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.     

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 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.     

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.     

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.     

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.

Better nutrient data improves public health: evidence and examples from the Dietary Approaches to Stop Hypertension (DASH) Trial

This keynote address opened the 26th National Nutrient Database Conference which had as its mission to look at the whole concept of Food Composition Databases: Important Tools for Improving Public Health. The specific purpose of this presentation was to present findings from a successful randomized clinical trial funded by the National Institutes of Health, National Heart, Lung, and Blood Institute of the United States to illustrate the integral use of a computerized nutrient database to generate the nutrient profile of the diets. These diets were subsequently chemically analyzed to verify the nutrient content. Obviously, the importance of quality food composition data, combined with the ease of use of the nutrient database software, lead to a timely execution of the study with reliable and accurate menus. Thus, this review focuses on the Dietary Approaches to Stop Hypertension Trial in illustrating how quality data and databases that contain that data can have implications on diet and health interactions. This paper provides an occasion to exemplify the value of better nutrient data and tools that can positively affect public health.     

The Dietary Approaches to Stop Hypertension Diet,Cognitive Function,and Cognitive Decline in American Older Women

Objectives

To examine the association between long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women.

Mediterranean Diet Adherence in Community-Dwelling Older Adults in Spain: Social Determinants Related to the Family

The Mediterranean diet (MD), a well-established quality diet model, and regular physical activity are associated with reducing the appearance or progression of several chronic diseases and reducing morbidity and mortality. However, reduction of these goals, adherence to the MD, and regular physical activity occur at all ages, including older individuals in Mediterranean countries such as Spain, where at least adherence to the MD is culturally rooted. Objective: To evaluate the degree of adherence to the MD and physical activity in older individuals. Methods: The sample comprises 679 older adults aged 60 and over who attended activities in municipal centers for older adults in Valencia. Adherence to the Mediterranean diet, frequency of physical activity, and anthropometric assessment were used. Results: High adherence (score ≥ 9) to MD was observed only in 23.7% of the study sample. Smoking habits or having meals in fast-food restaurants on a weekly basis were significantly (p < 0.05) associated with lower MD adherence. Age, BMI, marital status, and physical activity were not significantly associated with MD adherence. Physical activity was significantly (p < 0.05) lower in individuals who were divorced or widow/ers and in those taking care of their grandchildren several times a week. Conclusions: Adherence to the MD in a big Spanish city is low among older individuals. Socio-family factors seem to play a role. Public health and governmental strategies should reinforce adherence to the MD among older individuals as a gold standard for nutrition.     

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.     

Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial.

BACKGROUND: Effects of diet on blood lipids are best known in white men, and effects of type of carbohydrate on triacylglycerol concentrations are not well defined. OBJECTIVE: Our goal was to determine the effects of diet on plasma lipids, focusing on subgroups by sex, race, and baseline lipid concentrations. DESIGN: This was a randomized controlled outpatient feeding trial conducted in 4 field centers. The subjects were 436 participants of the Dietary Approaches to Stop Hypertension (DASH) Trial [mean age: 44.6 y; 60% African American; baseline total cholesterol: < or = 6.7 mmol/L (< or = 260 mg/dL)]. The intervention consisted of 8 wk of a control diet, a diet increased in fruit and vegetables, or a diet increased in fruit, vegetables, and low-fat dairy products and reduced in saturated fat, total fat, and cholesterol (DASH diet), during which time subjects remained weight stable. The main outcome measures were fasting total cholesterol, LDL cholesterol, HDL cholesterol, and triacylglycerol. RESULTS: Relative to the control diet, the DASH diet resulted in lower total (-0.35 mmol/L, or -13.7 mg/dL), LDL- (-0.28 mmol/L, or -10.7 mg/dL), and HDL- (-0.09 mmol/L, or -3.7 mg/dL) cholesterol concentrations (all P < 0.0001), without significant effects on triacylglycerol. The net reductions in total and LDL cholesterol in men were greater than those in women by 0.27 mmol/L, or 10.3 mg/dL (P = 0.052), and by 0.29 mmol/L, or 11.2 mg/dL (P < 0.02), respectively. Changes in lipids did not differ significantly by race or baseline lipid concentrations, except for HDL, which decreased more in participants with higher baseline HDL-cholesterol concentrations than in those with lower baseline HDL-cholesterol concentrations. The fruit and vegetable diet produced few significant lipid changes. CONCLUSIONS: The DASH diet is likely to reduce coronary heart disease risk. The possible opposing effect on coronary heart disease risk of HDL reduction needs further study.     

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.     

Mobile Apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation

Objective

To identify the availability and quality of apps supporting Dietary Approaches to Stop Hypertension (DASH) education.

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.     

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.