Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population

Background:  The Dietary Approaches to Stop Hypertension (DASH) diet is widely promoted in the USA for the prevention and treatment of high blood pressure. It is high in fruit and vegetables, low-fat dairy and wholegrain foods and low in saturated fat and refined sugar. To our knowledge, the use of this dietary pattern has not been assessed in a free-living UK population.
Methods:  The DASH diet was adapted to fit UK food preferences and portion sizes. Fourteen healthy subjects followed the adapted DASH diet for 30 days in which they self-selected all food and beverages. Dietary intake was assessed by 5-day food diaries completed before and towards the end of the study. Blood pressure was measured at the beginning and end of the study to assess compliance to the DASH style diet.
Results:  The DASH diet was easily adapted to fit with UK food preferences. Furthermore, it was well tolerated and accepted by subjects. When on the DASH style diet, subjects reported consuming significantly ( P  <   0.01) more carbohydrate and protein and less total fat (5%, 6% and 9% total energy, respectively). Sodium intakes decreased by 860 mg day⁻¹ ( P  <   0.001). Systolic and diastolic blood pressure decreased significantly ( P  <   0.05) by 4.6 and 3.9 mmHg, respectively when on the DASH style diet.
Conclusions:  The DASH style diet was well accepted and was associated with a decrease in blood pressure in normotensive individuals and should be considered when giving dietary advice to people with elevated blood pressure in the UK.     

Dietary Interventions on Blood Pressure: The Dietary Approaches to Stop Hypertension (DASH) Trials

The Dietary Approaches to Stop Hypertension (DASH) diet may improve health in new ways other than the obviously beneficial cardiovascular effects. The DASH diet may also reduce the risk of some cancers, and the calcium in the dairy products would help to lower the risk of osteoporosis. One of the key things that has been promoted in the DASH studies is that it is made up of regular foods that are available at most grocery stores. Additionally, the DASH diet is consistent with many of the recommendations made by organizations in the United States: the Dietary Guidelines for Americans, the National Cholesterol Education Program's Step 2 Diet, and the National Cancer Institute.     

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and risk of Nonalcoholic Fatty Liver Disease

This case–control study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of Nonalcoholic Fatty Liver Disease (NAFLD) development in 102 patients with newly diagnosed NAFLD and 204 controls. Adherence to DASH-style diet was assessed using a validated food frequency questionnaire, and a DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. Participants in the top quartile of DASH diet score were 30% less likely to have NAFLD (OR: 0.0.70; 95%?CI: 0.61, 0.80); however, more adjustment for dyslipidemia and body mass index changed the association to non-significant (OR: 0.92; 95%?CI: 0.73, 1.12). In conclusion, we found an inverse relationship between the DASH-style diet and risk of NAFLD. Prospective studies are needed to confirm this association.     

Dietary Approaches to Stop Hypertension (DASH) intervention reduces blood pressure among hypertensive African American patients in a neighborhood health care center

The purpose of this study was to pilot-test DASH-Dinner with Your Nutritionist, a university-neighborhood health care center intervention to promote the Dietary Approaches to Stop Hypertension (DASH) diet. Study participants were low-income African American adults (N = 82) with poorly controlled blood pressure. Six groups, each consisting of 12 to 15 participants taking antihypertensive medications, met for 1 to 2 hours per week for 8 weeks. The intervention followed constructs of Social Cognitive Theory and featured dinners based on the DASH diet plan. Blood pressure was significantly lowered (P < .05) among participants who missed no more than 2 of 8 sessions. Extension of the DASH-Dinner model could improve blood pressure control among low-income hypertensive African Americans and reduce health disparities.     

Cumulative Exposure to Lead in Relation to Cognitive Function in Older Women

Background

Recent data indicate that chronic low-level exposure to lead is associated with accelerated declines in cognition in older age, but this has not been examined in women.

Objective

We examined biomarkers of lead exposure in relation to performance on a battery of cognitive tests among older women.

Methods

Patella and tibia bone lead—measures of cumulative exposure over many years—and blood lead, a measure of recent exposure, were assessed in 587 women 47–74 years of age. We assessed their cognitive function 5 years later using validated telephone interviews.

Results

Mean ± SD lead levels in tibia, patella, and blood were 10.5 ± 9.7 μg/g bone, 12.6 ± 11.6 μg/g bone, and 2.9 ± 1.9 μg/dL, respectively, consistent with community-level exposures. In multivariable-adjusted analyses of all cognitive tests combined, levels of all three lead biomarkers were associated with worse cognitive performance. The association between bone lead and letter fluency score differed dramatically from the other bone lead-cognitive score associations, and exclusion of this particular score from the combined analyses strengthened the associations between bone lead and cognitive performance. Results were statistically significant only for tibia lead: one SD increase in tibia lead corresponded to a 0.051-unit lower standardized summary cognitive score (95% confidence interval: −0.099 to −0.003; p = 0.04), similar to the difference in cognitive scores we observed between women who were 3 years apart in age.

Conclusions

These findings suggest that cumulative exposure to lead, even at low levels experienced in community settings, may have adverse consequences for women’s cognition in older age.     

Genome-Wide Association Analysis of Over 170,000 Individuals from the UK Biobank Identifies Seven Loci Associated with Dietary Approaches to Stop Hypertension (DASH) Diet

Diet is a modifiable risk factor for common chronic diseases and mental health disorders, and its effects are under partial genetic control. To estimate the impact of diet on individual health, most epidemiological and genetic studies have focused on individual aspects of dietary intake. However, analysing individual food groups in isolation does not capture the complexity of the whole diet pattern. Dietary indices enable a holistic estimation of diet and account for the intercorrelations between food and nutrients. In this study we performed the first ever genome-wide association study (GWA) including 173,701 individuals from the UK Biobank to identify genetic variants associated with the Dietary Approaches to Stop Hypertension (DASH) diet. DASH was calculated using the 24 h-recall questionnaire collected by UK Biobank. The GWA was performed using a linear mixed model implemented in BOLT-LMM. We identified seven independent single-nucleotide polymorphisms (SNPs) associated with DASH. Significant genetic correlations were observed between DASH and several educational traits with a significant enrichment for genes involved in the AMP-dependent protein kinase (AMPK) activation that controls the appetite by regulating the signalling in the hypothalamus. The colocalization analysis implicates genes involved in body mass index (BMI)/obesity and neuroticism (ARPP21, RP11-62H7.2, MFHAS1, RHEBL1). The Mendelian randomisation analysis suggested that increased DASH score, which reflect a healthy diet style, is causal of lower glucose, and insulin levels. These findings further our knowledge of the pathways underlying the relationship between diet and health outcomes. They may have significant implications for global public health and provide future dietary recommendations for the prevention of common chronic diseases.     

Urine and Plasma Metabolome of Healthy Adults Consuming the DASH (Dietary Approaches to Stop Hypertension) Diet: A Randomized Pilot Feeding Study

We aimed to identify plasma and urine metabolites altered by the Dietary Approaches to Stop Hypertension (DASH) diet in a post-hoc analysis of a pilot feeding trial. Twenty adult participants with un-medicated hypertension consumed a Control diet for one week followed by 2 weeks of random assignment to either Control or DASH diet. Non-missing fasting plasma (n = 56) and 24-h urine (n = 40) were used to profile metabolites using untargeted gas chromatography/mass spectrometry. Linear models were used to compare metabolite levels between the groups. In urine, 19 identifiable untargeted metabolites differed between groups at p < 0.05. These included a variety of phenolic acids and their microbial metabolites that were higher during the DASH diet, with many at false discovery rate (FDR) adjusted p < 0.2. In plasma, eight identifiable untargeted metabolites were different at p < 0.05, but only gamma-tocopherol was significantly lower on DASH at FDR adjusted p < 0.2. The results provide insights into the mechanisms of benefit of the DASH diet.     

Association of Healthy Eating Index-2015 and Dietary Approaches to Stop Hypertension Patterns with Insulin Resistance in Schoolchildren

Background: Diet quality patterns are associated with a lower incidence of insulin resistance (IR) in adults. The aim of this study was to investigate the association between two diet quality indices and IR in schoolchildren and to identify the best diet quality index associated with a lower risk of IR. Methods: A total of 854 schoolchildren (8–13 years) were included in a cross-sectional study, who completed a three-day dietary record to assess their diet. Fasting plasma glucose and insulin were also measured, and anthropometric data were collected. Healthy Eating Index-2015 (HEI-2015), Dietary Approaches to Stop Hypertension (DASH), and adjusted DASH (aDASH) were calculated as diet quality indices. The homeostasis model assessment of insulin resistance (HOMA-IR) was used, and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.5%, and it was higher in girls. The mean HEI-2015 and DASH scores were 59.3 and 23.4, respectively, and boys scored lower in both indices. In girls, having a HEI-2015 score above the 33rd percentile was associated with a lower risk of IR (odds ratio [95% CI]: 0.43 [0.19–0.96], p = 0.020). Conclusion: Greater adherence to a healthy dietary pattern, as assessed by a higher HEI-2015 score, was associated with a lower risk of IR in schoolchildren, especially in girls.     

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: A Second Update of a Systematic Review and Meta-Analysis of Cohort Studies

BackgroundSuboptimal diet quality has a large impact on noncommunicable disease burden.ObjectiveThis study aimed to update the body of evidence on the associations between diet quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and the Dietary Approaches to Stop Hypertension score, and health status. Moreover, results of the previous systematic reviews and meta-analyses were extended by evaluating the credibility of the evidence.MethodsPubMed, Embase, and Scopus databases were searched to identify eligible studies published between May 15, 2017 and March 14, 2020. Pooled relative risk (RR) with 95% CI for highest vs lowest category of diet quality were estimated using a random-effects model. Heterogeneity was explored using Cochran's Q test and I² statistic with 95% CI. Presence of publication bias was detected by using funnel plots and Egger's regression test. The NutriGrade tool was used to assess the credibility of evidence.ResultsThe current update identified 47 new reports, resulting in a total of 113 reports including data from 3,277,684 participants. Diets of the highest quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores, were inversely associated with risk of all-cause mortality (RR 0.80, 95% CI 0.79 to 0.82, I² = 68%, n= 23), cardiovascular disease incidence or mortality (RR 0.80, 95% CI 0.78 to 0.82, I² = 59%, n= 45), cancer incidence or mortality (RR 0.86, 95% CI 0.84 to 0.89, I² = 73%, n= 45), incidence of type 2 diabetes (RR 0.81, 95% CI 0.78 to 0.85, I² = 76%, n= 16), and incidence of neurodegenerative diseases (RR 0.82, 95% CI 0.75 to 0.89, I² = 71%, n= 12). In cancer survivors, the highest diet quality was linked with lower risk of all-cause (RR 0.83, 95% CI 0.77 to 0.88, I² = 45%, n= 12) and cancer mortality (RR 0.82, 95% CI 0.75 to 0.89, I² = 44%, n= 12). The credibility of evidence for identified associations between overall healthy dietary patterns and included health outcomes was moderate.ConclusionThis updated systematic review and meta-analysis suggests that high diet quality (assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension) is inversely associated with risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or mortality, type 2 diabetes, and neurodegenerative disease, as well as all-cause mortality and cancer mortality among cancer survivors. Moderate credibility of evidence for identified associations complements the recent 2020 Dietary Guidelines Advisory Committee report recommending healthy dietary patterns for disease prevention.     

Adherence to the Dietary Approaches to Stop Hypertension eating plan in candidates awaiting coronary artery bypass graft surgery,Tehran, Iran

Aims: Hypertension (HTN) is a major risk factor for cardiovascular disease. We evaluated the degree of adherence to ‘Dietary Approaches to Stop Hypertension’ (DASH) diet in hypertensive (H) and normotensive (N) candidates awaiting coronary artery bypass graft surgery. Methods: This was a cross‐sectional study on 417 coronary artery bypass graft candidates (219 normotensives and 198 hypertensives) hospitalised at a large heart centre. We created an adherence score to a DASH eating plan using food intake assessed via food frequency questionnaire. Results: Diet score categories were specified as 0–5.4 (weak adherence), 5.5–7.4 (moderate adherence) and 7.5–10 (excellent adherence). Only 28% of all the participants were in the top score category. The mean of scores were not different between N and H groups (6.5 ± 1.2 vs 6.5 ± 1.2, P= 0.757). Regardless of HTN status, smokers had lower scores than non‐smokers (P= 0.023) and diabetics had higher scores than non‐diabetics (P= 0.045). The majority of participants met the goal for servings of meat followed by servings of vegetable and percent of energy from fat (87%, 81% and 71%, respectively). However, 68% of participants did not meet the sweet target and 49% of H patients did not reach the sodium intake recommendations. H patients consumed significantly lower sodium and sweets than N patients (P= 0.01 and P < 0.001, respectively). Conclusions: Our results indicate moderate adherence to the DASH diet among candidates awaiting coronary artery bypass graft in both H and N patients. The adherence was lower among smokers and non‐diabetic patients.     

The Effect of a Digital Behavioral Weight Loss Intervention on Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Medically Vulnerable Primary Care Patients: Results from a Randomized Controlled Trial

Background

Obesity treatment focuses primarily on reducing overall caloric intake with limited focus on improving diet quality. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is effective in managing hypertension and other chronic conditions, yet it is not clear whether behavioral weight control interventions improve DASH adherence. We conducted a post hoc analysis of a behavioral weight loss intervention that did not emphasize diet quality and examined whether the intervention impacted DASH adherence in medically vulnerable community health center patients.

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies

Background

Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases.

Consistency with the Dietary Approaches to Stop Hypertension Diet among Adults with Diabetes

Few studies have documented whether the dietary patterns of adults with diabetes are similar to the Dietary Approaches to Stop Hypertension (DASH) diet. Our objective was to determine differences in the degree of consistency with the DASH diet among adults with self-reported diabetes (with and without self-reported high blood pressure) compared with those without either disease. It was a cross-sectional study using data from 5,867 nonpregnant, noninstitutionalized adults aged ≥20 years with two reliable 24-hour recall dietary interviews in the National Health and Nutrition Examination Survey during 2003-2004 and 2005-2006. Diabetes and hypertension status were obtained from a questionnaire, and degree of consistency with the DASH diet was calculated based on nine nutrient targets (0- to 9-point DASH score). Multiple linear regression (adjusting for age, energy intake, and other covariates such as education, race, and body mass index) was performed to compare mean DASH scores and mean nutrient intakes among adults with diabetes, with and without high blood pressure, to those without either disease. No statistically significant differences were seen in mean DASH score among the three groups in the unadjusted or fully adjusted multivariable models. Compared with adults without either disease, those with only diabetes had higher intakes of fiber (8.1 g/1,000 kcal vs 7.6 g/1,000 kcal; P=0.02) and total fat as a percentage of total energy (35.3% vs 34.1%; P=0.006), and those with both diabetes and hypertension had higher sodium intake (153.0% of DASH target vs 146.6%; P=0.04). This information about individual nutrients could help guide the development of education programs.     

Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on the Metabolic Side Effects of Corticosteroid Medications

Objective: We aimed to determine the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the metabolic side effects of corticosteroid medication use.

Design: A randomized clinical trial was undertaken in 60 patients on corticosteroid therapy for 10 weeks. Patients were randomly assigned to a DASH or control diet. Carbohydrate, protein, and fat in both groups were 50–60%, 15–20%, 30%, respectively. DASH diet was a diet rich in fruits, vegetables, whole grains, low-fat dairy products, and low in total and saturated fat and cholesterol, refined grains, and also sweets. Fasting blood samples were collected to determine blood glucose and lipid profile. Blood pressure and anthropometric measurements were measured based on the standard guidelines.

Results: The mean age and body mass index (BMI) were 31.1 ± 3.6 year and 26.9 ± 2.6 kg/m², respectively. There were no significant differences between age and BMI in two groups at baseline. No significant difference was observed in body weight and waist circumference following the DASH diet compared to control diet. Systolic and diastolic blood pressures were significantly different following the DASH eating pattern (P = 0.04). Serum total cholesterol and fasting blood glucose significantly decreased in those following the DASH diet after adjustment for potential confounders.

Conclusion: The DASH diet had beneficial effects on several metabolic side effects among patients using corticosteroid medications.     

Adherence to Dietary Approaches to Stop Hypertension (DASH)-Style Diet and the Risk of Cancer: A Systematic Review and Meta-Analysis of Cohort Studies

Abstract

Objective: Several investigators have proposed a protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have had inconsistent results. The present study aimed to systematically review the prospective cohort studies and if possible quantify the overall effect using meta-analysis.

Methods: PubMed, Scopus, and Google Scholar were searched for cohort studies published up to July 2018. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. The random effects model was used to combine the RRs.

Results: Seventeen studies were eligible to be included in the systematic review, from which nine reports assessed the association between the DASH diet and risk of mortality from all cancer types, four assessed incidence of colorectal cancer, and two studies assessed the risk of colon and rectal cancer separately. Four studies examined the association with the incidence of other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high adherence to DASH is associated with a decreased mortality from all cancer types (RR = 0.84, 95% confidence interval [95%CI]: 0.81–0.86). Participants with the highest adherence to the DASH diet had a lower risk of developing colorectal (RR = 0.79, 95%CI: 0.75–0.83), colon (RR = 0.80, 95%CI: 0.74–0.87), and rectal (RR = 0.84, 95%CI: 0.74–0.96) cancers compared to those with the lowest adherence.

Conclusion: DASH-style diet should be suggested as a healthy approach associated with decreased risk of cancer in the community. Prospective studies exploring the association for other cancer types and from regions other than the United States are highly recommended.