Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Yin Ruixing, MD: Guangxi Medical University (GMU) Wu Jinzhen, MB: GMU Huang Yaoheng, MB: Baxu Health Station Tan Jing, MB: Nandan County People’s Hospital Wu Hai, MS: GMU Li Muyan, MB: GMU Li Yiyang, MD: GMU Fei Dongmei, MS: GMU Yang Hanjun, MB: Health Bureau of Nandan County Chen Yuming, MS: GMU JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing, Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Background There are fifty-six ethnic groups in China. Han is the largest group and Bai Ku Yao is the isolated subgroup of the Yao minority. Little is known about the difference in the prevalence of hyperlipidemia between the Han and other minority groups in the rural areas. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Objective The aim of this study was to compare the associations of diet and lifestyle factors with hyperlipidemia for the middle-aged and elderly between the Guangxi Bai Ku Yao and Han populations. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Design This is a cross-sectional study. A total of 485 subjects of Bai Ku Yao and 501 subjects of Han Chinese aged 40 and older were surveyed by a stratified cluster random sampling technique. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Methods Information on demography, dietary intake, and lifestyle factors was collected by standard questionnaires. Blood pressure, height, weight, waist circumference, and serum lipids were measured, and body mass index (BMI) was calculated JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Results The prevalence rates of hypercholesterolemia, hypertriglyceridemia, and hyperlipidemia in Bai Ku Yao and Han were 19.59% vs. 36.13% (P<0.001), 13.81% vs. 16.97% (P>0.05), and 28.45% vs. 43.11% (P<0.001); respectively. Hyperlipidemia was positively correlated with BMI, waist circumference, total energy, total fat, and saturated fatty acids intakes, and negatively associated with sex (female is higher), physical activity and total dietary fiber intake in Bai Ku Yao (P<0.05–0.001), whereas positively associated with BMI, waist circumference, total energy, total fat, and saturated fatty acids intakes, and negatively associated with physical activity and total dietary fiber intake in Han (P<0.05–0.001). JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Conclusions The prevalence of hyperlipidemia was significantly lower in Bai Ku Yao than in Han, which might mainly attribute to the more favorable dietary patterns, lifestyle choices, and physical activity levels in the former ethnic group. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Demographic, dietary and lifestyle characteristics between Bai Ku Yao and Han Characteristics Bai Ku Yao (N = 485) Han Chinese (N = 501) Age (years) 54.24±10.87 54.55±10.94 Male/female 265/220 261/240 Education level (years) 3.13±2.33 4.56±2.68*** Physical activity (h/week) 47.36±13.22 45.13±12.58** Height (cm) 151.72±7.17 154.02±8.08*** Weight (kg) 51.18±7.41 53.94±9.30*** Body mass index (kg/m2) 22.19±2.49 22.66±2.89** >24 kg/m2 [n(%)] 102 (21.03) 132 (26.35)* Waist circumference (cm) 71.47±7.15 74.38±8.23*** Systolic blood pressure (mmHg) 123.21±18.24 127.25±17.9*** Diastolic blood pressure (mmHg) 77.04±10.12 79.19±11.14** Pulse pressure (mmHg) 46.17±13.74 48.06±12.63* Hypertensive prevalence [n(%)] 106 (21.86) 145 (28.94)* Alcohol consumption [n(%)] 236 (48.66) 242 (48.30) <25 g/day 143(60.59) 136(56.20) 25–49 g/day 28(11.86) 50(20.66) ***P<0.001, **P<0.01 and *P<0.05 in comparison with the same subgroup of Bai Ku Yao JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Demographic, dietary and lifestyle characteristics between Bai Ku Yao and Han (cont’d) Characteristics Bai Ku Yao (N = 485) Han Chinese (N = 501) 59–99 g/day 49(20.76) 45(18.60) ≥100 g/day 16(6.78) 11(4.55) (g/day) 27.70±6.13 29.03±5.37* Cigarette smoking [n(%)] 147 (30.31) 169 (33.73) Energy (kcal/day) 2089.64±85.36 2121.28±89.91*** Fat (% of energy) 10.2±2.3 13.5±3.4*** Carbohydrate (% of energy) 75.7±8.5 68.5±7.8*** Protein (% of energy) 9.6±2.2 12.3±3.1*** Alcohol (% of energy) 4.5±1.8 5.7±2.2*** Carbohydrate (g/day) 395.56±18.76 363.36±16.59*** Protein (g/day) 50.16±3.82 65.24±4.74*** Animal (%) 28.3±2.6 35.5±3.4*** Plant (%) 71.7±4.3 64.5±3.8*** Total fat (g/day) 23.69±3.85 31.83±4.36*** Saturated (g/day) 6.35±2.26 8.78±2.87*** Monounsaturated (g/day) 7.78±2.38 10.37±3.42*** Polyunsaturated (g/day) 9.56±3.24 12.68±4.73*** Dietary cholesterol (mg/day) 181.26±106.45 199.22±110.77** Total dietary fiber (g/day) 9.76±3.26 8.13±2.18*** Sodium intake (g/day) 6.88±2.16 7.69±2.43*** 1 kcal = 4.186 kJ ***P<0.001, **P<0.01 and *P<0.05 in comparison with the same subgroup of Bai Ku Yao JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Prevalence of unfavorable cardiovascular risk factor levels in the Bai Ku Yao and Han populations and in subgroups [n(%)] TC = total cholesterol; TG = triglyceride; LDL-C = low-density lipoprotein cholesterol; Apo A1 = apolipoprotein A1; Apo B = apolipoprotein B; HDL-C = high-density lipoprotein cholesterol; Apo A1/B = the ratio of apolipoprotein A1 to apolipoprotein B; BMI = body mass index; WC = waist circumference; *P ***P < 0.001, **P < 0.01 and *P < 0.05 in comparison with men, BMI≤24 (kg/m2), WC (lower), normotensive, no drinking, or nonsmoker of the same ethnic group; a P < 0.001, b P < 0.01 and c P < 0.05 in in comparison with the same subgroup of Bai Ku Yao Characteristics n TC>199.92 mg/dl TG> 150.57 LDL-C> 123.74 Apo A1 <1.0 g/L Apo B >1.14 g/L HDL-C> 69.99 Apo A1/Apo B >2.50 Bai Ku Yao 485 95(19.59) 67(13.81) 51(10.52) 41(8.45) 178(36.70) 47(9.69) Men 265 47(17.74) 17(6.42) 52(19.62) 30(11.32) 20(7.55) 77(29.06) 10(3.77) Women 220 48(21.82) 50(22.73)*** 43(19.55) 21(9.55) 101(45.91)*** 37(16.82)*** BMI≤24 (kg/m2) 383 64(16.71) 44(11.49) 67(17.49) 43(11.23) 30(7.83) 142(37.08) 39(10.18) BMI>24 (kg/m2) 102 31(30.39)** 23(22.55)** 28(27.45)* 8(7.84) 11(10.78) 36(35.29) WC (lower) 357 53(14.85) 40(11.20) 58(16.25) 39(10.92) 24(6.72) 136(38.10) WC (higher) 128 42(32.81)*** 27(21.09)** 37(28.91)** 12(9.38) 17(13.28)* 42(32.81) 8(6.25) Normotensive 379 70(18.47) 43(11.35) 45(11.87) 30(7.92) 140(36.94) 34(8.97) Hypertensive 106 25(23.58) 24(22.64)** 6(5.66) 11(10.38) 38(35.85) 13(12.26) No drinking 249 42(16.87) 16(6.43) 50(20.08) 34(13.65) 20(8.03) 73(29.32) 8(3.21) Alcohol intake 236 53(22.46) 51(21.61)*** 45(19.07) 17(7.20)* 21(8.90) 105(44.49)*** 39(16.53)*** Nonsmoker 338 65(19.23) 36(10.65) 35(10.36) 28(8.28) 110(32.54) 26(7.69) Cigarette smoking 147 30(20.41) 31(21.09)** 16(10.88) 13(8.84) 68(46.26)** 21(14.29)* Age 40–49 210 42(20.00) 34(16.19) 20(9.52) 16(7.62) 83(39.52) 22(10.48) 50–59 139 30(21.58) 15(10.79) 32(23.02) 17(12.23) 13(9.35) 50(35.97) 12(8.63) ≥60 136 23(16.91) 18(13.24) 21(15.44) 14(10.29) 12(8.82) 45(33.09) 13(9.56) Χ2 for 3 age subgroups – 0.992 2.101 2.548 0.661 0.358 1.516 0.328 P for 3 age subgroups 0.609 0.350 0.280 0.719 0.836 0.469 0.849 TC, HDL-C and LDL-C: 1 mmol/L=38.67 mg/dl; TG: 1 mmol/L=88.57 JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Prevalence of unfavorable cardiovascular risk factor levels in the Bai Ku Yao and Han populations and in subgroups [n(%)] (cont’d) Characteristics n TC>199.92 mg/dl TG> 150.57 LDL-C> 123.74 Apo A1 <1.0 g/L Apo B >1.14 g/L HDL-C> 69.99 Apo A1/Apo B >2.50 Han Chinese 501 181(36.13)a 85(16.97) 116(23.15) 2(0.40)a 93(18.56)a 311(62.08)a 26(5.19)b Men 261 92(35.25)a 52(19.92)a 57(21.84) 1(0.38)a 44(16.86)a 152(58.24)a 13(4.98) Women 240 89(37.08)a 33(13.75)c 59(24.58) 1(0.42)a 49(20.42)a 159(66.25)a 13(5.42)a BMI≤24 (kg/m2) 369 115(31.17)a 49(13.28) 69(18.70) 1(0.27)a 59(15.99)a 243(65.85)a 23(6.23) BMI>24 (kg/m2) 132 66(50.00)***b 36(27.27)*** 47(35.61)*** 1(0.76)c 34(25.76)*a 68(51.52)**a 3(2.27) WC (lower) 343 98(28.57)a 44(12.83) 61(17.78) 1(0.29)a 52(15.16)a 234(68.22)a 21(6.12)c WC (higher) 158 83(52.53)***a 41(25.95)*** 55(34.81)*** 1(0.63)a 41(25.95)**b 77(48.73)***b 5(3.16) Normotensive 356 120(33.71)a 54(15.17) 77(21.63) 1(0.28)a 59(16.57)a 226(63.48)a 15(4.21) Hypertensive 145 61(42.07)b 31(21.38) 39(26.90) 1(0.69)c 34(23.45)a 85(58.62)a 11(7.59) No drinking 259 100(38.61)a 43(16.60)a 75(28.96)c 0a 53(20.46)a 157(60.62)a 14(5.41) Alcohol intake 242 81(33.47)b 42(17.36) 41(16.94)** 2(0.83)a 40(16.53)c 154(63.64)a 12(4.96)a Nonsmoker 332 131(39.46)a 51(15.36) 90(27.11)c 1(0.30)a 70(21.08)a 214(64.46)a 13(3.92) Cigarette smoking 169 50(29.59)* 34(20.12) 26(15.38)** 1(0.59)a 23(13.61)* 97(57.40)a 13(7.69) Age 40–49 208 79(37.98)a 41(19.71) 51(24.52) 1(0.48)a 38(18.27)b 130(62.50)a 11(5.29)c 50–59 139 52(37.41)b 22(15.83) 40(28.78) 30(21.58)b 87(62.59)a 7(5.04) ≥60 164 50(30.49)b 22(13.41) 25(15.24) 1(0.61)a 94(57.32)a 8(4.88) Χ 2 for 3 age subgroups – 2.581 2.712 8.514 0.789 2.032 1.274 0.033 P for 3 age subgroups 0.275 0.258 0.014 0.674 0.362 0.529 0.984 TC = total cholesterol; TG = triglyceride; LDL-C = low-density lipoprotein cholesterol; Apo A1 = apolipoprotein A1; Apo B = apolipoprotein B; HDL-C = high-density lipoprotein cholesterol; Apo A1/B = the ratio of apolipoprotein A1 to apolipoprotein B; BMI = body mass index; WC = waist circumference; *P ***P < 0.001, **P < 0.01 and *P < 0.05 in comparison with men, BMI≤24 (kg/m2), WC (lower), normotensive, no drinking, or nonsmoker of the same ethnic group; a P < 0.001, b P < 0.01 and c P < 0.05 in in comparison with the same subgroup of Bai Ku Yao TC, HDL-C and LDL-C: 1 mmol/L=38.67 mg/dl; TG: 1 mmol/L=88.57 JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Correlation of hyperlipidemia with demographic, dietary and lifestyle factors between Bai Ku Yao and Han Populations Risk factors Regression coefficient Standard error Wald P OR 95%CI Han plus Bai Ethnic group 0.589 0.138 18.120 0.000 1.802 1.374–2.363 Sex 0.329 0.183 3.240 0.072 1.389 0.971–1.987 Age –0.095 0.069 1.909 0.167 0.910 0.795–1.040 Education level –0.121 0.054 0.005 0.988 1.016 0.913–1.417 Physical activity –0.211 0.068 8.421 1.229 1.032–2.447 Cigarette smoking –0.008 0.070 0.014 0.907 0.992 0.864–1.138 Alcohol consumption 0.021 0.071 0.090 0.764 1.022 0.889–1.174 Body mass index 0.685 0.159 18.560 1.984 1.453–2.710 Waist circumference 0.555 0.224 5.576 0.017 1.742 1.314–2.159 Hypertension 0.375 0.160 5.477 0.019 1.455 1.063–1.991 Total energy 0.489 0.188 7.174 0.008 1.635 1.266–2.396 Total fat 0.331 0.155 5.113 0.028 1.412 1.118–1.643 Saturated fatty acids 0.591 10.777 0.002 1.809 1.322–2.614 Dietary cholesterol 0.142 0.152 1.324 0.338 0.876 0.916–1.435 Total dietary fiber –0.298 0.122 5.886 0.023 0.978 1.058–2.379 JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Correlation of hyperlipidemia with demographic, dietary and lifestyle factors between Bai Ku Yao and Han (cont’d) Populations Risk factors Regression coefficient Standard error Wald P OR 95%CI Han Chinese Sex 0.106 0.236 0.202 0.653 1.112 0.700–1.766 Age –0.101 0.090 1.529 0.262 0.904 0.758–1.078 Education level –0.039 0.031 0.232 0.652 1.012 0.782–1.133 Physical activity –0.161 0.088 4.832 1.214 1.015–2.381 Cigarette smoking –0.041 0.093 0.196 0.658 0.960 0.799–1.152 Alcohol consumption –0.076 0.096 0.638 0.424 0.926 0.768–1.117 Body mass index 0.719 0.212 11.517 0.001 2.052 1.355–3.107 Waist circumference 0.667 0.221 9.767 0.003 1.978 1.212–2.775 Hypertension 0.378 0.209 3.273 0.070 1.459 0.969–2.198 Total energy 0.615 0.258 7.846 0.006 1.897 1.533–2.454 Total fat 0.535 0.276 5.112 1.772 1.213–2.285 Saturated fatty acids 0.692 0.285 6.112 0.013 2.002 1.317–2.321 Dietary cholesterol 0.126 0.078 1.121 0.542 0.979 0.912–1.124 Total dietary fiber –0.242 0.073 6.221 0.018 1.245 1.033–2.078 JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008

and Elderly in the Guangxi Bai Ku Yao and Han Populations Associations of Diet and Lifestyle with Hyperlipidemia for the Middle-Aged and Elderly in the Guangxi Bai Ku Yao and Han Populations Correlation of hyperlipidemia with demographic, dietary and lifestyle factors between Bai Ku Yao and Han (cont’d) Populations Risk factors Regression coefficient Standard error Wald P OR 95%CI Bai Ku Yao Sex –0.636 0.289 4.856 0.028 1.890 1.073–3.328 Age –0.088 0.107 0.677 0.411 0.916 0.743–1.129 Education level –0.035 0.030 0.114 0.753 1.031 0.774–1.121 Physical activity –0.296 0.121 6.762 0.013 1.315 1.238–2.269 Cigarette smoking 0.009 0.105 0.007 0.934 1.009 0.820–1.240 Alcohol consumption 0.102 0.106 0.927 0.336 1.018 0.899–1.365 Body mass index 0.635 0.247 6.630 0.010 1.887 1.164–3.058 Waist circumference 0.646 0.172 11.930 0.001 1.995 1.273–3.317 Hypertension 0.407 0.253 2.590 0.108 1.502 0.915–2.464 Total energy 0.521 4.674 0.038 1.696 1.068–2.312 Total fat 0.373 0.142 7.125 1.458 1.326–2.784 Saturated fatty acids 0.528 0.239 4.983 0.024 1.701 1.317–2.574 Dietary cholesterol 0.088 0.045 0.326 0.668 0.875 0.867–1.142 Total dietary fiber –0.332 0.156 6.453 0.011 1.575 1.231–2.698 JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Ruixing Y, et al. J Am Diet Assoc. 108 (6), June 2008