Clinical InvestigationsA U-shaped association between dietary phosphorus intake and new-onset hypertension: a nationwide cohort study in China
Section snippets
Population and study design
The present study used data from the CHNS, an ongoing, nationwide, multipurpose longitudinal open cohort study established in 1989, which aimed to investigate the health and nutritional status and reflect national profiles in Chinese populations. Details on the study design, sampling methods, response rates, and some results of the CHNS can be accessed from the official website (http://www.cpc.unc.edu/projects/china) and previous reports.15., 16., 17., 18., 19., 20, 21. CHNS was scheduled for
Study participants and baseline characteristics
As demonstrated in Supplementary Figure 1, a total of 12,177 participants were included in the current study. The average age of the study population was 41.2 (SD, 14.2) years. 5,698 (46.8%) of the participants were males. The median dietary phosphorus intake was 941.2 (25th-75th range, 791.4-1113.7) mg/d. In addition, we conducted a longitudinal comparison of dietary phosphorus intake from 1997-2011, and found that the median levels of dietary phosphorus intake remained roughly stable, except
Discussion
In this relatively large-scale, nationally prospective cohort of Chinese adults, we observed a U-shaped association between dietary phosphorus intake and the risk of new-onset hypertension, with a minimal risk observed at 912.0 to 1089.5 mg/d (the 3rd-4th quintiles) of dietary phosphorus intake. Similar trends were found for animal-derived and plant-derived dietary phosphorus.
A recent prospective, single-blind, randomized study found high phosphorus intake (0.55 mmol/kg body weight phosphate
Conclusions
In summary, our study found a U-shaped association between dietary phosphorus intake with the risk of new-onset hypertension, with a minimal risk observed at 912.0 to 1089.5 mg/d (the 3rd-4th quintiles) of dietary phosphorus intake. If further confirmed, our findings encouraged to maintain the optimal phosphorus intake levels for primary prevention of hypertension in the general population.
Declaration
The authors are solely responsible for the design and conduct of this study, all study analyses and drafting and editing of the paper.
Author contributions
XQ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. QW, CL, and XQ designed the research; QW, ZY, CZ, ML, ZZ, PH, YZ, QL, and XQ conducted the research; QW, CZ, and CL performed the data management and statistical analyses; QW and XQ wrote the manuscript. All authors reviewed/edited the manuscript for important intellectual content. All authors read and approved the final manuscript.
Funding
This study was supported by the National Key Research and Development Program (2022YFC2009600, 2022YFC2009605), the National Key R&D program of China (2020YFC2005000) and the National Natural Science Foundation of China (81973133 and 81730019).
Role of funders
The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclosures
The authors declare that they have no conflict of interest.
Acknowledgments
This research uses data from the 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 and T32 HD007168), the University of North Carolina at Chapel Hill, the National Institutes of Health (NIH; R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077 and D43 TW007709) for financial support for the CHNS data
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Xianhui Qin and Chengzhang Liu contributed equally to this article.