Int'l Population on Macronutrients and BP - INTERMAP

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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.