Int'l Population on Macronutrients and BP - INTERMAP

说明(由申请人提供)：本申请书请求为国际合作的INTERMAP研究中进一步的数据分析和报告工作提供支持，包括完成关于原始和扩展目标的工作(假设检验和探索性分析)。InterMAP是关于饮食因素(宏量微量营养素)及其尿代谢物在大多数中老年人普遍存在的不良血压(BP)水平的病因中所起作用的基本流行病学调查。在这一总体目标的背景下，一个特别的重点是帮助阐明这些饮食因素在解释受教育程度较低的人群阶层，例如在美国受教育程度较低的非裔美国人、西班牙裔美国人和白人中更不利的血压模式中所起的作用。Intermap旨在根据其设计在这些重要问题上取得重大进展：从4个国家(中国、日本、英国和美国)的17个不同种族、社会经济地位和饮食习惯的不同人口样本中抽取4,680名年龄在40-59岁的男性和女性作为大样本。成本效益通过伦敦中心的成本分担和5个正在进行的NHLBI支持的项目的数据分析/报告目标来确保。具体目标包括阐明蛋白质、脂肪、碳水化合物以及各种氨基酸、脂肪酸、糖、维生素、钙、镁、铁、磷、铜、硒、纤维、咖啡因的数量和类型对血压的影响。在对体重指数、酒精摄入量、钠、钾、年龄、性别和其他混杂因素进行控制的情况下，主要假设是：饮食蛋白质与血压呈负相关；教育程度与血压呈负相关；多种饮食因素中与教育有关的差异显著；与膳食SFA、胆固醇、Keys评分、淀粉的血压直接相关；PFAs和P/S呈负相关。随机选择的参与者，提供两次定时的24小时尿液，用于评估Na、K、肌酐、尿素、钙、镁、大量和微量蛋白尿、氨基酸、代谢物(核磁共振、高效液相、MS分析)，以及四次24小时饮食召回。测量血压8次，共4次。这项研究由位于芝加哥的西北大学和位于伦敦的帝国理工学院两个协调中心进行协调。鲁汶和伦敦的中心实验室已经进行了尿液检测。24小时饮食召回已转换为营养素(目前为75个，到2004年年中为83个)，使用了4个国家最新的、广泛的、高质量的标准化国家数据库。关于多种饮食因素与BP关系的研究结果被用来估计人群营养的多种改善对BP的有利影响。反过来，这将有助于加强对高血压的一级预防的饮食建议，并向下调整血压分布，以避免与目前不利水平相关的额外风险。

DESCRIPTION (provided by applicant): This application requests support for further data analysis and reporting work - - including for completion of work on original and expanded aims (hypothesis testing and exploratory analyses) - - in the international cooperative INTERMAP Study. INTERMAP is a basic epidemiologic investigation on the role of dietary factors (macroland micronutrients) and their urinary metabolites in the etiology of unfavorable blood pressure (BP) levels prevailing for a majority of middle-aged and older individuals. A particular focus - - within the context of this overall objective - - is to help elucidate the role of these dietary factors in accounting for the even more adverse BP patterns of less educated population strata, e.g., in the U.S. less educated African-Americans, Hispanics, Whites. INTERMAP aims to achieve a major advance on these important issues, based on its design: large sample size of 4,680 men and women ages 40-59 from 17 diverse population samples of varied ethnicity, SES, and dietary habits in 4 countries (China, Japan, U.K., U.S.). Cost effectiveness is assured by cost sharing by London centers and inclusion here of data analysis/reporting aims from 5 on-going NHLBI supported projects. Specific aims involve elucidating influences on BP of amount and type of protein, lipids, carbohydrates, also individual amino acids, fatty acids, sugars, vitamins, Ca, Mg, Fe, P, Cu, Se, fiber, caffeine. Primary hypotheses being tested, with control for BMI, intake of alcohol, Na, K, age, sex, other confounders are: dietary protein is inversely related to BP; inverse relations between education and BP are significantly accounted for by education-related differences in multiple dietary factors; there is a direct relation to BP of dietary SFA, cholesterol, Keys score, starch; there is an inverse relation of PFAs and of P/S. Participants, randomly selected, provided 2 timed 24-hr urine collections for assessment of Na, K, creatinine, urea, Ca, Mg, macro- and microalbuminuria, amino acids, metabolites (NMR, HPLC, MS analyses), and four 24-hr dietary recalls. BP was measured 8 times (4 visits). The study is coordinated by two Coordinating Centers - - Northwestern University, Chicago and Imperial College, London. Urinary determinations have proceeded at Central Laboratories in Leuven and London. 24-hr dietary recalls have been converted into nutrients (75 currently, 83 by mid-2004) with use of 4 country-specific up-to-date, extensive, high-quality, standardized national data bases. Findings on relations of multiple dietary factors to BP are being used to estimate favorable impact on BP of multiple improvements in nutrition by populations. This, in turn, should aid in enhancing dietary recommendations for primary prevention o1 hypertension, and for shifting BP distributions downward to avoid excess risk associated with present unfavorable levels.