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Epidemiology

Impact of overall diet quality on association between alcohol consumption and risk of hypertension: evidence from two national surveys with multiple ethnics

European Journal of Clinical Nutrition volume 75, pages 112–122 (2021)Cite this article

Subjects

Abstract

Background/objectives

Alcohol is commonly consumed around mealtimes. This study hypothesized that the association between alcohol and hypertension was influenced by overall diet quality. This study aims to test the hypothesis that overall diet quality influenced associations between alcohol and risk of hypertension across different ethnicities.

Subjects/methods

Using nationally representative data from National Health and Nutrition Examination Survey(NHANES 03–12), China Health Nutrition Survey (CHNS), and an independent population-based study, 43,914 adults were included. Subgroup analysis included 6984 adults from CHNS with a 14-year follow-up. Light alcohol consumption was defined as <7standard drinks/week, moderate as 7–21 drinks/week, and heavy as >21 drinks/week. Alternative healthy eating index and diet balance index were calculated as indicators of diet quality.

Results

There were 3968 hypertensives in Caucasians (N = 11,325), 1976 in Africans (N = 5010), 1907 in Hispanics (N = 7274) and 5267 (N = 20,305) in Chinese. In context of high diet quality, light alcohol consumption was significantly associated with decreased risk of hypertension in Caucasians, and the risk of hypertension was not significantly increased with increasing in alcohol consumption in Caucasians, Chinese, and Hispanics (all Pfor trend > 0.05). On the contrary, in context of low diet quality, the risk of hypertension was significantly increased with increasing in alcohol consumption in Caucasians (Pfor trend = 0.005), Chinese (Pfor trend = 0.001) and Hispanics (Pfor trend = 0.022). Associations between alcohol consumption and risk of hypertension significantly varied by diet-quality scores in Caucasians, Hispanics, and Chinese (all Pfor interaction < 0.01) showing gradually changing from nonsignificant increasing trend to linear association.

Conclusions

This study firstly demonstrated that overall diet quality influenced associations between alcohol and risk of hypertension across different ethnicities, emphasizing that when examining health effects of alcohol on blood pressure, diet quality should be considered.

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Fig. 1: Association between alcohol consumption and risk of hypertension by diet quality.
Fig. 2: Joint association of overall diet quality and alcohol consumption with risk of hypertension.
Fig. 3: Association between alcohol consumption and subsequent risk of hypertension, and joint association of changing in diet quality and alcohol consumption with subsequent risk of hypertension.

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Data availability

NHANES could be download at http://www.cdc.gov/nchs/nhanes/. CHNS could be download at http://www.cpc.unc.edu/projects/china. For HDNNCDS, researchers should contact the principal investigator if they wish to explore the possibility of collaborative work.

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Acknowledgements

This research was supported funds from National Natural Science Foundation (81803227 to TH), National Key R&D Program of China (2017YFC1307401 to CS), and used data from National Health and Nutrition Examination Survey (NHANES), China Health and Nutrition Survey (CHNS) and the Harbin Cohort Study on Diet, Nutrition and Chronic Noncommunicable Disease (HDNNCDS). We thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center (P2C HD050924, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077, D43 TW007709) for financial support for the CHNS data collection and analysis files from 1989 to 2015 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011. We are indebted to the participants of NHANES and HDNNCDS for their cooperation and participation.

Funding

This research was supported funds from National Natural Science Foundation (81803227 to TH), National Key R&D Program of China (2017YFC1307401 to CS).

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Author notes

  1. These authors contributed equally: Wenbo Jiang, Xing Meng

Authors and Affiliations

  1. National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, PR China

    Wenbo Jiang, Xing Meng, Wanying Hou, Xiaoyan Wu, Yue Wang, Maoqing Wang, Xia Chu, Peng Wang, Changhao Sun, Tianshu Han & Ying Li

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  1. Wenbo Jiang
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Contributions

YL and TH planned the work. TH and CS conducted and reported the work. WJ and XM were involved in the data collection. MW, XW, and XC were involved in analysis of data. PW, WH, and YW wrote the paper. All the authors were responsible for revising the paper and approved the final version.

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Correspondence to Tianshu Han or Ying Li.

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Jiang, W., Meng, X., Hou, W. et al. Impact of overall diet quality on association between alcohol consumption and risk of hypertension: evidence from two national surveys with multiple ethnics. Eur J Clin Nutr 75, 112–122 (2021). https://doi.org/10.1038/s41430-020-00708-1

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