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Abstract

In our study, the association of Dietary Approaches to Stop Hypertension (DASH)-style diet with metabolic syndrome (MetS) was investigated in the crude and adjusted models. Age, sex, total energy intake, physical activity, dietary fiber, family history of diabetes, and body mass index were considered as covariates. In the univariate analysis, no significant associations were observed between each covariate and the DASH-style diet. However, to be consistent with similar studies, these variables were adjusted. In addition, to consider the stratification effect in the logistic models, we had to adjust all covariates, which may have an effect on the outcome according to the literature. Because adjustment of confounders did not change the results, it is concluded that the crude model has enough power for interpretation. In our study, there was a statistically significant association of reduced high fasting plasma glucose, hypertension, and enlarged waist circumference, and there was no significant association of risk of high triglycerides and low high-density lipoprotein-cholesterol with the DASH-style diet. Findings from studies that investigated the effect of the DASH diet on lipid profiles have reached contradictory results. Chiu et al1Chiu S. Bergeron N. Williams P.T. Bray G.A. Sutherland B. Krauss R.M. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial.Am J Clin Nutr. 2016; 103: 341-347Crossref PubMed Scopus (131) Google Scholar in a randomized crossover trial among adolescents found that adhering to the DASH diet significantly reduced low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and apolipoprotein A-I. However, Saneei et al2Saneei P. Hashemipour M. Kelishadi R. Esmaillzadeh A. The Dietary Approaches to Stop Hypertension (DASH) diet affects inflammation in childhood metabolic syndrome: a randomized cross-over clinical trial.Ann Nutr Metab. 2014; 64: 20-27Crossref PubMed Scopus (46) Google Scholar, 3Saneei P. Hashemipour M. Kelishadi R. Rajaei S. Esmaillzadeh A. Effects of recommendations to follow the Dietary Approaches to Stop Hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial.Br J Nutr. 2013; 110: 2250-2259Crossref PubMed Scopus (63) Google Scholar in a randomized cross-over clinical trial investigated the effect of the DASH-style diet recommendation among girls with MetS for weeks. The study revealed that the DASH-style diet led to reduced high-sensitivity C-reactive protein and MetS; however, plasma concentrations of lipid profile were not affected by the recommendations for the DASH diet. It seems that clustering of these risk factors (MetS) may be more important than individual components. Generally, the underlying mechanism for the favorable relation between the DASH diet and MetS are not well understood and still is a matter for research. Dietary intakes may affect body metabolism via potential metabolic factors, such as insulin and inflammation,4Anderson A.L. Harris T.B. Tylavsky F.A. Perry S.E. Houston D.K. Lee J.S. et al.Dietary patterns, insulin sensitivity and inflammation in older adults.Eur J Clin Nutr. 2012; 66: 18-24Crossref PubMed Scopus (64) Google Scholar or cellular mechanism, such as transcription factors.5Romagnolo D.F. Zempleni J. Selmin O.I. Nuclear receptors and epigenetic regulation: opportunities for nutritional targeting and disease prevention.Adv Nutr. 2014; 5: 373-385Crossref PubMed Scopus (26) Google Scholar Further studies are warranted to clarify these direct and indirect pathways, from which the DASH-style diet can modify lipid profile and MetS. Although studying individual food groups or food items in terms of DASH components might be appropriate to understanding their metabolic effects, their effects might be too small to be detected and could potentially be confounded by other components of the dietary pattern. The DASH diet score provides a comprehensive and complimentary method to diet-disease relations and more applicable to clinical and public health interventions than individual nutrients, foods, and food groups approached.6Hu F.B. Dietary pattern analysis: a new direction in nutritional epidemiology.Curr Opin Lipidol. 2002; 13: 3-9Crossref PubMed Scopus (2793) Google Scholar Indeed, the DASH diet approach includes any interactions or synergistic effects among individual foods or nutrients. In our study, we aimed to investigate the association of adhering to the DASH-style diet in a holistic view and risk of incident MetS among children and adolescents; and observed an association between the habitual dietary intakes in terms of the DASH-style diet with reduced risk of incident MetS after 3 years of follow-up. Dietary approaches to stop hypertension diet and metabolic syndromeThe Journal of PediatricsVol. 178PreviewAsghari et al1 assessed the association between Dietary Approaches to Stop Hypertension (DASH)-style diet and the development of metabolic syndrome (MetS) in 424 children and adolescents. The OR and 95% CI of developing MetS in the highest, compared with the lowest, quartile of DASH score was 0.36 (0.14-0.94). The incidence of some metabolic components also significantly decreased with higher adherence to DASH diet. I have some concerns on their study. Full-Text PDF