMed  Google Scholar 

  16. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3:e419–28.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhai F, Guo X, Popkin BM, Ma L, Wang Q, Shuigao WY, et al. Evaluation of the 24-hour individual recall method in China. Food Nutr Bull. 1996;17:1–7.

    Article  Google Scholar 

  18. Yao M, McCrory MA, Ma G, Tucker KL, Gao S, Fuss P, et al. Relative influence of diet and physical activity on body composition in urban Chinese adults. Am J Clin Nutr. 2003;77:1409–16.

    Article  CAS  PubMed  Google Scholar 

  19. 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;74:298–307.

    Article  PubMed  Google Scholar 

  20. Zhou C, Wu Q, Ye Z, Liu M, Zhang Z, Zhang Y, et al. Inverse association between variety of proteins with appropriate quantity from different food sources and new-onset hypertension. Hypertension. 2022;79(5):1017–27 HYPERTENSIONAHA12118222.

    Article  CAS  PubMed  Google Scholar 

  21. Zhou C, Liu C, Zhang Z, Liu M, Zhang Y, Li H, et al. 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;20:6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Zhang Z, Liu M, Zhou C, He P, Zhang Y, Li H, et al. Evaluation of dietary niacin and new-onset hypertension among Chinese adults. JAMA Netw Open. 2021;4:e2031669.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zhang Y, Liu M, Zhou C, Zhang Z, He P, Li Q, et al. Inverse association between dietary vitamin A intake and new-onset hypertension. Clin Nutr. 2021;40:2868–75.

    Article  CAS  PubMed  Google Scholar 

  24. Harttig U, Haubrock J, Knüppel S, Boeing H, on behalf of the EFCOVAL Consortium. The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr. 2011;65:S87-91.

    Article  PubMed  Google Scholar 

  25. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019;393:434–45.

    Article  CAS  PubMed  Google Scholar 

  26. Khan K, Jovanovski E, Ho HV, Marques AC, Zurbau A, Mejia SB, et al. The effect of viscous soluble fiber on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis: NMCD. 2018;28:3–13.

    Article  CAS  PubMed  Google Scholar 

  27. Aljuraiban GS, Griep LMO, Griep LMO, Chan Q, Daviglus ML, Stamler J, et al. Total, insoluble and soluble dietary fibre intake in relation to blood pressure: the INTERMAP Study. Br J Nutr. 2015;114:1480–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ma Y, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJ, et al. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 2006;83:760–6.

    Article  CAS  PubMed  Google Scholar 

  29. Krishnamurthy VMR, Wei G, Baird BC, Murtaugh M, Chonchol MB, Raphael KL, et al. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 2012;81:300–6.

    Article  CAS  PubMed  Google Scholar 

  30. Brock DW, Davis CK, Irving BA, Rodriguez J, Barrett EJ, Weltman A, et al. A high-carbohydrate, high-fiber meal improves endothelial function in adults with the metabolic syndrome. Diabetes Care. 2006;29:2313–5.

    Article  CAS  PubMed  Google Scholar 

  31. Dhital S, Gidley MJ, Warren FJ. Inhibition of α-amylase activity by cellulose: kinetic analysis and nutritional implications. Carbohydr Polym. 2015;123:305–12.

    Article  CAS  PubMed  Google Scholar 

  32. Quesada O, Claggett B, Rodriguez F, Cai J, Moncrieft AE, Garcia K, et al. Associations of insulin resistance with systolic and diastolic blood pressure: a study from the HCHS/SOL. Hypertension. 2021;78:716–25.

    Article  CAS  PubMed  Google Scholar 

  33. Du P, Luo K, Wang Y, Xiao Q, Xiao J, Li Y, et al. Intake of dietary fiber from grains and the risk of hypertension in late midlife women: results from the SWAN study. Front Nutr. 2021;8:730205.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mirmiran P, Bahadoran Z, Moghadam SK, Vakili AZ, Azizi F. A prospective study of different types of dietary fiber and risk of cardiovascular disease: Tehran Lipid and Glucose Study. Nutrients. 2016;8(11):686.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jacobs DR, Pereira MA, Meyer KA, Kushi LH. Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: the Iowa women’s health study. J Am Coll Nutr. 2000;19(3 Suppl):326S-330S.

    Article  CAS  PubMed  Google Scholar 

  36. Costabile G, Vetrani C, Bozzetto L, Giacco R, Bresciani L, Del Rio D, et al. Plasma TMAO increase after healthy diets: results from 2 randomized controlled trials with dietary fish, polyphenols, and whole-grain cereals. Am J Clin Nutr. 2021;114:1342–50.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research uses data from 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, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077, 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.

Funding

This study was supported by the National Key Research and Development Program (2022YFC2009600, 2022YFC2009605, and 2020YFC2005000) and the National Natural Science Foundation of China (81973133 and 81730019).

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Authors and Affiliations

  1. Division of Nephrology, 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, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Ziliang Ye, Qimeng Wu, Sisi Yang, Yanjun Zhang, Chun Zhou, Mengyi Liu, Zhuxian Zhang, Panpan He, Yuanyuan Zhang, Huan Li, Jing Nie, Fan Fan Hou & Xianhui Qin

  2. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China

    Rui Li, Chengzhang Liu & Xianhui Qin

  3. Institute of Biomedicine, Anhui Medical University, Hefei, 230032, China

    Rui Li, Chengzhang Liu & Xianhui Qin

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  1. Ziliang Ye
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  2. Qimeng Wu
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  3. Sisi Yang
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Contributions

ZY and XQ designed the research; ZY, QW, SY, YZ1, CZ, ML, ZZ, and XQ conducted the research; ZY and CL performed the data management and statistical analyses; ZY and XQ wrote the manuscript. ZY, QW, SY, YZ1, CZ, ML, ZZ, PH, YZ2, RL, HL, CL, JN, FH, and XQ revised and approved the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xianhui Qin.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the institutional review boards of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety and Chinese Center for Disease Control and Prevention. Each participant provided written informed consent.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Supplementary Information

Additional file 1:

Figure S1. Flow chart of study participants. Figure S2. The relationship of total dietary insoluble fiber intake with new-onset hypertension*. Figure S3. The relationship of total dietary insoluble fiber intake estimated by multiple source method with new-onset hypertension*. Figure S4. The relationship of total dietary insoluble fiber intake with new-onset hypertension after excluding those with physician-diagnosed hypertension or receiving antihypertensive treatment. Figure S5. Forest plots of the relationship of specific-sourced dietary insoluble fiber intake with new-onset hypertension. Figure S6. The association between variety score of dietary insoluble fiber sources and new-onset hypertension further adjusted for serum creatinine*. Table S1. Characteristics of the participants with and without blood pressure data. Table S2. Food sources of dietary insoluble fiber intake. Table S3. Sensitivity analysis for the association between total dietary insoluble fiber intake (g/d) and new-onset hypertension. Table S4. The association between total dietary insoluble fiber intake (g/d) in different waves and new-onset hypertension. Table S5. Sensitivity analysis for the association between variety score of insoluble fiber source and new-onset hypertension. Table S6. The association between variety score of insoluble fiber source and new-onset hypertension after the removal of any one kind of insoluble fiber from the insoluble fiber variety score. Table S7. Stratified analyses of the association between the variety score of insoluble fiber source and new-onset hypertension.

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Ye, Z., Wu, Q., Yang, S. et al. Variety and quantity of dietary insoluble fiber intake from different sources and risk of new-onset hypertension. BMC Med 21, 61 (2023). https://doi.org/10.1186/s12916-023-02752-7

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Keywords

BMC Medicine

ISSN: 1741-7015

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