An Inverse Association between Mediterranean- Like Dietary Pattern and Blood Pressure in Male, But Not Female, Adults in Shiraz

Farideh Dastsouz, Majid Kamali, Fatemeh Sadeghi, Sasan Amanat, Masoumeh Akhlaghi




Background: Dietary pattern is an effective way of studying the effect of diet on diseases. We investigated the association between dietary patterns and blood pressure (BP) in adults aged 20-50 years.

Methods: In a cross-sectional design, 418 individuals were selected through stratified multistage random sampling from households living in different regions of Shiraz. Information on demographic characteristics, anthropometric features, dietary intakes, and systolic (SBP) and diastolic (DBP) blood pressure was gathered. Dietary patterns were determined using a validated food frequency questionnaire.

Results: Three dietary patterns were specified: vegetable (high in vegetables and legumes), Western-like (high in meat, sugarsweetened beverages, salty and sweet snacks, refined grains, high-fat dairy), and Mediterranean-like (rich in low-fat dairy, fruit, vegetables, nuts, olive, fish, and low in hydrogenated fats). After adjustment for confounders, Mediterranean-like dietary pattern had an inverse association with SBP (β=-0.24; 95% CI: -5.25, -1.27) and DBP (β=-0.17; 95% CI: -3.65, -0.20) in males but not females. Vegetable and Western-like dietary patterns were not associated with BP in either sex after adjusting for confounders. Positive relationships were observed between BP and body mass index (r=0.28 and 0.33 for SBP and DBP, P<0.001), waist circumference (r=0.51 and 0.45 for SBP and DBP, P<0.001), and waist-to-hip ratio (r=0.54 and 0.44 for SBP and DBP, P<0.001). Dietary energy and carbohydrates were positively and fats inversely associated with BP. Among micronutrients, vitamin E had a significant inverse association with BP.

Conclusion: Mediterranean-like dietary pattern may lower the risk of hypertension in Shiraz males.



Blood pressure, Dietary pattern, Mediterranean

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Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007; 49(1): 69-75.

World Health Organization. A Global Brief on Hypertension: Silent Killer, Global Public Health Crisis. World Health Day 2013. Accessed October 10, 2014.

O’Shaughnessy KM. Role of diet in hypertension management. Curr Hypertens Rep 2006; 8(4): 292-7.

McCartney DM, Byrne DG, Turner MJ. Dietary contributors to hypertension in adults reviewed. Ir J Med Sci 2015; 184(1): 81-90.

Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 2001; 73(1): 1-2.

Lin P-H, Allen JD, Li Y-J, Yu M, Lien LF, Svetkey LP. Blood pressure-lowering mechanisms of the DASH dietary pattern. J Nutr Metab 2012; 2012.

Esmaillzadeh A, Azadbakht L. Food intake patterns may explain the high prevalence of cardiovascular risk factors among Iranian women. J Nutr 2008; 138(8): 1469-75.

Haidari F, Shirbeigi E, Cheraghpour M, Mohammadshahi M. Association of dietary patterns with body mass index, waist circumference, and blood pressure in an adult population in Ahvaz, Iran. Saudi Med J 2014; 35(9): 967-74.

Hart E, Charkoudian N. Sympathetic neural regulation of blood pressure: influences of sex and aging. Physiology 2014; 29(1): 8-15.

Mostafavi H .Blood pressure distribution among people residing in the city of Shiraz. Sci Med J Ahwaz Uni Med Sci 1381; (33): 26-32. [Article in Persian]

Esmaillzadeh A, Azadbakht L. Major dietary patterns in relation to general obesity and central adiposity among Iranian women. J Nutr 2008; 138(2): 358-63.

Cho H-J, Khang Y-H. Family Affluence Scale, other socioeconomic position indicators, and self-rated health among South Korean adolescents: findings from the Korea Youth Risk Behavior Web-based Survey (KYRBWS). J Public Health 2010; 18(2): 169-78.

Lee PH, Macfarlane DJ, Lam T, Stewart SM. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic. Int J Behav Nutr Phys Act 2011; 8: 115.

World Health Organization. Measuring obesityclassification and description of anthropometric data. Report on a WHO consultation of the epidemiology of obesity. Warsaw 21-23 October 1987. Copenhagen: WHO, 1989. Nutrition Unit document, EUR/ICP/NUT. 1987; 123.

Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45(1): 142-61.

Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 2009; 20(2): 150-8.

Ghaffarpour M, Houshiar-Rad A, Kianfar H. [The manual for household measures, cooking yields factors and edible portion of foods.] Tehran, Iran: Keshaverzi Press, 1999: 1-46. (Article in Persian).

Sadakane A, Tsutsumi A, Gotoh T, Ishikawa S, Ojima T, Kario K, et al. Dietary patterns and levels of blood pressure and serum lipids in a Japanese population. J Epidemiol 2008; 18(2): 58-67.

Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004; 80(4): 1012-8.

Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Papadimitriou L, Stefanadis C, et al. Status and management of hypertension in Greece: role of the adoption of a Mediterranean diet: the Attica study. J Hypertens 2003; 21(8): 1483-9.

Kim MK, Kim K, Shin M-H, Shin DH, Lee Y-H, Chun B-Y, et al. The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older. Nutr Res Pract 2014; 8(4): 453-62.

Ferrara LA, Raimondi AS, d’Episcopo L, Guida L, Russo AD, Marotta T. Olive oil and reduced need for antihypertensive medications. Arch Intern Med 2000; 160(6): 837-42.

Houston MC, Harper KJ. Potassium, magnesium, and calcium: their role in both the cause and treatment of hypertension. J Clin Hypertens 2008; 10(7): 3-11.

Covas M-I. Olive oil and the cardiovascular system. Pharm Res 2007; 55(3): 175-86.

Wang S, Melnyk JP, Tsao R, Marcone MF. How natural dietary antioxidants in fruits, vegetables and legumes promote vascular health. Food Res Int 2011; 44(1): 14-22.

Gillum RF, Mussolino ME, Madans JH. Fish consumption and hypertension incidence in African Americans and whites: the NHANES I Epidemiologic Follow-up Study. J Nat Med Assoc 2001; 93(4): 124.

Massey LK. Dairy food consumption, blood pressure and stroke. J Nutr 2001; 131(7): 1875-8.

Champagne CM. Dietary interventions on blood pressure: the Dietary Approaches to Stop Hypertension (DASH) trials. Nutr Rev 2006; 64(suppl 1): S53-S6.

Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. New Eng J Med 1997; 336(16): 1117-24.

Trichopoulou A. From research to education: the Greek experience. Nutrition 2000; 16(7): 528-31.

Jiang J, Liu M, Parvez F, Wang B, Wu F, Eunus M, et al. Association of major dietary patterns and blood pressure longitudinal change in Bangladesh. J Hypertens 2015; 33(6): 1193-200.

Eilat-Adar S, Mete M, Fretts A, Fabsitz R, Handeland V, Lee E, et al. Dietary patterns and their association with cardiovascular risk factors in a population undergoing lifestyle changes: The Strong Heart Study. Nutr Metab Cardiovas Dis 2013; 23(6): 528-35.

Sun J, Buys NJ, Hills AP. Dietary pattern and its association with the prevalence of obesity, hypertension and other cardiovascular risk factors among Chinese older adults. Int J Environ Res Public Health 2014; 11(4): 3956-71.

Shin J-Y, Kim J-M, Kim Y. Associations between dietary patterns and hypertension among Korean adults: the Korean National Health and Nutrition Examination Survey (2008-2010). Nutr Res Pract 2013; 7(3): 224-32.

Wang L, Manson JE, Gaziano JM, Buring JE, Sesso HD. Fruit and vegetable intake and the risk of hypertension in middle-aged and older women. Am J Hypertens 2012; 25(2): 180-9.

Ortiz MC, Manriquez MC, Romero JC, Juncos LA. Antioxidants block angiotensin II-induced increases in blood pressure and endothelin. Hypertension 2001; 38(3): 655-9.

Lee S-A, Cai H, Yang G, Xu W-H, Zheng W, Li H, et al. Dietary patterns and blood pressure among middleaged and elderly Chinese men in Shanghai. Br J Nutr 2010; 104(02): 265-75.

Park J, Lee J-S, Kim J. Relationship between dietary sodium, potassium, and calcium, anthropometric indexes, and blood pressure in young and middle aged Korean adults. Nutr Res Pract 2010; 4(2): 155-62.

Davarian S, Crimmins E, Takahashi A, Saito Y. Sociodemographic correlates of four indices of blood pressure and hypertension among older persons in Japan. Gerontology 2013; 59(5).

Adedoyin RA, Mbada CE, Bisiriyu LA, Adebayo RA, Balogun MO, Akintomide AO. Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults. Int J General Med 2008; 1: 33.

Shah M, Adams-Huet B, Garg A. Effect of highcarbohydrate or high-cis-monounsaturated fat diets on blood pressure: a meta-analysis of intervention trials. Am J Clin Nutr 2007; 85(5): 1251-6.

Azzi A, Breyer I, Feher M, Pastori M, Ricciarelli R, Spycher S, et al. Specific cellular responses to α-tocopherol. J Nutr 2000; 130(7): 1649-52.

Chen J, He J, Hamm L, Batuman V, Whelton PK. Serum antioxidant vitamins and blood pressure in the United States population. Hypertension 2002; 40(6): 810-6.

Boshtam M, Rafiei M, Sadeghi K, Sarraf-Zadegan N. Vitamin E can reduce blood pressure in mild hypertensives. Int J Vit Nutr Res 2002; 72(5): 309-14.

Ward NC, Wu JH, Clarke MW, Puddey IB, Burke V, Croft KD, et al. The effect of vitamin E on blood pressure in individuals with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. J Hypertens 2007; 25(1): 227-34.

Hodgson JM, Croft KD, Woodman RJ, Puddey IB, Bondonno CP, Wu JH, et al. Effects of vitamin E, vitamin C and polyphenols on the rate of blood pressure variation: results of two randomized controlled trials. Br J Nutr 2014; 112(09): 1551-61.


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