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Gender-specific association between carbohydrate consumption and blood pressure in Chinese adults
  1. Ruru Liu1,2,
  2. Baibing Mi1,
  3. Yaling Zhao1,
  4. Qiang Li1,
  5. Shaonong Dang1 and
  6. Hong Yan1
  1. 1Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
  2. 2Department of Disinfection, Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi Province, China
  1. Correspondence to Dr Shaonong Dang, Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; tjdshn{at}


Background The association between dietary carbohydrate consumption and blood pressure (BP) is controversial. The present study aimed to evaluate the possible gender-specific association of carbohydrate across the whole BP distribution.

Method Cross-sectional survey including 2241 rural adults was conducted in northwestern China in 2010. BP was measured by trained medical personnel. Dietary information was collected by semiquantitative Food-Frequency Questionnaire. Multivariate quantile regression model was used to estimate the association between total carbohydrates consumption and systolic BP (SBP) and diastolic BP (DBP) at different quantiles. Gender-specific β coefficient and its 95% CI was calculated.

Results The average carbohydrate intake was 267.4 (SD 112.0) g/day in males and 204.9 (SD 90.7) g/day in females, with only 10.6% of males and 6.5% females consumed at least 65% of total energy from carbohydrates. And more than 80% carbohydrates were derived from refined grains. In females, increased total carbohydrates intake was associated with adverse SBP and DBP. An additional 50 g carbohydrates per day was positively associated with SBP at low and high quantiles (10th–20th and 60th–80th) and with DBP almost across whole distribution (30th–90th), after adjusting for age, fortune index, family history of hypertension, body mass index, physical activity level, alcohol intake and smoke, energy, two nutrient principal components, protein and sodium intake. Both relatively low and high carbohydrate intake were associated with increased SBP, with minimum level observed at 130–150 g carbohydrate intake per day from restricted cubic splines. However, no significant associations were observed in males.

Conclusions Higher total carbohydrates consumption might have an adverse impact on both SBP and DBP in Chinese females but not males. Additionally, the positive association varies across distribution of BP quantiles. Further research is warranted to validate these findings and clarify the causality.

  • blood pressure lowering
  • nutrition assessment

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  • Contributors All authors and our whole research group completed the study and acquired the data. RL and SD took responsibility for the study concept and design. RL and BM conducted the statistical analysis and drafted and finished the final manuscript. YZ, QL, SD and HY critically revised the manuscript for important intellectual content. SD and HY were responsible for the final approval of version to be published. All authors participated in the interpretation of the results and approved the final manuscript as submitted.

  • Funding This work was supported by the China Medical Board (Grant Number: 08-925), National Natural Science Foundation of China (Grant Number: 81230016) and National Key R&D Program of China (grant number: 2017YFC0907200, 2017YFC0907201).

  • Disclaimer The funding authority does not have roles in this study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Review Committee, School of Medicine, Xi’an Jiaotong University (Number: 2002001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement We are committed to maximising the use of our study data to advance knowledge to improve adult’s health. The datasets in present study are available from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.