Abstract
Household air pollution (HAP) from solid cooking fuels continues to affect 600 million people in China and has been associated with high blood pressure. The role of diet in HAP-associated high blood pressure has yet to be evaluated in China. The aim of this study was to estimate the impact of cooking fuel on change in blood pressure and evaluate whether intake of antioxidant- and omega-3 fatty acid-rich foods (fruits, vegetables, and seafood) attenuates any adverse effects of solid fuel use on blood pressure. We analyzed longitudinal data collected between 1991 and 2011 from nonpregnant women aged 18 to 80 years living in rural areas of China. We used linear mixed effects models to estimate the association between cooking fuel (coal or wood versus clean [electric or liquid petroleum gas]) and blood pressure. Possible mediation of the fuel effect by diet was assessed by the difference method. A total of 6671 women were included in this study. Women less than 40 years of age cooking with cleaner fuels over time had lower rates of change in systolic blood pressure compared to women cooking with coal (p = 0.004), and this effect was not mediated by dietary intake. Associations between fuel use and change in diastolic blood pressure were not significant. These findings lend further support for there being a direct effect of reducing HAP on improvements in blood pressure, independent of concurrent dietary intake.
Highlights
In 2016, an estimated 2.6 million premature deaths worldwide were attributable to household air pollution (HAP) [1,2,3]
This study was limited to nonpregnant women aged 18 to
Data from over 20 years of observation in this prospective cohort show that women in rural China increasingly cooked with cleaner fuels (LPG or electric), especially those with higher socio-economic status
Summary
In 2016, an estimated 2.6 million premature deaths worldwide were attributable to household air pollution (HAP) [1,2,3]. The underlying biological mechanism linking HAP exposure to CVD may involve the promotion of oxidative stress pathways by fine particulate matter less than 2.5 μm in diameter (PM2.5 ), which in turn leads to vasoconstriction, thereby increasing blood pressure—an important CVD risk factor [6]. Both cross-sectional and longitudinal observational studies have reported a significant positive association between HAP and blood pressure in China [7,8,9,10,11].
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