Modifiable risk factors including sunlight exposure and fish consumption are associated with risk of hypertension in a large representative population from Macau.

Chinese populations are known to be at risk for vitamin D deficiency, with some evidence that this is due to lack of exposure to sunlight. Vitamin D deficiency and/or low sun exposure have been associated with higher incidence of hypertension in Caucasians. Thus, we investigated these associations in a Chinese population with a high rate of hypertension. From a random household survey of 1410 residents aged ≥18 years, height, weight and blood pressure were measured and demographic, exercise and dietary data were collected, as well as estimated hours of sunlight exposure on weekdays and weekends (in winter and summer). Modifiable predictors of hypertension in these data were lack of sunlight exposure and low intake of fish as well as smoking, obesity and lack of exercise. When investigated in a linear model, sunlight exposure was negatively associated with hypertension (β=-0.072, p<0.001) as was physical activity (β=-0.021, p<0.001) and fish consumption (β=-0.177, p<0.001). In contrast body mass index (weight/height(2)) was positively associated with hypertension (β=+0.62, p<0.001), as were pack-years of smoking (β=+0.27, p<0.001). On multivariate categorical analysis taking into account demographic risk factors in these data (age, gender and occupation) having more than half an hour's sun exposure per day compared to none was associated with less hypertension (OR=0.6, 95% CI: 0.4-0.8). Similarly, consuming either oily fish or seafood more than four times per week compared to less was also associated with less hypertension (oily fish (OR=0.4, 95% CI: 0.3-0.5); seafood consumption (OR=0.8, 95% CI: 0.7-0.9)). Having daily moderate physical activity compared to none was also associated with a lower risk of hypertension (OR=0.8, 95% CI: 0.7-0.9). In contrast, being obese compared to normal weight and having more than five pack-years of smoking compared to none were associated with a higher risk of hypertension (OR=4.6, 95% CI: 3.7-5.7; OR=1.4, 95% CI: 1.0-1.8, respectively). The major new findings of this study are that more sun exposure and high weekly fish consumption (especially oily fish) may be potentially modifiable independent factors for protecting against risk of hypertension in this population. This article is part of a Special Issue entitled '16th Vitamin D Workshop'.