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Dietary intakes of total, nonheme, and heme iron and hypertension risk: a longitudinal study from the China Health and Nutrition Survey

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Abstract

Aims

Evidence is limited regarding the long-term impact of dietary iron intake on the development of hypertension. We investigated the association between dietary intakes of total, nonheme, and heme iron and hypertension risk in a large prospective cohort of Chinese populations over 26 years.

Methods

A total of 16,122 adults (7810 men and 8312 women) who participated in the China Health and Nutrition Survey (1989–2015) were included. Dietary intake was repeatedly assessed by combining three consecutive 24‑h individual dietary recalls with household food inventory weighing at each survey round. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, diagnosis by physicians, or current use of anti-hypertensive drugs.

Results

During a median follow‑up of 11.1 years, 2863 men and 2532 women developed hypertension. After adjustment for non-dietary and dietary factors, a lower risk of hypertension was found in men and women with higher intakes of total, nonheme, or heme iron. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the highest vs. lowest quartiles were 0.76 (0.67, 0.87) in men and 0.85 (0.74, 0.97) in women for total iron intake, 0.77 (0.67, 0.87) in men and 0.85 (0.74, 0.98) in women for nonheme iron intake, and 0.73 (0.62, 0.87) in men and 0.69 (0.58, 0.82) in women for heme iron intake. Dose–response analyses further revealed a U-shaped association of total and nonheme iron intake and an L-shaped association of heme iron intake with hypertension risk in both men and women (all P for non-linearity < 0.001).

Conclusions

Our findings emphasize the importance of maintaining moderate iron intake in the prevention of hypertension. Both insufficient and excess intake of iron might increase the risk of hypertension.

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Data share statement

Data described in the manuscript, code book, and analytic code will be made publicly and freely available without restriction at https://www.cpc.unc.edu/projects/china/.

Abbreviations

BMI:

Body mass index

BMR:

Basal metabolic rate

BP:

Blood pressure

CHNS:

China Health and Nutrition Survey

CI:

Confidence interval

DBP:

Diastolic blood pressure

HR:

Hazard ratio

INTERMAP:

The International Collaborative Study on Macro-/micronutrients and Blood Pressure

PAL:

Physical activity level

RCS:

Restricted cubic splines

ROS:

Reactive oxygen species

SBP:

Systolic blood pressure

TLGS:

The Tehran Lipid and Glucose Study

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Acknowledgements

This research used data from CHNS. The authors thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center (P2C-HD-050924, T32-HD-007168); the University of North Carolina, Chapel Hill; the National Institutes of Health (R01-HD-30880, DK-056350, R24-HD-050924, R01-HD-38700); and the National Institutes of Health Fogarty International Center (D43-TW-009077, D43-TW-007709) 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.

Funding

This study received no sources of support from any grants, fellowships, or gifts of materials.

Author information

Author notes

  1. Shangling Wu and Peiyan Chen contribute equally to this work and are the co-first authors for this paper.

Authors and Affiliations

  1. Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Shangling Wu, Peiyan Chen & Yi Sui

  2. Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, 100083, China

    Jingjing He

  3. Department of Nutrition, School of Public Health, Sun Yat-Sen University, Yuexiu District, 74 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Zhaoyan Liu & Aiping Fang

  4. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, 510080, People’s Republic of China

    Zhaoyan Liu & Aiping Fang

  5. Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, People’s Republic of China

    Keji Li

  6. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Aiping Fang

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Contributions

K-JL, and A-PF designed the research; S-LW, P-YC, J-JH, Z-YL and YS conducted the research; S-LW, P-YC and A-PF performed the data management and statistical analyses; S-LW wrote the manuscript; A-PF and K-JL revised the final paper. All authors reviewed/edited the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Keji Li or Aiping Fang.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Ethics permission was obtained from the Institutional Review Boards of the University of North Carolina at Chapel Hill and the Institute of Nutrition and Food Safety and the Chinese Center for Disease Control and Prevention (2015024).

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Written informed consent was obtained from all participants.

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Wu, S., Chen, P., He, J. et al. Dietary intakes of total, nonheme, and heme iron and hypertension risk: a longitudinal study from the China Health and Nutrition Survey. Eur J Nutr 62, 3251–3262 (2023). https://doi.org/10.1007/s00394-023-03230-9

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