Dietary factors related to hypertension risk in Korean adults-data from the Korean national health and nutrition examination survey III

  • Lee, Jung-Sug (Cancer Epidemiology Branch, Research Institute, National Cancer Center) ;
  • Park, Ju-Yeon (Cancer Epidemiology Branch, Research Institute, National Cancer Center) ;
  • Kim, Jeong-Seon (Cancer Epidemiology Branch, Research Institute, National Cancer Center)
  • Received : 2010.07.12
  • Accepted : 2011.02.12
  • Published : 2011.02.28


Regional differences between large cities and rural areas are observed in the Korean National Health and Nutrition Examination Survey (KNHANES). This present study was conducted to evaluate the effect of dietary factors on hypertension risk in Korean populations, especially residents of the Chungcheong province which was not in metropolitan area, using KNHANES III. A total of 544 adults aged ${\geq}$ 19 years were placed into either the normotensive or the hypertensive group. Subject characteristics, BMI, blood pressure, and nutrient intakes were compared between the two groups using a chi-square test and t-test. We estimated odds ratios (ORs) using multiple logistic regression, adjusted for energy intake and selected covariates. There were significant differences in age, education level, alcohol consumption, and BMI between the normotensive and hypertensive groups. We found decreased ORs for the medium versus lowest tertile of calcium intake (multivariate OR=0.43, 95% CI: 0.21-0.88), for the highest versus lowest tertile of calcium intake (multivariate OR=0.43, 95% CI: 0.20-0.90) with significant trends in risk (P=0.040), and for the medium versus lowest tertile of potassium intake (multivariate OR=0.43, 95% CI: 0.20-0.89). Subjects with the highest sodium/calcium ratio had a 2.10-fold greater risk of hypertension compared to the subject with the lowest, with significant trends in risk (P=0.002). Adequate calcium and potassium intake should be encouraged and regional differences should be considered in making a healthy plan for hypertension management.


Supported by : National Cancer Center


  1. Singh RB, Suh IL, Singh VP, Chaithiraphan S, Laothavorn P, Sy RG, Babilonia NA, Rahman AR, Sheikh S, Tomlinson B, Sarraf-Zadigan N. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens 2000;14:749-63.
  2. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104:2746-53.
  3. Whitworth JA; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-92.
  4. KOSIS [Internet]. Death cause statistical data; 2009 [cited 2009 6 May]. Available from:
  5. Khor GL. Cardiovascular epidemiology in the Asia-Pacific region.. Asia Pac J Clin Nutr 2001;10:76-80.
  6. Vorster HH. The emergence of cardiovascular disease during urbanisation of Africans. Public Health Nutr 2002;5:239-43.
  7. Wu Y, Huxley R, Li L, Anna V, Xie G, Yao C, Woodward M, Li X, Chalmers J, Gao R, Kong L, Yang X; China NNHS Steering Committee; China NNHS Working Group. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation 2008;118:2679-86.
  8. Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health 2004;14:235-9.
  9. Han HR, Kim KB, Kang J, Jeong S, Kim EY, Kim MT. Knowledge, beliefs, and behaviors about hypertension control among middle-aged Korean Americans with hypertension. J Community Health 2007;32:324-42.
  10. Korean Ministry of Health and Welfare. The Korean National Health and Nutrition Examination Survey - KNHANES III(2005); 2006.
  11. Stamler J, Elliott P, Appel L, Chan Q, Buzzard M, Dennis B, Dyer AR, Elmer P, Greenland P, Jones D, Kesteloot H, Kuller L, Labarthe D, Liu K, Moag-Stahlberg A, Nichaman M, Okayama A, Okuda N, Robertson C, Rodriguez B, Stevens M, Ueshima H, Horn LV, Zhou B. Higher blood pressure in middle-aged American adults with less education-role of multiple dietary factors: the INTERMAP study. J Hum Hypertens 2003; 17:655-775.
  12. Sugiyama T, Xie D, Graham-Maar RC, Inoue K, Kobayashi Y, Stettler N. Dietary and lifestyle factors associated with blood pressure among U.S. adolescents. J Adolesc Health 2007;40: 166-72.
  13. Ruixing Y, Shangling P, Shuquan L, Dezhai Y, Weixiong L, Qiming F, Yuming C, Yaoheng H, Yijiang Z, Qinchen L. Comparison of hypertension and its risk factors between the Guangxi Bai Ku Yao and Han populations. Blood Press 2008;17:306-16.
  14. Mellen PB, Gao SK, Vitolins MZ, Goff DC Jr. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med 2008;168:308-14.
  15. Lin SJ, Lee KT, Lin KC, Cheng KH, Tsai WC, Sheu SH, Wu MT, Lee CH, Lai WT. Prevalence of prehypertension and associated risk factors in a rural Taiwanese adult population. Int J Cardiol 2010;144:269-73.
  16. Schroder H, Schmelz E, Marrugat J. Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr 2002;41:161-7.
  17. Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S, Julka S, Kumar A, Singh HK, Ramesh V, Bhatia E. Prevalence & risk factors of pre-hypertension & hypertension in an affluent north Indian population. Indian J Med Res 2008;128:712-20.
  18. Ikeda N, Gakidou E, Hasegawa T, Murray CJ. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986-2002. Bull World Health Organ 2008;86:978-88.
  19. Droyvold WB, Midthjell K, Nilsen TI, Holmen J. Change in body mass index and its impact on blood pressure: a prospective population study. Int J Obes (Lond) 2005;29:650-5.
  20. Cohen HW, Hailpern SM, Alderman MH. Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III). J Gen Intern Med 2008; 23:1297-302.
  21. The Korean Nutrition Society, Dietary reference intakes for Koreans 2005: The Korean Nutrition Society.
  22. He FJ, Marrero NM, Macgregor GA. Salt and blood pressure in children and adolescents. J Hum Hypertens 2008;22:4-11.
  23. Dickinson HO, Nicolson DJ, Campbell F, Beyer FR, Mason J. Potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev 2006;3: CD004641.
  24. Gao SK, Fitzpatrick AL, Psaty B, Jiang R, Post W, Cutler J, Maciejewski ML. Suboptimal nutritional intake for hypertension control in 4 ethnic groups. Arch Intern Med 2009;169:702-7.
  25. Townsend MS, Fulgoni VL 3rd, Stern JS, Adu-Afarwuah S, McCarron DA. Low mineral intake is associated with high systolic blood pressure in the Third and Fourth National Health and Nutrition Examination Surveys: could we all be right? Am J Hypertens 2005;18:261-9.
  26. Dickinson HO, Nicolson DJ, Cook JV, Campbell F, Beyer FR, Ford GA, Mason J. Calcium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev 2006;19:CD004639.
  27. van Mierlo LA, Arends LR, Streppel MT, Zeegers MP, Kok FJ, Grobbee DE, Geleijnse JM. Blood pressure response to calcium supplementation: a meta-analysis of randomized controlled trials. J Hum Hypertens 2006;20:571-80.
  28. Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension 2008;51:1073-9.

Cited by

  1. Salt Intake and Diabetes vol.13, pp.4, 2012,
  2. Dietary Intake Ratios of Calcium-to-Phosphorus and Sodium-to-Potassium Are Associated with Serum Lipid Levels in Healthy Korean Adults vol.17, pp.2, 2012,
  3. (Maca), a Plant from the Peruvian Highlands vol.2012, pp.1741-4288, 2012,
  4. Seven Dietary Minerals (Ca, P, Mg, Fe, Zn, Cu, and Mn) and Their Relationship with Blood Pressure and Blood Lipids in Healthy Adults with Self-Selected Diet vol.153, pp.1-3, 2013,
  5. Quality Characteristics of Low-Salt Kimchi with Salt Replaced by Salicornia herbacea L. Powder vol.28, pp.6, 2013,
  6. Sodium intake of a city population in Korea estimated by 24-h urine collection method vol.67, pp.8, 2013,
  7. Web-Based KNHANES System in Cloud Computing vol.17, pp.3, 2014,
  8. High Sodium Intake in Women with Metabolic Syndrome vol.44, pp.1, 2014,
  9. Investigation of variations in energy, macronutrients and sodium intake based on the places meals are provided: Using the Korea National Health and Nutrition Examination Survey (KNHANES, 1998-2009) vol.8, pp.1, 2014,
  10. Urinary sodium-to-potassium ratio: it may be SMART, but is it easy? vol.20, pp.04, 2017,
  11. Nutrients intake, and serum calcium and phosphorus levels: An evidence-based study pp.08878013, 2017,
  12. Association of Habitually Low Intake of Dietary Calcium with Blood Pressure and Hypertension in a Population with Predominantly Plant-Based Diets vol.10, pp.5, 2018,