Elsevier

American Heart Journal

Volume 259, May 2023, Pages 21-29
American Heart Journal

Clinical Investigations
A U-shaped association between dietary phosphorus intake and new-onset hypertension: a nationwide cohort study in China

https://doi.org/10.1016/j.ahj.2023.01.013Get rights and content

Background

The association between dietary phosphorus intake and the risk of hypertension remains uncertain. We aimed to investigate the relation of dietary phosphorus intake with new-onset hypertension among Chinese adults.

Methods

A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey (CHNS) were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. New-onset hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by a physician or under antihypertensive treatment during the follow-up.

Results

During a median follow-up of 6.1 years, 4,269 participants developed new-onset hypertension. Overall, the association between dietary phosphorus intake and new-onset hypertension followed a U-shape (P for nonlinearity<.001). Consistently, when dietary phosphorus intake was assessed as quintiles, compared with those in the 3rd to 4th quintiles (912.0-<1089.5 mg/d), a significantly higher risk of new-onset hypertension was found in participants in the 1st to 2nd quintiles (<912.0 mg/d: HR, 1.23; 95% CI, 1.14-1.33), and the fifth quintile (≥1089.5 mg/d: HR, 1.21; 95% CI, 1.10-1.33).

Conclusion

There was a U-shaped association between dietary phosphorus intake and new-onset hypertension in general Chinese adults.

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.

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