Int'l Population on Macronutrients and BP - INTERMAP

描述（由申请人提供）：本申请要求支持进一步的数据分析和报告工作-包括完成国际合作INTERMAP研究的原始和扩展目标（假设检验和探索性分析）-。INTERMAP是一项关于饮食因素（宏观微量营养素）及其尿液代谢物在大多数中老年人群中普遍存在的不良血压（BP）水平病因中的作用的基础流行病学调查。在这个总体目标的背景下，一个特别的焦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中更不利的血压模式中的作用，例如在美国，受教育程度较低的非洲裔美国人，西班牙裔美国人，白人。INTERMAP的目标是在这些重要问题上取得重大进展，基于其设计：从4个国家（中国、日本、英国、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4680名年龄在40-59岁之间的男性和女性进行大样本研究。成本效益通过伦敦中心的成本分担和包含5个正在进行的NHLBI支持的项目的数据分析/报告目标来保证。具体目标包括阐明蛋白质、脂类、碳水化合物以及单个氨基酸、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。在控制BMI、酒精摄入量、钠、钾、年龄、性别和其他混杂因素的情况下，正在测试的主要假设是：膳食蛋白质与血压呈负相关；受教育程度与血压呈负相关关系，与多种饮食因素的受教育程度相关差异有显著关系；饲粮SFA、胆固醇、Keys评分、淀粉与血压有直接关系；pfa与P/S呈反比关系。随机选择的参与者提供2次定时24小时尿液收集，以评估Na、K、肌酐、尿素、Ca、Mg、宏、微量白蛋白尿、氨基酸、代谢物（NMR、HPLC、MS分析），并进行4次24小时饮食回顾。测量血压8次（4次）。这项研究是由两个协调中心协调的——芝加哥西北大学和伦敦帝国理工学院。在鲁汶和伦敦的中央实验室进行了尿液测定。24小时膳食召回已转化为营养成分（目前为75份，到2004年中期为83份），使用了4个针对具体国家的最新、广泛、高质量、标准化的国家数据库。多种饮食因素与血压之间关系的研究结果被用于估计人群多种营养改善对血压的有利影响。反过来，这应该有助于加强初级预防高血压的饮食建议，并将血压分布向下转移，以避免与当前不利水平相关的过度风险。

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.