Abstract
This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001–2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1–8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0–9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.
Highlights
Previous studies have emphasized the role played by single nutrients in chronic disease prevention, more recent studies have concentrated on dietary patterns which take into account complex interactions among nutrients [1]
Whereas Dietary Approaches to Stop Hypertension (DASH) total score and two-component scores were negatively correlated with ALI score, these same dietary factors were not significantly related to all-cause and cause-specific mortality rates, either before or after controlling for ALI score
Whereas all-cause mortality was negatively related to high protein score and positively related to high potassium score, cardiovascular disease-specific mortality was negatively related, and cancer-specific mortality was positively related to potassium score
Summary
Previous studies have emphasized the role played by single nutrients in chronic disease prevention, more recent studies have concentrated on dietary patterns which take into account complex interactions among nutrients [1]. Healthy dietary patterns that are consistent with the Healthy Eating Index, the Mediterranean-style, and the Dietary Approaches to Stop Hypertension (DASH) have been linked to a reduced risk of chronic diseases, including the two leading causes of death, namely cardiovascular disease and cancer [2,3,4,5,6,7,8,9]. A recently published update on a systematic review and meta-analysis of prospective cohort studies has established that healthy dietary patterns could reduce the risks of all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative diseases by. Non-pharmacological strategies for the prevention and treatment of hypertension have emerged, including the DASH dietary pattern [12,13]
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