Nutritional risk factors for the development of hypertension in diabetic patients Fatma Celik a, ⁎ , Murat Celik b , Veysi Akpolat c a Nutrition and Dietetics Division, Hospital of Dicle University, 21280 Diyarbakir, Turkey b Division of Internal Diseases, State Hospital of Nusaybin, 47300 Nusaybin/Mardin, Turkey c Department of Biophysics, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey Received 24 October 2007; received in revised form 13 January 2008; accepted 9 February 2008 Abstract The aim of this cross-sectional study was to determine the significant limitations, sensitivity, specificity, partial correlations, and odds ratios of nutrient intake in patients with and without hypertension with Type 2 diabetes mellitus. Diabetic patients (n=220) with clinical diagnosis of hypertension and diabetic patients (n=230) without hypertension were included in this study. The questionnaire form included a list of 65 food items formed from five main food groups (grain, meat and alternatives, dairy products, vegetables–fruits and fat) and 25 dietary habits. When both groups were compared and analyzed by logistic regression, black tea consumption (OR=0.823, Pb.001), vegetables–fruits scores (OR=0.853, Pb.001), triglycerides (OR=0.726, Pb.05), waist-to-hip ratio (WHR) (OR=0.777, Pb.01) and high- density lipoprotein cholesterol (HDL-C) (OR=0.526, Pb .001) made significant differences. In ROC curves, the area under the curve of black tea (0.921), vegetables–fruits (0.906), triglycerides (0.889), WHR (0.881) and HDL-C (0.820) provided high accuracy to distinguish between patients with and without hypertension (Pb.001). In diabetic patients without hypertension, significant partial correlations were observed between blood pressure and dairy products (systolic: r =)0.14; diastolic: r =)0.14, Pb.05), vegetables–fruits groups (systolic: r =)0.18; diastolic: r =)0.17, Pb.01) and black tea intake (systolic: r =)0.23; diastolic: r =)0.22, Pb.001). It has been found that higher intake of black tea and vegetables–fruits consumption in diabetic patients protect against developing hypertension. © 2009 Published by Elsevier Inc. Keywords: Diabetes; Hypertension; Vegetables; Black tea; ROC curve 1. Introduction In recent years, epidemiologic studies suggest that reducing risk factors for cardiovascular disease (CVD) is also of major importance for patients with diabetes (Harwell, Moore, McDowall, Helgerson, & Gohdes, 2003). Patients with Type 2 diabetes mellitus have a risk of death from cardiovascular causes that is two to six times that among persons without diabetes (Gaede et al., 2003). Adolescent obesity is also associated with the insulin resistance syndrome that includes hypertension and Type 2 diabetes. Obesity and hypertension are significantly linked (Calderon, Yucha & Schaffer, 2005). Obesity is a major underlying cause of the metabolic syndrome. The key components of the metabolic syndrome include abdominal obesity, hypertension, insulin resistance with or without glucose intolerance, or diabetes (Sarti & Gallagher, 2006). Increased body mass index (BMI) and/or waist/hip ratio (WHR) increases the risk of hypertension, and it has been found that waist circumference (WC) is positively associated with high blood pressure (BP) (Feldstein et al., 2005). Even though dietary habits can have a direct effect on blood pressure, lifestyle choices such as alcohol intake, cigarette smoking, physical activity, and obesity can profoundly impact blood pressure regulation (Tam et al., 2005). The JNC 7 report has advised four lifestyle changes for reducing Journal of Diabetes and Its Complications 23 (2009) 304 – 309 ⁎ Corresponding author. Tel.: +90 412 2488185; fax: +90 412 2488522. E-mail address: fcelik@dicle.edu.tr (F. Celik). WWW.JDCJOURNAL.COM 1056-8727/08/$ – see front matter © 2009 Published by Elsevier Inc. doi:10.1016/j.jdiacomp.2008.02.005